Dear Doc
by Allison Futterman
For S.S.—one of the good ones.
Make sure to lock your bedroom door at night. This is what he really wants to tell them. Or sleep with a weapon within reach. Don’t be fooled by the rare moments that seem like genuine human feeling. It’s just a very skilled act. He wants to tell the parents this, but of course he can’t. He has to couch it in a palatable way. Sometimes even ambiguously hopeful.
“Let’s discuss our short terms goals,” he might say. “Robert or Ryan or Richard made it through last week without causing any injury to his siblings. This is good.”
True, their son pulled the dog’s fur to the point that it let out a bloodcurdling yelp, but he did not slam his sister or brother’s hand in the door. He called both his parents vulgar names, along with telling them how stupid they were, but he didn’t threaten them. “This is progress,” the child psychiatrist says.
This work only leads to two places. You become indifferent or it drains you. In his case, it’s stressful and taxing. Because as much as he wishes he didn’t, he still cares. All these years later. He cared when he was idealistic after residency. It was new and he was filled with enthusiasm about helping troubled, ignored, and abused children.
He saw all the run-of-the-mill conditions psychiatrists encounter. Anxiety, depression. Although anytime a young child has either of those, something is very wrong. He maintained a caring spirit when he went on to research and teaching. Studying these troubled kids was going to be a way for him to bring about change. He wouldn’t just be another doctor who spouted psychobabble but offered no help.
So he worked with the worst of the worst. They called them “callous-unemotional.” Adults that displayed their symptoms would be diagnosed as having antisocial personality disorder, colloquially what’s referred to as a psychopath. Officially, nobody under 18 can be given this diagnosis. But the shrink knows. He knows psychopaths are mostly born, sociopaths are usually made. He’s seen plenty of both.
He knows very quickly when he meets them. Sometimes the more charming they are, the more dangerous. Rarely has he been surprised, either in a bad or good way. He’s not shocked when they lie, steal, or violently hurt others. He’s not even stunned when some have tried to kill a family member, classmate, or teacher.
Unfortunately, he hasn’t enjoyed the pleasure of being proven wrong by overestimating the negative consequences that could happen in certain cases. Never has he thought, I really misread this one. And yet, he still has a part of him that want to believe he can help.
Some of these kids have it very bad. Abusive parents. Neglect. Poverty. If he can get to them early enough, which is rare—there’s a glimmer of hope. He tries to work with the parents to bring out the best in their kid, to help them turn a corner. Many thoughts go through his mind, but the words that come out are said in a calm, professional manner. Inside, he’s thinking you’re living with a powder keg. It’s not going to end well. Among other things.
Sometimes it’s “try not being an asshole to your kid.” Or “did you ever think of hugging him instead of screaming”? Other times he’s thought, “You’re just horrible people, no wonder he wants to stab you in your sleep.”
But he keeps it professional. And he likes to think he’s had some impact. His studies have been published in many professional journals. He’s spoken around the world. He has an important position at his university teaching hospital. But he’s tired. Years of this takes a toll on a person. Most of his colleagues just go through the motions, but he can’t. It would be easier if he could. He’s tried. It’s a weird thing, actively trying to be less tuned in.
On really bad days, he goes to his drawer, where he keeps a letter from a former patient. The outlier. The anomaly. The unicorn. He was damaged, but not to the point of no return.
He told his patient that he needed to get as far away from his parents as soon as he could. “Accept your aunt’s offer to live with her,” he told him. He gave him his cell phone number, something he almost never did. “You can contact me if you need to talk.”
“Boundaries,” his colleagues would have said.
It’s not like he was inviting the kid to live with him. There were times he wanted to ask his colleagues if they ever actually did anything, other than write reports and prescriptions. In his opinion, “boundaries” was too often an excuse to be lazy and not invest any of yourself.
And about nine years later, he got the letter. He never shared the contents with anyone. Not a colleague. Not his kids. Not his wife. It started, “Dear Doc—and ended with “You saw the truth. When nobody else noticed or cared, you did.”
Every now and then, he glances at the letter then puts it back in the drawer. And goes on to the next meeting, the next session, the next fucked up family.
Allison Futterman's flash fiction, poetry, and essays have appeared in a variety of literary journals. She can be found at allisonfutterman.com.