Consistent with earlier assessments, the patient exhibits a classic schizophrenic process, with delusions and hallucinations in addition to motor stereotypy and episodes of frank catatonia. The history of the “nervous exhaustion” in the grandmother suggests a possible hereditary component. The mother is exceedingly anxious, hysterical even. I would not discount a latent paranoia, especially given the history of her mother. The prognosis is poor; the current course, despite the respite offered by the removal from the stimulus of urban life, is clearly dementing. All evidence suggests that he will continue to deteriorate. Despite no history of violence, the possibility of vengeance against a perceived aggressor cannot be discounted, as is the likelihood that one of his long pilgrimages will result in exposure, injury, or death. Already he has been found collapsed due to sheer exhaustion, though fortunately this has not occurred beyond the help of his fellow man.

  That he is a good candidate for our procedure is self-evident. I would expect rapid cessation of hallucinations and superstitions, while the docility which we commonly observe would have the added benefit of keeping him from wandering off.

  I communicated this at once, and forcefully, to the mother, who responded immediately by breaking into tears. She has been given the dire prognosis before, and this is the first time anyone has offered any hope. But when I mention our schedule, the brief open window this month before I travel to Philadelphia for more demonstrations, she becomes hesitant, asks for time.

  February 22

  Had scheduled a meeting with Lillian at the end of the month, but to my surprise, she arrives today at the office, insisting that she see me. There has been a setback. Robert, it seems, has been told of the procedure by a fellow patient at the asylum (K.P.). Now he has correctly divined the reasons for my interview and has become antagonistic. There has been an extension of the persecutory complex: in a meaningless scar of another patient, he claims to see the marks of a barbaric saw. The mother is distraught, angry at me (though I have told the patient nothing), and must be reminded that our approach does not leave any visible mark, that K.P. has not had the surgery, is not even a candidate. When I calm her at last, she insists I see Robert again and try to reason with him. I remind her that this is not necessary; she is his guardian, she may make the decision alone. She begins to weep, asks how we can carry out the procedure if he does not go willingly. I make the mistake of answering this question literally, which only sends her into further distress. Again, asks me to return to the asylum. I agree, though I’ll admit a reluctance. Am beginning to see the extent of her fragility, and I have no shortage of patients. And yet something about the young man (the severity of symptoms, the potential for rehabilitation, the tragic mother?) is compelling.

  Lillian has just left when there are loud voices in the waiting room, and Zenobia comes to tell me that the mother of S.B. has returned and is demanding to see me, starts screaming that she wants a “reversal,” that I’ve turned her daughter into a “drooling piece of meat,” etc. All quite horrible: I am as distressed as she is, did not wish for this outcome, but I have also seen that, for one S.B., I have fourteen other patients well enough that they can live at home. I don’t dare remind her that her daughter had twice attempted to take her own life—there is no winning this argument. Unlike last time, the distraught mother will not be pacified by conversation, and I must threaten to call the police before she at last agrees to leave. It is late, and I am shaken.

  February 23

  To the asylum to see Robert. The nurse tells me he is in the jacket, that he has been given barbital, is sleeping. Dr. Barnes comes. He is new to Longridge, but has heard of me, makes no attempt to hide his disapproval, says that I am “shooting fish in a barrel” by coming there. I must remind him that the Board of Overseers has sanctioned my visits—that they have an interest in trying all means to help the most chronic cases. He changes his tactic, reminds me of my age, his experience, etc., claims that he has read deeply about our procedure, believes that it does nothing to relieve delusions, but works entirely upon the will. That, while he sees such potential in cases of chronic manic excitement, he has little hope for any substantive improvement in a patient who must already make such an effort to form a coherent understanding of the world. My argument that such fantasy is the product of an excess of mental association does not move him. For some time, we go in circles. The conversation is civil but tense, the mutual antagonism clear. He is of a generation that has resigned themselves to stasis, monotony, who will cheer when a young man of once-great promise can learn to darn a sock.

  At last, the nurse arrives to tell me that Robert is awake, and I can see him. He is still in the jacket, which I ask to have removed. She demurs—this can only be ordered by Barnes, I must wait, etc.—and she leaves me with Robert, who, despite the lingering effect of the barbital, has returned to a state of agitation, says the Harrow has threatened him with worse torments if he lets the doctors “hack up his brains,” though doesn’t seem to register that I am the one who would be doing the “hacking.” Asks me to inspect his foot, which he says has been injected with poison, with semen, with radio wires, that he can hear them speaking from his heel, “listing the names of the dead.” When I point out that the “lump” on his ankle which has precipitated such distress is but a small varicosity, he accuses me of being incompetent, says I am not a doctor, that he is the doctor, etc. The picture is of severe disorganization, though one is compelled to listen, as there are flashes of coherence that seem at first insightful, even poetic. But no thought is carried out to its conclusion, it is exhausting, his desperation to be believed is palpable. I make no headway in convincing him, see no point in trying, as it only seems to agitate him again. I leave in low spirits, not only from the spectacle of such sufferings, but from the lack of courage in those who seem content to consign the boy into a state of raving.

  February 24

  Received a message from my office that Lillian returned again, wished to speak to me, did not say why, though my suspicion is that she has made a decision—why else would she bother to make the trip?

  March 8

  A third meeting with Lillian. Dressed elegantly today: beret, muskrat coat, kid gloves. To my surprise, she arrives with a copy of my address to the Society from last October—got her hands on a copy of the Proceedings from the asylum library. She has read it carefully, she says, and passes it to me as if I might wish to read it too. I see she has underlined sentences of more rhetorical effect—“The mind, man’s most precious possession,” “our sentimental attachment to the memory of who a person was,” “a restoration of the whole person,” etc.—while seeming to have skipped over the technical sections. She has come to tell me that she has decided definitively against the procedure, that she wishes to thank me for my time, but that she will not be coming back.

  Of course, this is quite odd—it is a two-hour journey by car from her home to my office. My suspicion is that she remains ambivalent, wishes me to convince her. She tells me that her son has improved noticeably, that Dr. Barnes has allowed him to go home, has made two house calls, takes the boy on walks in the woods. Robert still talks incessantly about the Harrow, but he sleeps—she thinks—and there have been no more “catonic (sic.) episodes” (I disagree with Freud about most everything, but such mistakes regarding a word that is hated/feared are hard to ignore). I do not argue with her. She has come prepared to dispute me, but it is evident that she has doubts—else why would she come? I thank her, wish her well, and tell her that she may always return.

  Predictably, she hesitates. She wants to know if I agree with Barnes’s approach—if there is not a better way. I tell her that I am glad to see that the boy is no longer in a straitjacket, that Dr. Barnes clearly has a salutary effect on him, that perhaps this is all that can be hoped for. Yes, she says, perhaps that is all that can be hoped for. I hand her back the paper. I have another patient who is waiting, I tell her, which is true. She says she wonders whether I might come see her son again. At her home? I ask. She clarifies: just a single consultation, to assess if I would still recommend the surgery. She knows it is far, she is willing to pay for the travel expenses, etc. I ask her what Dr. Barnes would think of my visit. Ah! But it isn’t necessary for me to come on a day when Barnes is there; I would just need to speak to Robert.

  And so, as expected, I will visit Saturday. I suspect it is a waste of time—she will change her mind again, etc. but I feel as if a gauntlet has been thrown. It is as if a worldview is being tested, of which she is the jury. Reason, pragmatism, even basic arithmetic suggest I shouldn’t bother—I could see six patients in the time I make this fruitless trip.

  March 11

  Drove today to see Robert. In my haste, did not consider the challenges of the weather—a warming spell had left the road awash with icy slush, and I had to abandon the car, dig my boots and raincoat out of the trunk, and cover the last mile by foot. Sprawling yellow house, quite picturesque—wasn’t sure which entrance I was to choose from, but after some ringing, was greeted by someone who could only be the Finnish maid. Had the strange notion that I might ask her what she thinks of the boy, that somehow the flinty old girl in her apron and kerchief might offer an insight into the case.

  Anyway, there is no time for this, for Lillian follows swiftly behind her in a state of high anxiety—she had told Robert the night before that I would visit and he agreed—it seemed—but this morning, she awoke to find him missing. Of course, she has grown used to such departures, but she is afraid that she will waste my time. She leads me to the living room. I sit, and she sits close to me. She says she has been sent signs to help her with her decision: a silent owl in the oak, an unfamiliar button salvaged from between a pair of kitchen flagstones. I am struck for the first time by her beauty, which, in the old house, takes on an almost fabled, tragic dimension. There is something very different about seeing her here, and I am aware of the men who drifted through her story—dance instructor, neighbor, and now—I suspect—Barnes. Does she know the effect she has? Or is it unintended, a habit of survival? Thankfully, the Finn brings tea. We talk of the roads, the weather. Lillian wonders about Robert, nervously tries to fill time by showing me some heirlooms: a portrait of her father, a stuffed bird, a scattering of unremarkable antiques. She grows silent, rises, leaves and then returns, says she thought she heard something.

  It is nothing. The clock chimes the hour. A figure descends the stairs, stops, but it is the sister—Lillian introduces her—Helen, sixteen or seventeen—she eyes me warily, a look of exhaustion and resentment in her eyes. I can only imagine what it is like to grow up in the shadow of all this turmoil.

  At last, I ask if we might look for him. I do not say it, but if we can’t find him, I will leave.

  She agrees. She leads me out through the kitchen and into a field. Snow is falling, but it is still possible to see footprints that lead off up the hill. Everywhere are fallen trees—chestnuts, she tells me, each storm will bring another down. They used to be magnificent, she tells me—when she was younger, she could gather basketfuls of nuts. It is one of her fondest memories of childhood, and it is hard not to feel that somehow the blight, and Robert’s illness, are part of the same process—something sinister that attacked them from within. Could he also have been infected? she wonders. I tell her no one knows the causes of his illness, but I have never heard this hypothesis. Anyway, she says, there is a single grove remaining—sometimes he goes there. Yes, I say: he believes that he can save it, he told me this. He told you so much, she says, he is not so open with anyone else.

  I don’t know how to answer her, so I just follow, past an old wall, as the trail steepens and we enter the woods. Everywhere is ice and slush, she holds her skirt in one hand, slips and reaches out and grabs my arm to keep from falling, does not let go. Am I wrong to allow it? It would be unkind to brush her off. The forest closes in, the footprints branch, return, vanish at a stream which trickles around blocks of frozen snow. We follow the river, though I see no prints, no sign of passage. Still, she insists—there is a glen where she often finds him, amidst the old trees, where he digs to listen to the words he says are buried in the earth. But Robert is not there, and she begins to cry again. Around us are the chestnuts he spoke of, extraordinary—it occurs to me that I haven’t seen a chestnut since I was a boy.

  She is very close, her cheeks are red, as someone with a fever. She begins to speak, again. Do I have children? She has seen my ring. She imagines that my wife is so lovely, perhaps in another time, under other circumstances, they might be friends, she and my wife. I say nothing, but I offer no objection. To correct her, to remind her of the professional capacity of my visit, would seem unkind, scolding. We walk back. She drops my arm when the path narrows, and I hasten so that she may not take it again.

  Back at the house there is still no sign of Robert. Helen still upstairs—I could see her in the window, watching us before she let the curtain drop. Evening is coming. Lillian asks if I wish to stay. It is not an unreasonable offer given the weather, the roads, but I am aware of certain vulnerabilities, of all parties, and I do not wish to be drawn in.

  To leave with Robert missing seems negligent, but I have been there for nearly four hours already. I remind myself that he has vanished many times. She offers to walk with me to my car, says that Robert sometimes goes that way—it is in the line of one of his “Stitchings.” I must be careful, she says—there are animals in the woods. I joke I’m not afraid of squirrels, but she doesn’t laugh. I accept her offer. On the road, she takes my arm again. I am worried about being seen like this, am certain for a moment that I see another traveler, pink- or scarlet-coated, but no: just the flutter of a cardinal. Lillian speaks of Robert, admits that there are times that she is frightened of him, feels that he doesn’t recognize her, that his loyalty is to something else. The fallen snow has erased my footsteps. We walk for some time, but I do not see the car; I tell myself it must be farther, but the woods are the same in all directions. We reach a farm with a grand barn I recall driving past. Somehow, we must have missed the roadster—but how? It is impossible, one does not simply misplace a sky-blue DeLuxe. We circle back; this time I recognize my parking place. The car is gone.

  It is the boy, of course. There can be no other answer. Back at the house, the Finnish maid tells us that Robert is home, but there is no sign of the car. In truth, I do not care. I just wish to leave. Then Robert comes out, tells me I should not be there, the “Soul Heirs” have warned him of my intention, that if I know what is best, I will go and not come back. We agree! But Lillian wants me to stay, says it is too late, the roads aren’t safe, etc. I remind her of my family. She says my wife will understand, that women understand each other. She seems unsurprised by the theft of the car. I can make no sense of this; I just want to be gone from this house. I ask for her to drive me. She demurs, says we will not make it through the snow. I say I must get back home, that I have consultations tomorrow morning. I am adamant, I do not like the house, the boy, the sullen sister, the Finnish maid (might she have stolen it?). I wish to go.

  Lillian consents. We go to the garage, the old barn, now connected through a mudroom. Her Ford requires half a dozen tries before it starts.

  We make it perhaps two hundred yards before the road banks and we slide off into the verge and into a slope of snow-covered ferns. I am certain this is deliberate. Lillian is in tears again, apologizes, knows that I came to help her and she has made such trouble for me, seizes my arm and begins to kiss my face, my neck, climbs onto me, legs clamped to either side of mine. She is smaller but she is wedged between me and the dashboard and I am pressed into the door and at first I cannot push her off. I register only shock, then, briefly, in my confusion, I am swept up by the warmth of her mouth, the cold of her cheeks, the weight of her body, and I reciprocate, but only very briefly, and then reason comes, I find the door handle, and we go spilling into the snow.

  I stand. We are both chastened. She apologizes, I bow stiffly. I must go—she is not to follow.

  It is very far to Oakfield by foot. Fortunately, after an hour, I flag a passing truck. Along, I pass the farmhouses, once picturesque, now threatening. In which barn would I find the DeLuxe? I have the sense of being watched by hostile creatures. Behind the weather-beaten doors, I see the pinch-faced natives of this region, each harboring a sinister son.

  March 22

  Leaving the office late last night, and who meets me on the street but Lillian? I startle at first, am afraid that she will make a scene there on the street, but she has come to apologize. She was not well, has not been well, had not meant to draw me into her troubles. It is her burden, she says; she knows she must bear it alone, and yet at times, this happens…others are drawn in. Others! But I do not ask. Anyway, she says that she’s relieved to see that I am safe. The car, she asks, has it been found? I know she knows it hasn’t. The police have been notified, and if I am to believe them, the neighbors have been interviewed, without resolution. I ask what it is she wants of me. She says she wishes to forget the moment of indiscretion and continue where we left off.

  The boy, she says, now wants the procedure.

  Ha! I do not believe this, suspect some trick. Perhaps by Robert, more likely by his mother. But why?

  And Barnes? I ask.

  Dr. Barnes will no longer see Robert, she says. Dr. Barnes confused his professional duties with his affections.