Looking back now, I can see hints of Fran's developing devotion to me during her stay. But at the time, I hadn't even an inkling of what lay ahead. The Saturday before her release, for example, I made my usual rounds at the hospital. I, like every other psychiatrist there, tended to dress less formally on the weekends. That particular Saturday I recall wearing a casual blouse and skirt that came just above my knees. Since it was still over one hundred degrees in Tucson, I was not wearing stockings. As Fran and I sat facing each other, talking in her room, she suddenly pointed to a scar on my left knee and asked, "What happened?"
The stereotype of patients asking psychiatrists questions only to be answered with another question is generally true. Usually it is more important to hear what the patient's fantasies are about the psychiatrist's personal life, rather than close off such a discussion with a direct answer. I have found that I learn much about my patients and they about themselves by exploring such fantasies, but with patients like Fran, there are other concerns. Her fantasy life had already overripened into delusions. I didn't want to encourage that trend. So instead of asking her the standard, "What do you think happened?" I simply answered her question honestly and directly. I had been in a bicycle accident several years earlier. Fran shyly looked up at me and said, "Ooh, that must have hurt really bad." At the time, her effort to connect with me had seemed painfully juvenile, but I took it as a sign, along with her diminishing delusions, that she was getting better and trying to relate to me in a healthier way. In hindsight, I see that itwas an effort to be coy, but she was flirting with me in such an awkward, immature manner that my inexperience caused me to completely miss her true intent.
The day after her discharge, Fran returned to the hospital and delivered a letter for me to the receptionist. It was written in the same childlike scrawl and disjointed style I recognized from her inpatient stay. It said: "I was surprised, flattered, by your interest, since I know you and Dr. J. are an item. Hope we can pursue, but if don't respond, I'll understand" and included her phone number. I was stunned. How could she think I was interested in her? Had she mistaken my offer to forgive her portion of her bill as something more than routine kindness? I was angry at myself that I had not picked up on Fran's amorous interest while she had been in the hospital, but I really wasn't worried. I took her at her word that if I did not respond, she would drop the matter. Still, it bothered me that she had somehow managed to find out that Tim and I were "an item." Maybe she just overheard some of the staff talking, I told myself. By the time I got home that day and showed Tim the letter, any nagging doubts I had about Fran's further intentions had been calmed.
"What are you going to do?" he asked.
"Well, nothing." I shrugged. "She said she'd understand if I didn't call her." Oh, to be young and innocent again. Within a few days, another letter followed: "This entitles bearer, Dr. Doreen Orion, to free concert by sender, Fran Nightingale, length depending on ability to play." She followed up the next day by calling my office, twice, leaving a number where I could reach her. When I still did not respond, she sent me an extremely hostile, disorganized "play" she had written that seemed to be about a doctor who mistreated his patients. It contained angry, accusatory lines that told of "unforgivable behavior" and "molesting" people's minds with "psychological rape," and ended with "I hate your fucking guts" repeated over and over. With every contact, I was becoming more troubled, but I wasn't really afraid yet. Fran hadn't directly threatened me, I reasoned. If I continued not responding to her, I thought she would make good on her original promise and just go away.
Three weeks later, I had just finished seeing my last inpatient in the hospital and was on my way to my office, when I remembered that I had left my appointment book in my car. I would certainly be needing it that afternoon to schedule patients for the coming weeks. The covered parking lot was between the hospital and my office, set back from a busy thoroughfare. It was the beginning of November, my favorite time of year in Tucson: still warm enough to be out without a jacket, with the oppressive heat of the summer at last just an unpleasant memory. I was hoping that my appointment book was, indeed, in my car, and that I had not left it at home. I had done so once before, resulting in some embarrassing moments as I blankly looked out into the waiting room, trying to discern who my new patients were. Just in case the book was still sitting on my dining room table, I attempted to reconstruct my schedule for the coming afternoon from memory and was not having much luck.
Absorbed in these thoughts, I was not paying attention as I walked to my car. I could afford to be preoccupied; it was the middle of the day and I was vaguely aware that the entire lot was still. I opened the door and sat sideways in the driver's seat with my legs dangling to the ground, intently rummaging through the piles of papers and work-related items scattered about the "auxiliary closet" that doubled as my transportation. Where was the book? It was black, and even in midafternoon, the covered parking made seeing within almost impossible. It must have slipped out of my bag this morning, I hoped. Maybe it had fallen behind my seat.
Using the steering wheel as a handle, I pulled myself out of the car and onto my feet--coming face-to-face with Fran. I gasped involuntarily, but quickly stifled any further response. I needed to assess the situation calmly, not just react to it. I had been faced with potentially dangerous patients many times before, I reminded myself, and had never gotten hurt--yet. I saw that Fran was standing between me and the open door, effectively blocking any escape. She looked almost as disheveled as she had the first day I had met her. She wore a T-shirt that was only half tucked into her jeans. Her eyes had a glazed stare that frightened me. How long had she been watching me? She didn't look rational, but I didn't know if I could continue to force myself to think rationally, either, as I felt the adrenaline surging in my brain, seeming to wash away more of my psychiatric training with every accelerating pulse.
I glanced around, hoping to find someone who could help me. The parking lot was empty. I had never felt so vulnerable. Reflexively, I took a small step backward, closer to the car so that I was forced to lean against it awkwardly. But at least we were not standing quite so close. Until Fran took a step toward me.
"What do you want, Fran?" I asked, trying to control the fear in my voice, and hoping to stop her with my words.
"I've taken a lot of Navane. I don't know what to do," she said as she fished an empty bottle out of her pocket. That explained the glazed look. While she was absorbed in her task, I noticed that the step she had taken meant she was no longer blocking the space between her and the car door. I reasoned that with all that Navane, a major tranquilizer, slowing her down, I could probably outmaneuver her. I sidestepped quickly around her, shut the door and locked it. Fran stood holding the empty bottle, as if it were an offering to me.
As I started to walk away, I was more concerned for myself than for her. Fran was probably experiencing some muscle stiffness, some drowsiness and dullness of thinking, but she was not in any danger. Even ingesting a full bottle of Navane would not kill her. The worst that could happen was that she would become terribly uncomfortable, if she did not fall asleep first. Through my terror, I saw this overdose as a desperate ploy to get my attention, to finally get me to respond to her. And I knew, as memories of Sarah upping the ante on Albert flashed through my mind, that if I responded, there was no telling what Fran would do in the future.
"Fran," I said as I continued to walk away from her. "You need to call your psychiatrist. I am not your psychiatrist anymore. Do not contact me again." Not wanting to encourage her, I did not look back. But the entire walk to my office was spent in fear, straining to hear her footsteps behind me, not knowing if she would do anything to me or to my car while my back was turned. My thoughts were racing. She knew which car I drove and she already knew where I worked. She had obviously been waiting for me. For how long, I wondered. And was this the first time?
It was not until I reached my office, closed the door, and sat down that I realized I was trembling. I called Dr. Trottle immediately. That's when he said those words I'll never forget: "I was afraid this would happen." Now I understood what those who called him pompous meant. He proceeded to tell me the part of Fran's history that he had somehow neglected to mention when I first called. Dr. Trottle's initial meeting with Fran had been three years before, in 1986, when she had been assigned to him as an inpatient, just as she had recently been assigned to me. At that time, she had been hospitalized under court order for violating a restraining order.
"She was suffering from erotomania," Dr. Trottle intoned.
"Erotomania?" I pronounced the unfamiliar word for what would be the first of thousands of times to come. "What's that?" I asked. I soon wished I hadn't, because Dr. Trottle told me that Fran had believed a married law student was really a lesbian and in love with her. Fran would show up on this poor woman's front porch, guitar in hand, and serenade her with original love songs. When gentle explanations and then forceful insistence did not stop Fran's ardent pursuit, the woman obtained a restraining order. When this only led to Fran's jumping up and down in frustration on the hapless student's car, she was involuntarily hospitalized under Dr. Trottle's care. He soon discovered that this was neither the first nor the second time she had had such delusions. Nor was it even the third. Apparently Fran had become obsessed with and stalked five or six other women, all professionals of some kind. At least two of these victims had taken out restraining orders against her.
I started feeling smothered, as I had the one time I had tried to scuba dive, a few months before on a vacation in Hawaii. It was an introductory dive that included no classroom preparation, and little other instruction beforehand. I was a bit apprehensive even suiting up, and once in the water, holding onto the anchor line that was supposed to guide us into the deep, I felt none of its steadying force. Instead, all I could envision was plunging into some cold, dark, terrible unknown. As I felt the water closing over my head and the pressure building all around me, I thought that if I went any deeper, I would surely suffocate. Panicked, I returned to the boat. I felt that way again, talking to Dr. Trottle. I couldn't listen anymore. I couldn't take any more in, as if going any further into the depths of Fran's erotomanic delusions would consume me. I thought I might faint from the tingling, stifling heat closing in around me in my air-conditioned office. I had to get off the phone. I did not want to be vulnerable with the very one who had made me so.
I was unable to speak for several moments, when Dr. Trottle said, "Don't worry. I'll handle it." I hung up the phone without another word.
I sat in my office for some time, staring at nothing in particular. I could still feel the fear suffocating me. But as I replayed our conversation over and over in my mind, I gradually became aware that I could breathe again, because instead of fear, I was now burning with anger. Why hadn't Dr. Trottle warned me? Obviously, our conversation when Fran was first admitted to the hospital would have been the most opportune time to enlighten me. Surely he knew there were several male psychiatrists practicing at Tucson Psychiatric Institute that I could have asked to take over the case. And just what did he mean, he would handle it? Could I look forward to the same insensitivity he had shown when I had first called him?
I became lost in thoughts of what he had allowed to happen to me, focusing more on what he had done than on what Fran might do. It was easier to feel rage at him than fear of her. When my receptionist buzzed me, I nearly jumped out of my chair. So much for not feeling fear. My next patient was waiting and I had two more after that. How could I possibly focus on them or on anything except what I had just learned? I was resigned to not doing my best therapy that afternoon, knowing that my patients and I would somehow get through. But how would I get through the coming days and weeks? How, indeed, would I get home that night?