The dog owner was Fenske. He'd been in repeatedly, like so many others, for drug rehab. I noticed him right away because he looked like a New Yorker, a college-educated bohemian East Village type, who'd somehow been airlifted to this desolate place and left to languish among the drab, doltish natives. He had luxurious wavy shoulder-length blond hair and a pale freckled complexion. He wore horn-rimmed gla.s.ses, jeans, red Puma Clyde sneakers, and a beat-up black leather blazer.

He made an impression on me right away, as I must have on him, because going up in the elevator after one of the breaks he looked across the group of us, all crammed in like cattle, focused on me, and said, "You," he pointed thoughtfully. "You're some kind of emotional parasite, aren't you?"

"A spy, actually," I murmured.

"Thought so."

"Nah. Just an emotional cripple like the rest of us. Wrist-slasher, oven-header, that sort of thing."

"Oh, okay. Gotcha."

He said this like I was telling him what I did for a living at a barbecue, which is what we all learned to do in there when we heard even the most extreme stories.

I found myself doing it when I made the mistake of asking the shaved-headed handlebar-mustachioed guy in the Marines sweatshirt what he was in for.

"Drinking. Drugs."

"Were you in Iraq?"

"First time around. Got discharged."

Post-traumatic stress, I presumed, but feigned ignorance.

"Why?"

"Liked it."

"Liked what?"

"Killing."

"Oh, right."

"Volunteered for one too many missions and they were on to me."

I remembered reading a recent article about sociopaths flying under the radar in the military and then surfacing as the henchmen of some civilian ma.s.sacre or Abu Ghraib-type fiasco.

We crowded into the elevator right after he told me this. I was standing close enough to practically lick the scorpion tattooed on his scalp.

"Uh-huh," I said, pretend-thoughtfully. "Gotcha."

In the ICU, I had a room to myself. It was a double, but I didn't have a roommate. It was just me and the empty bed next to mine, and the deliriously clean tiled bathroom.

I was in love with that bathroom. I sat in there a lot with the light out and the door shut, like a kid playing fort in a closet. I forgot myself in there, where there was only the thick enveloping dark and the band of light around the door frame, and the close, cool quiet. I was whole in it, unseen and unseeing, crept away in a cleared place so perfect in remove, like a pod gliding in s.p.a.ce.

Sometimes when I sat in there I thought about odd things, more of those depressive thought patterns I had come to recognize. I thought, for example, about the woman who cleaned my bathroom. Like everyone else here, Fridge excepted, she was white. Scandinavian white and chirpy cheerful even as she mopped. I imagined she baked pies on the weekends for her extended family and smiled at the weather from the porch, where she rocked away her aching back and what I thought must be her quiet desperation. For all I knew she was happy. But I couldn't imagine that. I inhabited her bland life as I saw it, and grew sadder.

As with everyone else I encountered when I was depressed, I went way too deep too fast. I was like a sponge, or a medium, soaking up the pain and dissatisfaction of strangers. The minute my eyes took them in, I took them in. This was another aspect of my disease, my problem, or my way of being in the world, whatever tag you want to put on it. It was a habit of mind that had no filter, no sh.e.l.l or thick skin that separated me and my pain from everyone else's. Call it depression as a form of extreme empathy, and then overstimulation, as if every person I met or pa.s.sed in the street was a loud radio blaring.

This was why I hid in the bathroom or in the tub or on the couch curled up in a ball, because even to leave the house was like stepping into some relentless Russian play. I was overwhelmed immediately-by the post-man whose shorts were his humiliation, and the dog walker whose acting career was not going so well, and the cashier at the drugstore whose life happened behind a counter, and even the filthy rich lady sitting alone at the bar at Bergdorf's at noon in her kelly green broad-brimmed hat that said "Notice me."

Pain. Too much pain. Loneliness, frustration, loss, the broadcast of each striving mind, the malaise of a failed attempt, so common, or the vortex of one never made, commoner still.

And me sitting in the bathroom in the dark thinking about it.

The truth was, I was spending too much time alone. The thoughts were too heavy again. Besides, I thought I should have been working. Or spying, I guess, so I wandered into the kitchen to join another game of cards.

Bunny was playing bulls.h.i.t with Bard, Clay, and Fridge. Bard was a nineteen-year-old Ritalin wastoid committed by the state for ninety days. He dropped out of school in the eighth grade, after having done the grade twice, moved into an apartment with his father, worked at a thrift store, and sat around doing "hot rails" (crystal meth inhaled through a superheated gla.s.s straw) for the rest of his adolescence. When he was eighteen he came home one day to find that his father had left him, just took the furniture and moved without a word.

They had him on the antipsychotic Zyprexa, but true to form in that joint, he was as clear as a bell. He admitted to paranoid moments in the past, but to see him you would have thought he was just like any other jacked-up parap.u.b.escent vandal with too many muscles and nothing to do with them.

He was small, but built and wired to do damage, with a buzz cut, black wife beater, and a bulbous pair of ever susurrating headphones, which the nurses had lent him as a pacifier. He looked and acted like he was raised backstage at a rock concert, weaned on noise and petty crime, like a mascot of dystopia. He was singing along with the radio as he put down his cards.

"If you want to undo my sweater . . ."

"Five jacks," he blurted.

"Buuuuulll shiiiiiittt," shouted Bunny.

Bard flipped the cards. There were indeed five jacks.

"Suck on that, b.i.t.c.h."

Bunny laughed, and so did the rest of us.

In bulls.h.i.t you use two or three decks, depending on the number of players. The decks are dealt evenly among the players, so it's possible to have as many as eight to twelve of any suit. The object of the game is to be the first to get rid of all your cards, so fibbing about what you've discarded, and catching other players in their fibs is the sole object. Hence the name of the game.

These games of cards were another gold mine for me. People will talk about almost anything if their conscious minds are otherwise engaged, and they don't have to look you in the eye. That was part of what was so relaxing about a game of cards in there. It functioned as a form of group therapy, but for my purposes, far better, because people would spill everything they wouldn't dream of saying in front of the staff.

Bard, for example, who was peevish and monosyllabic in social work group or activity therapy or any of the other meetings that formed the backbone of the treatment at St. Luke's, was positively chatty in a game of bulls.h.i.t. He even produced his commitment papers, which Bunny had asked to see, because she had once worked as a paralegal, and because she'd been committed enough times to at least claim to know the minutiae of state law on mental hygiene.

I was peering over her shoulder as she read.

"So you were committed initially for two weeks," she said, perusing the doc.u.ment, "and then at the end of that time you were recommitted for ninety days. I a.s.sume you had a lawyer?"

"Yeah," said Bard, "but he was insane himself." Stretching out an exaggeratedly shaking hand to mime the action, he added, "He signed the papers like this."

Bunny flipped through the pages of the order. "Yeah, you're pretty screwed."

"So I should elope?"

"Well, you could. I've done it. They'll put out a bench warrant for you, but if you leave the state until the commitment expires, and don't get pulled over for speeding in the meantime, you should be fine."

"What do you mean?"

"Well, if they pull you over for a violation, they'll call in your license and find out about the bench warrant and drag your a.s.s in. Do you have a plan?"

"Yeah. I can have my sister waiting outside in the car, and just slip out on smoke break."

Unlike at Meriwether, elopement at St. Luke's would have been easy. I had slipped away from the group unnoticed once already, on the way back from a smoke break earlier in the day. I had found a bathroom in the hallway with a lock on the door and a gla.s.s mirror. For a suicide risk this is a bad combo. I sat in there for ten minutes just to see if anyone would come for me, but no one did. Granted, that bathroom was still inside one of the three locked doors, so I couldn't have gone anywhere had I wanted to, but I could have done a lot of damage to myself.

On smoke breaks they lead us past all three locked internal doors and within twenty feet of an unlocked outside door. A person could have turned off and been long gone before they caught on. This was Bard's plan.

Bard was not doing well at St. Luke's. Cooped up and resentful, he lashed out unwisely at the staff, some of whom could be too prissy and petty to deal with a blunt adolescent whose usual form of protest was "b.i.t.c.h." The way he said it, it sounded like a punch in the face, especially when paired with his other favorite epithet, "f.u.c.k."

"She's a f.u.c.king b.i.t.c.h," he would say. Or, "f.u.c.k that b.i.t.c.h."

I could feel his frustration bursting out through the words.

He said it right then during the game of bulls.h.i.t. He was talking about Nurse Grace, a plump, vaguely officious type who took the bait every time Bard threw it.

"Grace is a f.u.c.king b.i.t.c.h," he said, putting down his cards. "Four kings."

"Bulls.h.i.t."

Nurse Tally, another plump tattletale, was spying, lurking by the door with her arms crossed. At this, she stalked out, off to inform to Nurse Grace.

Sure enough, five minutes later, Bard was called to the nurse's station.

Nurse Grace: "Tally tells me you called me a b.i.t.c.h."

Bard: "Then I must have."

NG: "I would like an apology."

Bard: "Forget it, fatty."

NG: "Well, you may want to think about that for a minute while we consider taking away your smoking privileges."

Silence.

Bard (sighing heavily): "Fine. I'm sorry."

NG: "Sorry for what?"

Bard: "Calling you a b.i.t.c.h."

NG: "A what?"

Bard: "A f.u.c.king b.i.t.c.h."

NG: "Thank you, Bard. Now, I would like you to go and apologize to the other patients."

Bard: "What?!!! For what?"

NG: "For poisoning the therapeutic atmosphere."

Bard: "You're f.u.c.king kidding me."

NG: "Eh, eh, language."

And so it went.

Scoffing, I told Bard to shove his superfluous apologies and resumed the game.

I spent the rest of that weekend in the ICU plugging people for information-their stories, their diagnoses, their meds. I compiled a chart with all this information on it. I suppose it was then that it really began to strike me how many of the people who were in St. Luke's for detox were really depressed or, in one case, psychotic. That was why St. Luke's used the label DD, dual diagnosis. It was the gray area between illness and abuse.

Obviously, it wasn't an accident that St. Luke's catered to the addicted and the mentally ill. There was, I was beginning to see, considerable overlap between the two.

Of course it would be hard for anyone to say for certain whether it was the mental condition, the depression, the anxiety, the aggression, or even the psychosis that had brought on and worsened the substance abuse, or the other way around.

We've all heard stories about teenagers who were fine until they got a bag of bad pot dusted with PCP, or they overdid it their first time experimenting with LSD, mushrooms, or methamphetamine and then just never came back, were never the same again.

But it's really impossible to know in so many cases if that kid went for the drugs in the first place because he was depressed, or trying to manage anxiety or mania or incipient psychosis and then went into orbit after using these drugs because his brain was already compromised to begin with. Clearly, the drugs didn't help.

Bard was a perfect example of this, it seemed to me. Perhaps his childhood hyperactivity had ended, or been managed by Ritalin, but, to hear him tell it, that's also where his subsequent drug abuse had begun.

"Meth made me feel calm," he said. He said he'd gotten to the point where the Ritalin just didn't do it anymore. He needed something stronger. Another form of speed to slow him down. Would he have gone for the meth if he'd never had the Ritalin? Maybe. Did the meth tip him over into psychosis? Or what looked like psychosis, but was really an effect of the drug? Or would he have been psychotic anyway? Who knows. It was all a big mess at this point, but it was certainly possible that the doctor who prescribed his Ritalin had set him on the course that ended here, with Zyprexa and a ninety-day commitment. Not that Bard was innocent, mind you. But he was certainly dually diagnosed.

All in all, however it began, in many of the people I met at St. Luke's there was a mutually reinforcing and destructive correlation between MI and CD. Almost everyone, whether they were categorized that way formally or not, was DD. The depressives had abused alcohol, and the alcoholics were depressed. The meth-heads had heard voices, and the psychotics had abused meth, and c.o.ke, and alcohol, too.

Chicken or egg? It was anybody's guess.

I had a speech prepared. It was Monday at last, and I was going to meet my doc. I had been told his name already, but had forgotten it, but it didn't matter. I had only one thought anyway. I was sure he was going to be a d.i.c.k and a pusher, so I'd worked up a preemptive rant about my unwillingness to take drugs, except maybe Klonny or Ambien, if I just want to blunt out the world at 10 p.m., like slamming the door on the day.