The Referral

He doesn't move. He doesn't ask if he said something wrong, which is what most people would do. He just waits, gray-green eyes steady on your face, as if he's decided whatever comes next deserves his full attention.

"I'm not the right clinician for you," you say.

"Because I'm difficult."

"No. You're not difficult. You're unusually easy to talk to." You keep your voice level, the voice you'd use for anyone. "There's a conflict on my side. It would affect my objectivity, and you deserve someone whose objectivity isn't in question. So I'm declining the case."

"What kind of conflict?"

"The kind I take to my consultant," you say. "Not to you."

Something moves behind his eyes. You watch him read you, the way you've been reading him for forty minutes, and you watch him arrive somewhere and decide not to say it. That, more than anything, makes your pulse stumble. He could say it. Men like him usually do.

"All right," he says.

"I'm going to refer you to Dr. Yaw Okonedo. He's a psychiatrist on the West Side, and he's the best I know with people whose lives involve a lot of risk. He's careful, he's unhurried, and nobody, including your board, will ever be able to say he was the wrong choice." You write the name and number on a card, then add his direct line, which you don't give to anyone. "I'll call him today, if you consent. I'll send him my notes from this session, if you sign a release. Nothing else. And there's no fee for today."

"Your practice was paid in advance."

"Then the practice will return it."

His eyebrows go up, the scarred one a little higher than the other. "Your senior partner will love that."

"My senior partner isn't the one in the room."

He takes the card. He looks at it for a long moment, turning it over with long fingers, and then at you.

"I'll go," he says. "Not because the board told me to." He stands, buttons his coat. "Because you asked."

"Mr. Vantreight, that's not..."

"I know it's not how it's supposed to work. I'm telling you anyway. I said I'd be honest in this room." At the door he stops. "For what it's worth, Dr. Ambery, you're the first person this year who's told me no to my face."

You walk him out because you'd walk anyone out. The waiting room watches. The man in the black suit rises from his chair by the door as if pulled by a string, opens the outer door, and looks at you for one second with an expression you can't read. Joachim pauses on the landing.

"Thank you," he says. Not for the referral. You can tell that much.

Then he's gone, and the waiting room exhales.

You write the note while it's fresh, the way you were trained to. Date, time, duration: forty minutes. Presenting circumstances. What was discussed. No diagnosis. No treatment plan. Session terminated by clinician due to clinician-side conflict affecting objectivity. Client informed. Referral made to Dr. Y. Okonedo. Fee waived. Consultation to follow. You sign it. You lock it.

Then you call Yaw Okonedo, who listens without interruption and says, in his low unhurried voice, "Send him to me. And Ava? Good for you. Most people don't notice in time."

Then you go and see Steinhauer.

"You did what?" He's standing behind his desk. You've never seen him stand behind his desk. "That's a sixty-thousand-dollar evaluation contract."

"I know what it is."

"What possible conflict could you have with Joachim Vantreight? You'd never met the man."

"It's mine to name to my consultant, Alban. It's in the note."

He stares at you. Then he sits, slowly, and rubs his eyes, and when he looks up he's your mentor again, tired and kind. "You're right. Of course you're right. I'm sorry. It's been a hard quarter." He waves a hand. "Sylvia will process the refund. Go home."

Dr. Hildegard Feld's brownstone in Cobble Hill smells like coffee and old paper. There are books on every stair. She opens the door in a cardigan with her reading glasses on a chain, looks at your face, and says, "Ah. Come in, then."

She was your supervisor for two years and sat on the state psychology board for ten. She is the most frightening and most fair person you know. You tell her everything. The file on your chair. The forty minutes. Lonely. The floor tilting. You say the words out loud, I was attracted to him, and they sound smaller than they felt.

She lets you finish. She pours you more coffee you don't drink.

"So," she says. "You had a reaction you couldn't set aside. You noticed it within the first session. You stopped. You told him there was a conflict without burdening him with its content. You referred him to an excellent colleague, waived the fee, documented the termination and called your consultant the same day." She takes her glasses off. "Ava, that isn't a confession. That's the textbook."

You let out a breath you've been holding since four forty.

"Let me be precise, because you'll want me to be. You conducted part of one intake. You made no diagnosis and provided no treatment. He was never your client in treatment, and he never will be. The rules people quote about former clients, the two-year rules, are written about people who were treated." She raises a finger. "But you wrote a note. That note is a clinical record, and you are its custodian. That duty doesn't end. Not in two years, not in twenty."

"I know."

"And if you ever see him again, outside that room, you make sure he's in care with someone else, and that there's nothing left between you that looks like a professional duty. You don't get to be his doctor even a little. Not a kind word about his childhood. Nothing."

"I'm not going to see him again, Hilde."

She looks at you over the rims of her glasses for a long moment, the look that used to make postdocs cry.

"Mm," she says.

Your phone buzzes on the subway home, and buzzes again, and keeps buzzing.

It's Adwoa, your best friend since freshman year, who does digital forensics for a living and texts like she's defusing a bomb.

ARE YOU OKAY

DID YOU KNOW ABOUT THIS

Ava PICK UP

Then a link.

You open it standing between two strangers on the 4 train. It's a gossip site called The Undercurrent, and the photo fills your whole screen: the door of your building on Seventy-Fourth Street, you in your gray dress holding it open, Joachim Vantreight half a step past you, his head turned toward you, close enough that it looks like he's about to say something only you will hear.

The headline is four words long.

Vantreight's New Shrink?