The Naked Lady Who Stood on Her Head (29 page)

To determine whether or not he needed an antidepressant, I used the mnemonic I learned during residency to go through the eight features of major depression: SIG E CAPS. “SIG” is an abbreviation doctors use for
prescribe;
“E” stands for
energy;
and “CAPS” stands for
capsules.
Each letter is an abbreviation for one of the symptoms:
s
—sleep decrease or increase;
i
—interest loss;
g
—guilt feelings;
e
—energy decline;
c
—concentration impairment;
a
—appetite change;
p
—psychomotor disturbance (agitation or slowed movements); and
s
—suicidal thinking. Patients with three or more of these symptoms generally respond well to antidepressants. Larry had enough of them to warrant a trial of medication. This
realization made me feel better because there was something concrete I could do to help him.

Being depressed could explain Larry’s escalating paranoia. But maybe he had reason to be paranoid. Larry’s instincts about people were usually right, and Tony Wilson did have a reputation for being devious and back-stabbing. If I could find out more about the committee’s investigation, it would help—but I knew it was off-limits. At the university, there were lots of committees that deliberated in secret, and this was sure to be one of them.

I’d become so lost in my thoughts, I’d been on the elliptical for more than an hour and was sweating up a storm. Gigi came up the stairs and said, “Are you trying to kill that thing?”

I slowed down and stopped. “I guess I was just going for the endorphin high.”

“Well, when you’re done with that party, why don’t you take a quick shower and come hang out with us.”

ON FRIDAY MORNING I WAS WAITING FOR
Larry in my office, ready to discuss antidepressants, when he barged in carrying a couple of Starbucks lattes and Louise’s strudel. “Grab a seat, Larry,” I said. “I’ll get some napkins.”

“Oh, no. We’re not meeting in here today. Let’s get some fresh air out on the patio.”

“Okay,” I said, wondering if he thought they’d bugged my office before he got there.

Outside my suite of offices, there was a large deck with round tables, chairs, and umbrellas, and an incredible view of the Pacific Ocean. I sat in the shade, while Larry took a chair in the direct sunlight and put on his giant sunglasses.

“Larry, I’ve been thinking about our discussion on Wednesday, and it sounds like you may have symptoms of depression.”

“No shit, Sherlock,” he said. “You’ve got to try this strudel. It’s amazing I don’t weigh five hundred pounds.”

“Thanks,” I said. “Have you thought about taking some Zoloft or Prozac?”

He laughed. “I’m way ahead of you, Gary. After our meeting I started myself on forty milligrams of Cymbalta. I thought the combination of a serotonergic and noradrenergic boost would lift my mood and possibly quiet down my obsessive thinking.”

His choice made sense. As opposed to Zoloft or Prozac, which only elevated serotonin to improve mood, Cymbalta also tweaked noradrenalin to diminish obsessive-compulsive symptoms. Not surprisingly, Larry was right on top of the psychopharmacology. I was concerned that he was self-prescribing, but I would fight that battle another time.

“Look, Gary, I told you about the investigation and some of my symptoms the other day, but I didn’t get to what’s really bothering me.”

I couldn’t imagine what new bombshell he had to drop today. I hesitated and then asked timidly, “What is it, Larry?”

He finished his strudel and leaned back in his chair before answering. “I feel like a fraud. I always have.”

“What do you mean?” I asked.

“As long as I can remember, I’ve been faking it. I’m not the genius everybody thinks I am. I just act like one.”

I couldn’t believe it. “Are you saying that throughout your career you’ve been faking data?”

“Of course not, you imbecile. I may be a fraud, but I have ethics. I’m scrupulous about my data. What I mean is that all I do is take information that’s already out there and regurgitate it in different ways.”

“So you’re saying you put together available scientific discoveries in a fresh way that no one else has thought of before?” I asked.

“I guess you could say that,” he said.

“Isn’t that the very definition of genius? It’s the basic scientific method—you take observations, spin a hypothesis, and test it. Anything that’s new and makes the world a better place is at the core of creativity.”

“Spare me, Gary. Don’t try to make me feel better with a lame philosophical argument about creativity and genius. I’ve been faking this smart-aleck persona since grade school, and I have it down. Sure, I’ve got
a high IQ—it was 183 when they tested me in the army. But most successful con men are also highly intelligent when you test them.”

“Larry, you can’t con the most brilliant academics in the world for fifty years and get away with it.”

“Obviously, you can,” he said, “because I’ve done it. And
that
is my genius. I’m a genius at being a fraud. And I can thank Tony Wilson and his silly investigation for making me realize the truth. And you know, I just don’t want to go on playing this game anymore.”

“Larry, I think it’s your depression talking right now. You’re not seeing things clearly. You know as a psychoanalyst and as a psychopharmacologist that when your brain biochemistry is off, you tend to see only the negative and your thinking is distorted. Let’s give the Cymbalta some time to do its work.”

“Cymbalta or no Cymbalta,” he said. “I’ve felt this way since before you were born.”

I flashed back to my early days in residency and how I too felt like a fraud when my patients so much as called me
Doctor.
I had to consciously play the part of a psychiatrist even though it felt awkward and unnatural, but eventually those feelings subsided, and with experience I became the doctor I was. Sure, feelings of inadequacy came back from time to time, especially when I ventured into unfamiliar areas of research or practice. I figured everyone must feel that way sometimes. But Larry was talking about his entire career.

“Larry, I’ve felt like a fraud at times. It’s a universal feeling. I think this investigation has made you depressed and now you’re seeing everything through dark glasses.”

Larry took off his sunglasses and smiled. “You’ve got a point, and I’m already feeling a little better with the meds. But I can tell you, this fraud feeling is not going away.”

“You said you weren’t going to play this game anymore. What did you mean by that?” I asked, concerned that he might be expressing indirect suicidal thoughts.

“Don’t worry, I’m way too narcissistic to off myself,” he said. “I just might want to scale down some of this academic bullshit pretty soon.
Everyone needs an exit strategy, right? It doesn’t mean I’m going to jump off a building or something.”

I suddenly looked around the railing of the eighth-floor patio to make sure there were no openings for a would-be jumper to squeeze through. “Oh shit!” Larry suddenly exclaimed. “I completely forgot about a division meeting half an hour ago. Keep the strudel. I’ve gotta go.”

He ran toward the door and the elevators, looking panicked. I’d never known him to get flustered like that or miss a meeting. This investigation had really gotten to him.

Later that afternoon, Larry’s assistant called to cancel our Monday meeting because he had a scheduling conflict and would be out of the office that day. This seemed out of character as well, since Larry usually knew his schedule weeks ahead and would have canceled with me far in advance. I wondered if there was more to it. Perhaps Larry was purposely avoiding Monday afternoon’s quarterly departmental meeting, already trying to slip out of the academic game.

Departmental faculty meetings of this size were held in the institute’s auditorium, and many of us arrived early to mingle in the foyer near the coffee and cookies. I chose my regular cookie—white-chocolate chip—and figured I’d make it up on the elliptical that evening.

Somebody stepped up beside me and said, “Excellent choice of cookie, Dr. Small.” That haughty, slightly sarcastic voice felt like fingernails scratching a chalkboard.

“Thank you, Professor Wilson,” I said without looking up. “And what fine snack are you opting for this afternoon?” I asked Larry’s nemesis.

“Just coffee for me. I’m watching my girlish figure.” His tone changed and he leaned in a bit, “Seriously, Gary, if you have a moment, I want to speak with you briefly about a colleague I’m concerned about.”

Like most academic psychiatrists, Tony Wilson was complicated. Although he was easy to dislike with his arrogant style, there were moments when he seemed to have a heart and actually care about people. At times I wondered if he might have Asperger’s syndrome, a mild form of autism characterized by difficulty reading the normal but subtle cues
of a social interaction. It often seemed like he was working very hard at playing the part of a normal person.

“Sure, Tony. Let’s sit down in the back before the others come in.”

We took our coffees into the auditorium and sat down. Tony spoke in a quiet voice, “I’m telling you this because I know you’ve been close to Larry Klein for many years and he respects you.”

Oh my God, I thought, where the heck was this going? As casually as possible I asked, “What’s your concern about Larry?”

“I can’t tell you the details or how I learned of this, but I’m worried that Larry may be in the early stages of dementia, or perhaps mild cognitive impairment.”

“That’s absurd. Larry is still brilliant. Sure he’s quirky and suspicious, maybe even a bit paranoid at times, but demented? I don’t see it.”

“Maybe you’re not looking, Gary, or you might be too close to see. But I came to you because you are
the
dementia expert around here, and if anyone can help Larry, it’s you.”

“Look, Tony, I’ve got my own sources and I understand there’s been some kind of investigation going on. Maybe that’s just stressing him out.”

“You didn’t hear it from me, but I can tell you that there was an investigation but it was closed weeks ago. The data error was a simple oversight and the journal is publishing a retraction. There was no fabrication, no data fraud, and Larry knows it.”

The auditorium was filling up, and we had to stop our conversation. “I appreciate your sharing all this with me, Tony. I’ll give it some thought and see if there’s something I can do.”

“Thanks. See you later.” Tony got up and took a seat toward the front. I stayed where I was, my mind reeling with this new information.

As the speaker droned on about budget cuts and the latest university regulations, I thought about Larry and all the signs I might have been missing. He was at an age for increased risk of dementia or Alzheimer’s disease, and his forgetfulness was showing in his missed meetings and schedule conflicts. I was concerned that I was not paying enough atten
tion to his paranoia—Larry seemed to be ignoring the fact that the investigation was over and he had been cleared. I might have been too quick to assume that depression was the only cause of his symptoms.

Many times people with mild cognitive impairment, a subtle predecessor of Alzheimer’s or dementia, show symptoms of paranoia—it’s a way of filling in missing information. In fact, even depressive symptoms can be an early indication of progressive cognitive decline. Several studies have shown that older people with mixed symptoms of mood change and memory loss have an increased risk of developing an irreversible dementia.

I was so close to Larry and admired him so much that I had failed to even consider dementia as a possibility—I didn’t want either of us to go through that pain. There were treatments, even cures, for depression, paranoia, and obsessive-compulsive disorder. But we had only symptomatic treatments for dementia that could help for a while. Eventually, every patient got worse and succumbed to the disease.

This was the very reason why I was reluctant to take Larry on as a patient from the beginning. There’s an old saying that goes, “The doctor who treats himself has a fool for a patient.” In treating someone close to me—a mentor, friend, and father figure—I couldn’t allow myself to consider the worst—that he could literally be losing his mind—even though it was right in front of my nose. Unconsciously I must have feared that if someone like Larry could get dementia, then so could I.

The following Wednesday, Larry decided we would meet again at the Brentwood golf course. I got there first and waited in the car with the air-conditioning blasting while I slathered on sunscreen. I also put on a ridiculously large visor that Gigi had dug out of some old beach bag and that I now kept in the car. I was taking no chances with the sun today.

Larry parked right next to me, got out, and pulled a set of ancient golf clubs out of his trunk. “We talk too much,” he said. “Let’s hit some balls. We’ll share my clubs.”

The course was a nine-hole pitch-and-putt that I knew I could handle. In fact, I liked the idea of playing a little golf lite to break up my
workday. But I wondered why Larry suddenly wanted to play instead of talk.

After he birdied the first hole and I sank my putt, I said, “So I ran into Tony Wilson at the faculty meeting the other day. He said your investigation has been closed for weeks, and the data error was just an oversight. There was no fabrication, and you’re in the clear.”

“Oh, yeah. I forgot about that, but so what? I still feel like a fraud.” Larry took out a driver and in one stroke got his ball onto the next green within three feet of the flag.

“How’s the Cymbalta going?” I asked as I drove my ball into the brush.

“Pretty good. My mood is better and I’m less obsessive,” he said as he used his handkerchief to meticulously wipe clean the handle of the driver I had just handed back to him.

I thought the game was too distracting for us to have a serious discussion, so I said, “Let’s sit down on this bench for a minute.”

Larry laughed. “What are you, pooped? You never could keep up with me.”