“To his work.” Eileen smiled. “He’s the most caring person I’ve ever met and takes great interest in every patient. They all adore him.”
What Nina had said. “Does he see every patient personally?”
“Absolutely.” She seemed offended by my question. “Dr. Korwin does the initial evaluation, and consults with the doctors on staff to create a therapy program. And he follows up regularly. You said you’re a reporter. Is this for a newspaper or magazine article?”
“I’m not sure yet.” I glanced at my watch.
“He’s running a little late.” She picked up the phone receiver and pressed a button. “Dr. Kor— I’m sorry. I just wanted to remind you that Miss Blume is here.” She put down the receiver, her face flushed. “He’ll see you now. We’ve had a stressful few days because of a crisis, and he hasn’t been himself.”
“You mean Lenore Saunders’s death. I saw on the news last night that she was Dr. Korwin’s patient.”
Eileen sighed. “What a horrible tragedy. I don’t think I’ve ever seen Dr. Korwin so shaken. Her mother phoned on Friday, and I didn’t know what to say. And of course, patients have been calling nonstop, needing reassurance.”
Korwin met me at the door and escorted me to one of the black leather chairs in front of an oversized mahogany desk cluttered with books and papers. My kind of guy. He was wearing suspenders over a light blue shirt that strained across his gut. His handshake was firm, and his eyes were a warm brown.
“Sorry I kept you waiting,” he said when he was seated. “It’s been a little hectic the past few days.”
If he was tense, he was covering up well. “Congratulations on your book. Your receptionist filled me in. Good Morning America. The Today Show.” I smiled. “You’ll be a household name right up there with Tom Cruise.”
“Eileen’s my biggest fan.” Korwin’s grin was ingenuous. “It’s a real kick at first, and my parents are thrilled. Now they can tell all the neighbors that their weird kid made it big. But you wanna know the truth? I hate flying, and I hate hotel rooms, and I hate the whole media circus. I’d rather be here at the clinic. This is where it comes alive for me.” He waved his hand.
I like to think that I’m a good judge of people, and I have to say he sounded sincere. “So why do it?”
“It sells books, so it makes my publisher happy, and they’ll publish my next book. Listen, I’m grateful the shows want me. Despite what you said, Tom Cruise I’m not.” He pointed to his paunch. “Without the media exposure, I’d reach a handful of women. My goal is to reach thousands, tens of thousands. The more, the better.”
“Women suffering from postpartum depression.” I took out my notepad.
“Women who are pregnant or contemplating becoming pregnant or have just given birth. Ten to twenty percent of new moms suffer from postpartum depression, maybe more. One to two in a thousand suffers from postpartum psychosis—again, maybe more. I want to help them and protect them from themselves, and protect their babies. And if elected . . .” He smiled again. “Sorry for the speech. I get carried away.”
“Good speech.” I smiled back. “So what’s the difference between depression and psychosis?”
“You know about baby blues, right? Happens to most moms right after birth and lasts a couple of days. Postpartum depression is more intense and doesn’t go away after a week or two.”
“Describe ‘intense.’ ”
“A woman with postpartum depression feels uncontrollably miserable and has some, but not necessarily all, of the following symptoms. She’s crying daily, has trouble sleeping, and not just ’cause the baby’s keeping her up all night. She loses interest in doing anything, can’t concentrate or make decisions. She feels listless, worthless, guilty, inadequate as a mother. She worries excessively over her child’s health. She loses her appetite, and feels an overall sense of helplessness. She thinks about death and suicide.”
A catalog of gloom and despair. Was that what Lenore and other mothers like her felt all day, every day? I scribbled madly to keep up, engulfed with a wave of sadness. “What about psychosis?” I asked, wondering how anything could be worse than what Korwin had just described.
“It’s far more severe and usually strikes in the first two weeks to one month after delivery, although it can start later. In extreme cases, it can lead mothers to harm themselves or their babies. By the way, we’re the only Western country that puts postpartum psychotic mothers in jail. Other Western countries, like England and Italy, recognize that new moms are particularly vulnerable to mental illness that could, in some cases, lead to infanticide.”
I shuddered. It was a horrible word. “What are the symptoms?”
“Obvious mood swings, extreme insomnia. Excessive concern about the infant. Hallucinations—seeing or hearing things that aren’t there, like hearing voices when no one’s around. Or delusions—having thoughts that aren’t based on reality. A mother may be convinced that someone is trying to harm her, or that her baby is the devil.”
What had Lenore seen in her baby’s eyes? What had she heard in his cry that had caused her to shake him to death? I tried to picture a mother gazing at the face of a newborn and seeing the devil, but it was beyond me. It was a place I didn’t want to go.
“The risk of psychosis after childbirth is twenty times higher than the risk before pregnancy,” Korwin added. “Did you know that?”
I shook my head.
He grunted. “I’m not surprised. We doctors know all about gestational diabetes, preeclampsia, and preterm delivery, but even though postpartum depression is more common, it hasn’t received equal attention in contemporary medical literature, training, and clinical practice.”
“Until Andrea Yates.”
“That’s postpartum psychosis, not depression,” Korwin corrected, his voice stern.
“Sorry.” I’d obviously pushed a button.
“It’s upsetting when the media carelessly label Yates and other women like her who killed their children ‘depressed.’ Postpartum depression and psychosis are two completely different entities. PPD doesn’t lead to psychosis. It’s not like a flu that can become pneumonia.”
“Okay.”
“It’s not just a question of semantics, Miss Blume. Say you’re a mother with PPD and you heard a news broadcast about Andrea Yates or someone like her, and the reporter said she’d killed her child because she’d been suffering from PPD. Can you imagine how stigmatized you’d feel, how terrified that you might end up killing your own child? And what if that stigma prevented you from seeking help?” He stopped, his point made, but he was still frowning.
“I can see what you mean. So postpartum depression is a relatively new diagnosis?” I asked, seeking safer ground.
“Actually, in 460 B.C. Hippocrates talked about puerperal fever and theorized that suppressed lochial discharge traveled to the brain, where it produced agitation, delirium, and attacks of mania.”
“Lovely theory.” I had no idea what lochial meant, but it didn’t sound pleasant. And “discharge” has never been one of my favorite words.
“You like that?” Korwin smiled. “Here’s another. An eleventh-century gynecologist thought that if the uterus was too moist, the brain would fill with water, and the excess moisture would spill into the eyes, causing the woman to involuntarily cry. I know,” he said, seeing the expression on my face. He leaned forward, his hands clasped. “My point is that postpartum depression has been around a long time. Left undiagnosed and untreated, it can have devastating consequences. In New York State, by the way, the law says new moms have to be advised that one in ten women will have a depressive episode, and that one or two in a thousand will suffer postpartum psychosis. I’d like to see that happen nationally.”
I could see why Nina and Lenore admired him. He was passionate about his field, caring, charismatic. “Won’t that make moms with baby blues more nervous?”
“Better nervous than unaware. And remember, baby blues go away after a few days. The go
al is to have women who need help get that help.”
“Why wouldn’t a woman who’s feeling all those symptoms want to get help?”
“Good question.” He nodded his approval. “Maybe she can’t distinguish between feeling miserable and feeling exhausted and overwhelmed. Maybe she’s embarrassed to admit she’s depressed. She’s getting congratulatory phone calls and visits, the baby’s being showered with gifts. She’s supposed to be thrilled. Or maybe she thinks she’s a failure if she admits she needs help. So she tells herself things will get better if she hangs in there.”
Korwin was echoing what Lenore had told Robbie. “So what is the cause of postpartum depression?”
He leaned back against his chair. “There are several factors. First, there’s the patient’s medical history. Did she suffer from depression before becoming pregnant? Depression in women, by the way, is twice as common as in men. Is there a history of depression in the family? If we’re dealing with psychosis, is there a previous history of postpartum psychosis, or of a bipolar mood disorder or schizophrenia? Second, what about the home situation? Was she unhappy to learn she was pregnant? Was her partner unhappy to learn she was pregnant? Is she having marital problems? Did she recently have a stressful incident in her life? By the way, adolescent moms have a much higher rate of postpartum depression.”
According to Jillian, Robbie had wanted a divorce even before the baby was born. And Nina had said that the marriage had problems, that Lenore was unhappy because Robbie was away so much, that she’d suspected him of cheating on her. Had Lenore worried that Robbie would leave her and go back to Jillian, just as her father had left her mother?
“And then there’s the biochemical component,” Korwin said. “Estrogen has been shown to inhibit depression. Immediately after childbirth, there’s a dramatic drop in progesterone and estrogen, which causes changes in the chemicals in the brain. We think that in some women, those changes can trigger postpartum depression or psychosis.”
“So what’s the treatment?”
“Depends on the diagnosis. For baby blues, I recommend encouragement followed by a few hours at Elizabeth Arden once the baby sleeps through the night.” Korwin smiled. “For postpartum depression, psychotherapy is highly effective, combined with antidepressants. For psychosis, you’re talking psychotherapy, antidepressants, and antipsychotic drugs, and the patient has to be hospitalized—for her safety and the child’s. In both cases, if the mom is nursing or pregnant, we’re limited as to what drugs we can safely use without harming the infant or fetus.”
Which explained why Korwin had wanted to wean Lenore off her medications. “Do you treat psychotic patients here?”
Korwin nodded. “We have twenty-five rooms and a staff of psychiatrists and nurses. We also offer on-site electroconvulsive therapy for depression and psychosis. It has no effect on a fetus, if the mom is pregnant, or on breast milk.”
I grimaced. “It sounds barbaric.”
Korwin smiled. “Most people have your reaction. ECT has a bad rep, but I’ve seen it do wonders. There are side effects—temporary memory loss, headaches, confusion. But they go away.”
“I’ll skip, thanks.” I flipped a page to the questions that had really brought me here. “Dr. Korwin, what’s the prognosis for a woman who’s had postpartum depression or psychosis if she has another child?”
Korwin shook his head. “Without help, not good. There’s a much higher incidence of repeated depression—twenty-five to thirty-three percent, maybe higher. With psychosis, recurrence can be as high as a hundred percent. But there’s been experimentation with different prophylactic treatments. In fact, we’re in the middle of a clinical trial here right now, using an estrogen patch with progesterone, antidepressants, and psychotherapy on a controlled group and a placebo on the other. The results are encouraging. Can you imagine what that would mean to millions of women if we’re successful?” Korwin’s eyes shone with excitement.
“It would be wonderful,” I agreed. “I have another question, Dr. Korwin. Hypothetically—”
He cut me off with an exaggerated groan. “I hate hypotheticals.”
I smiled. “Hypothetically, if a woman was treated for postpartum depression or psychosis and became pregnant again, would it be likely that she’d try to kill herself because she feared being depressed and possibly harming her child?” That’s what Connors had suggested, and I wanted an expert opinion.
Korwin scratched his beard. “I’d have to know more about her history and how she presents and her diagnosis. What her symptoms were, the severity of her condition. Whether she’s tried to kill herself before.”
“She has, twice. The first attempt was after she killed her infant son.”
Korwin’s face registered surprise, which quickly turned to anger. He sat up straighter, his teddy bear softness gone. “You’re not asking a hypothetical, are you?” He studied me as though I were a bacterium on a microscope slide. Journalistus nosyus. “And you’re not here to interview me about my book or about postpartum depression. You’re here about Lenore Saunders.” He shot me a baleful look.
“I am interested in the subject, and yes, I’m writing about Lenore. I apologize for not being up-front, but I didn’t think you’d agree to see me if I told you. I wanted to understand more about postpartum depression and psychosis so that I could understand her. Since she was your patient, I thought I’d come to you.”
“You could have done research in a library or on the Internet. You didn’t need to come here. If you’ll excuse a nonmedical term, Miss Blume, that’s a crock.” He picked up a pen and tapped it on the desk. “So what rag are you writing for? Or is this for a TV movie of the week?”
He was entitled to sarcasm. “Actually, I write books about true crime. I was troubled by the circumstances of Lenore’s hit-and-run, so I talked with her when she was in the hospital. The next night she left a message on my machine.” The pen tapping had stopped, so I assumed I’d sparked Korwin’s interest. “She said she needed to talk to me, that she was afraid. I waited until the morning to see her. By then she was dead. To be honest, I feel guilty.”
“I’m not a priest, and if you need a therapist, I can recommend a few good ones.”
I didn’t answer.
He took a breath, and when he spoke again, his tone was less hostile. “Lenore’s death is a shocking, senseless tragedy,” he said quietly. “We’re all trying to come to terms with it. It’s not easy for any of us.”
“You were an expert defense witness during her trial, and her therapist for over a year. You must have been close.”
“I’m close with all my patients,” he said curtly. “What’s your point?”
Touchy, touchy. “That you probably know what she was thinking better than anyone else.”
“I’m a psychiatrist, not a mind reader. Aren’t the police saying it’s homicide?”
The thought occurred to me that if Lenore had been killed, Korwin would be off the hook—legally, professionally, morally. “They’re considering the possibility, but they’re not ruling out suicide.”
Korwin’s phone rang. He picked up the receiver and uttered a sharp “Yes?” A pause. “Tell her I’ll call her back in a few minutes.” Another pause. “I understand that she’s upset.” He hung up the phone and pinched the bridge of his nose. “It’s been like that all day. Where were we?”
“We were talking about Lenore’s death. My question is, when she found out she was pregnant, would she have panicked and become suicidal?”
Korwin tsked. “Come on, Miss Blume. You know I can’t discuss Lenore. Doctor-patient confidentiality.”
“Even if she’s dead?”
“She still has a right to privacy. Suppose you were my patient, and you knew that after you died, I could reveal things you’d told me in confidence. Wouldn’t you think twice before confiding in me? Wouldn’t that inhibit the therapy?”
“Probably,” I admitted, disappointed. “But isn’t it important to know whether Lenore was su
icidal? If she wasn’t, it’s more likely she was killed.”
“I don’t need you to tell me my job, Miss Blume. I’ve already talked to the police and told them what I could about Lenore, based on the law.” In a less prickly voice, he added, “Believe me, I want to help, but I won’t compromise my ethics.”
“Even to identify a killer? If Lenore told you she was afraid of someone specific—”
“She never did,” he said brusquely. “She never said anything about it.” He was frowning, his eyes focused somewhere beyond me, and he sounded troubled.
“Maybe it has to do with her pregnancy,” I said. “Did Lenore tell you who the father was?”
Korwin snapped his attention back to me. “Which part of confidentiality don’t you understand?” he asked, annoyed again. He picked up a folder. “I have about ten calls to return and patients to see. If that’s all?”
“Can we get back to my hypothetical?”
He sighed deeply, and for a moment I thought he was going to refuse. Then he put down the folder and swiveled in his chair.
“Hypothetically, if a pregnant woman has a history of ongoing depression and feelings of worthlessness and suicide attempts following postpartum psychosis that caused her to kill her child, and depending on whether she was taking medication for her depression and the efficacy of the medication, would she kill herself—is that your question?”
I leaned forward. “Yes.”
“No comment.”
He looked pleased with himself, and I had to admit he’d played me well. “Because you don’t have an opinion,” I asked, “or because your attorney advised you not to answer?”
Korwin smiled. “It was nice to meet you, Miss Blume. Sorry I couldn’t be of more help, but I have to play by the rules. No hard feelings?”
“No hard feelings.” I slipped my notepad into my purse and stood. “Thanks for your time, and for all the information. I really do find the subject fascinating.”
“Buy the book,” he said and smiled again.
twenty-six
Blues in the Night Page 16
