Shortly before her death, Sandra had been drinking, and there was evidence that she had been smoking marijuana too. She had been pushed out the window by the downstairs neighbor. The townhouse they had shared had been advertised in the market as “magnificent.” Sandra’s apartment occupied the top two floors. Laurie Clay, her murderer, occupied the bottom two.
Like Sandra, Ms. Clay was twenty-three years old. She studied fashion at New York University and wrote a style blog on the Internet. Her family came from Louisville, Kentucky, and she was the heiress of the largest mustard producer in the state. She surrendered voluntarily to police, five days after the crime.
Laurie claimed she had been under the influence of drugs and alcohol when she killed Sandra. That she had been ordered do to so by God, who had appeared to her in a hallucination. She was sentenced to twenty-two years in prison and was incarcerated at the Beacon Correctional Facility in the town of Beacon, about 100 kilometers north of New York.
At Hoskings’s suggestion, a search was done to determine whether there was in the civil records of New York anything indicating that Sergio Emílio Y. had, at some point, changed his identity.
That is how I discovered that Sergio Y. and Sandra Yacoubian were the same person. Or rather, that they were distinct branches of the same body. Sergio, who had acquired American citizenship thanks to an investor visa, formally filed a request in August 2009 to change his name and gender in a Manhattan court, which recognized the request and authorized the change. The grounds given for the request was “transsexuality.”
After I discovered and understood what had happened to Sergio Y., I went into shock. It was as if I had fallen ill. To this day, I still do not understand exactly what happened to me. I became apathetic. I could not concentrate. I stopped eating. I lost almost six kilos in one month.
As bedtime approached, I felt an unease, a discomfort that I only managed to free myself from with a warm bath and some antianxiety medication. Sometimes I would sleep well at night and wake up in a relaxed mood. Other times, however, I would spend all night awake, unable to sleep until daybreak.
I felt obliged to review all my notes and to listen to all my recordings of Sergio’s sessions. Our years of analysis had yielded a green-covered notebook and multiple computer files.
I spent a whole afternoon reviewing my notes. Often they seemed disjointed. After five years, our memory fades and becomes selective. I had to accept that many of the words and conclusions I had jotted down concerning Sergio no longer made sense to me. I could not even remember what they referred to. Only sentence fragments and underlined words remained. Nowhere in the notebook was there any mention of “transsexual” or “transsexuality,” which was lamentable for a doctor of the caliber I judged myself to be.
Based on what I could ascertain from reviewing my notes, Sergio Y. felt unhappy and did not want to resign himself to the unhappy condition he had found himself in. Once he had told me that he was “the fruit of my great-grandfather’s courage.” If Areg had stayed where he had been born, he would have died, have been murdered, and he, Sergio, would never have been born. “Abandoned where he’d lived to continue living.” I wrote that sentence down in quotation marks. I think even then, Sergio Y. saw immigration as a way to ensure his survival and his future.
Surprisingly, mention of New York jumped out in these notes. “New York as a possibility for reinvention” (08/08/2006), written in blue ink. “Trip to New York, on vacation. Visit to the Ellis Island Museum”(11/12/2006), in black ink. It became clear to me that, somehow, Sergio’s future in New York was already recorded in these notes.
When I had questions or wanted to deepen or clarify something I came across in my notebooks, I would listen to the recording for the corresponding session. It was strange to hear his voice knowing he was dead. The sensation I had when I went back to the recordings was that he was speaking from beyond, using the computer as a speaker. That week, I spent two afternoons and two nights listening to the dead Sergio Y. discuss his life.
IT IS ALL MY FAULT
I never saw any evidence that Sergio Y. was a transsexual. Neither did he ever mention anything that would, in my opinion, indicate an inner conflict over his sexual identity. It seems incredible, but I did not notice anything.
When Tereza Yacoubian approached me in front of the cheese counter at the supermarket and told me her son lived in New York, I found it perfectly natural. I could imagine him living in New York. It made sense. It seemed plausible.
However, it was difficult to reconcile what I thought I knew about Sergio with the discoveries I was now making with regards to his condition as a transsexual and the circumstances surrounding his premature death.
For me, the questions were now different: What role might I have had in the tragic fate of Sergio Y.? Was I as important as I deemed myself to be when I heard he was happy?
When his mother told me he was fine in New York and opening a restaurant in the West Village at twenty-three, I felt responsible for his happiness. I felt I had helped construct his happy life or at least been a catalyst. I even bought a pair of moccasins I had been flirting with as a reward.
Whose responsibility was it now that my patient’s happy life was over? Was that mine too? Was I guilty of not acting? Was I guilty of not seeing? Of malpractice? Negligence? Arrogance?
But even if I were guilty, no one but me would ever know. The Federal Medical Council could not revoke my license. They would not even open an investigation. They would never make the connection between Sergio Y.’s death and our therapy sessions. Sergio died years later, in the United States, the victim of another crime.
But what did I say that led him to the tragic circumstances that precipitated his demise? How could I not have noticed his greatest affliction? Did I somehow help him arrive at the warped revelation that led to his death? According to Sergio himself, it was a conversation we had had that led him to his “revelation” as to what he should do with his life.
And what did he do with his life? He disfigured it. He surrendered it to a murderer.
I went to the cemetery twice to visit his grave. “Sergio Emílio Yacoubian, 01/10/1988 - 02/02/2011” is written on the gravestone. Sandra did not leave a record of her brief life on that tombstone. Sandra was born Sergio and remained Sergio in death.
After Sergio’s death, my work with patients became less enjoyable. What had once felt stimulating now felt threatening. I began to imagine a different death for each one of my patients, one caused by me. My patients were no longer proof of the good work I was doing but instead began to represent the possibility of error. My shortcomings could mean the death of each one of them, as apparently had already happened once.
At that moment, all I wanted was to wash off the blood I could not help feeling was on my hands. When patients canceled, I now felt relief. I expended too much energy in every session and paid too high a price in terms of the discomfort I felt. Just being around patients became torture. I had to rid myself of these feelings. I did not bother with excuses. “We need to suspend treatment for three weeks.” I went on vacation.
I felt I was not coping with the psychological anguish and guilt which Sergio’s death had triggered in me. Before the problem grew any worse and made me seriously ill, I decided to talk to Eduardo, a friend from my university days, whom I have known for over forty years.
Eduardo is the person I discuss my cases with. I talk to him when I have doubts and want a second opinion. We talked twice before I left on vacation. But my consternation with regard to my patients persisted.
During the three weeks I was away, I spent only four nights at the beach house, just to make sure things were all right. The rest of the time I stayed in São Paulo. I would go to the gym in the mornings, and to the cinema at night, for at that time the International Film Festival was on.
On the one hand, I tried to be as productive with my time as possible. On th
e other, I wanted to be transported as far away from my everyday existence as possible. I wanted to escape the present. Today I see things more clearly. At the time, I was not sure if I knew what was going on.
The main source of my frustration was not having detected any hint of Sergio Y.’s transsexuality. I felt I had been duped solely and exclusively by my own incompetence. I had always thought that the secret to transsexuality was not all that deep, that it revealed itself in all of the individual’s attitudes, at all times, in all the decisions he or she took, since early childhood. As far as I was concerned, the pain in the patient’s soul and their inner confusion would be so visible that one did not need to be a Freudian or Jungian psychoanalyst to make the diagnosis.
Medical malpractice. Not so different from a doctor who fails to diagnose meningitis. I remember a professor of mine in medical school, Dr. Pedro Veríssimo, who liked to say, “Malpractice can always be avoided.” I had failed at my job and felt that my incompetence was the key element in the tragedy that led to Sergio Y.’s death.
But he never mentioned anything that I could have interpreted as indicating any conflict over his sexual identity. Not once. I have no idea how many layers of fear drowned out this secret inside of him. It was all hidden. He, of course, knew what was happening and willingly said nothing. He did not have the obligation to tell me anything. We must respect the patient’s will.
Eduardo did not seem shocked at my professional failure. One of the first comments he made after I told him of my anguish was, “I don’t know why you care so much about a case that’s unsolvable. Death really has no solution, Armando. All of these therapies we do only have meaning while we’re alive. The dead are useless to us. Sergio Y. died, right? Things are not so black-and-white. This obvious fact is what I want to impress upon you. The responsibility you feel you have in the case of Sergio Y. is unfounded, almost ridiculous. Wake up, Armando! You’re merely one of the many factors in the equation that resulted in the death of this twenty-three-year-old. You weren’t the determining factor here. You have no idea under what circumstances his death occurred. The sad truth, Armando, is that in this case, your role was minimal. I know you. I know it’s hard for you to accept a minor role, but I think that’s what you need to try to do.”
At the time I did not understand that I had inadvertently reproduced in my mind the stereotype that the death of a transsexual is always caused by the tragic circumstances of his life.
But the death of Sergio Y.—regardless of whether he was a transsexual or not—might have been random. His life might not have been tragic at all. This also happens. That was the conclusion I should try to reach. If he had been hit by a stray bullet, or lightning, or a runaway car in São Paulo or in New York, he would be just as dead. Still young, transsexual and dead, regardless of the agent of his death.
With this psychological guidance in mind, I went on with my life. Gradually, I went back to seeing my regular patients and to going to the gym in the mornings. I felt at peace, but I still thought daily of the nature of my role in the untimely death of my former patient.
Time, however, wears everything down, and gradually the feelings of responsibility for having harmed Sergio Y. began to dissipate. The more I managed to distance myself from the problem, the more my guilt began to turn into doubt.
Reviewing my datebook, I see that I decided to call Tereza on March 19.
It was raining heavily. From my window, I could see the headlights reflected on the wet highway below. The sound of rain drowned out the hum of the traffic. The soaked and tense city grew dark. That afternoon, the main concern of the inhabitants of São Paulo was to get home.
My Thursday patient called at 5:20 P.M. telling me he would not be arriving on time for his session. His call gave me thirty free minutes before my next meeting—a student who wanted my opinion about a project, but who might also not make it because of the rain.
I decided to take advantage of the additional time to answer e-mails and to pay my credit card statement online. From my bank page, I started surfing the web aimlessly, until, don’t ask me how, I arrived at the Brazilian Oncology Association page.
I only mention my wanderings on the computer because that was how I arrived at photos of the National Cancer Institute anniversary dinner. The third picture showed Tereza and Salomão Yacoubian with the president of the institute. Salomão wore a dark blue suit, white shirt and burgundy tie; his wife wore a gray dress and looked directly at the camera. It was not a look of celebration, but they hid their sorrow with dignity.
That afternoon, on impulse, I called Tereza Yacoubian. It crossed my mind that this call could be seen as inappropriate, but I decided to interpret the fact that they had been photographed at a social event as evidence that their mourning had come to an end. I chose to believe that photo meant they were accessible.
That was what I was thinking when I picked up the telephone to call.
“Tereza? How are you? This is Armando, I was Sergio’s therapist. Do you have a moment? I’m sorry to call you like this, out of the blue. But I’ve been reviewing my notes from our sessions and I had some questions I wanted to ask you, if you don’t mind. I’ve had dreams of Sergio. In my dream, he wore an apron. I think it’s the image you gave me when we met in supermarket.”
“I was buying cheese for a soufflé . . . ”
“How did this happen, Tereza? What happened to Sergio?”
“Doctor, we still don’t understand fully. I can’t speak about this just yet. It’s not that I don’t want to. I’d like to talk to you about Sergio. Just like you have questions for me, I also have questions for you. It’s just that I can’t now. I’m afraid I’ll fall apart. You know how important you were in the decisions he made. If you have questions of a medical nature, I can give you his doctor’s e-mail in New York. If you like, I can write to her and say you’ll be in touch. Her name is Cecilia Coutts. She can explain what happened to Sergio. But as I said, it’s still too painful to talk about my son’s death. Please write down Dr. Coutts’s e-mail.”
“Of course, Tereza. Please excuse the call,” I said.
I wrote down the address she gave me. “As soon as I’m able to, we’ll talk,” she said before hanging up.
I felt embarrassed by the call. At that moment, I felt sorry that I had given in to my impulse.
I had attempted to satisfy my curiosity without regard for the feelings of a mother who had lost her only son. I felt awful. How much lower could I go? I wanted her to understand that what seemed like mere curiosity on my part was not curiosity at all but concern. When someone shows concern for a child who has died, he gives comfort to the surviving parents because that interest is noble and resuscitating.
“Doctor Armando, I appreciate your interest in my son, but I can’t help you now. I’ll help when I feel up to it.”
Suddenly, I realized that for Tereza, Sergio was still unburied.
I would stay up until late reading the news online. I would wake up at around 8 A.M. I would make coffee and feed the cat. I would see the patients I had to see, I would return phone calls, and through it all life apparently remained the same.
The only conspicuous change in my routine was the absence of my cleaning lady, Rosa, who was on maternity leave. Her cousin Rosangela came instead. The presence of one made up for the absence of the other. Nonetheless, in the months that followed Sergio Y.’s death, much had changed for me. I had become cowardly and less committed as a doctor. The death of Sergio Y. had made me a worse person.
A sense of guilt began to weigh on me, and a sadness, which I did not want anyone to know, filled my heart. I did not feel diminished, but I was filled with shame.
Sergio had been the great failure of my professional life. I believed I had never been so wrong with a patient as I was with him. It was only fair that my hands should feel dirty with a blood so real I could almost smell it. But I did not want anyone to know
how vulnerable I was.
The only person who knew was Eduardo, my friend from college, who was discreet by nature and always sensible in his advice. He understood how I felt without ever blaming me in any way.
THE THINGS WE DO FOR LOVE
Mariana was born on the eve of my forty-fourth birthday. By then I already had white hair and a belly. I never expected to have children. It was a surprise when Heloísa told me she was pregnant.
Even nowadays it is hard to understand the transformation that occurs when a child is born. One’s worldview changes. Old worries fade; others, new ones, emerge. Important things become trivial. This is true even with cats and dogs.
I would not say I was an absent father, but I know I sacrificed time I could have spent with my daughter. I do not regret it. With the time I sacrificed, I did important things for other people. After Heloísa’s death Mariana and I became closer. It was a silver lining.
My daughter is beautiful and polite. She has always been a good student. As a sophomore in college she interned at a German bank on Avenida Paulista. She was in her third year studying economics when her mother died. She was twenty.
Shortly before graduating, she told me she wanted to continue her studies. She had decided she wanted to do her MBA in the United States. She did everything herself. She filled out the applications. Wrote her essays. Obtained her letters of recommendation.
She devoted months to the effort. But it was worth it. She was accepted everywhere she had applied to. She chose Columbia University because she would have the opportunity to live in New York. I supported her choice. She asked me to help her financially, and I did.
Sergio Y. Page 4
