Guilt by G. H. Ephron

He’d taken a couple of Advil, but that was—” Kwan broke off and sat forward, alert. There was a commotion in the hall.
    Gloria and Kwan exchanged a look, and everyone headed for the door. A heavyset man Peter hadn’t met before was in the corridor, bent nearly double and groaning. One of the nurses was propping him up, helping him in through the doorway from the screen porch.
    A well-practiced team, they sprang into action. Peter and Kwan rushed over to assist the patient, while Gloria went for a wheelchair. The man had his hand clutched to his chest and his face was glazed with sweat. A three-inch gash in his head, lined with stitches, was purple against his pale skin. This had to be their new patient, Rudy Ravitch.
    His face twisted in agony as they eased his rigid body into the wheelchair. “Oh, god, it hurts. I can’t breathe. My back—” he said, gasping. “I’m dying.”
    Kwan listened to Ravitch’s chest while Peter crouched in front of him.
    â€œJust keep breathing and try to relax,” Peter said. He could smell cigarette smoke. The nurse had probably taken Ravitch outside for a smoke. “You’re going to be all right.”
    After examining Ravitch, Kwan called a technician to administer an EKG. Later that morning Kwan called Peter in his office. As they’d both suspected, test results ruled out heart attack. That left the default diagnosis: panic attack. The symptoms were nearly identical to a heart attack, just as painful and terrifying to experience but not life-threatening. After what Ravitch had witnessed, panic attack seemed an entirely appropriate aftermath.
    The standard treatment for panic attacks would have been an anxiolytic such as Xanax and a few weeks of behavioral therapy, but Ravitch’s head injury complicated things. Kwan ordered an MRI. They needed a closer look at Ravitch’s brain before deciding what to do next.
    *   *   *
    â€œI heard this place was a country club. So where’s the first tee?” Ravitch asked with a nervous chuckle. He and Peter were sitting opposite one another in the examining room. Peter had asked him if he’d be willing to talk to MacRae, and he’d agreed.
    â€œSo, you play golf?” Peter asked. Ravitch nodded. “Unfortunately, you’re fifty years too late. There used to be a golf course right on the grounds.”
    Ravitch looked around the room, taking in the floral watercolor on the wall. His look said: How the hell did I end up here?
    â€œYou a shrink?” he asked, addressing a blue-and-white Chinese vase lamp base.
    â€œA neuropsychologist. That’s someone who studies the relationship between behavior and what goes on in the brain.”
    Ravitch’s jaw tightened. “I’m not crazy.”
    â€œYes, well, that’s our working assumption as well.”
    He seemed startled, and for the first time he looked right at Peter.
    â€œAnd since your problem doesn’t seem to be heart disease, either, the likeliest scenario is that you’re having panic attacks.”
    Peter told him he wanted to hear more about what had happened to him, and then he was going to administer some psychological tests to help determine the best treatment.
    â€œI smoke,” Ravitch said. It sounded like a non sequitur, but it wasn’t. “That’s what I was doing when it happened. I was out in front of the building, lighting up. My buddy, Leon, he’s an ex-smoker, so he’s sympathetic. The other guys, they’re all a bunch of stiffs.
    â€œSo Leon tells me it’s okay, he’ll cover for me.” He grimaced and shook his head. “You know what happened to Leon?” His voice broke and his shoulders heaved. Tears flowed down his cheeks. For a few moments, he couldn’t say anything. “Pieces. He got blown into pieces. His wife won’t even get a whole body to bury. Jesus Christ, what a shitty thing to