Last Day on Earth by David Vann Page A

guide him. He talks a lot about social anxiety. The move to a new school was a terrible idea.
    “Steve shows elements of both social anxiety and obsessive/compulsive disorder,” records the doctor who sees him. “My working diagnosis is Obsessive/Compulsive Disorder with the DSM-IV code 303.3. My plan is to start Prozac 10 mg each morning with breakfast.” The doctor doesn’t ask whether Steve owns a gun.
    This is the first time Steve’s been on Prozac in six and a half years.
    But it’s still not enough. Because now he’s getting panic attacks. As he’s sitting in one of his classes, his heart starts beating fast and hard. It’s like a fist in there, balled up. He looks around, but no one seems to notice. He’s short of breath, getting dizzy, disoriented. He’s going to pass out, right here in front of everyone. He holds on to thedesk, though, gets through the moment. His heart is still pounding, his breath still fast, but he’s able to get up, gets out of there. No one will know. He’s had panic attacks since high school, not very often, but they scare the shit out of him.
    So now there’s this on top of all the stomach problems. He has diarrhea, feels bloated, can’t seem to get his stomach under control, and over-the-counter meds don’t do much. His mother always said he had a nervous stomach.
    He’s also fighting with his sister, Susan. Their relationship has always been rough. She resented all the attention he sucked in high school, and he resented how perfect she seemed. But they have one good talk on the phone. He tells her, “I think I might be gay.” She’s gay, and perhaps he’s reaching out to her. But peace between them never lasts long. The first of three tense and aggressive emails to her is on September 3, 2007:
    “Susan, Just because Jessica and I aren’t dating doesn’t mean I don’t care about her as a friend. Decisions that I make often impact her since we are roommates, and she has expressed interest in going to Florida in November, (although I am going alone to visit my father). Sometimes, it is very frustrating talking to you because you sometimes seem blinded by your personal outlook on life, relationships, and even family. If you are going to judge me and threaten to hang up on me when we talk on the phone, then don’t bother calling. I don’t need the additional stress/abuse in my life. The only people who I’ve ever known who were like this was my mother, and yourself. She used to hang up on me as well at times, (when I called from Chicago), and I don’t need you to pull the same bullshit. You seem to get angry at the most petty things. If you want to know the real reason that I don’t often want to hang out with you, it is because I often feel that you judge me and others, (i.e. my interest in working at a prison rather than finishing school, my relationships at times, etc.), and then you get incredibly mad at me for a decision that I own, and one that doesn’t affect your life in the least. While this may be your function at work, it shouldn’t be that way with family, especially your own brother. I’m not trying to quarrel with you, but this is something that I had to say.”
    Steve returns to McKinley the next day, on September 4, says his mother’s death was a traumatic experience, still is. The doctor notes it in his evaluation. Steve worries, also, about his father, who has diabetes, hypertension, and a recent stroke.
    Steve is anxious all the time in this new place, feels judged, worries what people think of him. He’s hiding all the time, still doing well in his schoolwork, so no one would suspect. He did this at NIU, too. He’s good at hiding. The doctor asks him whether he’s planning to kill himself or anyone else. He says no. They up his Prozac from 10 to 50 milligrams a day and add Xanax, 0.5 milligrams a couple times a day as needed for anxiety. He’s on Ambien, also.
    He goes to dinner with Susan on 9-11, their mother’s birthday. Susan thinks