Chapter 1

Usually one can make a plan to treat a patient based on the diagnosis of a known affliction that is treatable with known methods. There are also diseases we know exist, but haven't figured out how to mediate yet.

But the really tough cases are those in which the difficulty lies not in treatment of the patient, but in trying to decide whether or not the fantasies being displayed are, in fact ... fantasies. Maybe you've heard the saying "I'm not paranoid ... everybody really is out to get me!" Well, there actually are situations where that's true. It's rare, but not impossible.

I met the patient I'll call Bob when his case was assigned to me for a mental evaluation to determine whether he was capable of understanding the charges against him in court. He'd been arrested for groping a pregnant woman in a restaurant. It was late August and we'd been through a grueling heat wave. A lot of people had sought relief in air conditioned restaurants and bars and because of that I assumed there was alcohol involved. When I checked the police report, though, I found that his blood alcohol level suggested he'd had nothing to drink at all. At least nothing alcoholic. The blood sample obtained wasn't screened for other mind altering drugs.

Bob was still in jail the first time I visited him. Normally, somebody in his situation would have been released, either on bail or to his own recognizance. It was a minor charge, after all. All the report said he'd done was put his hands on the woman's swollen belly and "behave irrationally." But in this case, whatever he told the judge during his arraignment resulted in him being slapped right back in a cell until I could get there and do an evaluation.

The jail has what they call a "First aid room" that can be used for the kind of initial exam I was being asked to do. Bob presented as a completely unremarkable fifty-seven year old white male. He had none of the physical features of a man who has abused drink for years, and he carried too much body fat to have been involved with most other drugs for any extended period. Of course there are substances like LSD or PCP that can wreck a mind while leaving the body unaffected.

While my initial interview with him was supposed to gather information to decide what my report to the judge would be, I always approach these situations with an eye toward possible future involvement with he subject as a patient. My initial approach, therefore, was more to get the lay of the land, rather than come up with a firm diagnosis or prognosis. The first step was to talk to him and see where his thought processes were. If needed, further interviews and tests would come later that would illuminate underlying causes of concern. Assuming there actually developed any concern concerning his level of sanity, of course.

Bob was already in the First aid room when I was taken there myself. I was handed from one guard to another, a burly, tall man, who stood against the door once I was inside the room. Bob was in restraints. The guard looked bored, but I asked the routine question anyway.

"Has he displayed any violent tendencies?"

The guard just shook his head.

"Is there any really need for you to be in here with us?"

"It's policy," he said calmly.

I turned to Bob, who appeared to be sitting comfortably in an uncomfortable chair. I introduced myself and explained why I was there.

"Will the presence of the guard bother you while we talk?" I asked.

He looked at the guard and then addressed him.

"You're married, aren't you?"

The guard blinked and looked at his left hand, at the silver on his ring finger.

"Do you have any children?" Bob went on.

The guard still made no answer. Bob seemed unconcerned that the guard wasn't saying anything.

"Were any of your kids born in September or October?"

The guard moved then, centering his weight on both feet. This simple question had obviously hit a nerve. That was fascinating on one level, both because of the reaction to such a banal question and his obvious unwillingness to share any kind of personal information with an inmate, no matter how harmless. I decided to remain silent and watch. As so often happens, silence is uncomfortable and people try to fill it unconsciously.

"I've got one kid who was born in September," the guard said. "How did you know that? Are you psychic or something?"

Bob blinked a couple of times and then looked at me, ignoring the guard. "It would be better if he wasn't in here while you talk to me."

This was the first indication that Bob's thought processes might be irrational, but he didn't tense up or display any aggression. Additionally his choice of phrase was interesting. He hadn't said he didn't want the guard in there. He said it would be better if the guard wasn't present. I would expect the former, and for him to use the latter was puzzling. I threw him a bone by addressing the guard.

"This is technically a medical procedure," I explained. "Privacy will enhance the success of my objective."

The guard shrugged. "I'll be right outside if you need me." He opened the door and then paused on his way out. "Unless the watch commander says I have to come back in."

"Have him see me if there's a problem," I said.

The door closed and I sat down across the gray steel table from Bob.

"So you're a shrink," said Bob. He still showed no signs of agitation.

"I'm a psychiatrist," I corrected. "Your brain will be exactly the same size when we're done as it is right now." I sometimes use that little joke to defuse anxiety in a new patient and break the ice.

He gave me a wane smile. "You're going to think I'm insane," he said calmly. "Everybody does."

"Why don't you let me be the doctor," I suggested. "You want to talk about why you got arrested?"

"Sure," he said lightly. "Beats sitting in a cell with a bunch of drunks." He smiled ... a perfectly normal, completely ordinary facial expression to follow such a statement. "By the way, doc," he went on. "Do you have any children born in September or October?"

I knew we'd get to the seat of what was appearing to be an obsession of some sort. He was obviously willing to discuss it.

"I do not," I said. "I have a nephew who was born in October though. Does that count?" I didn't mention that I was born in September myself. If that month had some trigger effect on his psychosis I didn't want to disqualify myself right out of the chute.

He frowned, and then said something that was mysterious on the face of it, and which would turn out to be prophetic.

"Well, Doc, assuming you decide I'm not as crazy as a loon, you may think about your nephew ... and sister ... differently by the time we get done."

What his situation could possibly have to do with my sister was beyond me, so I just smiled and suggested we get started.

I went through the routine questions with him. I asked him if he had, in fact, groped a pregnant woman, and he explained that he had touched her, but not for sexual reasons.

"We were in line together, waiting for tables," he said. "I was alone. She was with another woman, her sister I think. We got to talking and when she said she was due in September I put my hand on her belly. She got upset, and I tried to explain why I'd done it. That was when she freaked and they called the cops."

"Why do you think she got scared, Bob?" I asked.

"They all get scared," he said. "The ones I'm interested in, I mean. I don't pay any attention to the others." He blinked. "Well, that's not exactly true. I like pregnant women. I think they're beautiful. But I'm only really interested in certain ones."

"Why is that, Bob?" I asked.

"That's the part that will make you think I'm wacko," he said calmly. "That's why the women get scared too ... when I ask them about how they got pregnant."

"You ask them how they got pregnant?" I couldn't help raising my eyebrows. This was a very interesting fetish already. "Why, Bob? I have a feeling you know how a woman gets pregnant."

"Oh, I know how, all right," he said. "In some cases, though, the important thing is who got them pregnant."

He wasn't making any sense. There was no thread to his comments. I began to think he had a dissociative problem. He must have seen something in my eyes, because he raised one manacled hand, palm out.

"Look, Doc, why don't I just tell you the story. It will make more sense that way and you'll hear it in order. You'll still think I'm a candidate for the loony bin, but maybe it won't be as frustrating for you, okay?"

"You're going to tell me the story of why you groped this pregnant woman," I suggested.

"You'll understand that after I tell you the story. It's a long story, though. Have you got time?"

I looked at my watch. I had forty-five minutes, which was plenty of time for any story a dissociative mind would try to spin out.

I leaned back and nodded.

He started off by going off on a tangent first, which lent more credence to my budding diagnosis.

"I'm going to assume you don't believe in magic," he said. "Most men of science and medicine don't. But I'd like to propose something." He looked to see what my reaction would be, but I held my face impassive. "I'd like to propose, just for the sake of argument, that any phenomenon that science cannot explain may be assumed to be magic."

"I can't agree to that," I said.

"I understand that lots of things that have been called magic have been disproven by the scientific process," he said. "But there are things that science cannot explain. I can't prove they're magic, but you also can't prove they are not. True?"

"Within a very narrow meaning of the concept of proof, I'll accept that," I said.

"So magic could exist," said Bob. "Because we can't prove conclusively that it cannot."

"That's like saying there must be a color named blixtorg, because no one has proven there is not such a color," I said.

"We understand each other perfectly," he said, with a small smile.

I blinked. I had a sneaking feeling I had just agreed that magic could exist, and that there was a color named blixtorg, which nobody had yet seen. At least in Bob's mind.

"Go on," I said. "I thought we were talking about your obsession with pregnant women."

"We are," he said. "May I go on?"

"Of course," I said.

"What do you know about global birth rates?" he asked.

"I thought you were going to tell me the story, not ask me questions," I said, a little peeved.

"I can do that," he said, and launched into what sounded for all the world like a professor lecturing an undergraduate student.

"Something happened to me as a child that was the seed of my obsession. I'll tell you about that later, but it resulted in me doing a whale of a lot of research, and you need to hear that part first.

"I was born in September. In school, I noticed that an awful lot of other kids also had birthdays in September and October ... more, in fact, than any other months. There were so many more, in fact, that teachers picked one day of each month to have a classroom birthday party for all of the kids born in those months, instead of having individual ones, like the other kids got. That stuck in my mind for some reason. It was just something odd, back then, but then something happened to me that made me get a lot more interested in that phenomenon. What happened is something I need to tell you later. What is most important is that it started my obsession.

"I started collecting and reviewing data concerning birth rates by month. I found out I was right. The birth rate spikes in late September and early October ... not just in America, but all over the world, Doctor. I'll say it again. More babies are born in the months of September and October than any other months of the year. I have the data to show this phenomenon exists in multiple countries and has been a trend, statistically, for over a hundred years. No good data is available prior to that because of insufficient or suspect record keeping. What this means is that more babies are conceived during late December than any other month."

He paused, looking at me as if he expected me to realize something. I didn't, and to be honest, I still thought he was rambling. I wanted him to keep talking, however, and I admit I was a little curious about where this would end up. That's because I was also born in September. I didn't tell him that, of course. I just nodded to keep him going. He looked almost disappointed, and then spoke again.

"I wanted to know why."

He stopped, closed his eyes for a long moment and then reopened them. He looked anguished.

"Actually I already knew why, but I didn't want to believe it. I thought I was insane, and was actually trying to prove it, because that would prove that what I knew to be the case was false."

He was definitely rambling, now, and it was appearing more and more that his dissociative problems made it difficult for him to concentrate.