How did that make you feel? Zee never even had to ask the standard shrink question. She already knew the answer. Lilly felt all the most destructive emotions out there-fear, judgment, inadequacy-as if there were some secret to parenting that she’d never been taught.

“Look,” Mattei had told Lilly’s husband when he’d dragged her in to see the famous doctor in what amounted to his last hope for his wife. “Most places they give you a pill, they send you on your way. I’m not going to do that.” Zee could see the look of relief in his eyes as Mattei explained the process. First they would wean Lilly off all her meds, and then they would be able to see just what they were dealing with. In the meantime Lilly would be given a complete physical and all the standard tests, checking thyroid and estrogen levels, and even a dexamethasone-suppression test to rule out Cushing’s, though both Mattei and Zee were already pretty sure what the diagnosis would turn out to be.

“We already had a physical,” the husband said, confused by some of the terms Mattei was using but clear on this one. He gestured to the folder he had presented her with earlier.

“I want you to have it at Mass General,” Mattei said.

They agreed. Then Mattei asked Lilly one more question, one she asked all of her patients.

“Where were you when you had your first panic attack?”

There was a long silence. The husband, who usually answered every question for his wife, looked baffled.

Everyone waited for Lilly to speak. Finally, after the silence was so awkward that the husband was getting nervous, he started to make suggestions to Lilly. In church, maybe? Or at the market? Maybe at the beach with the kids?

“Let your wife answer the question,” Mattei said.

“I don’t know where I was,” Lilly said. Her voice was flat.

“That’s bullshit,” Mattei said privately to Zee after the session ended. “Everybody knows.”

5

THE PARKING LOT ACROSS from the Old North Church in Marblehead was already full, so one of the funeral directors waved Zee down a side street where there were more spaces. When she turned the corner, she caught a flash of ocean so bright her eyes throbbed with it.

The pallbearers were unloading the coffin as she climbed the steep granite steps. She hurried ahead, into the wide expanse of church, taking a seat in the back row. An old woman moved aside to make room for her, dragging her cane across the wooden bench with a scraping sound.

There were photos of Lilly everywhere.

Zee had to swallow hard to keep from crying. She hadn’t cried yet; up until now all she had felt was shock. And guilt. She recognized Lilly’s children from photos. They sat in the front pew, the little girl unaware and chatting; the boy, who was reputedly so spirited, sat apart from his father and sister, staring straight ahead at the plain white wall. Zee couldn’t take her eyes off the boy. His stoicism stole her heart. She almost expected him to salute the coffin like the famous photos of John-John Kennedy, though she knew it would not happen.

MATTEI HAD PRESCRIBED LITHIUM TO Lilly at their third session. She diagnosed Lilly with bipolar 2 disorder, probably with a chromosomal element, she said, and definitely with panic. Mattei treated Lilly alongside Zee for the first two months, until she was certain the medication was working. So often during manic periods, patients were tempted to discontinue their medication. It was very important to monitor both the meds and the dosage. When Mattei was certain that the drugs were properly dosed and were being taken, she turned the case over to Zee.

It had taken Lilly several months to start talking. But when she finally did, it was like opening the floodgates at Salem Harbor after a nor’easter. She didn’t stop. Her childhood had been ideal, she said when Zee asked. There was no abuse of any kind and no history of alcoholism. Her mother and father had a wonderful relationship. And Lilly loved her husband. Maybe not more than life itself, the way he said he loved her, but she did love him. She spent the next three sessions talking about how and why this was true.

“I WAS HAVING SEX.” LILLY hadn’t answered Mattei’s question until her sixth month of treatment with Zee. So it took a moment for Zee to understand the implications. “When I had my first panic attack…I was having sex with Adam.”

It was before Lilly had told her the story of Adam. At first Zee thought that she meant her husband. But her husband’s name was William, not Adam. Lilly watched for Zee’s reaction. She expected to be judged. But Zee didn’t flinch.

“Tell me about Adam,” was all she said.

IT WAS ABOUT THIS TIME that Zee stopped sharing all of Lilly’s stories with Mattei. Her case discussions, which had always been so detailed, began to have their sharper edges rounded over, so that they would more easily merge into the general. There were more discussions about the symptoms, the phases and progression of disease, than about the details of each case. For her part, Mattei thought this was a good step, that Zee was gaining confidence as a therapist. Sensing that she could handle the caseload, Mattei began to send more patients Zee’s way.

BY JUNE IT WAS APPARENT either that Lilly had stopped taking her medication altogether or that the dosage Mattei had prescribed was insufficient. Lilly was in the middle of one of the most clearly manic periods Zee had ever witnessed.

Lilly’s feet were moving again. She never slept. She spent huge sums of money. Her food bills alone for the elaborate guilt feasts she was cooking for her family were running about $750 a week-for two adults and two children, both of whom were picky eaters. Lilly no longer remembered why she’d ever needed a nanny in the first place. She could easily handle two young children. And her trysts with Adam were getting more and more daring. With no nanny on board, Lilly had taken to sneaking Adam into her house in the late afternoons, claiming that the place needed some repair work, first on the playroom shutters and later on a crooked piece of crown molding in the living room that had bothered her for years.

Lilly and Adam had sex on every horizontal surface in the house. Hearing their cries of passion one afternoon and thinking that someone was hurting the children, a neighbor called the police. As the cruiser pulled up in front of the house, Adam went out the back door of the basement, hurrying across the yard by Black Joe’s Pond and down Gingerbread Hill, pulling on his work clothes as he ran. The police were waiting for him at the bottom of the hill, where his red truck was almost always parked these days. He knew them all, had gone to high school with a couple of them.

“Everyone knows what you’re up to,” one of the cops told him. “Why don’t you try to keep a lower profile?”

There were some stifled smiles, maybe even a pat on the back from the cop he knew.

“They don’t exactly disapprove,” Adam had said to Lilly when she freaked out about the cops. “One of us? Messing with some rich guy’s wife?”

It was the first time Lilly had felt uneasy about what she was doing and the first time she felt bad for her husband. Sweet William, who had never done anything to deserve this. For the first time during her long affair with Adam, Lilly felt shame. And the minute the shame cloud descended, things began to fall apart.

At Zee’s direction Mattei wrote a script and added a sedative to take the edge off and a light sleeping pill to keep Lilly’s feet from wandering. When Lilly complained of weight gain from the lithium, they switched her to an antiseizure medication.

It was difficult to say when Mattei started to become suspicious. “Tell me what’s going on,” she asked Zee directly. “I don’t mean with the symptoms, I mean in her life.”