“She’s been having an affair,” Zee confessed, feeling her face redden.

“And you didn’t tell me this because…?”

“Doctor-patient confidentiality.” Zee knew that this was a hot button with Mattei, who claimed to have enormous respect for doctor-patient confidentiality.

“What’s the real reason?” Mattei said.

“That is the real reason,” Zee insisted.

“Is the affair still going on?”

“Yes,” Zee said.

“What else is she doing?”

“What do you mean, what else?”

“Is she drinking, is she doing drugs? What other kinds of risky behavior is our so-called Mrs. Perfect indulging in?”

There was some triumph in Mattei’s voice as she asked. She’d begun calling Lilly “Mrs. Perfect” ever since William’s initial goddess-like description of her. No one was that perfect, Mattei had told him with Lilly right there. Perfect was a huge burden for any woman.

“Just the affair.” Zee was aware that her stomach was churning. She wished she hadn’t said anything. Her face felt hot and red. She wanted to throw up. In all the cases she’d treated so far, nothing like this had ever happened to her. It was as if she had just confessed to the infidelity herself.

“Maybe you should take back this case,” she said.

Mattei seemed to think about it for a while before making her decision. “No,” she said. “I don’t have time to take on another patient. And you’re not getting out of this that easily.”

Zee sat quietly as she waited for Mattei to mull over their plan of action. She thought about getting up and walking out of the office and never looking back. It had become her fantasy lately. Not yet five years into her practice, and she was already having burned-out escape fantasies. Not a good sign.

“We’re upping her meds,” Mattei said, reaching for her pad. She slid a prescription across the desk.

As the new dosage of antiseizure medication started to work, Lilly seemed to come back to mid-range. During the next several sessions and into the early fall, she drove herself to Boston and spoke in her sessions with Zee the way a more normal patient might have. She talked about going back to college, or at least taking a class or two. She talked about the competitive process of getting her son into their private school of choice.

She had stopped seeing Adam, she told Zee. It had been very difficult for her. The medicine hadn’t changed the fact that she thought she was in love with him. She said she believed that Adam was the great love of her life, her soul mate. But she was trying hard to do the right thing. For her children. And for the man who used to be referred to simply as “my husband” and who had now taken on the permanent moniker of “Sweet William.”

It seemed to work. Right up until Halloween weekend, when (as she later put it herself) “all hell broke loose.”

First Lilly’s cat had disappeared. She’d looked everywhere, hanging posters all over town, calling all the neighbors. The children were upset, especially her daughter, who’d planned to carry the black cat she had named Reynaldo with her as part of her witch costume. But by Halloween night there was still no sign of the cat, and so her daughter had refused to wear the costume Lilly had made for her and refused to go trick-or-treating until Lilly took her downtown to buy another one.

It had been raining intermittently on Halloween, so instead of paper bags Lilly had given them pillowcases in which to collect their candy, but her daughter was still little, and her pillowcase hung too low and dragged along the sidewalk as they went house to house. The kids had wanted to trick-or-treat alone, insisting that they were only going to the neighbors’ homes, that they wouldn’t leave Gingerbread Hill. But Lilly wouldn’t hear of it. Terrible things happened to children all the time: razor blades in apples, kidnapping. No town was immune, not even Marblehead. She had always taken them trick-or-treating, and she wanted to go along. She even had a costume picked out for herself-or half a costume, at least. She still had on her jeans, but from the waist up she was Snow White, or a rather Disneyfied version of the famous beauty. She wore a black wig with a red bow, a half-length pink cape, and a blue shirt with puffy sleeves. In her hand she carried an apple.

She was actually excited about going. But at the sight of Lilly dressed up and ready to walk with them, her daughter started to cry. “I’m not a baby!” she insisted. And so Lilly walked behind them, staying in the shadows, watching while they knocked on the doors of her neighbors, and eventually eating the apple she carried house to house, dropping the core into a neighbor’s compost pile.

When they got home, it was past their usual bedtime, though William was still at work. She had hoped to keep the children up long enough for him to see their costumes, but tomorrow was a school day. They had their baths. She tucked them in. As she started down the stairs, she heard a noise from the basement. She decided it was the wind, slapping the French windows they’d recently had put in. It had happened before. The house had a walk-out basement, which they’d had remodeled a few years back. But the new windows were faulty; they often didn’t close properly. She’d already had two of them repaired by Adam. She’d been meaning to speak with him about fixing this final one, but she hadn’t gotten around to it before she stopped seeing him.

William returned home later that night, but Lilly wasn’t there. The children were asleep. At midnight he called the police and reported her missing. They told him he’d have to wait forty-eight hours before they got involved. Though they didn’t share their information with him, the police had a pretty good idea where she might be.

Lilly didn’t come home until two days later. When she did, she was sullen and down-cycling. She wouldn’t eat. She had several bruises. No matter how many times she was asked, she would never say where she’d been or what had happened.

After the emergency room took care of her injuries, Zee had Lilly admitted to a Boston psychiatric hospital on an involuntary seventy-two-hour hold.

Lilly’s three-day stay turned into three weeks. Zee went by every other day. One weekend, when Lilly wasn’t expecting her, Zee showed up. Lilly was in the lounge, a book in front of her. Instead of reading, she was staring out the window.

Zee paused to watch. Lilly was looking at a red construction truck, idling outside in the parking lot. Zee recognized it immediately. She had walked out of the office one day after Lilly’s session in time to see her getting into that same truck. Adam clearly knew who Zee was, and the look he gave her as she walked by that day had sent a shiver up her spine.

“You have to get away from him,” Zee said to Lilly.

Lilly didn’t answer.

By offering advice Zee knew she had crossed a line with Lilly. A therapist is never supposed to tell a patient what to do. But it was a line Zee felt she had to cross.

Zee left Lilly and called security.

WILLIAM DIDN’T KNOW WHAT HAD happened while Lilly was away. He could tell from the police reaction that they were not as worried as he was. “People walk out on marriages all the time,” they said.

He had convinced himself that it had been a kidnapping, from which his wife had narrowly escaped. He waited until Zee had been seeing Lilly at the hospital for almost two weeks before he couldn’t stand it anymore and came by the office.

He demanded to know what had happened to Lilly. “I know she told you,” he said.

“She didn’t, actually,” Zee said. “But even if she had, I couldn’t tell you.”

“I’m the one who brought her to you. I’m the one paying the bills,” he said.

“Lilly has to be able to trust me,” Zee said calmly. “Doctor-patient confidentiality.”

It was the only time she had seen William angry. “What the hell am I paying you for?” he demanded.