“What do you think, kiddo?” she said, trying to shake off the mood. “Should we stop by the bookstore and see if they have any new puzzles?” Karim shared her passion for large, fiendishly difficult jigsaw puzzles. She liked to think that it meant their intellects were alike, attuned to solving problems.

“Can we order a pizza, too?” Karim asked eagerly. “Great idea.”

And just like that, for the moment at least, the distance was gone; he was her little boy again. They were Jenna and Karim, together against the world.

28. Genevieve

Genevieve

Wednesdays were a challenge because of Jenna’s three afternoon patients. It wasn’t that their problems were especially tricky, although Colleen Dowd’s was certainly difficult. The trouble was that Jenna personally liked all three women and found it hard to maintain objectivity.

Colleen Dowd was forty-five, several years divorced, no children. She suffered from agoraphobia.

The term, a combination of Greek words meaning “fear of the market- place,” had once signified an irrational fear of open places. Now it was applied to a spectrum of phobic reactions to various circumstances, which usually involved being out of one’s accustomed sphere. Colleen had panic attacks whenever she went more than a short distance from home.

Over the years, she had circumscribed her life ever more tightly to avoid them, even relocating her business to a storefront on the same block of Hanover Street as her apartment. At her first appointment, she had been triumphant at having accomplished the short cab ride to Jenna’s office. Ironically, she was a travel agent.

Barbara Aston presented a quite different set of problems. She was an alcoholic who also depended heavily on prescription drugs, especially Vali- um—a dangerous combination. She was also addicted—the word was quite accurate—to cosmetic surgery.

At forty-three, in a desperate effort to stay thin and young for fear of losing the husband she professed to adore, she had already undergone a dozen procedures ranging from breast implants to a facelift, and from a tummy tuck to two separate nose jobs.

Before attacking the deep insecurity that underlay all this, Jenna was attempting to deal with Barbara’s chemical dependencies, which not only interfered with other therapeutic efforts but were potentially life-threatening.

The final Wednesday-afternoon patient, Toni Ferrante, was thirty-five, married for fifteen years, the mother of two sons a bit older than Karim. She was also a lesbian, a fact she had finally admitted to herself only a year earlier. The problem was that she could not admit it to her husband, her boys, or—especially—her parents. From Jenna’s point of view, Toni was a difficult patient simply because there was nothing wrong with her.