The Wrong Patient

By the time the third email came true, I stopped sleeping. The first one had been strange, unnerving in that uncanny-valley way spam sometimes is, like it's gotten just close enough to you to graze your skin.

Subject: New Patient Intake Tomorrow

I read it at 11:48p.m, blue light burning the back of my eyes, the hum of the fridge the only sound in the apartment. My cat Lilith was a warm comma at my feet. I was still in my work clothes, blouse wrinkled, hair in a knot that had half-collapsed, the day's notes spread out around me on the couch like a paper crown. The sender's address was nothing-just a meaningless string: [email protected]. The body of the email was written like one of my own intake summaries:

Presenting Problem:

Insomnia. Intrusive images. A sense of standing next to one's own life instead of inside it.

History:

You will wake at 6:17 a.m. to the sound of rain. You will think about canceling your 8 a.m. with Kennedy, but you won't. You'll spill coffee on your wrist at 7:03 and swear under your breath, you won’t wipe it up immediately, and a brown crescent will dry against your watchband and go with you to work. At 8:41, your patient will say, “I feel like I'm living a rerun.” You will think: Join the club. Your receptionist will wear the green scarf you hate and ask whether you want to move the 3 p.m. because she just called to say she'll be late. You will say, “No, leave it. I'll make it work.” You always make it work.

Diagnosis (Provisional):

We'll discuss this together. Soon.

Name:

You can call me whatever you like. For now.

Your Future Patient.

Your Future Killer.

I remember frowning at the screen, waiting for the chill to really hit. It didn't. Not yet. Someone was messing with me. That was the obvious answer. I looked at the timestamp: “Sent: 11:47 PM.” One minute ago. No attachments. No links. No “click here to confirm your account" phishing garbage. Just…this.

I told myself it was a prank. Maybe one of my colleagues, bored or drunk, got hold of a blank intake form and tried to be clever. We used ProtonMail for some of our more privacy-conscious clients, it wouldn't be hard to mask a sender that way. I marked it unread, left it in my inbox, and shut my laptop with a snap that startled Lilith awake.

“Bed,” I told her, as if issuing the command to myself. “We're going to bed, and we're going to forget about creepy internet nonsense.”

I slept, sort of. You know the kind of sleep that's really lying down with your eyes closed, letting worries change costumes and parade in front of you? That. At 617a.m., the rain started. The sound of it on the bedroom windowpanes pulled me out of a thin dream, and the red digits of my alarm clock read: 6:17. I stared at them for a long time, then rolled over.

Almost canceled my 8 a.m., just like the email said. Came close. The thought brushed past. Kennedy will be late, you know she will, you could use the extra hour, but the old familiar guilt moved in, heavy as wet wool. My schedule was already packed. Rescheduling would create a domino line of inconvenienced people. I got up.

At 7:03, my phone vibrated with a news alert. I was standing at the counter, mug in hand, phone on speaker with the prescription line for one of my clients. I flinched at the vibration, jerked my wrist, and sloshed coffee over my watchband. Swore under my breath. I did not wipe it up. The brown crescent dried against the leather, faintly sticky, all the way to work.

You learn in my profession not to jump to conclusions. Things line up sometimes. The brain is a pattern-craving animal; it will create constellations from scattered stars and faces from random noise. I told myself it was coincidence. The specifics had been creepy, yes, but those particular specifics happened, and now I was noticing.

At 8:41 a.m., Kennedy sat forward on my office couch, legs in perfect, anxious right angles, fingers knotting the hem of her sweater, and said, “I feel like I’m living a rerun.”

I looked at the clock on the wall behind her. The second hand ticked to 41 as she spoke. I must have gone very still, because she faltered. “Did I…say something wrong?”

“No,” I said quickly, making my voice softer than I felt. “No, you’re fine. Please, go on.”

At noon, my receptionist, Lisa, unwound a lumpy green scarf from her neck and asked if I wanted to move the 3 p.m., the patient had called to say she might be late.

“No, leave it,” I automatically. “I’ll make it work.”

I heard the echo of the words I’d already read. The room tilted for a second, the way it does when you stand too fast. You always make it work. That night, I opened the email again and read it from top to bottom. My finger traced the trackpad over the last line, highlighting “Your Future Killer” as if that might reveal a hidden hyperlink.

It didn’t. The second email came three days later.

Subject: Follow-Up Session

Time of Send: 2:13 a.m.

Progress Notes:

Your hands are shaking as you open this. You’re alone with your laptop in the dark, of course. Pip is asleep at your feet again. (She likes the left side better, less leg movement.)

You’ve convinced yourself the first email was a fluke. That’s what you do when reality misbehaves: you treat it, you smooth it, you medicate it, you name it until it is manageable. Misfiring neurons. Unresolved trauma. Classic cognitive distortions. Confirmation bias. You’re very good at naming other people’s illusions.

Tomorrow at 9:27 a.m., the fire alarm will go off in the lobby, even though there’s no fire. A kid will have pulled the handle because he likes the red color. You’ll watch his mother apologize and then snap at him in the same breath. Your 10 a.m. will cancel. You’ll see the unknown number flashing on your cellphone while you pour yourself tea in the staff kitchen and feel a wave of irrational relief as you let it go to voicemail. In that free hour, you will start googling burner email services.

At 3:15 p.m., you’ll write a note in your own hand in one of your locked drawers and immediately forget you did it. You’ll be very upset when you find it again later.

We’ll talk about it.

Risk Assessment:

Ongoing.

Name:

You can keep calling me your Future Patient if that makes you feel better. The other part is still true, though.

I didn’t open it at 2:13 a.m. I didn’t open it until the next night, after everything it described had already happened.

At 9:27 that morning, the firm, relentless shriek of the fire alarm drilled into my skull. I poked my head out of my office along with everyone else, blinking at the flashing strobe in the ceiling. Downstairs, in the lobby, a small boy wailed while his mother alternated between hugging him and hissing in his ear. “I told you not to touch anything. Do you know how much trouble we could be in? Stop crying, everyone’s looking at you.”

The alarm shut off after five minutes. No smoke, no smell. My 10 a.m. canceled. Unknown number. I watched it light up and go dark as I stirred a chamomile tea bag in my mug. I didn’t pick it up, because I already knew, didn’t I? I told myself that was the only reason. And yes, in that free hour, I opened a browser tab and started typing “anonymous email,” “burner,” and “trace sender” into the search bar. Nothing satisfying came up. With ProtonMail, you could enable encryption, route things through Tor. It would take subpoenaing records to get at anything meaningful, and even then, maybe not.

I was still frowning at an article about end-to-end encryption when the alarm in my head went off, louder than the physical one had. At 3:14 p.m., according to my appointment software, I was between sessions. I remember Lisa knocking on my door to ask if I wanted anything from Starbucks; she was doing a run for the office.

I do not remember writing the note.

But later that night, after I read the second email and felt my scalp prickle, I went to my bag, pulled out the office keys, drove back to the building in my oldest hoodie and leggings, and let myself in.

My office felt different in the dark. The couch became a crouching animal shape. The framed diplomas on the wall were accusing rectangles. The clock's ticking was the only sound. I flicked on the lamp and sat at my desk, breathing very carefully. My bottom left drawer held patient files. The one above it held a box of tissues, my emergency stash of chocolate bars, and a small stack of blank yellow sticky notes. On top of the sticky notes sat a single sheet of lined paper, torn from my personal notebook. My own handwriting slanted across it in tight, rushed strokes.

Who is the one sending these?

Underneath, as if in answer, the same hand had written in all caps: CHECK YOURSELF.

The floor fell out from under me. I dropped the note like it burned and slammed the drawer shut. For a long time, I just sat there with my elbows on my desk, forehead pressed to my clasped fingers. There was an explanation. There had to be. I was overworked. I saw thirty, sometimes thirty-five clients a week. I did intake assessments, wrote case notes, supervised interns, consulted on complex cases. I taught one evening seminar a week, and then there was my own life to maintain. Groceries, bills, laundry, Pip. The human body has limits. The brain compensates. I’d started sleepwalking as a kid under stress, once my parents found me in the backyard at 3 a.m. staring down the dark shape of the pool.

“You’re doing too much, Mara,” my supervisor, Dr. Kwan, had told me more than once. “You know burnout is real, not just a buzzword. You can’t treat yourself if you break.”

I had nodded at her with the bland compliance of all my own burnout cases and gone right back to doing too much. So, I was tired, that’s all. I must have written the note earlier, then forgotten. An absent-minded scribble during a lull. It didn’t mean anything ominous that I’d admonished myself to “check yourself.” Therapists are their own harshest critics; we self-monitor like it’s religion. We’d all written similar lines in margins and journals and sticky notes, what am I missing here? What’s my countertransference? Where am I avoiding?

I could talk to Kwan about it. Tell her, in a casual, wry way, about the weird emails, the coincidences. She’d probably tell me what I would tell a patient, any threatening or harassing contact is serious, document everything, and we can figure out the next steps. But I didn’t tell her. I didn’t tell anyone. Not then. The third email came a week later and put its foot squarely on my neck.

Subject: Family History

Time of Send: 1:06 a.m.

Content:

You’re not going to like this one.

Tomorrow, your 11 a.m. will cry when you ask about family. She’ll talk about her father drinking and smashing plates and then buying replacements as if that made it better. You’ll feel the familiar nausea of recognition, that vise around your chest when someone’s story brushes yours.

After the session, you’ll stand in the staff bathroom with your hands braced on the sink and your eyes on the crack in the tile grout between your feet so you don’t have to look at your face in the mirror. You keep thinking you can separate yourself into compartments...Therapist, daughter, sister, woman-who-was-at-the-lake. You forget that water seeps.

At 4:12 p.m., your brother will call. You won’t pick up, at first. You’ll let it go to voicemail again. You’ll tell yourself he’s busy. You’ll tell yourself it’s fine.

At 9:36 p.m., your mother will call with news about an accident. You will drop the phone. Pip will bolt under the bed. You will blame yourself, of course. That’s what you're best at.

We can talk about the lake too, if you’d like. It’s where all of this really started, isn’t it?

Question for Reflection:

Do you ever wonder if this is the punishment you’ve been waiting for?

I emailed my brother at 1:08 a.m.

Hey, are you okay? Just had a weird dream about you drowning lol. Text me in the morning, so I know you’re alive. -M

I tried to turn it into a joke halfway through typing and failed. I deleted “drowning,” replaced it with “doing something stupid,” and hated myself for knowing exactly why that word had come to my fingers first. He texted back at 1:15.

I’m alive, drama queen. Go to sleep. I’ve got an early shift. Love you.

The next day, my 11 a.m. did cry about her father smashing dishes. She did use the word “replace” like it had a bitter taste. I did stand in the staff bathroom afterward, staring at the floor instead of the mirror. I refused to let myself be surprised by any of it. The emails had primed me; that was all. Confirmation bias. Suggestion. I’d noticed those details because the email had told me to look for them.

At 4:12 p.m., my brother called. The name “JASON” lit up my cellphone screen. My chest tightened. I stared at it for a second too long, frozen in the weird ambivalence that happens when you both want and don’t want to talk to someone. I let it go to voicemail. The moment it cut off, I swore and hit play.

“Hey,” Jason’s voice said. “It’s me. I’m on break. Just wanted to check in about Sunday, Mom’s asking if you’re still coming for dinner. Call me when you get this, okay? Love you.”

Something in his tone, fatigue, or a roughness I couldn’t immediately name, made my scalp prickle. I called him back at 4:18. The phone rang once, twice, three times, then clicked to voicemail. I hung up, my thumb poised over the red button and tried again…Same thing.

“He’s in the bathroom or something,” I told myself firmly, shoving my phone into my bag. “He’ll see the missed calls. He’ll call back.”

He did not call back. At 8:52 p.m., I texted him. You alive? No answer.

At 9:36 p.m., my mother’s number appeared on my screen. There is a register of maternal voice that the human body recognizes before comprehension. It’s the sound of someone trying to hold themselves together and failing.

“Mom?” I spoke. “What’s wrong?”

“Jason,” she said, and then nothing else for a long time.

I didn’t drop the phone so much as it slid out of my hand. My fingers went numb. Pip, who’d been curled up on the back of the couch, sprang down and vanished under the bed. He lived. Let me say that up front, because the way my heart shattered in that moment, it felt like death. It turned out he’d been in a car accident on the highway, late returning from a double shift at the restaurant, tired and distracted. Another car had swerved into his lane, and he’d overcorrected. He walked away with a concussion and a broken clavicle. The other driver, an elderly man, went into surgery.

“He’s lucky to be alive,” my mother sobbed. “If that barrier hadn’t been there…”

Lucky, I thought. Lucky. My mind, treacherous thing that it is, flashed an image of dark water closing over a small boy’s head, no barrier between him and the deep end of the pool.

I drove to the hospital with my teeth clenched so hard my jaw ached.

Jason sat up in bed when I came in, pale and bruised, a white sling cradling his arm. His hair stuck up in tufts. He smiled lopsidedly. “Hey, drama queen.”

“You’re an idiot,” I said, and burst into tears.

Later, after the doctors and my mother and the clatter of trays and the smell of antiseptic and the exhaustion of relief, I came home to my apartment, slid down the back of the door, and opened my email with hands that still shook. There was nothing new in my inbox. The “Family History” message sat there like a landmine I’d already stepped on.

I went to the sender’s address and hit Reply. Who are you? I stared at the blinking cursor. Then I added: How did you know about any of that? I hovered over the Send and hesitated. It felt like feeding something. In the end, I pressed send anyway. No answer came. Days passed. I started waiting for the emails the way you wait for a panic attack. Hypervigilant, exhausted, sure the absence meant something worse was building.

I triple-checked my doors and windows at night. I bought a second deadbolt for my apartment. I googled “stalking laws” and “cyber harassment therapist.” I drafted and deleted ten versions of an email to Dr. Kwan asking for a consult on a “hypothetical” situation, and in the spaces between, I saw my clients. I asked about nightmares and intrusive thoughts, and safety plans. I watched people cry on my couch and grip its edges and wring their hands and apologize for taking up space, and I told them what I always tell them.

“Your feelings are valid, you are not crazy, this makes sense given what you’ve lived through.” I did not say, “My own grip on reality feels like wet paper.”

Instead, I called an IT-savvy friend.

“It’s probably some jerk with too much time and a Reddit account,” Noah told me over coffee. He squinted at my laptop screen, scrolling through the message headers. “The ProtonMail headers are pretty limited, but let me see…”

We sat in the corner of a noisy café around the corner from the clinic, the white noise of conversation and clinking dishes becoming weirdly comfortable.

“These time stamps,” he said eventually, “they’re legit. Server logs match up. No spoofing that I can see.”

“So, they’re coming when they say they are…,” I said.

“Looks like it. Could be… someone who knows your schedule? A patient, maybe?” He looked up and winced. “Sorry, is that a terrible thing to say?”

“It’s an obvious thing to say,” I said. “But no, I don’t know who would have access to this much detail. And the personal stuff, about my family, my brother…they’d have to be what, hacking my private records? Sitting in my mother’s kitchen with a tape recorder?”

He shrugged helplessly. “All I can tell you is what I see here. No traceable IP. Encrypted relay. If it escalates, you should talk to the cops.”

“Right,” I said. “The cops.”

I did call, eventually. A detective took my statement and told me to keep copies of everything, not to respond further, and to call again if there were any direct threats. I did not read him the line about “Future Killer.” Somehow that felt like tempting fate, like saying it out loud would make it more real. Weeks went by. I breathed again. I let myself think…Maybe that was it, maybe whoever was doing this got bored, maybe they moved on…

Then the next email arrived.

Subject: Scheduling

Time of Send: 12:00 a.m.

Content:

Therapists like their calendars. Grids and boxes and colored blocks. Safe little compartments for other people’s chaos. You think that if you just line everything up correctly, no one will slip through the cracks.

On Tuesday, two weeks from now, at 3:00 p.m., you will have an opening. You don’t know that yet, but you will. Your regular 3 p.m. will cancel that morning, a work emergency. You will look at the gap in your schedule and think, Maybe I’ll go home early, and then feel guilty about it.

At 10:17 a.m., Lisa will call to say that a new patient has requested that exact 3 p.m. slot. She’ll ask if you can squeeze them in for an initial consultation. She’ll sound a little unnerved, though she won’t say why; she’ll attribute it to not having enough coffee. The new patient will give a false name. You’ll recognize it, eventually. I’ll wear something you’ll remember.

And then our work together can really begin.

I printed that one out and carried it folded in my wallet like a poisonous amulet. The day it predicted came, and I waited for it like the weather. At 8:03 that morning, my 3 p.m. texted: “Hey, Dr. Ellison, can we move today?” Work emergency.”

At 10:17 a.m. on the dot, Lisa poked her head into my office. “Mara, you have a sec?”

“Sure,” I said, though my pulse had quickened so sharply I could hear it. “What's up?”

“Got a call from a new potential client,” she said. “Says he's, um, a referral from Dr. Patel across town? He was pretty insistent about being seen today.”

“That's unusual,” I said carefully.

“Yeah, I told him you were booked, because you usually are, but he asked if there were any cancellations.” She frowned. “And there is that 3 p.m. now, so…”

“What's his name?” I asked, the words coming out thin.

She checked the notepad in her hand. “Rowan Hale. Like the tree and…whatever ‘Hale' is. He spelled it out for me.”

The folded paper in my wallet might as well have been a hot coal. Then I heard my own voice answer from a long way away. “Put him in.”

Lisa hesitated. “You sure? He sounded…off.”

“I’ll do the usual risk assessment,” I said. “If it doesn’t feel right, I won’t schedule follow-ups.”

She nodded. “Okay.” She lingered in the doorway. “Do you...want me to stay late? In case…”

“No,” I said a little too quickly. “Thank you, but no, it’s fine.”

It was not fine.

At 2:45 p.m., I reread the email in the empty space between sessions, my eyes dragging again and again over “false name” and “you’ll recognize it.” I searched every mental file I had for a “Rowan Hale” and came up empty. No past patient, no ex, no colleague. Maybe it was an anagram. I grabbed a pen and scrap paper and started shuffling letters.

ROWANHALE

HALE, ROWAN

ALONE, WARH

Nothing useful. I felt ridiculous, like I’d stepped into one of those cheap thrillers where the killer leaves clues in crossword puzzles.

Lisa knocked on my door at 2:59. “He’s here,” she said.

My mouth went dry. “Send him in.”

The door closed. I heard footsteps in the waiting room. Then my office door opened, and someone stepped through.

He was… ordinary. That was the worst of it. Average height. Dark hair, a little too long at the collar. Jeans, hiking boots, and a gray sweater. He looked like every other tech guy in the city. His gaze flicked over the room, a couch, an armchair, diplomas, and landed on me.

“You must be Dr. Ellison,” he said.

His voice was familiar in the way strangers’ voices sometimes are, like you’d heard them order coffee once years ago.

I gestured to the couch. “You can sit wherever you’re comfortable.”

He chose the middle cushion, sat, and folded his hands loosely in his lap. His nails were bitten down to the quick.

“I’m Mara,” I said. “Mara Ellison. Would you like me to call you Rowan?”

He tilted his head. “Sure. That’s what we put down, isn’t it?”

The wording snagged. We.

“I like to start by talking about what brings someone in,” I said. “What made you decide to seek therapy now?”

He smiled; it was a small, rueful expression that never reached his eyes.

“Let’s call it… a series of unfortunate emails.”

My heart slammed against my ribcage. He watched me in the way I watch my own patients, attentively, assessing each micro-expression.

“You look tired,” he observed gently. “Not sleeping?”

“Insomnia is common,” I said, automatically. “Particularly under stress.”

“What kind of stress are you under?” He asked.

“Mr. Hale,” I said, and the name tasted strange in my mouth, “I’m here to talk about you, not me.”

“Are you?” He asked

A silence stretched between us. His eyes were dark, almost black in the dim light.

“You requested this appointment,” I said. “You insisted on today. That suggests some urgency.”

He shrugged. “I like a deadline.”

I glanced at the notepad in my lap. The pen felt slippery in my fingers.

“Do you have any history of psychiatric diagnosis?” I asked. “Any previous therapy?”

He smiled again, a flash of teeth. “You tell me.”

It was like trying to scoop water with a fork. Every question I asked slid off him, leaving me with nothing solid to hold. He responded with more questions, evasions, statements that sounded like punchlines to jokes I hadn’t heard.

“What do you do for work?” I asked.

“Pattern recognition.” He stated, not missing a beat.

“Do you ever feel like harming yourself or others?” I countered, hoping to get something, anything.

“Haven’t we both?” He spoke.

At one point, he leaned back and looked at the diplomas on my wall. “You were younger than you think when you started this,” he said. “You remember it as graduate school, but really it was long before then. Wasn’t it? The first time you tried to rescue someone and failed.”

A flash of blue. Chlorinated water. A pale face beneath the surface.

I tightened my grip on the pen. “I’m going to be very clear here, Rowan. Talking in circles isn’t going to help either of us. If you continue to refuse to answer basic questions, I’m not going to be able to evaluate whether we’re a good fit for ongoing work.”

“Good fit,” he echoed softly. “Like a key in a lock.”

He looked at me then with an intensity that felt like hands on my throat. My pulse beat in my ears.

“Fine,” he said. “Here’s something concrete for your risk assessment… I believe that I am going to kill you.”

My mouth went very dry. “Do you mean that you have thoughts about killing me? Or that you’re afraid you might lose control?”

“Afraid?” He chuckled. “No. That’s your department, isn’t it? Fear. Second-guessing. Hesitation. I’m just following the treatment plan.”

My chair felt too small. The room felt too small.

“Have you made any specific plans about harming me?” I asked, moving into the rote script I’d recited too many times. “Any concrete steps toward that?”

“Oh, I’d say quite a few steps,” he said. “Appointments, emails, little nudges. You’d be surprised how easy you are to steer.”

The fluorescent buzz in the ceiling sounded like static.

“This is a safe space to talk about thoughts and fantasies,” I said. “But I need you to understand, if you’re telling me you intend to harm me or anyone else, I have an obligation to take steps to protect potential victims, including myself. That could involve catching law enforcement.

“Law enforcement,” he repeated, amused. “You already tried that. They were very helpful, weren’t they?”

The air went out of my lungs. “How do you know that?” I whispered.

He looked at me for a long moment. Then his face softened, and for the first time since he’d walked in, he looked almost kind.

“You’re very tired,” he said again. “You’re doing your best. I mean that. We’re just… out of room.” His gaze flicked to the door. “We’re almost at the end of the hour, aren’t we?”

I glanced at the clock. It was 3:50. We had ten minutes left.

“I’m afraid I can’t schedule further sessions with you,” I said. My voice shook. I clamped my teeth together to steady it. “Given what you’ve just disclosed, I’m going to need to consult with my supervisor and take some protective measures.”

He nodded slowly. “Of course. Boundaries. You’re good at saying what you’re supposed to say.”

He rose from the couch. “I’ll walk myself out.”

“I’ll have Lisa…” I started, but he was already at the door.

His hand closed on the knob, then paused. Without turning around, he said, “Check your sent folder.”

Then he was gone. I didn’t move, I just listened to the retreating rhythm of his footsteps, the murmur of voices in the waiting room, the soft chime of the front door opening and closing. Then I got up, shut my office door as quietly as I could, and leaned against it with my forehead pressed to the wood.

Check your sent folder.

I went to my desk, hands shaking so hard I could barely control the mouse, and opened my email client. Inbox. Drafts. Sent. I clicked “Sent.” At the top of the list were the usual confirmations and scheduling emails. Below them, in neat chronological order, was a series of messages with the subject lines I knew too well…

New Patient Intake – Tomorrow

Follow-Up Session

Family History

Scheduling

All from my own address. All to: [email protected]. The blood roared in my ears. I clicked the first one with trembling fingers. The content was identical to the “anonymous” message I’d received, the predictions, and the last line about Future Killer.

Sent: 11:47 p.m.

Received: 11:47 p.m.

The timestamps matched. My vision tunneled, and I scrolled to the next one. Same with the second, and third, every chilling paragraph was mine, apparently. Written and sent by me. I tried to breathe. The air felt thick, like syrup. There was one more message, one I hadn’t seen yet, sitting at the top of the list with a timestamp of 2:07 p.m. that day.

Subject: Termination Plan

Sent from: me.

To: [email protected].

CC: none.

Attachments: none.

With a creeping, horrified inevitability, I clicked it.

Treatment Summary:

You’ve done good work. That’s important to say up front. If you were sitting where you usually sit, notebook in hand, back straight, you’d insist on some kind of strengths-based feedback before we got to the hard part. You’re very diligent about not letting people define themselves only by what’s broken.

So here. You are competent. You are compassionate. You have helped countless people step back from edges you know too well. You also know that avoidance is the engine of fear. You tell your patients this. Exposure and response prevention, little by little, inch by inch, turning toward the thing instead of away. You say, “What we don’t face, we repeat.” You have been repeating this for a long time. The lake. The floating toy. The way his fingers slipped.

Gavin, turning away from your office door two years ago with his shoulders hunched, saying, “It’s fine, we don’t need to go there.” You watched him walk out. You didn’t follow. You tell yourself it wasn’t your fault. You know, professionally, about risk factors and protective factors and the limits of your control. But there is a part of you that has been waiting for a verdict, a sentencing.

You decided, one night not so long ago, that you were tired of waiting. You logged into this anonymous email account (You picked the handle because you thought “futureintake” was clever. You were a little drunk, you’re not usually that on-the-nose.) You typed up a plan, messages to yourself predicting small, manageable things. Coffee spills, fire alarms. Voicemails. You scheduled them to send at odd hours using a delayed-send function and an app whose name you don’t remember for reasons that will be clear shortly.

Behavioral Experiment: Could you trust your memory of what you’d done? Could you tolerate uncertainty when the ground shifted under you? Could you sit with fear without rushing to soothe it away? It worked better than you expected. The problem is, as any therapist could have predicted, once you opened that door, the rest of you started walking through it. The part that doesn’t want to be let off the hook. The part that believes you deserve is not just discomfort, but punishment. Call it an altar, if you like. Call it a part, a subpersonality, a schema, a complex. Whatever the label, it grew teeth. It sent a few more emails. It got ambitious. You started losing time. Today at 3 p.m., you will sit across from me, you, who is also me. You will ask me questions as if we are separate people. I will tell you the truth. You won’t want to hear it.

Plan:

Exposure, in vivo.

Loss of control.

Reversal of roles.

There is no future patient and future killer, not in the way you understand those words. There is only one patient here.

It has always been you.

Safety Considerations:

I know what you’re thinking as you read this. That’s why I’ve taken the usual precautions. No firearms. No easily accessible sharp objects on your person. (You really should clean out your bag more often, by the way.) The worst you can do, in the immediate term, is run. You can run if you like. You know how this ends, though. We’ll talk more about it in person.

I don’t remember shutting the laptop, but suddenly it was closed, and my hands were on the lid, white-knuckled. There is a particular kind of horror in realizing the enemy you’ve been hunting is located exactly where you are. That every breadcrumb trail leads back to your own doorstep. I thought of the note in my drawer, CHECK YOURSELF. I thought of Rowan sitting on my couch, nails bitten to the quick, eyes dark and knowing. You could call it psychosis. You could call it dissociation. You could call it a midlife breakdown, burnout, revenge of the repressed, pick your flavor of pathology. All I knew was that my sense of what was inside and what was outside had been quietly inverted, like someone had turned my whole life inside out and hung it on a clothesline. I stood up on legs that felt like someone else’s and walked into the hallway.

Lisa looked up from her desk. “Everything okay?” she asked.

“I’m… not feeling well,” I heard myself say. “I need to cancel the rest of my day.”

“Oh,” she said, blinking. “Do you want me to…”

“Call Kwan,” I said. “Tell her I need to speak with her, and if this number calls again…” I scribbled my own cell number on her notepad, then shook my head, erased it, and wrote Jason’s instead… “patch it through no matter what.”

Lisa frowned but nodded. “Sure. Are you alright?”

“I don’t know,” I said honestly, and walked out.

The least romantic place to have a breakdown is the parking lot behind a strip mall. I sat in my car and stared through the windshield at the brick wall, my fingers locked around the steering wheel. My heartbeat was so hard I could see my blouse move.

“Okay,” I said aloud. “Okay.”

I tried to regulate my breathing like I coach others to do. In for four, hold for four, out for six. It helped a little. Enough to think. If what the email said was true, and the evidence suggested that at least some of it was, then I had, at some point, in some state of mind I didn’t fully remember, constructed this elaborate experiment on myself. Set up the email account, wrote the messages, scheduled them, then…forgotten. For a while. Until some part of me remembered, apparently, and took reins.

There was a bleak kind of irony in it. I’d always prided myself on not being one of those therapists who thought they were above their own advice. I’d gone to my own therapy regularly. I’d practiced what I preached. What I had not accounted for was the depth of the split between the part of me that wanted to heal and the part that wanted to be punished. You can run, the email had said. My fingers flexed on the steering wheel. I thought of driving straight out of the city. Just…leave, letting the clinic figure it out. Letting my clients get reassigned. Letting my life collapse so I’d at least know where the bottom was. Instead, I picked up my phone and called my supervisor.

She answered on the second ring. “Mara? Lisa said you needed to talk.”

I opened my mouth.

“Hi,” I said, and then I started to cry.

If I’d been my own therapist, I might have been suspicious of how quickly I spilled everything. But relief can look a lot like confession. The words poured out of me, tangled and contradictory.

“I’ve been getting these emails,” I said, voice raw. “Except they’re from me. I mean, apparently, I’ve been sending them to myself. They predict things, and then those things happen. And I met with this… man? This patient? Who I think might not be real. Or he’s real but also not. I don’t know. I sound insane. Don’t I sound insane?”

On the other end of the line, I heard Kwan breathing. “You sound distressed,” she said calmly. “Which makes sense. Where are you right now?”

“In my car,” I said. “Behind the clinic.”

“Are you in immediate danger?” she asked.

I thought about it. “Not… physically,” I said. “Unless you count myself as a danger.”

She was quiet for a moment. I could picture her sitting at her desk, pen in hand, just like me, assessing.

“I’m very glad you called,” she said. “This is exactly what we teach, reaching out when things feel unmanageable. I’m proud of you for that.” A pause. “From what you’ve described, there are a few possibilities. One is that you’re experiencing some kind og dissociative process, perhaps exacerbated by stress and by this… experiment you mentioned. Another is that external factors are contributing, someone exploiting your vulnerability. We need to take both seriously.”

“It was me,” I said. “The sent folder…”

“I believe that you saw what you saw,” she said. “But I also know that when we’re shaken, our perceptions can be unreliable. Which is why I’d like you not to be alone right now.”

“I have Pip,” I said weakly.

“I mean another adult,” she said. “Can you drive safely? If you don’t feel comfortable doing that, I can call an ambulance to meet you.”

“I can drive,” I said automatically.

“Alright. I’d like you to drive to the emergency department at St. Micheal’s and check in,” she said. “I will call ahead and let them know you’re coming. You can tell them you’re having thoughts of hurting yourself or that you’re afraid you might. If it’s easier, you can say your supervisor recommended you be evaluated. I’ll meet you there as soon as I can.”

“I don’t…” I started.

“This doesn’t have to mean anything catastrophic,” she said gently, and that was the part that made my throat close. “It’s just more data. We’d recommend the same for any other provider in your position.”

I swallowed. “You think I’m going to hurt myself.”

“I think you are scared of yourself,” she said. “And I don’t want you to have to hold that alone.”

Something inside me unclenched. “Okay,” I whispered. “Okay.”

“Good,” she said. “Stay on the phone with me while you drive if you want. Or call your brother, mom, or Noah. We can pull in support.”

“I’ll keep you on,” I said.

I put the car in gear and pulled out. I wish I could tell you that what happened next was some grand climax, that I confronted my shadow self in a hallucinated lake, that I wrestled the metaphorical gun from my own hand. That there was some cinematic moment of choice where I opted, dramatically, to live. What happened was more mundane, which is to say, it was real.

I drove to St. Michael’s with one hand on the wheel and Kwan’s voice in my ear. I parked and walked into the glaringly lit emergency department, walked up to the counter, and told the triage nurse who I was, and watched her expression shift almost imperceptibly at the word “therapist.” We’re not supposed to crack. We’re the ones holding the line.

They took my vitals. My blood pressure was through the roof. A resident did a quick mental status exam. “Are you having thoughts of wanting to die?” he asked.

“I’m having thoughts about being killed by myself,” I replied, which was not the neat yes/no checklist answer he wanted.

They gave me Ativan. The edges of the world blurred. At some point, in the haze between being admitted to a quiet room and Kwan appearing by my bed, I checked my phone. One new email.

Subject: Rescheduling

Time of Send: 4:02 p.m.

Content:

You did better than expected. I’m not thrilled about the extra witnesses, but I suppose that’s appropriate. Group work, right? We’ll pick this up another time. After all, termination is a process.

- Your Future Patient

I stared at it until the words doubled, then tripled.

“Mara?” Kwan’s voice came from the doorway. “Can I come in?”

I looked up. Her face swam, then steadied.

“Yeah,” I said. “Please.”

She sat in the plastic chair by the bed and folded her hands. “ How are you doing

right now?” she asked.

“Medicated,” I said. “Apparently.”

“Is it helping?” she asked while looking at me with slight worry.

“A little,” I admitted. “I feel… less like I’m about to jump out of my own skin.”

She nodded. “Good.” She let the silence sit for a moment. “Would it be okay if we

looked at some of the emails together?” she asked gently.

I thought of the last message. I thought of showing her “Group work, right?” and

watching her translate it into diagnostic categories.

“Sure,” I said, and handed her my phone.

She scrolled. Her expression didn’t change much, but I watched small muscles in her jaw shift. After a long time, she looked up.

“What do you see?” I asked.

“I see someone who is very skilled at using therapeutic language in a way that’s both insightful and weaponized,” she said. “Someone who knows you very well. Someone who is ambivalent about you getting help.”

“So…me,” I said flatly.

“Maybe,” she said. “Or the part of you that’s been carrying guilt alone for a long time.”

She set the phone aside. “This doesn’t erase the good work you’ve done,” she added. “With your clients, your own therapist, and yourself. It does, however, mean we need to shift the focus for a while.” A small, wry smile. “From being the therapist to being the patient.”

“The wrong patient,” I said.

“Maybe the overdue one,” she suggested.

Something in my chest loosened. I laughed, a short, broken sound that was half sob.

“I feel like an idiot,” I said. “I’d flag all of this in a heartbeat if a client brought it in. But because it was me, I told myself it was fine that I could handle it. That I could outsmart it.”

“Brains are very creative when it comes to not letting us see our own blind spots,” she said. “Yours is no exception.”

“So, what now?” I asked. “Do I get a DSM code? Do I lose my license?”

“Right now…” she said, “…you rest. You let the team here make sure you’re medically safe. You and I, and your personal therapist, and maybe a psychiatrist, will talk more in the days ahead about what language fits. Dissociative features, acute stress reaction, complex grief… We’ll figure it out. Longer term, you might take a leave. Let someone else hold your caseload. That’s logistics, we can solve logistics.”

“And the emails?” I asked quietly.

She glanced at my phone, then back at me. “We can work on that, too,” she said. “One piece at a time, increasing awareness. Reducing avoidance… Sound familiar?”

I closed my eyes. “Exposure and response prevention,” I said.

“Exactly,” she said. “And maybe next time, you don’t design a whole protocol you in secret.”

“At least not without IRB approval,” I muttered.

She laughed. “There you go. Gallows humor intact. That’s a good sign.”

We sat in silence.

“You know,” she said softly, “wanting to punish yourself for perceived failures is a kind of self-importance too. As if you were the sole variable in every tragedy you’ve touched. You weren’t the only one at that lake. You weren’t the only person in Gavin’s life. You’re not the only factor in your brother’s accident. That’s not how causality works.”

Tears burned behind my eyelids. “I know that,” I said. “Intellectually.”

“Well,” she said, “now you have the opportunity to know it more deeply. That’s terrifying, and freeing.”

Terrifying and freeing. The twin poles of every major decision I’d ever watched anyone make on my couch. I look at my phone again. The last email sat in my inbox like a coiled snake. We’ll pick this up another time.

“Do you think it’s over?” I looked back at Kwan and asked.

She followed my gaze. “I think the part of you that wrote those messages isn’t gone,” she said. “Because we can invite it into the room properly…where there are more than two chairs.”

“We,” I repeated.

“We,” she said firmly.

They kept me overnight for observation. I lay in the thin hospital bed and watched the ceiling tiles slide past the corners of my vision. Sometime in the blue hours before dawn, when the Ativan had worn off enough for my thoughts to sharpen but not enough for me to act on them, my phone buzzed on the tray beside me… One new email.

Subject: Next Session

Time of Send: 3:03 a.m.

Content:

You really did it. I’ll admit, I didn’t see that coming. Or maybe I did, and I didn’t want to. You’re very good at recruiting allies. Irritatingly good, from my perspective. I suppose this means we have to share now. No more secret experiments, no more private trials. I hate groups. But… you’re not alone anymore, that complicates things. We’ll have to revise the treatment plan.

-Your Future Patient

(Working on the other title.)

I stared at it for so long. Then, for the first time, I hit Reply without overthinking it.

Dear Future Patient,

Thank you for your honesty. We’ll discuss this in group.

-Present Therapist

I hovered over the Send button, it felt so… terrifying… but also freeing. I pressed the button. Somewhere inside me, something shifted, a barely perceptible weight redistribution, like a house settling on its foundations. Maybe the wrong patient had finally checked in. Or maybe, for the first time, I had.