Carl paged through the chart, rereading his notes. 'Patient was withdrawn ... Pt spoke freely about fears for the future ... Pt appeared more relaxed today.'

It had been three weeks since his first session. Luka was definitely doing better. He was making good progress. He had a long way to go, but the improvement was clear. There were still good and bad days, but the good days, the productive sessions, were beginning to outnumber the bad ones.

Still, his physical progress was even more rapid. He would be going home soon, probably within a week to ten days. Once he was home, Carl knew he he couldn't expect him to come back for daily counseling sessions. He might not even choose to come back at all.

While he had spoken of many horrible things, things that made Carl feel a little sick to hear them -- and he thought he'd heard just about everything in his many years as a psychiatrist -- he had not yet spoken about one part of his experience. It was in his medical records, Carl knew it had occurred. Sexual assault. He had been gently encouraging Luka to talk about it, but he wouldn't. And whenever the encouragement was anything more than gentle, Luka would shut down completely, refuse to speak for the remainder of the session. But he still talked about it at night. The nurse's notes reported almost nightly nightmares, in which he tossed restlessly in bed, calling out in his sleep, pleading for someone to stop ....

Carl sighed. It was 5 to 4. Gathering up his papers and pens, he headed for the elevator.

Luka was up in a chair. He usually was now. Being in bed, he said, made him feel like a patient, like he was sick. Being up in a chair made him feel like he was getting well.

Carl smiled a greeting, sat down in the other chair. "What's on your mind today?" he asked. His usual opening.

And, as usual, Luka just sat for a minute before answering, trying to gather his thoughts, gather his courage to reopen the box of memories, expose himself again to the pain.

"There's nothing else, Carl. I've told you everything, I think."

"No, you haven't." Luka just looked down at his hands, rubbed the scars. "And you've talked a lot about facts, about what happened. We need to start talking about feelings, about how all those things made you feel, and are making you feel now.

An amazed look, a short bitter laugh. "How do you think I feel?"

"I don't know, Luka. If I knew, I wouldn't be asking."

Luka shook his head. He stopped rubbing his wrists, began pulling pieces of paper off the magazine he held in his lap, shredding them into tiny pieces and dropping them onto the floor.

Carl waited for a few minutes, but Luka clearly wasn't going to say anything more. Was this going to be another session where he would sit for an hour while Luka said nothing? There had been a few of those along the way. No. It was time to push a little harder. "Luka," he said gently, and waited until Luka looked at him. "I want you to tell me ... you need to tell me about the assault."

"No." Luka's response was immediate. His voice sounded calm, but his hands started to shake, a reaction he attempted to cover by shredding the paper faster.

"You're making good progress. You are ready to go there."

"No!"

Carl kept his words calm and measured, against Luka's rapidly increasing agitation. "Luka, I don't need, or expect a description of the act. I know what happened to you. But the effect it is having on you now is obvious -- it's like a wall inside you, and behind that wall is the pain, and the memories. The longer that wall stays up, the more pain is going to build up behind it, and the worse things are going to get. Until you can get through it, you are not going to heal."

"Then I won't heal. I've survived this long." Carl saw Luka's eyes look towards the door, a flicker of fear.

"Anything you tell me is confidential. You know that, right?"

Another short laugh. "I work here, Carl. Doctors talk."

"Not about this. There is nothing about your case that I have felt the need to tell to Allenson or Heneley. I don't anticipate ever needing to tell them anything. If anything should come up that I think might benefit them to know ... might help in your medical care, I still won't tell them without first getting your permission."

Luka continued his destruction of the magazine. He seemed to be devoting all his attention to it. Finally he said slowly, "I can't ... I don't remember, Carl. I don't ... let myself remember. I think maybe I did ... once ... but it hurt too much. Now there are just the dreams when I sleep. When I wake up there's just the pain ... it still hurts, but not as much as when I had to remember it too. All I remember now is the pain."

"So tell me about the pain."

Luka's breathing quickened ... his eyes seemed to darken. He folded his hands, perhaps as a way of forcing them to be still. He seemed to be looking at something, seeing something that wasn't in the room. But he didn't say anything.

"It's ok, Luka," Carl said gently. "You're safe here."

Another few minutes of silence, then Luka began to speak slowly, his voice without emotion. "I ... I wanted to die ... I kept begging God to let me die ... it would stop ... I knew it would stop if I died ... I prayed and prayed... He didn't hear me ... never heard me. They were laughing ... I think He couldn't hear me over the laughing." His voice began to shake. "I was crying ... and they were laughing. I was trying to be somewhere else ... to not have to be there ... if I couldn't be dead ... I just didn't want to be there. Then I couldn't pray anymore ... they were pushing my face into the dirt. I couldn't breathe. I couldn't die, but I couldn't breathe. There was dirt in my mouth ... and blood ... and dirt ... so much dirt ..."

Luka's breathing had become ragged. The magazine, what was left of it, had slid unnoticed to the floor, and he was rocking again. His words had faded away to nothing and he just moaned now, sometimes there were what seemed to be words, but Carl couldn't understand them. Perhaps it was Croatian, or perhaps he was just mumbling now. Far from 'not remembering' Carl knew he was remembering all too clearly, he was there. Let him stay 'there', try and get this finished, or bring him back before the emotional pain got to be too much?

Luka made the decision for him. After a few more moments some pain, real and physical, made him suddenly double over, and the movement startled him back into reality. A sudden cry, his eyes widened with shock, and as Carl instinctively reached out to catch him before he fell forward out of the chair, touched his shoulders, another scream of fear and confusion.

"Ok, Luka," Carl said. "Everything's ok now."

"Sick..." Luka choked out faintly, and vomited. He didn't resist as Carl gently supported his shoulders so he could lean forward, vomit onto the floor without falling from the chair.

When the spell appeared to be over, Carl helped Luka sit up again. He went into the bathroom without saying anything. Bringing back a towel, he tossed it over the mess on the floor, and then quietly handed Luka a wet washcloth.

"Thanks." Luka's voice was shaking. He wiped his mouth and his damp face. He was still shaking, and when he'd finished with the washcloth, he let it drop from his hand. "I'm tired," he said faintly.

Carl nodded. "I think that we're done for today."

"We're done, Carl. I can't...."

"Tomorrow we'll talk about something else. We'll come back to this..."

"No!" Luka interrupted. "I can't go back there."

"Ok, Luka. " Carl's voice was gentle. He wouldn't accomplish anything by upsetting his patient. "We'll discuss this all another time." To his relief, Luka nodded. "Can I help you back into bed? You look pretty tired."

"I don't need help." Luka transferred himself from the chair to the bed, just a few inches away.

"Luka," Carl said. "You talked a little bit about God earlier. And you've talked about that before, about praying. I think it might help you, might make you feel better, to talk to a priest. You are Catholic, right?"

"More or less. I don't belong to a church; don't have a priest."

"The hospital chaplain, maybe?"

"No... that's not necessary. And it won't help."

"Ok," Carl said. "Well, I'll see you tomorrow. I'll get someone in to clean this up."

Out in the hall, Carl leaned against the wall, took a deep breath. These sessions left him almost as exhausted as his patient. He was glad he had chosen to schedule them for late in the day. But he was sure he'd see Luka's terrified eyes in his dreams tonight. Maybe he should have chosen an easier specialty ... like trauma surgery.