James listened carefully to the noise. It had a distinctive mechanical sound, like a car ignition turning over on a cold morning. Turning, turning, turning but never catching.

“Ehhh-ehhh-ehhh-ehhh. Ehhh-ehhh-ehhh-ehhh, ehhh-ehhh-ehhh-ehhh.”

Conor had the stuffed cat clutched tightly against his chest. Slowly he lifted it up until it was pressed under his chin, then higher still until the head of the cat lay against his lips. He stopped the ignition sound. Taking one hand off the cat, he flapped it frantically. “Meow?” he said.

Was he making the noise on behalf of the toy? James wondered. Was he trying to make it ask something that Conor dared not voice himself? Or was it the other way around? Was the cat putting its words in Conor’s mouth?

“Meow?”

“When you’re ready, Conor, you can come all the way into the room and we’ll shut the door,” James said. “But if you wish to stand there, that’s all right too. In here you can choose what you want to do.”

The boy remained immobile in the doorway, the toy cat pressed against the lower half of his face. His eyes flickered here and there but never to meet James’s gaze.

An expectancy seemed to form around them and James didn’t want this. He didn’t want Conor to feel there were any expectations of what he should or shouldn’t be doing, so James attempted to diffuse it by lifting up his spiral notebook. “This is where I take my notes. I am going to write in it while I sit here. I will write notes of what we are doing together so that I don’t forget.” He picked up his pen.

For a full five or six minutes Conor stood without moving, then very cautiously he began to inch inward. As with the first session, he stayed near to the perimeter of the room and kept well away from James, sitting at the small table. Once, twice, Conor circumnavigated the room and pressed the cat’s nose lightly against things as he went.

He was saying something under his breath. James couldn’t hear at first, but as Conor passed the third time, he could make out words. House. Car. Doll. Conor was naming the items he saw, as he passed them. This was a good sign, James thought. He understood the meaning of words. He knew things had names. He had at least some contact with reality.

So it was when Conor came again on Thursday. And again the next week. Fifty minutes were spent quietly circling the room, touching things lightly with the nose of the stuffed cat, naming them. James didn’t intrude on this activity. He wanted the boy to set his own pace, to construct his own sense of security within the room, to understand that James had meant what he’d said: that Conor alone would decide what he wanted to do in here. That was how trust was built, James believed. That was how you made a child feel safe enough to reveal all that was hidden. Not by schedules. Not by reward and punishment. But by giving time. There were no shortcuts. Even when it meant session after session of naming.

Three weeks passed. During the sixth session Conor circled the room upon entering and again touched everything he could easily reach with the toy cat’s nose, still murmured the names, but this time it was different. He elaborated. Red house, he whispered. Brown chair. Blue pony.

For the first time, James answered Conor’s murmuring.

“Yes,” James said, “that’s a blue pony.”

Conor’s head jerked up abruptly. “Ehhh-ehhh-ehhh-ehhh.” He stared straight ahead. The hand not holding the cat came up and fluttered frantically in front of his eyes. “Ehhh-ehhh-ehhh-ehhh.”

James sat very still.

Moments passed.

Slowly Conor exhaled. Extending the cat away from his body, he touched its nose to the edge of the shelf. “Wood,” he murmured very softly.

“Yes, that’s made of wood,” James said.

The cat was retracted instantly.

James watched the boy, who kept his head averted to avoid eye contact.

“Ehhh-ehhh-ehhh-ehhh.” There was a long pause, then Conor whispered, “Brown wood.”

“Yes, the wood is brown.”

Conor turned his head. Not to look at James. His eyes never left the far distant point they were fixed on, but his head inclined a little in James’s direction. That was all that happened.

“Bob and I were thinking of going over to the Big Horns to squeeze in a couple of days of elk hunting,” Lars said and sank down in the beige-cushioned softness of James’s office. “You want to come?”

“That’s a very kind invitation, Lars, but I don’t know one end of a rifle from the other.”

“You can borrow one of Davy’s guns,” Lars replied. “Davy killed his first buck when he was just twelve. Did I tell you about it? A six-pointer.”

“Yes, you mentioned it.”

“So come with us. Time you got blooded, Jim. How else we gonna make a South Dakota man out of you?” Lars laughed heartily. “It’ll just be Bob and me. We’ll take some beers and some grub and have a great time.”

“When?”

“Next weekend.”

Relief flooded through James. “Well, damn! Wouldn’t you know it? I’ve got the kids coming out next weekend. Remember? Because I’m taking Monday and Tuesday off the following week.”

“Oh Jesus, yeah.”

“Darn. I’m sorry to miss it. Maybe next time.”

Stretching his arms up behind his head, Lars settled back into the chair. “So how’s it been going between you and Sandy? Is she getting any more reasonable about the kids?”

“Not really. They can come out at Easter but she says no way over Christmas,” James replied, but he couldn’t quite keep the disappointment from his voice.

“Why not? I thought you got to alternate Christmases,” Lars said.

“The court says yes. But Sandy keeps on about how disruptive it is for them at their ages.”

“Yeah, but they’re your kids too. You’ve got the right to spend time with them.”

“I know, but all this fighting over them isn’t good for them either. I don’t want them to grow up seeing Sandy and me at each other’s throats the whole time. And she’s probably got a point. It is disruptive for them at Christmastime. Sandy always goes to her folks in Connecticut. They have one of those big old Cape Cod houses and do Christmas with this enormous ten-foot tree and all the trimmings. The kids have their grandparents there, their cousins, their aunts and uncles, their friends. Christmas is supposed to be a happy time. Desperately as I want Mikey and Becky with me, I want what’s best for them more.”

“You’re a pushover, Jim,” Lars said, shaking his head. “You need to learn how to stand up to her. To say: ‘This is important to me and I’m going to fight for it.’”

“I already have, Lars. That’s how I’ve ended up here.”

“Well, once in a lifetime isn’t enough. You need to keep at it.”

James nodded morosely. “Yes, I know.”

The day was one of those in autumn of pure lapis lazuli sky and crystal air. From the large playroom window, James could see out over the city to the open plains beyond. Below in the street the dappled tints of gold and orange flickered restlessly in the sunlight, but the sky stretched ever onward, a clear, almost luminescent blue.

Gentle joy always filled James when he stood at this window. Clichéd as the vision was, he knew there was a metaphorical eagle somewhere inside him that would one day spread its wings and soar in response to this infinite landscape. His heart still felt depressingly sparrow-sized most of the time, but seeing such immensity always gave him hope of greater things.

Not that his sparrow’s heart hadn’t had its own share of struggling to get free. The most horrible moment had come two years ago when, after ten years of training, James suddenly realized that he couldn’t bear the thought of spending another day in the sheltered prison of psychoanalytic theory. That moment still relived itself with soul-shattering clarity. He’d been fighting his way through heavy traffic on FDR Drive in Upper Manhattan when the insight mushroomed up with all the subtlety of an H-bomb going off. His hands went rigid on the steering wheel; sweat ran down the sides of his face and his heartbeat roared up so loudly into his ears that it drowned out whatever the hell was playing on that jazz station he always listened to but didn’t really like. He realized then that things had to change. He had to get out of the life he was living …

God, what that moment of insight did to Sandy. She’d been beyond furious when he told her. The rows they had. And some of her anger was justified. She’d supported him all those years. She’d put her own career on hold while he’d finished medical school, then the training, the internship, the residency and his own analysis to emerge as a fully qualified psychiatrist. Sandy had stuck through it all for the chance of a brownstone on the Upper West Side and private school for the kids. Those were her goals in life and she’d worked just as hard to achieve them as he’d worked for his.

“Theory?” she’d screamed when he’d tried to give voice to his confusion. “What the hell’s this sudden thing with theory? How can you wreck our entire lives over something like that? It isn’t even real. So what if you don’t believe it? You’re not a priest, for fuck’s sake. Believe in something else.”

How did he explain it, his inarticulate longing for something beyond the narrow corridors of analysis, the domineering views of his colleagues and the shadowy brick-and-mortar ravines of Manhattan? A panic attack in the middle of rush-hour traffic hadn’t been very subtle, but it got the message over.

James began to dream ceaselessly of escaping to a world where everything was simpler. He was, however, still dreaming of civilization. A small practice out in Queens perhaps. South Dakota had never entered his head. Then, in the fated ways some things happen, he had run into an old friend who had another friend who had known Lars from medical school and knew too that he was looking to expand his practice in Rapid City. James had gone home that night and looked South Dakota up on the internet, and the first picture to fill up the screen was of a lone pronghorn antelope standing on the flattest, emptiest land James had ever seen. The sheer otherworldliness of it felt like the answer to everything.

Except for Sandy, of course. The idea of moving to South Dakota quickly reduced the whole matter to a simple choice for her: staying with him or staying in the city. New York won, hands down. The gut-wrencher was that she got custody of the kids.

What kind of impostor filled a room with toys for strangers’ children and then hardly ever saw his own? He had access, of course, but now two thousand miles separated him from their routine of splashy bath times and “dinosaur kisses.” His greatest fear was that he’d become a stranger to Mikey and Becky. A very nice stranger, to be sure, but a stranger nonetheless.

When Conor arrived, James began reflecting his words immediately. If Conor said “doll’s house,” then James said, “Yes, that’s a doll’s house.” If Conor elaborated and said, “big doll’s house,” then James mirrored that back in a sentence, “Yes, that’s a big doll’s house.” James felt quite secure in interpreting Conor’s extensive naming of items in the playroom as an embryonic effort at interaction. It was conversation at a most rudimentary level, like an infant’s speech, but James recognized it as conversation.

Conor was increasingly attracted to the low shelves and their baskets of small toys. He didn’t take the baskets from the shelf, didn’t even touch them, but more and more often he would stand in front of them and press the cat’s nose against their mesh. “Meow? Meow? Basket. Wire basket. Silver wire basket.”

“Yes, silver wire baskets. Baskets full of toys. Toys you can play with, if you want. In here, you decide.”

Conor lifted the cat up and continued on his journey around the room. Coming to the expanse of windows, he paused. He didn’t go near them enough to look down on the vast view visible from the playroom, but he reached the cat out and pressed its nose to the glass. “Window. Meow?”

“Yes, those are the windows. We can see out,” James said.

Conor moved on.

In the far corner was what James called his “road sheet”. Made of heavy-gauge white plastic sheeting, it was about four by four feet in size and printed with an elaborate layout of roads just the right size for toy cars and little buildings made of Lego bricks. It had been folded up on the shelf when Conor had been in the playroom previously, but now it was lying flat on the floor.

Coming up to it, Conor stood stone still. Not a muscle quivered. A full minute passed, feeling an eternity long. “Meow?” he whispered.

“That’s the road sheet,” James said. “Toy cars can drive there.”

The muscles tensed along Conor’s jaw as he stared at the plastic square on the floor. Raising one hand, he flapped it frantically in front of his face for a few moments.

“Man on the moon,” he said with very precise clarity. “July 20, 1969. Neil Armstrong accompanied Buzz Aldrin. Apollo Project. Put the first man on the moon. July 20, 1969.”

Surprised by this sudden burst of speech, James studied the boy. Exact regurgitation of overheard conversations was common with autistic children, but it was the first time in the three weeks Conor had been coming that James heard him do it. Did Conor have any understanding of the words he had just said or was it simply autistic echolalia?

“Something has made you think of the men who went to the moon,” James said carefully.

“One small step for man, one giant leap for mankind.”

James probed further to discover if there was any glimmer of meaning. “Yes, that is what Neil Armstrong said when he stepped on the moon, isn’t it?”

Conor raised his head. “The cat knows.”

Chapter Three

In an ideal world, all child therapy was family therapy. As a child’s problems virtually never arose in isolation, James considered it as vital to see the mother, the father and the siblings as it was to see the child him- or herself.

Everyone in the business knew this, of course, but things seldom worked out that way nowadays. Philosophies had changed. The business model had taken over psychiatry just as it had everything else. “The bottom line” and “accountability” had replaced “self-discovery” and “insight”. Insurance companies often refused to pay for more than twelve sessions of therapy. Behavioural contracts and token economies provided a swifter intervention than play therapy. Drugs provided an even swifter one. Both mothers and fathers worked and were generally unavailable for therapy during office hours. And everyone was in a hurry. Impatience had become the motif of modern life. As a consequence, the main function of many psychiatrists was simply to prescribe drugs. James often felt like a dinosaur for trying to turn the clock back to a slower, more humanistic model.

South Dakota hadn’t been a good place to choose for a renaissance of traditional therapeutic values. They were a self-reliant people, not used to talking to strangers about their personal problems, so it was hard enough to get them through the door at all. And with agriculture still the main industry, they understood “bottom lines” acutely well. Many parents of his young patients had refused outright to come in for therapy sessions themselves because of the additional cost. In the end, James had had to go “commercial” to create a genuine family therapy setting by coming up with the concept of a “package deal” – that he would see each member of the immediate family for three sessions for one set price. Truth was, he was quite proud of that idea and thought it would work, but no. Too often he still had to charm them in.

Laura Deighton was going to be one such, James could tell. It became apparent almost instantly that from her perspective, Conor had sole ownership of his problem. When James raised the issue of family therapy, of seeing her, her husband and their daughter as well as Conor, Laura had actually stood up. She literally started to leave and James had no doubt she would have done so, if he hadn’t pulled back immediately. This reaction fascinated him, because, of course, it said so much more to him about how unwilling she was to look at the problem than words could have done.

Conor’s father, Alan McLachlan, however, was just the opposite. When James explained how Conor’s therapy would work, Alan agreed straightaway. “Yes, of course,” he said. He’d be happy to come in.

With the same care that James had put into designing the playroom, he had laid out his office for use in interviews and adult therapy sessions. Beyond the desk, he’d created a rectangular-shaped “conversation centre” with soft, comfortable chairs and a sofa. The coffee table, the end tables and the plants had all been chosen with care to give a pleasant, airy, relaxed atmosphere. He’d purposely picked real wood and natural materials to help mitigate the artificiality of the situation and used a pale beige upholstery to give the room an open, positive feeling. Lars kidded him about such attention to detail, but James was pleased with the effect. He felt it worked.

Laura Deighton had shown little interest in his conversation centre and seated herself beside his desk before he’d had the chance to encourage her elsewhere. When Alan came in, however, he had moved naturally to the sofa. Sinking into the beige-cushioned softness, he settled down comfortably. So comfortably, in fact, that he soon was resting one scuffed and, as James noticed, rather dirty cowboy boot on the edge of the coffee table.

Alan wasn’t a tall man. James was six foot, so not a giant by any means, but he must have had three or four inches over him. Alan’s hair, thick and rumpled by the removal of a red-and-white duckbilled hat, was the uneven grey of galvanized metal. His eyes were the same misty Celtic blue as Conor’s. He looked older than his fifty years. His face was ruddy and lined, his skin long since gone to leather from a lifetime spent outdoors, but he still had about him a worn-out handsomeness.

James had been a little nervous about Alan. He’d never come face to face before with that iconic stereotype of the West – a cowboy – a man who rode horses as part of his daily working life, who gathered cattle, branded them, calved them and, when necessary, wrestled them to the ground and cut off their balls. It all spoke to James of the kind of mythic masculinity that existed only in movies, and he worried about finding common ground. Alan didn’t help James’s confidence at all with the way he’d so casually put his boot onto the coffee table. It was like territorial marking. Subtler than peeing, perhaps, but James felt like it meant pretty much the same thing.

“Thank you very much for coming in,” James said.

“Nope, my pleasure.”

There was a pause then while James waited for him to set the tone of the session. In the brief silence James found himself wondering about Alan and Laura as a couple. What had attracted her to this country man? How did he cope with having a world-famous wife?

Alan didn’t give James much time to think, however, as he almost immediately asked, “So how’s Conor doing?”

“We’re still establishing trust,” James replied. “He seems very uncertain in the new situation.”

“Yeah, he doesn’t deal with new situations well. Autistic kids are like that.” A pause. “So what do you actually do with him in here?” Alan asked. “Because I wasn’t quite clear what this was all about from the way Laura explained it.”

“And how was that?” James enquired.

“Well, it’s her version, so who knows. To be honest, I’m pleased you’ve asked me in yourself, because this way I actually stand a chance of understanding what’s going on.”

“You feel you haven’t been consulted as much on Conor’s treatment in the past as you’d like?”

Alan let out a long, heavy breath. “I don’t think it’s not being consulted so much as that I’ve long ago lost track of what led to what led to what.”

A pause.

James waited calmly. He was getting the sense of a man who thought quite deeply but wasn’t quick with words, who took time to organize his thoughts and get them out. How had someone like that ended up with a woman whose life was made of words?

“I never wanted Conor in that Colorado school,” Alan finally said. “That’s the first thing I want to make clear. I mean, who sends their young child seven hundred miles away? We shouldn’t ever have done that. Autism happens. A lot of people have autistic children. They cope with it. They don’t put the kid away.”

“So how did the decision come to be made?” James asked.

“Laura. This, here,” he said with a broad sweep of his hand. “It’s about the fact that Laura needs treatment.”

James was not quite certain what Alan meant. “You’re saying that coping with Conor is causing problems for Laura? Or coping with Laura is causing problems for Conor?”

“Both, really. I don’t think they’re two different things,” Alan replied. “But the biggest problem up to now has just been getting Laura to take responsibility for it. When she said this was a family therapy thing, that we couldn’t get Conor in here unless we were involved too, I thought ‘Thank God. She’s finally taking me seriously.’ She’s always pooh-poohed the idea of therapy and been so quick to blame it all on Conor, make it all Conor’s problem. But it’s also been about Laura not being able to cope with him. That’s how I got railroaded into sending him to Avery.”

“Can you tell me how you saw Conor’s problems starting?” James asked.

“We had a couple of absolute shit years. It was about the time Conor was two or three. Everything just happened at once. I was having some serious money problems with the ranch. People assume because Laura’s work is well known that we must be wealthy, but there is a big difference between literary and commercial. The truth is, both ranching and book-writing are very uncertain ways to earn a living.

“So we were having major financial problems. Right in the middle of it, Laura got pregnant. It was unplanned and quite complicated. We thought Laura had actually lost the baby, because she miscarried, but apparently it was a twin pregnancy and she’d lost only one. Anyway, cue for lots of medical problems and bills just at a time when we desperately needed her earnings. Poor Conor. His little life just got turned on its head. I was gone all the time because I was hiring out to other ranches to earn some extra money and Laura felt so unwell. Conor’s always been a sensitive kid, and this just made it worse. He got fearful of just about everything. I didn’t think much of it at the time. I thought he’d settle down once things were more stable, once I was able to be around more and the baby was born. What I didn’t appreciate was that during all this time I was away, Laura was falling apart too.

“I felt bad – feel bad even now – because I know I left Laura to cope on her own too much of that time, even when I did see signs of trouble. But, Christ, it’s hard to know what’s right. I was working all the hours God sends to save the ranch and I just couldn’t be in two places at once.

“The turning point came when the preschool told us they couldn’t keep Conor any longer. After that, he was home all the time. Laura just was not handling it. So that’s when she started looking into residential placements for Conor … I felt I had to let Laura have a chance to recover, because otherwise … Well, to be honest I was afraid if I didn’t, I was going to end up on my own with two young kids.”

Alan fell silent.

James sat back in his chair. “So did placing Conor in the residential school help Laura recover?” he asked.

“Things settled down.” Alan lifted his shoulders in a faint shrug. “But I guess ‘recovery’ implies they got better. That didn’t happen. It just got buried, because that’s Laura’s way of handling things. And I’ve about had my fill of it.”

“Horse?” Conor said in a sing-songy tone that was halfway between a statement and a question.

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