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On paper, Dan Griffin was nothing out of the ordinary. He was anxious, he was urgent, he was like any other patient we see at the Trauma Unit. "Unremarkable" was how I described him to the police. When they looked for answers in those early therapy sessions, they read about the bruise on his face, the terror in his voice, and the flashbacks that were so visceral they took his breath away, but there was nothing to hint at his capacity for violence. Nothing at all to suggest what he was capable of. It took a while to understand that the question to ask wasn't Why didn't I see it coming? but Why didn't I move out of the way?

It's a Friday afternoon in April when I see Dan for his first appointment, at the end of a difficult week-an onslaught of new referrals, an email about the budget cuts, and then, that morning, the unexpected phone call about the death of a patient, Alfie Burgess. The hospice nurse is kind as she tells me what happened. "Peaceful," she says, "and surrounded by family," then some other things I don't hear. "You'll let the team know?" is how she ends the call. Of course, it should be me as head of department to tell them all, and in the past I'd happily rise to such leadership requests It was something I was good at-competent, capable, and in control, spreading my arms wide to contain the distress of the department. But that day, in the run-up to Tom's birthday, my hand is shaking as I replace the receiver.

It's a feeling that's been getting worse. The once fluttery sensation in the pit of my stomach has become a band of tension across my chest. It could be the death of anyone, a next-door neighbor's friend, or even a story in the news; but when it's someone I know well, like Alfie, it tightens, until it becomes hard to move. There's never a picture or image that forms in my head, just a creeping sense of dread about Tom. I try to focus on Alfie, on how I will tell the team, but my body is rigid, like it's gone into hiding.

Tom's birthday has become an obsession. I knew it would. It did last year. But lately, almost any event can serve as a marker of time-the first autumn leaves, the first dusting of frost, or the first smudge of purple and yellow crocuses. All small signs that the world is turning without him. But the day of his birth? His birthday? What mother doesn't want to transport herself back to the glorious cocoon of that moment, whatever the age of her child? There's a nervous kind of anticipation that I know will come to nothing. The date will come and go without him, the balloon of hope will deflate, and sometimes, the sheer effort required to pump myself back into shape simply feels too much. I've had days like this before, and I know it will pass. For the moment, however, I am too full of it. If it were anyone else, any other member of my team, I'd tell them they shouldn't be at work. "Go home," I'd say, "be kind to yourself." But for obvious reasons, home is the last place I want to be.

That day, I am like an overfull bath. Drip. Drip. Drip. I feel heavy with the weight of it all, as if one more small request will send me sloshing and spilling out all over the floor. And yet, still I hold up my hand for more. Another referral? An extra supervision group? A paper to present at a conference? Yes, I'll do it, I hear myself say. And I do it in the hope it'll fill the void. I'm not making excuses. There are no excuses. But my state of mind on the day I first meet Dan Griffin cannot be denied.

After the phone call, I sit at my desk for a while. I think about imparting the news about Alfie, and I know exactly how it will go. There will be grave faces. Sadness, tears, hushed tones, and hugs. We will make tea and remember him, his cheery "What's up?" when he arrived at reception. Our thoughts will be with his parents, their quiet-spoken dignity; together we will rage against the injustice of it all. We will remind ourselves that he was ill, that porphyria was a degenerative condition. That he defied all expectations, that "he did so well," we'll conclude, "considering." Beneath all the camaraderie and commiseration, there will be an undercurrent of competition-who knew him best, who's entitled to grieve the most. We will think about how long he'd been coming to the department for his needle phobia, on and off for more than eight years, maybe more. I remember telling Tom about him once. No names, of course, but in the face of his own nightmares, it was an attempt to normalize his fears. I remember how he sat wide-eyed as I told him about Alfie's panic and what we did to help him. "You see," I said, stroking his hair, "everyone has worries."

We will recall how well Alfie seemed the last time he came in. There will be a card to sign, a collection for the flowers; I feel dizzy just thinking about it all. Tasks that I have both welcomed and risen to effortlessly over the years today feel insurmountable.

I don't want more grief. More death. I already feel stalked by it. I want to put the phone down and pretend it hasn't happened. But I can't do that. It falls on me. Ruth Hartland. Director of the Trauma Unit. I am in charge. It says so on my door.

In the event, I am lucky. After telling my colleagues in neighboring offices, I bump into Paula in the corridor, and given she delights in the status of her new position as office manager, I know she'll tell the rest of the team and have a collection organized by lunchtime.

I manage to steer clear of everyone for the rest of the morning, but in the afternoon it's my responsibility to log all new patient referrals in the main office. I can feel the quiet sadness. There's also an air of stoic resilience. Look at us, it seems to say, we're clinicians, we're trained to manage and contain difficult feelings-including our own. Tom used to joke about it. "Mum," he'd say, "you're at home. You can stop being the therapist now." Still, I can feel the heightened sensitivity, people treading carefully around each other, as though bruised and tender after an accident. After ten minutes, I can't breathe for the kindness and the solicitous glances.

Things soon shift. Death makes us selfish-and eventually it pushes everyone inward, to reflect on their own lives and families. For once, I am grateful for Paula, who always speaks with flourish on behalf of the team. She glances up from her paperwork. "Makes you think about what we take for granted," she says, looking around at everyone. "I just want to get home and give my kids a hug." She wraps her arms around her waist and gives herself a squeeze. "I'm sure we all do."

I don't say anything. I don't call her to one side, remind her about Eve, who has no children and wishes she had. I just smile and nod. I don't speak about myself. I can't. No one knows about my situation. It's better that way.

Dan Griffin is my last patient that afternoon. My consulting room is around the corner from the waiting area and the walk to collect a patient takes about a minute-a journey I have made hundreds of times over the last twenty-five years. Tom and Carolyn used to visit me here sometimes when they were small. I remember how Tom liked the "swingy" chair in the main office, where he'd sit gazing out of the window over the tops of the trees. They'd both be surprised to see how little it's all changed; the carpet and the furniture are exactly as they were. Over the years, there have been a few additions to the walls in the corridor, the framed Beacon Award, the Trust commendation for clinical excellence. Otherwise, it's the same-the seascape by the lift, the row of abstract pictures with scattered geometrical shapes, and the one Tom liked best, the shaggy dog jumping in the rain. It's what we offer here, a sense of stability, something constant and reliable for people who've known terror in their lives. These days, David would shrug in the face of any psychological theorizing. What difference does any of it make? he'd say. But maybe that's because of what's happened to our own family.

Usually, as I walk to collect a new referral, I spend a few moments clearing my head, orienting myself to the new patient and the process about to begin. Today, I don't. I'd like to say I was thinking about Alfie and his parents, but that would be a lie.

I walk slowly and deliberately, my eyes on those swimming-pool-blue carpet tiles. It's just as I pass the stairwell that I look up and see him in the waiting room at the end of the corridor. I stop and stare. Everything else falls away.

He's hunched in the chair by the door, head in hands, hair hanging down over his fingers. I hear myself make a noise, a muffled sort of cry, and then suddenly a wave rolls gently through me. I feel suddenly light. Elevated. He's grown his hair long again. David would hate it, but I'm pleased. One of the last times I saw him, he'd hacked it off completely, leaving long golden curls in the bathroom sink that made me want to weep. Now it's grown back down to his shoulders. It suits him long, I think, as I reach a hand to the wall to steady myself.

As I move closer, I can see his donkey jacket. The one we bought him for Christmas. The one with the tartan lining. My heart is thumping now. There's a new shirt, one I don't recognize, and a red rucksack on his lap. On his feet, Doc Martens boots. Always those black boots. The sight of them makes me smile. Tom, here you are, is what I think, or perhaps I say out loud. My chest rises and falls and I break into a clumsy run, startling the patients in the waiting room. Some look up. One of them is Tom. As he lifts his head, I feel a dull pain in my solar plexus, swift, like a punch. It is not him.

I come to a jarring halt. I pull back, a strange lurching movement. The young man who looks up-just a boy, really-glances at me briefly, his expression blank, then he looks back down into his hands. I take in the black eye, the bruise on his cheek, and his bandaged hand. It is not Tom. I feel light-headed, sick. I reach for the door frame and hold on tight.

I am used to seeing my son in odd places. I've come to understand that it's normal, something we all do. I have "seen" him many times over the last year and a half. Only last week, I spotted him walking up the hill to his old primary school. It was just before his growth spurt in Year Six. He was walking with Finn, kicking his bag and laughing and joking as they jostled into each other.

Sometimes I see him when he's older. It's the smallest thing that pulls me in-the curl of hair on his neck as he's getting out of the Tube, or his floaty, airborne walk as he strides across a beach. Sometimes, and these are the times that upset me most, he looks exactly as he did when I last saw him. Seventeen, with a haunted face and a brutal haircut. These glimpses are always fleeting, images that shimmer then disappear when I look more closely. Usually, I know exactly what I am doing, that I am willfully conjuring him up, turning unsuspecting strangers into the face I want to see. As I stand in the doorway that day, the likeness does not fade or shift, it is clear and hard and unsettling.

"Dan Griffin?" I say, eyes scanning the waiting room, knowing exactly who will get up and rise to his feet. At the sound of his name, he jerks up awkwardly and nods in response. After that I don't remember much. Perhaps he is sweating, perhaps his hands are shaking when he picks up his rucksack; I don't recall any of these details. I am thinking very little about him. As I walk back to my office, all my efforts are concentrated on keeping my body in an upright position and my steps even and balanced along those blue carpet tiles.

The referral letter said he was twenty-two, but he looks much younger. He'd been fast-tracked by Dr. Jane Davies, a substitute GP in Hackney I'd never met.

Dear Ruth Hartland,

I would be grateful if you could urgently assess this young man, who has just moved to the area. Dan Griffin has recently experienced a highly traumatic event and is displaying the classic PTSD symptoms. He was unable to disclose the event, but I believe it was a vicious attack in a park. Given the severity of his anxiety, however, I did not press him for details. I have requested notes from his previous GP. . . .

Yours etc.

Dr. Davies

Dan is looking down at the floor, his rucksack hugged to his chest. His body is tense, his eyes uncertain. I introduce myself, ask how I can help him today. There's a long pause. He looks up, swallows several times, then stares at me with such intensity I want to look away.

Perhaps it's because he's so preoccupied with his own distress that he doesn't notice my own. My flushed face, my heart still thumping wildly, it's impossible to believe he can't see it under my blue fitted jacket. Is it shock? Disappointment? Or rage or shame at my own stupidity? What was I thinking? What would David have thought? I imagine eye rolling, but really I wonder, too, if he might have seen what I am seeing.

Dan talks a lot at the beginning of the session. His voice is clipped and breathless as he tells me he's "desperate, not coping," and reveals the extent of his flashbacks. I am grateful for this detail. I use the opportunity to ease my way back into my body, but even as he speaks I feel a surge of resistance, wild and hopeful thoughts that want to reject the reality of who's in front of me. I sit still. I breathe.