Alexandre Vidal Porto - Sergio Y.

After I discovered and understood what had happened to Sergio Y., I went into shock. It was as if I had fallen ill. To this day, I still do not understand exactly what happened to me. I became apathetic. I could not concentrate. I stopped eating. I lost almost six kilos in one month.

As bedtime approached, I felt an unease, a discomfort that I only managed to free myself from with a warm bath and some antianxiety medication. Sometimes I would sleep well at night and wake up in a relaxed mood. Other times, however, I would spend all night awake, unable to sleep until daybreak.

I felt obliged to review all my notes and to listen to all my recordings of Sergio’s sessions. Our years of analysis had yielded a green-covered notebook and multiple computer files.

I spent a whole afternoon reviewing my notes. Often they seemed disjointed. After five years, our memory fades and becomes selective. I had to accept that many of the words and conclusions I had jotted down concerning Sergio no longer made sense to me. I could not even remember what they referred to. Only sentence fragments and underlined words remained. Nowhere in the notebook was there any mention of “transsexual” or “transsexuality,” which was lamentable for a doctor of the caliber I judged myself to be.

Based on what I could ascertain from reviewing my notes, Sergio Y. felt unhappy and did not want to resign himself to the unhappy condition he had found himself in. Once he had told me that he was “the fruit of my great-grandfather’s courage.” If Areg had stayed where he had been born, he would have died, have been murdered, and he, Sergio, would never have been born. “Abandoned where he’d lived to continue living.” I wrote that sentence down in quotation marks. I think even then, Sergio Y. saw immigration as a way to ensure his survival and his future.

Surprisingly, mention of New York jumped out in these notes. “New York as a possibility for reinvention” (08/08/2006), written in blue ink. “Trip to New York, on vacation. Visit to the Ellis Island Museum”(11/12/2006), in black ink. It became clear to me that, somehow, Sergio’s future in New York was already recorded in these notes.

When I had questions or wanted to deepen or clarify something I came across in my notebooks, I would listen to the recording for the corresponding session. It was strange to hear his voice knowing he was dead. The sensation I had when I went back to the recordings was that he was speaking from beyond, using the computer as a speaker. That week, I spent two afternoons and two nights listening to the dead Sergio Y. discuss his life.

I never saw any evidence that Sergio Y. was a transsexual. Neither did he ever mention anything that would, in my opinion, indicate an inner conflict over his sexual identity. It seems incredible, but I did not notice anything.

When Tereza Yacoubian approached me in front of the cheese counter at the supermarket and told me her son lived in New York, I found it perfectly natural. I could imagine him living in New York. It made sense. It seemed plausible.

However, it was difficult to reconcile what I thought I knew about Sergio with the discoveries I was now making with regards to his condition as a transsexual and the circumstances surrounding his premature death.

For me, the questions were now different: What role might I have had in the tragic fate of Sergio Y.? Was I as important as I deemed myself to be when I heard he was happy?

When his mother told me he was fine in New York and opening a restaurant in the West Village at twenty-three, I felt responsible for his happiness. I felt I had helped construct his happy life or at least been a catalyst. I even bought a pair of moccasins I had been flirting with as a reward.

Whose responsibility was it now that my patient’s happy life was over? Was that mine too? Was I guilty of not acting? Was I guilty of not seeing? Of malpractice? Negligence? Arrogance?

But even if I were guilty, no one but me would ever know. The Federal Medical Council could not revoke my license. They would not even open an investigation. They would never make the connection between Sergio Y.’s death and our therapy sessions. Sergio died years later, in the United States, the victim of another crime.

But what did I say that led him to the tragic circumstances that precipitated his demise? How could I not have noticed his greatest affliction? Did I somehow help him arrive at the warped revelation that led to his death? According to Sergio himself, it was a conversation we had had that led him to his “revelation” as to what he should do with his life.

And what did he do with his life? He disfigured it. He surrendered it to a murderer.

I went to the cemetery twice to visit his grave. “Sergio Emílio Yacoubian, 01/10/1988 — 02/02/2011” is written on the gravestone. Sandra did not leave a record of her brief life on that tombstone. Sandra was born Sergio and remained Sergio in death.

After Sergio’s death, my work with patients became less enjoyable. What had once felt stimulating now felt threatening. I began to imagine a different death for each one of my patients, one caused by me. My patients were no longer proof of the good work I was doing but instead began to represent the possibility of error. My shortcomings could mean the death of each one of them, as apparently had already happened once.

At that moment, all I wanted was to wash off the blood I could not help feeling was on my hands. When patients canceled, I now felt relief. I expended too much energy in every session and paid too high a price in terms of the discomfort I felt. Just being around patients became torture. I had to rid myself of these feelings. I did not bother with excuses. “We need to suspend treatment for three weeks.” I went on vacation.

I felt I was not coping with the psychological anguish and guilt which Sergio’s death had triggered in me. Before the problem grew any worse and made me seriously ill, I decided to talk to Eduardo, a friend from my university days, whom I have known for over forty years.

Eduardo is the person I discuss my cases with. I talk to him when I have doubts and want a second opinion. We talked twice before I left on vacation. But my consternation with regard to my patients persisted.

During the three weeks I was away, I spent only four nights at the beach house, just to make sure things were all right. The rest of the time I stayed in São Paulo. I would go to the gym in the mornings, and to the cinema at night, for at that time the International Film Festival was on.

On the one hand, I tried to be as productive with my time as possible. On the other, I wanted to be transported as far away from my everyday existence as possible. I wanted to escape the present. Today I see things more clearly. At the time, I was not sure if I knew what was going on.

The main source of my frustration was not having detected any hint of Sergio Y.’s transsexuality. I felt I had been duped solely and exclusively by my own incompetence. I had always thought that the secret to transsexuality was not all that deep, that it revealed itself in all of the individual’s attitudes, at all times, in all the decisions he or she took, since early childhood. As far as I was concerned, the pain in the patient’s soul and their inner confusion would be so visible that one did not need to be a Freudian or Jungian psychoanalyst to make the diagnosis.

Medical malpractice. Not so different from a doctor who fails to diagnose meningitis. I remember a professor of mine in medical school, Dr. Pedro Veríssimo, who liked to say, “Malpractice can always be avoided.” I had failed at my job and felt that my incompetence was the key element in the tragedy that led to Sergio Y.’s death.