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"With a structured environment, supportive therapy and medications, the patient should become less enraged," Brennan wrote to the court before the hearing.
Chernov would be dead less than three weeks later.
Alvin Chernov's rage would not diminish after his release, as his psychiatrist had hoped.
His "environment" wasn't structured. His Tempe roommate asked him to move out by the end of September, and he didn't know where to go. At least in Chernov's mind, he was not receiving "supportive therapy" from his new ComCare psychiatrist, whom he despised.
That psychiatrist issued him drugs--Zoloft, an antidepressant, and Zyprexa, an antipsychotic--four days before the suicide. But postmortem blood tests didn't determine if he'd taken the antidepressants--or if he had resumed using fen-phen.
Even if Chernov had quit fen-phen, say two doctors and a pharmacologist contacted by New Times, the dramatic change in his seratonin and dopamine levels may have caused him to plummet into an even deeper funk. That may lend credence to Hitzig's argument that removing Chernov from fen-phen may have been dangerous.
Chernov's journal entries indicate his love affair with fen-phen wasn't over. In an undated entry, he explained: "The fen/phen protocol under Dr. Hitzig is [a] very good one. I know that many people will try to blame my wildness on fen/phen. My wildness was not due to fen/phen, but rather to the near-constant intrusions on my privacy. Fen/phen was the only treatment program that seemed to help."
Chernov wrote to Hitzig last August 28, two days after his release from the psych ward.
"I was ordered to stop fen-phen," his letter said. "I guess I'm glad to be free. I've decided to delay my book until I've recovered from the 'help' being given by Maricopa County. The county wants to 'help' me for a year. According to the true spirit of progress, my shrinks have ordered me to stop the fen-phen. So I am suspending my use of fen-phen for right now. . . . In about 60 days, I'll have the opportunity of having my case reviewed . . . Right now, I'm working on getting my debts in order and finding work as a computer tutor. I love programming; it's just the many, many dumb bosses that I dislike. Thanks for your help so far."
Chernov spent endless hours at his apartment in early September, preparing job applications and typing How I Think into his computer. In the latter, he listed four goals for the coming year: "Get and keep a job. Publish How I Think by Alvin Chernov. Get a different psychiatrist. Meet Meredith Brooks."
But Chernov's life was in tatters. He couldn't get a job. He had no friends to rely on, and he'd estranged himself from his siblings, often launching into diatribes when he spoke with Debbie Knight by phone.
"I fear what will happen if I do not get a job," he confided in his computer journal.
On September 7, Chernov sent a letter to Knight, defending Hitzig. "Dr. Hitzig is short with most people probably because he is tired of explaining the same thing to people because it is unconventional," it said. "I understand that shortness completely."
Knight soon phoned her brother's ComCare caseworker, Omar Clark, of whom Chernov had spoken highly. Clark's case notes say Knight told him Chernov was broke and had no place to move to, but that Gary Chernov wasn't going to let him move in.
On September 11, Alvin Chernov phoned his sister to apologize for his behavior.
"He said he wanted to call while the [antidepressant drug] Zoloft was in effect," she recalls. "He told me how tired he was--'Is it always going to be like this?' He was talking about giving up his car, which he loved. He says, 'Debbie, the darkness comes and the darkness goes.' It was the scariest thing."
Knight says she tried to call Omar Clark the next day, to no avail.
On September 13, Chernov stopped at his father's home about 10 a.m. Gary Chernov and his girlfriend were having a yard sale.
Alvin sat outside with his father for a few minutes, asking where he could buy a gun. Gary tells New Times he told Alvin he couldn't buy a gun because of his precarious mental state. Alvin insisted he needed a weapon because he'd been held up at gunpoint the previous night in Tempe. He stood up and walked into the house.
There was a loud bang. Gary's girlfriend rushed to the bathroom, and saw blood running out from under the door. Alvin was still breathing when help arrived, but he was effectively dead. Doctors kept him on life support for more than a day, during which time his family decided to allow his vital organs to be harvested for transplantation.
At Alvin's apartment after the suicide, Gary Chernov found bottles of fen-phen and the other drugs prescribed by Hitzig and the ComCare doctor.
"I don't blame Alvin for killing himself," he says. "I blame Hitzig. Alvin was totally, thoroughly screwed up in the head after he started taking those drugs."
The day after Alvin Chernov was pronounced dead, the FDA ordered the recall of fenfluramine and dexfenfluramine.