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http://www.nytimes.com/2005/03/10/sports/10steroids.html?ei=5094&en=8acecdd2df34ef81&hp=&ex=1110517200&partner=homepage&pagewanted=all&position=
Steroids Are Blamed in Suicide of Young Athlete
<nyt_byline version="1.0" type=" "> [size=-1] By DUFF WILSON [/size]
</nyt_byline> <table align="right" border="0" cellpadding="0" cellspacing="0"> <tbody><tr><td>
</td></tr> </tbody> </table> <nyt_text> </nyt_text>
ACAVILLE, Calif. - Brenda Marrero came upon her son Efrain surfing the Internet one day last October. When Efrain hid what was on the screen, she asked what he had been looking at. He turned and said he wanted to tell her something: He was using steroids.
She called her husband, Frank, and they told Efrain he needed to stop, because steroids are dangerous.
"But Barry Bonds does it," his parents remember Efrain saying.
"That doesn't make it right," his father responded.
To please his parents, Efrain retrieved a dozen pink pills, a vial of liquid and two syringes. His mother flushed the pills and kept the vial. Efrain, who played football, promised to stop using steroids. It was a promise that no one doubts he kept.
Three and a half weeks later, Mrs. Marrero found Efrain in a bedroom at home, a bullet in his head, a .22-caliber pistol in his hand. He left no explanation for his suicide. He had no history of depression or mental illness. He was 19.
"We didn't see it coming," Mrs. Marrero said, crying. "We were absolutely devastated."
Not until weeks later did the Marreros learn that their son had been surrounded by steroids; his sister's boyfriend, co-workers at the mall and other weight lifters at his gym used steroids. And when Efrain went off to the College of the Siskiyous, he joined a football team in which a number of players were using steroids, three former teammates said.
And not until they learned what steroid withdrawal can do to a teenager's hormones did the Marreros find a plausible explanation for Efrain's suicide: the family, their doctor and their friends think that Efrain fell into an abyss from having suddenly stopped using steroids.
Two previous suicides had been attributed by parents to steroid use by young athletes: Rob Garibaldi, 24, of Petaluma, Calif., in 2002, and Taylor Hooton, 17, of Plano, Tex., in 2003. The athletes, both baseball players, died shortly after they stopped using steroids.
At a time of increasing concern about the use of steroids by young athletes and the long-term health risks associated with the drugs, the three suicides, while extreme, have underscored for many medical experts the short-term risks linked to withdrawal from steroids.
Donald Hooton Sr., Taylor's father, is scheduled to be among the witnesses discussing steroid use by teenagers at a hearing today of Congressional health and consumer protection subcommittees. Mr. Hooton and Mr. Garibaldi's parents have also been invited to testify on baseball's steroids policy before the House Committee on Government Reform on March 17, and the Marreros said they planned to attend.
Many medical experts suspect that other teenage suicides have been connected to the cessation of steroid use, because adolescents are especially vulnerable to hormonal swings. But the link has not been proved. For ethical reasons, researchers cannot design a medical study that would try to induce depression in someone using a steroid by taking him off the drug.
Medical experts said, however, that there is persuasive anecdotal evidence and a reasonable biological explanation for a connection. When someone takes steroids, the body suppresses its natural production of testosterone. After a person stops, it takes weeks or months to produce normal levels again, leaving some but not all people vulnerable to profound mood changes.
"Efrain stopped, just like we asked him to," Mrs. Marrero said. "And I believe he spiraled into a severe depression. We didn't know this at the time, but we're finding out the thing to do is not go off them cold turkey like that. And I believe that is what happened: steroids killed my son."
Mr. Marrero's suicide occurred in a region where the steroids scandal involving the Bay Area Laboratory Co-Operative has dominated news coverage for more than a year. In San Francisco, about 50 miles southwest of Vacaville, federal prosecutors are preparing to go to trial in the Balco case, in which four men, including Barry Bonds's personal trainer, have been charged with conspiracy to distribute steroids.
And in Sacramento, 35 miles east of Vacaville, Gov. Arnold Schwarzenegger has admitted that he used steroids during his long career as a bodybuilder. Mr. Schwarzengger says young people should never take steroids, but he has been fighting with the Legislature over whether high schools should be encouraged to ban the use of legal substances like creatine that are suspected of having performance-enhancing effects.
'That Stuff Is Everywhere'
The Marreros moved to this clean, friendly town when Efrain was 10 years old. Frank Marrero is a pilot for United Airlines based in San Francisco and a colonel in the Air Force Reserve. The family picked Vacaville for the quality of life and the schools. "Everything we ever did," he said, "we did for our kids."
Efrain Marrero lived with his father, mother, a younger sister and baby brother in a four-bedroom house with vaulted ceilings. Together, they ate meals, played in the backyard near the pool, attended church and took vacations.
He turned 14 the year Mark McGwire hit 70 home runs, and pretty soon he asked his parents if he could use creatine, an amino acid that helps build muscle mass. Creatine, he observed, was sold in health food stores. And a lot of teenagers used it. But his parents said no.
Mr. Marrero, who was always one of the biggest boys in his class, grew to be 6 feet 1 inch and 270 pounds. He played offensive line for four years at Vacaville High School.
Daniel Shirar, a friend and fellow lineman on the high school team, said he thought Mr. Marrero had tried creatine. "But he wasn't on it constantly, like I was," Mr. Shirar said.
Mr. Marrero also talked to his friends about androstenedione, a steroid precursor used by McGwire. "He said it's a legal steroid you can buy, and you rub it on and it makes your fat go away," said Rob Cullinan, Mr. Marrero's best friend. "He was always big and fast, but he always wanted an edge."
Mr. Marrero also talked about steroids with Erik Svendsen, the boyfriend of his sister, Erika. Mr. Svendsen said in an interview that he had injected himself with steroids to bulk up for football his senior year at Vacaville High School.
Mr. Svendsen said that he had sold some veterinary steroids from Mexico to Mr. Marrero about two years ago, but that he thought Mr. Marrero had sold them to someone else.
Mr. Svendsen talked about this, he said, to help the grieving Marrero family understand what had happened. "I could say I didn't, but anything I can do to help them, I will," he said. "They are a wonderful, wonderful family. Big-hearted people."
Shown a picture of the vial of liquid that Mr. Marrero had given to his parents, Mr. Svendsen said it contained about 8 milliliters, or about two weeks of usage. The Olympic Analytical Laboratory at U.C.L.A. tested the contents of the vial for The New York Times; it contained methandienone, a powerful steroid that is also known as dianabol.
"That stuff is everywhere here," Mr. Svendsen said. "It's pretty easy to get if you know the right people at the gym and stuff. You can pretty much look at people and know who to talk to."
Dan Garcia, a bodybuilder, sold steroids for about two years to a network of people at Gold's Gym, Solano Community College and other places in the Vacaville area. He was arrested in 2001 for selling drugs, pleaded guilty and served about six months in jail. Mr. Garcia said in interviews that he had not known Mr. Marrero, but that Mr. Marrero would have had no trouble finding steroids in Vacaville.
Mr. Svendsen said that despite having sold steroids to Mr. Marrero, he had not known that Mr. Marrero was using the drugs until Mr. Marrero died. And he said he had never seen an unlabeled vial like the one Mr. Marrero gave to his parents.
"They're all labeled," Mr. Svendsen said. "Anyone who would buy a bottle like that wouldn't know what they were getting."
After Mr. Marrero's death, his sister, who is captain of the cheerleading squad at Vacaville High, broke up with Mr. Svendsen, her boyfriend of two years.
"I couldn't forgive him, because I thought he had some contribution to it," Erika Marrero said. Four months after her brother's suicide, she wipes tears from her eyes. "It's hard. You start to realize he's really gone."
Plenty of Company
"I don't think we have a problem here," said Ed Santopadre, the football coach at Vacaville High, "but you know, I'd be the last to know. They'd try to keep it from me."
Mr. Santopadre said he was perplexed by Mr. Marrero's use of steroids, describing him as a nice young man and a talented player.
"He was quick, big, strong and hit like a truck," Mr. Santopadre said. "Why? That's what I don't understand. Why? He didn't need them."
Mr. Marrero was recruited to play football in 2002 at the College of the Siskiyous, a two-year college in a small town 250 miles north of Vacaville. He joined a family friend, Casey Lee, who was a receiver and co-captain of the Siskiyous Eagles. Casey is the son of Mike Lee, who had coached Mr. Marrero in Pop Warner football, and Cathy Lee, who is Brenda Marrero's best friend.
The Siskiyous football program was awash in steroids, former players said.
"I don't want to badmouth my school, but there were at least a dozen people I know of who were on steroids," Casey Lee said.
Mr. Marrero hurt his knee and did not play his freshman year, but he stayed on the roster and attended practices.
Mr. Lee said at least 10 players had been injecting steroids and were open about it. "To the point where they were driving all the way from Northern California to Mexico to get it and then sell it," he said. "It was in-your-face. It was easy to get. It was not looked on as a big deal. Coaches didn't see it. I don't know if they wanted to or not."
Matt Ledbetter, another co-captain, said: "I personally knew of seven or eight people that were doing it. At a drop of the hat, you could get it from any of them."
The players said athletes at junior colleges, like those in high schools, are well aware that they will not be tested for steroids. Henry Ochs, a lineman at Siskiyous, said some players had taken steroids during the summer to bulk up. "I wouldn't say a lot," Mr. Ochs said. "I'd probably say 8 or 9 people in a 70-person team used them."
Dennis Roberts, the athletic director at Siskiyous who was the head football coach when Mr. Marrero was there, said he was "really, really surprised" to hear what former players had to say about steroids.
"It seems like somehow the coaching staff would have known about it," he said. Mr. Roberts said the college tests athletes for recreational drugs, but not for steroids, because of the additional cost. "If we suspected something, we would not let it go," he said, adding that Mr. Lee and Mr. Ledbetter, the former co-captains, were extremely credible. "They wouldn't make up anything that didn't really happen," he said.
Clues Begin to Emerge
Mr. Marrero left the college after one year, telling friends it was too remote. He lived with his family, worked at several local stores and enrolled at Solano Community College, near home.
He could not play football because of poor grades, but he hit the gym and planned to play the following year. He talked about his competition being bigger than ever. By then, his friends were certain he was taking steroids.
"He showed me what he was taking, and it was a lot more than anybody else," Kenny Groen, a friend from Vacaville, said.
When he confessed to his parents, Mr. Marrero said he had been taking steroids for six months, but his parents and friends think it was longer than that, perhaps years. They had seen a change in his physique - less fat, more muscle - and he had started wearing tighter clothes. His parents noticed mood swings, too, but they chalked it up to adolescence.
At one point, Mrs. Marrero confronted her son. "I said, 'Are you on steroids?' " she said. "He said, 'No, Mom.' Then he looked at me and said, 'Mom, why would you even ask me that?' I said, 'You're getting so big.' He said, 'That's what happens when you go to the gym every day. You get big when you work out.' "
Early last fall, Mr. Marrero told his mother he was feeling a little paranoid; he thought people were staring at him, laughing at him.
"I told him he was just looking really good," Mrs. Marrero said. "But like I told Frank, now I think I was just feeding the addiction to steroids."
Help Proves Elusive
Experienced users sometimes take fertility drugs at the end of their cycles of steroids to jumpstart their natural production of testosterone and avoid the psychological crash that can accompany the cessation of steroid use.
"You're left with very low testosterone levels, which can affect the chemicals in the brain, which control mood, and these people can very often become very depressed and suicidal," said Dr. Edward L. Klaiber of Worcester, Mass., a leading researcher and endocrinologist. "I've had a number of steroid-using adolescents who have expressed suicidal thoughts."
Dr. Kurt J. Brower, a steroids expert with the Department of Psychiatry and the Addiction Research Center at the University of Michigan, said, "The time of highest risk is 3 to 12 weeks after withdrawal."
Rick Collins of Carle Place, N.Y., a lawyer who defends people accused of selling or using steroids, said he had known hundreds of users and that none had committed suicide. "It's certainly not the typical result of steroid use, and to present it as such is disingenuous," he said.
Frank Marrero had consulted the family's longtime physician, Dr. Robert A. Varady, about Efrain. Dr. Varady assured him that the steroids would gradually leave Efrain's system, and he recommended counseling.
"So I thought, O.K., we talked to the doctor," Mrs. Marrero said. "We tried to do everything right."
Dr. Varady said in an interview that he had not known what dose Mr. Marrero had been taking. He said he knew that stopping a high dose of steroids could result in deep depression. "But I'm definitely not on the cutting edge of bodybuilding abuse of steroids," Dr. Varady added.
Mrs. Marrero responded, "If you don't know, say you don't know and you will find out, because you're a doctor."
Mr. Marrero had set up a counseling session at his parents' urging. He never made it. He shot himself the day before.
"It's really such a shocker," Cathy Lee, Mrs. Marrero's friend, said. "Knowing Efrain, he was so caring, that's why I know something in his mind was altered. He just wouldn't have done that to his family, caused that kind of pain."
Steroids Are Blamed in Suicide of Young Athlete
<nyt_byline version="1.0" type=" "> [size=-1] By DUFF WILSON [/size]
</nyt_byline> <table align="right" border="0" cellpadding="0" cellspacing="0"> <tbody><tr><td>
</td></tr> </tbody> </table> <nyt_text> </nyt_text>
She called her husband, Frank, and they told Efrain he needed to stop, because steroids are dangerous.
"But Barry Bonds does it," his parents remember Efrain saying.
"That doesn't make it right," his father responded.
To please his parents, Efrain retrieved a dozen pink pills, a vial of liquid and two syringes. His mother flushed the pills and kept the vial. Efrain, who played football, promised to stop using steroids. It was a promise that no one doubts he kept.
Three and a half weeks later, Mrs. Marrero found Efrain in a bedroom at home, a bullet in his head, a .22-caliber pistol in his hand. He left no explanation for his suicide. He had no history of depression or mental illness. He was 19.
"We didn't see it coming," Mrs. Marrero said, crying. "We were absolutely devastated."
Not until weeks later did the Marreros learn that their son had been surrounded by steroids; his sister's boyfriend, co-workers at the mall and other weight lifters at his gym used steroids. And when Efrain went off to the College of the Siskiyous, he joined a football team in which a number of players were using steroids, three former teammates said.
And not until they learned what steroid withdrawal can do to a teenager's hormones did the Marreros find a plausible explanation for Efrain's suicide: the family, their doctor and their friends think that Efrain fell into an abyss from having suddenly stopped using steroids.
Two previous suicides had been attributed by parents to steroid use by young athletes: Rob Garibaldi, 24, of Petaluma, Calif., in 2002, and Taylor Hooton, 17, of Plano, Tex., in 2003. The athletes, both baseball players, died shortly after they stopped using steroids.
At a time of increasing concern about the use of steroids by young athletes and the long-term health risks associated with the drugs, the three suicides, while extreme, have underscored for many medical experts the short-term risks linked to withdrawal from steroids.
Donald Hooton Sr., Taylor's father, is scheduled to be among the witnesses discussing steroid use by teenagers at a hearing today of Congressional health and consumer protection subcommittees. Mr. Hooton and Mr. Garibaldi's parents have also been invited to testify on baseball's steroids policy before the House Committee on Government Reform on March 17, and the Marreros said they planned to attend.
Many medical experts suspect that other teenage suicides have been connected to the cessation of steroid use, because adolescents are especially vulnerable to hormonal swings. But the link has not been proved. For ethical reasons, researchers cannot design a medical study that would try to induce depression in someone using a steroid by taking him off the drug.
Medical experts said, however, that there is persuasive anecdotal evidence and a reasonable biological explanation for a connection. When someone takes steroids, the body suppresses its natural production of testosterone. After a person stops, it takes weeks or months to produce normal levels again, leaving some but not all people vulnerable to profound mood changes.
"Efrain stopped, just like we asked him to," Mrs. Marrero said. "And I believe he spiraled into a severe depression. We didn't know this at the time, but we're finding out the thing to do is not go off them cold turkey like that. And I believe that is what happened: steroids killed my son."
Mr. Marrero's suicide occurred in a region where the steroids scandal involving the Bay Area Laboratory Co-Operative has dominated news coverage for more than a year. In San Francisco, about 50 miles southwest of Vacaville, federal prosecutors are preparing to go to trial in the Balco case, in which four men, including Barry Bonds's personal trainer, have been charged with conspiracy to distribute steroids.
And in Sacramento, 35 miles east of Vacaville, Gov. Arnold Schwarzenegger has admitted that he used steroids during his long career as a bodybuilder. Mr. Schwarzengger says young people should never take steroids, but he has been fighting with the Legislature over whether high schools should be encouraged to ban the use of legal substances like creatine that are suspected of having performance-enhancing effects.
'That Stuff Is Everywhere'
The Marreros moved to this clean, friendly town when Efrain was 10 years old. Frank Marrero is a pilot for United Airlines based in San Francisco and a colonel in the Air Force Reserve. The family picked Vacaville for the quality of life and the schools. "Everything we ever did," he said, "we did for our kids."
Efrain Marrero lived with his father, mother, a younger sister and baby brother in a four-bedroom house with vaulted ceilings. Together, they ate meals, played in the backyard near the pool, attended church and took vacations.
He turned 14 the year Mark McGwire hit 70 home runs, and pretty soon he asked his parents if he could use creatine, an amino acid that helps build muscle mass. Creatine, he observed, was sold in health food stores. And a lot of teenagers used it. But his parents said no.
Mr. Marrero, who was always one of the biggest boys in his class, grew to be 6 feet 1 inch and 270 pounds. He played offensive line for four years at Vacaville High School.
Daniel Shirar, a friend and fellow lineman on the high school team, said he thought Mr. Marrero had tried creatine. "But he wasn't on it constantly, like I was," Mr. Shirar said.
Mr. Marrero also talked to his friends about androstenedione, a steroid precursor used by McGwire. "He said it's a legal steroid you can buy, and you rub it on and it makes your fat go away," said Rob Cullinan, Mr. Marrero's best friend. "He was always big and fast, but he always wanted an edge."
Mr. Marrero also talked about steroids with Erik Svendsen, the boyfriend of his sister, Erika. Mr. Svendsen said in an interview that he had injected himself with steroids to bulk up for football his senior year at Vacaville High School.
Mr. Svendsen said that he had sold some veterinary steroids from Mexico to Mr. Marrero about two years ago, but that he thought Mr. Marrero had sold them to someone else.
Mr. Svendsen talked about this, he said, to help the grieving Marrero family understand what had happened. "I could say I didn't, but anything I can do to help them, I will," he said. "They are a wonderful, wonderful family. Big-hearted people."
Shown a picture of the vial of liquid that Mr. Marrero had given to his parents, Mr. Svendsen said it contained about 8 milliliters, or about two weeks of usage. The Olympic Analytical Laboratory at U.C.L.A. tested the contents of the vial for The New York Times; it contained methandienone, a powerful steroid that is also known as dianabol.
"That stuff is everywhere here," Mr. Svendsen said. "It's pretty easy to get if you know the right people at the gym and stuff. You can pretty much look at people and know who to talk to."
Dan Garcia, a bodybuilder, sold steroids for about two years to a network of people at Gold's Gym, Solano Community College and other places in the Vacaville area. He was arrested in 2001 for selling drugs, pleaded guilty and served about six months in jail. Mr. Garcia said in interviews that he had not known Mr. Marrero, but that Mr. Marrero would have had no trouble finding steroids in Vacaville.
Mr. Svendsen said that despite having sold steroids to Mr. Marrero, he had not known that Mr. Marrero was using the drugs until Mr. Marrero died. And he said he had never seen an unlabeled vial like the one Mr. Marrero gave to his parents.
"They're all labeled," Mr. Svendsen said. "Anyone who would buy a bottle like that wouldn't know what they were getting."
After Mr. Marrero's death, his sister, who is captain of the cheerleading squad at Vacaville High, broke up with Mr. Svendsen, her boyfriend of two years.
"I couldn't forgive him, because I thought he had some contribution to it," Erika Marrero said. Four months after her brother's suicide, she wipes tears from her eyes. "It's hard. You start to realize he's really gone."
Plenty of Company
"I don't think we have a problem here," said Ed Santopadre, the football coach at Vacaville High, "but you know, I'd be the last to know. They'd try to keep it from me."
Mr. Santopadre said he was perplexed by Mr. Marrero's use of steroids, describing him as a nice young man and a talented player.
"He was quick, big, strong and hit like a truck," Mr. Santopadre said. "Why? That's what I don't understand. Why? He didn't need them."
Mr. Marrero was recruited to play football in 2002 at the College of the Siskiyous, a two-year college in a small town 250 miles north of Vacaville. He joined a family friend, Casey Lee, who was a receiver and co-captain of the Siskiyous Eagles. Casey is the son of Mike Lee, who had coached Mr. Marrero in Pop Warner football, and Cathy Lee, who is Brenda Marrero's best friend.
The Siskiyous football program was awash in steroids, former players said.
"I don't want to badmouth my school, but there were at least a dozen people I know of who were on steroids," Casey Lee said.
Mr. Marrero hurt his knee and did not play his freshman year, but he stayed on the roster and attended practices.
Mr. Lee said at least 10 players had been injecting steroids and were open about it. "To the point where they were driving all the way from Northern California to Mexico to get it and then sell it," he said. "It was in-your-face. It was easy to get. It was not looked on as a big deal. Coaches didn't see it. I don't know if they wanted to or not."
Matt Ledbetter, another co-captain, said: "I personally knew of seven or eight people that were doing it. At a drop of the hat, you could get it from any of them."
The players said athletes at junior colleges, like those in high schools, are well aware that they will not be tested for steroids. Henry Ochs, a lineman at Siskiyous, said some players had taken steroids during the summer to bulk up. "I wouldn't say a lot," Mr. Ochs said. "I'd probably say 8 or 9 people in a 70-person team used them."
Dennis Roberts, the athletic director at Siskiyous who was the head football coach when Mr. Marrero was there, said he was "really, really surprised" to hear what former players had to say about steroids.
"It seems like somehow the coaching staff would have known about it," he said. Mr. Roberts said the college tests athletes for recreational drugs, but not for steroids, because of the additional cost. "If we suspected something, we would not let it go," he said, adding that Mr. Lee and Mr. Ledbetter, the former co-captains, were extremely credible. "They wouldn't make up anything that didn't really happen," he said.
Clues Begin to Emerge
Mr. Marrero left the college after one year, telling friends it was too remote. He lived with his family, worked at several local stores and enrolled at Solano Community College, near home.
He could not play football because of poor grades, but he hit the gym and planned to play the following year. He talked about his competition being bigger than ever. By then, his friends were certain he was taking steroids.
"He showed me what he was taking, and it was a lot more than anybody else," Kenny Groen, a friend from Vacaville, said.
When he confessed to his parents, Mr. Marrero said he had been taking steroids for six months, but his parents and friends think it was longer than that, perhaps years. They had seen a change in his physique - less fat, more muscle - and he had started wearing tighter clothes. His parents noticed mood swings, too, but they chalked it up to adolescence.
At one point, Mrs. Marrero confronted her son. "I said, 'Are you on steroids?' " she said. "He said, 'No, Mom.' Then he looked at me and said, 'Mom, why would you even ask me that?' I said, 'You're getting so big.' He said, 'That's what happens when you go to the gym every day. You get big when you work out.' "
Early last fall, Mr. Marrero told his mother he was feeling a little paranoid; he thought people were staring at him, laughing at him.
"I told him he was just looking really good," Mrs. Marrero said. "But like I told Frank, now I think I was just feeding the addiction to steroids."
Help Proves Elusive
Experienced users sometimes take fertility drugs at the end of their cycles of steroids to jumpstart their natural production of testosterone and avoid the psychological crash that can accompany the cessation of steroid use.
"You're left with very low testosterone levels, which can affect the chemicals in the brain, which control mood, and these people can very often become very depressed and suicidal," said Dr. Edward L. Klaiber of Worcester, Mass., a leading researcher and endocrinologist. "I've had a number of steroid-using adolescents who have expressed suicidal thoughts."
Dr. Kurt J. Brower, a steroids expert with the Department of Psychiatry and the Addiction Research Center at the University of Michigan, said, "The time of highest risk is 3 to 12 weeks after withdrawal."
Rick Collins of Carle Place, N.Y., a lawyer who defends people accused of selling or using steroids, said he had known hundreds of users and that none had committed suicide. "It's certainly not the typical result of steroid use, and to present it as such is disingenuous," he said.
Frank Marrero had consulted the family's longtime physician, Dr. Robert A. Varady, about Efrain. Dr. Varady assured him that the steroids would gradually leave Efrain's system, and he recommended counseling.
"So I thought, O.K., we talked to the doctor," Mrs. Marrero said. "We tried to do everything right."
Dr. Varady said in an interview that he had not known what dose Mr. Marrero had been taking. He said he knew that stopping a high dose of steroids could result in deep depression. "But I'm definitely not on the cutting edge of bodybuilding abuse of steroids," Dr. Varady added.
Mrs. Marrero responded, "If you don't know, say you don't know and you will find out, because you're a doctor."
Mr. Marrero had set up a counseling session at his parents' urging. He never made it. He shot himself the day before.
"It's really such a shocker," Cathy Lee, Mrs. Marrero's friend, said. "Knowing Efrain, he was so caring, that's why I know something in his mind was altered. He just wouldn't have done that to his family, caused that kind of pain."
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