I Know This Much Is True

by Wally Lamb

  “I see you’re looking at my dancing Shiva,” Dr. Patel said. “He’s sweet, isn’t he?”

  “It’s a he?” I said. “I thought it was a she.”

  Dr. Patel laughed. “Well, ‘he’ or ‘she’ is not as grave a matter with the gods as it is with us mere mortals,” she said. “Whereas we are fixed and inflexible, they are impish, transmutable. Perhaps, for you, Shiva is a woman. I have—let’s see—chamomile and peppermint and wildberry spice.”

  “Whatever,” I said.

  “Ah, ‘whatever.’ The favorite word of ambivalent American men. All day long, ‘whatever, whatever.’ It’s passive-aggressive, don’t you think?”

  I told her I’d have the spice. She nodded, smiling—pleased with me. “Do you know much about Hindu beliefs, Mr. Birdsey?” she asked. “Shiva is the third god of the Supreme Spirit. The Hindu trinity. Brahma is the Creator, Vishnu is the Preserver, and Shiva is the Destroyer.”

  “The Destroyer?” I said. “Well, if they ever make the movie, Arnold Schwarzenegger could play the lead.” The second I made the crack, I realized it was probably sacrilegious or something. I’ll do that: make a wise remark when I’m nervous. When a situation’s new. But Dr. Patel’s soft chuckle short-circuited my apology.

  “No, no, no,” she said, shaking a scolding finger. “Shiva represents the reproductive power of destruction. The power of renovation. Which is why he’s here in this room, where we dismantle and rebuild.”

  She sat down on the chair opposite mine, a notepad and the tape recorder in her lap. Through the partition came the faint plunking of piano music, a dance teacher’s muffled command to lift and reach, lift and reach. “And of course, Shiva is a dancing god, too, so I know he’s happy with my next-door neighbors. All the little tap dancers and ballerinas.”

  I nodded at the tape recorder. “What’s that thing for?” I said. “Are you taping us or something?”

  She shook her head. “I would like to play something for you, Mr. Birdsey. A bit later. Let’s chat first.”

  “All right,” I said. “What’s going on with him, anyway? The message you left said something about an ‘incident.’”

  She nodded. “I believe I’ve told you over the telephone about your brother’s preoccupation with the surveillance cameras. Have I not?”

  “His fear of being watched,” I said. “It’s always been an issue with him.”

  She sighed. “With most paranoid schizophrenics, of course. But at Hatch, the cameras are a ‘necessary evil.’ On the one hand, the activities at a maximum-security facility certainly need to be monitored, for everyone’s protection, patients and staff alike. On the other hand, many of the patients feel intimidated by them. Resentful. Which is entirely understandable.”

  For the past two or three days, Dr. Patel said, Thomas had grown more agitated about being watched. More and more preoccupied with the omnipresence of the cameras. He’d begun to stare and mumble at them, she said—to whisper threats and curses, engage in a one-sided dialogue. “I’ve tried to address the behavior in our sessions, but he has not wanted to discuss his worries. With me, he has remained rather uncommunicative. Polite and politic during some sessions, glum and nonverbal during others. Winning the trust of someone suffering from paranoid schizophrenia is a long, slow process, Mr. Birdsey. And a tenuous one. A rickety bridge.”

  “The incident?” I said.

  “Ah, yes, the incident. This morning at breakfast, your brother apparently began shouting and throwing food at the camera mounted on the wall in the dining room. When an aide attempted to contain him, the table where he’d been sitting was overturned and—”

  “Thomas turned it over?”

  She nodded. “From what I understand, several of the other patients’ meals landed on the floor and something of a melee followed. The guards were called and the situation was quickly brought back under control, but your brother had to be restrained and confined to the close observation room.”

  “Restrained how?”

  “Four-point restraint. His arms and legs.”

  I flashed on an image from when we were kids: Ray dragging Thomas to the “bad boy seat” in the front parlor—yanking him by the wrist with one hand, the toes of Thomas’s shoes skidding along the floor. One time I saw Thomas’s feet lift all the way off the floor—saw Ray wallop him one, my brother tethered by his skinny arm, swinging back and forth and screaming.

  “The restraints were removed by midmorning,” Dr. Patel said. “As quickly as possible. He was back in his room by eleven.” She didn’t want to alarm me, she said; it was not abnormal for patients suffering paranoia to decompensate—to act out occasionally. She was telling me about the incident because I’d made it clear to both Lisa Sheffer and her that I wanted to be kept informed.

  “How is he now?” I asked.

  He’d been sullen for the rest of the morning, she said. Withdrawn, even with Lisa. At lunchtime, he had refused to go back to the dining hall and made do instead with a piece of fruit and some cookies. “But I’m happy to report that our session this afternoon was a productive one. This afternoon we made some progress. Now I must also tell you that I’ve talked to Dr. Chase, the staff psychiatrist—just before I left the Institute to come here, as a matter of fact. Dr. Chase is considering, as one of his options, increasing Thomas’s dose of Haldol.”

  “Oh, Jesus, here we go,” I said. “Take off the restraints and straitjacket him with his meds instead. That’s bullshit. That’s business as usual.” She started to say something, but I interrupted her. “Excuse me, but I’m not interested in hearing any bogus justifications for it, okay? I’ve heard them all before. Your American colleagues are way ahead of you, Doctor. They’ve been pulling that particular stunt for years.”

  The smile stayed on her lips, but I thought I could read resentment in her dark eyes. “My colleagues have been pulling what particular stunt?” she asked.

  “Overmedicating him when he freaks out. Look, the last time they upped his dosage after an episode, he was like something out of Night of the Living Dead. You’d go to visit him, and he’d just sit there, ramrod straight, his hands and legs twitching away like someone had plugged him into the wall socket.”

  “Well, Mr. Birdsey, neuroleptic medications are mostly effective in lessening delusions and hallucinations,” Dr. Patel said. “They allow a reprieve from the positive symptoms which plague the patient. Unfortunately, the medication often enhances the negative symptoms: the flat affect, the Parkinson’s-like tremors we so often see in—”

  “Turn off his voices by turning him into one of the body snatchers. Jesus Christ, I know all this! I know all about Stelazine and Prolixin and all the other fun stuff. You think you can have a brother in and out of the state hospital for twenty years and not already know about all this chemical voodoo?”

  She said nothing. Waited.

  “Look, he hates taking Haldol, okay? Even the smaller dose. It makes him feel like shit. I don’t want you guys turning him into a zombie just because he pitched a fit and turned over a table. Just because it’s convenient to the staff. Upping his dosage is unacceptable.”

  “It’s unacceptable to me, too, Mr. Birdsey,” Dr. Patel said. “Please give me credit for some professional ethics. I am an advocate for your brother, not an enemy. Not a mad scientist.”

  We sat there facing each other. Her eyes, young and mischievous, belied her salt-and-pepper hair. I opened my mouth to say something, then changed my mind.

  “I told Dr. Chase that, in my opinion, increasing the dosage of your brother’s haloperidol—his Haldol—was probably ill advised. And certainly premature. And I’ll be glad to relay your concerns to the doctor as well.”

  I let go a laugh. “As if that counts for anything. As if one of the divine gods of psychiatry would do anything except listen politely and then proceed the way they damn well wanted to, anyway.”

  Her smile remained constant. “That’s quite a broad indictment, Mr. Birdsey,” she said. “You’re very
angry. Aren’t you?”

  “Hey, I’ve earned the right. Believe me. But what I am is irrelevant. All I’m saying is that if he—”

  Smiling still, she reached across and covered my hand with her own small butterscotch-colored hand. Squeezed it. Relaxed the pressure. Squeezed again. The gesture was so unexpected, it disarmed me. Shut me up for once. “Squeeze back,” she said. And I did.

  “Drug treatment with schizophrenics is always a balancing act,” Dr. Patel said. “As you said, a trade-off. But unless the patient is in danger of harming himself or other people, it’s always best to err on the side of caution. So you and I are in agreement. Isn’t that nice? And in these days of American malpractice suits, it’s my guess that Dr. Chase will probably be inclined to agree as well. To listen more carefully than you’d think to the opinions of the patient’s family.” She gave me that mischievous look again. “Ah,” she said. “The water is ready for our tea. Isn’t that lovely?”

  She stood and went over to the hot plate. While I waited, I looked again at her smiling statue. What had she called him? Shiva?

  She handed me a small yellow cup, hand-painted with monkeys. Poured the tea from a matching monkey pot. It smelled delicious. Warmed my hands.

  “It’s ironic that I never drank tea when I was growing up in India,” Dr. Patel said. “I acquired the habit later on when I was in my twenties. During my London days.”

  I wasn’t sure why, exactly, but I was starting to like her in spite of myself. “Is that where you studied psychology?” I said. “In England?” This was the kind of small talk I usually had no patience for.

  “Oh, no, no. When I was in London, I was earning a degree in anthropology. I got my psychology degree later on at the University of Chicago. I studied with Bettelheim. Do you know his work? Dr. Bruno Bettelheim?”

  I shrugged.

  “Oh, you must read him! The Uses of Enchantment, The Informed Heart. Splendid works.”

  “So you’re both, then?” I said. “A psychologist and an anthropologist?”

  She nodded. “Actually, my interest in the one field led to the other. They’re quite interrelated, you know. The stories of the ages and the collective unconscious. Have you ever read Jung, Mr. Birdsey?”

  “A long time ago. In college.”

  “How about Joseph Campbell? Or Claude Lévi-Strauss? Or Heinrich Zimmer?”

  “I’m a housepainter,” I said.

  “But surely, Mr. Birdsey, you must read other things besides the side of a paint can.” Her smile, her soft, nasaly voice cut against the sarcasm. “Your brother says you’re an avid reader. That your house is filled with books. He was quite animated when he was telling me about you. He seems so proud of your mind.”

  “Yeah, right,” I laughed.

  “Oh, I’m serious, Mr. Birdsey. You think otherwise?”

  “I think . . . I think Thomas doesn’t focus much on anything or anyone beyond Thomas.”

  “Elaborate, please.”

  “Because of his disease. He can’t think beyond himself. . . . Compared to, you know, the way he used to be.”

  “How did he used to be?”

  “Before the illness?”

  She nodded.

  “Well . . . when we were kids, he used to worry about me all the time. I used to get into things, you know? Take chances. Take risks. And he’d get nervous about it. Try to talk me out of it. He was always worried about me.”

  “What kinds of risks did you take?”

  “Oh, you know. Climb ledges we weren’t supposed to climb. Jump off the garage roof. Cut through people’s yards. Kid stuff. But Thomas would always hang back. Warn me I was going to get in trouble or get hurt or something. He was as big a worrywart as she was.”

  “Your mother?”

  “Yeah.”

  “So when you look back, you would say that you were the more adventurous brother?”

  “My mother used to call Thomas the bunny rabbit and me the spider monkey because . . . well, who cares, right? I’m going off on a tangent here.”

  “No, no. Continue, please. You were the spider monkey be- cause . . . ?”

  “Because I was always getting into everything. I was Curious George.” She smiled. Waited. “He’s a . . . a character in a kid’s book. A little monkey who’s always getting into—”

  “Indeed, he is, Mr. Birdsey. An inquisitive little fellow. My granddaughter would have me read her Curious George day and night if she had her way. But go on. You were the more curious brother and Thomas was more . . . ?”

  “More mellow, I guess.”

  “Excuse me, please. By that, do you mean more relaxed or more fearful of venturing forth?”

  I looked up at her, impressed by her insight. “More fearful,” I said.

  She jotted something down. “The little bunny rabbit,” she said.

  “We were like that right from the beginning, I guess. That’s what Ma used to say. Thomas would sit there in the playpen and watch me escape.”

  “Clarify something for me, Mr. Birdsey. Thomas was your mother’s bunny rabbit because . . . ?”

  “Because he was . . . soft, I guess. More affectionate. They were pretty close.”

  “Your mother and Thomas?”

  “Yes.”

  “Closer than your mother and you?”

  I looked away. Nodded. Watched my fingers lace and unlace themselves.

  “And what about your father?”

  “What about him?” I snapped back.

  Dr. Patel waited.

  “We never knew our father. . . . Do you mean Ray? Our stepfather?”

  “Yes, your stepfather. Which of you was closer to him? Or were you equally close?”

  I laughed one of those nothing’s-funny laughs. “We were equally distant.”

  “Yes?”

  “Well, not distant. You couldn’t get much distance from Ray. He was always in your face. . . . Cautious, I guess you’d say. We were equally cautious of Ray.”

  “Go on.”

  “He would . . . he used to pick on Thomas. I mean, he’d get on both our cases, but Thomas was the one who usually got it with both barrels. Thomas or Ma.”

  “And not you?”

  “Uh, not so much. No.”

  “And how did that make you feel? To be the one of the three not getting it ‘with both of the barrels’?”

  “What? I don’t know. . . . Good, in one way, I guess. Relieved. But not so good, either.”

  “Not good how?”

  “It made me feel . . . it made me feel . . .”

  “Yes?”

  “Guilty, I guess. And, I don’t know . . . responsible.”

  “I don’t understand. Responsible for . . . ?”

  “For keeping them safe. They wouldn’t stand up for themselves. Neither of them. So it was always me who—hey, look, I’m not the patient here. I thought we were talking about Thomas.”

  “And so we are, Mr. Birdsey. You were saying that, before his illness began to manifest itself, he used to worry about you and that since its onset—”

  “It’s like . . . there’s nobody home at Thomas’s anymore, you know? I look at him sometimes and he’s like . . . this abandoned building. No one’s been home at Thomas’s for years.”

  I watched her thinking. Waited. “This just occurred to me,” she said. “When your brother expresses pride in your intellect, pleasure about all the books in your house,” she said, “he may be celebrating the achievements of his mirror image—the part of himself that is free of the burden of his disease. Do you think that’s plausible?”

  I shrugged. “Couldn’t tell you.”

  “In a sense, as your identical twin, he is you and you are he. More than most siblings, you are each other. No?”

  My old fear: that I was as weak as Thomas. That one day, I’d look in the mirror and see a crazy man: my brother, the scary guy on the city bus that day. . . . When I tuned back to Dr. Patel, she was talking about anthropology.

  “And, oh, my goodnes
s, the myths of the world are laden with twins,” she said. “Think about it, Mr. Birdsey. Castor and Pollux, Romulus and Remus. It’s a fascinating aspect of the collective unconscious, really. The ultimate solution to human alienation. I assure you, Mr. Birdsey, whatever burdens you bear as a twin, the untwinned world is quite envious. Your own and Thomas’s duality is something we might wish to play with later on as we try to help your brother. But, as usual, I am getting ahead of myself. Going sixty-five miles per hour when I should be going forty.”

  Laughing at her own little joke, she pushed the tape recorder’s “rewind” button and set it whirring. “This is a cassette recording of my session with your brother from this afternoon,” she said. “The one I told you about. I thought it might be useful to play it for you and to hear your reactions. And perhaps, if you are willing, you can share some of your observations?”

  I nodded. “Is this fair, though?”

  “Fair? How do you mean?”

  “In terms of—what do you call it? Patient confidentiality?”

  The cassette clicked to an abrupt stop; the “rewind” button popped back up. “Ah, Mr. Birdsey, there you go again, worrying about my ethical intent. Listen.” She depressed “play.” Smiled down at the machine.

  “Session with Thomas Birdsey, 2:30 P.M., 23 October 1990,” Dr. Patel’s voice said. “Mr. Birdsey, you are aware I am taping our session today, are you not?”

  A muffled grunt, but unmistakably Thomas’s.

  “Would you speak up, please? Are you aware this is being taped?”

  “Yes, I’m aware. I’m aware of plenty.” He sounded put out. Put upon. But it was a relief to hear his voice.

  “And I have your permission to replay the tape to the people we talked about? Your brother, Ms. Sheffer, Dr. Chase?”

  There was a pause. “Not Dr. Chase. I changed my mind about him.”

  “Why is that?”

  “Because it’s too risky. How do I know he’s not working for the Iraqis? In my line of work, you can’t afford to take chances.”