by M. J. Cates
The lecture room was directly beneath the lab, and at 5:45 she locked up and was halfway down the east stairwell when she met Donna coming the other way.
“Why are you coming up? It starts in a few minutes—we won’t get a seat.”
Donna sagged against the stair rail, looking as if she had been shot.
“I’ve been fired.”
“Good God. What for?”
“For daring to refer patients for psychoanalysis. You know, you reach a line with Ganz—there are certain areas of his impenetrable Swiss skull that are surrounded by trip wires.”
“But he believes in analysis, he just—”
“I meant authority. If he senses his Olympian authority is being questioned let alone contradicted he goes berserk.”
Imogen reached out and squeezed Donna’s arm. “Come on. Let’s go for a walk.”
“You don’t want to see Ferenczi?”
“I want to see you.”
“Oh, Imogen.” Donna suddenly leaned forward and kissed Imogen full on the mouth. “You’re the only person in this place who was ever kind to me.”
Imogen, unnerved by the kiss, backed up the stairs. “Wait here. I’ll just get my coat.”
They walked through the evening crowds down Wolfe Street and over to Patterson Park. Baltimore was enjoying a long, beneficent spring and Imogen liked the idea of a stroll around the boat pond, but the area was not safe once it started to get dark. They decided instead on Kauffman’s Pharmacy and Soda Fountain, where they sat at the counter. Donna was too upset to order anything, so Imogen ordered them two strawberry phosphates.
“This place reminds me of Willard’s,” she said. “A pharmacy I worked at in Chicago.”
“It’s probably where I’ll wind up working,” Donna said. Her high-boned, slightly hollowed-out face looked beautiful when sad.
Imogen squeezed her hand.
“You’ll do fine. You were already planning to go into private practice.”
“I’m not ready. I haven’t completed my own analysis yet. Snake says I need another six months to a year. To tell you the truth I don’t think I can finish it with him.”
“Why is that?”
“He’s too crazy.”
“Well, really, Donna—shouldn’t the name ‘Snake’ have provided you with some small clue? Not to mention the naval uniform.”
“He’s a brilliant man, Imogen. A terrific analyst and an even better supervisor. The stuff he points out to me when I’m having trouble with a patient…”
“You’ve been analyzing patients at his clinic?”
“Yes, of course.”
“Well, that’ll be the reason Ganz is so angry. You’re essentially advising people to come to you for treatment outside the Phipps. You must see it’s using the Phipps to further your private business.”
“He’s making a private fortune off the McCormicks. I don’t see the difference.”
“They sought him out—he didn’t refer them to himself. It’s not the same thing.”
Donna took a pensive sip of her soda, and Imogen waited.
Eventually Donna said, “I can’t get over how much this hurts. Personally. I feel worse than I ever felt about any romance, that’s for sure. It’s a rejection, obviously, but losing a job—it’s one’s place in the world. To have it suddenly torn away…”
“You did have some warning,” Imogen said gently.
Donna continued as if she hadn’t heard. “Also—and despite things I may have said—I have a lot of respect for Ganz. His achievements are undeniable. And it meant such a lot to be accepted as part of the Phipps. I suppose I took it for granted. Mind you, I can’t tell you how much I will not miss his idea of a patient history.”
“He is obsessive on that score.”
“He’s a bloody tyrant. All that time probing for fact, fact, fact, when there’s no guarantee any of it is relevant. When you’ve got schizophrenics growing up with siblings who are completely normal—how can you call it a reaction to anything?”
Imogen let her friend go on, uttering sympathetic murmurs from time to time. It felt good to offer a kindness to her friend who always seemed supremely confident, invulnerable, even a kind of champion. She was aware too of some filament of resentment glowing in her heart—that Donna had provoked her own ouster, thus depriving Imogen’s day-to-day existence of her company.
“Well,” Donna said with a sigh, “it might be a good time for you to push for a raise. With me out the door, he certainly won’t want to lose you.”
“Don’t worry about me on a day like this.”
“I can’t help it—I’m practical.”
“Supremely. Very feet-on-the-ground.”
“Donna Artemis,” Donna said ruefully, “salt of the earth.”
Donna had for once read the chief correctly. Having lost one good psychiatrist, he was not prepared to lose another. When he received Imogen’s letter outlining her case, he summoned her to his office and responded with a series of proposals. Behind him, on a shelf, the brain she had brought him from Chicago so long ago floated in its amber jar, still with its Rush label of Dementia praecox.
“I have corresponded with the treasurer’s office and they have agreed to change your official designation to assistant psychiatrist, but they tell me there is nothing they can do in terms of your salary. Unfortunately, we are under severe budget restraints, and they are treating the departure of Dr. Artemis as a chance to save money.”
“Dr. Ganz, you know my situation. I am still paying off what I borrowed to attend medical school. Carl and I have two children to feed and clothe. We have only a tiny apartment, and we’ll be moving into an even smaller one at the end of the month.”
“Oh,” Dr. Ganz said, as if this were cheerful news. “Where is it?”
“On Dukeland Street.”
“I don’t believe I know it.”
“No. Well, you wouldn’t. But even with the lower rent, there are things we just can’t afford for the children, or ourselves, on our current pay. You know I want to stay here, but I may have to seek a position elsewhere if my income doesn’t increase.”
A slight nausea stirred inside her as she spoke.
“Now, now.” Dr. Ganz raised his small hands in a calming gesture. “I’ve not been entirely idle on your behalf. I can make it possible for you to take every other Thursday to teach on a topic of clinical discussion—starting immediately. I’ve also asked Dr. Quinn to arrange with you a schedule of group teaching. And I will get to work on the matter of publication.”
“When do you foresee my being able to publish?”
“I can’t put a date on it just yet.”
“The research will be out of date soon.”
“Yes, yes, I’ll see to it.”
What was there to “see to”? Her results and write-ups on depression had been sitting in his inbox for years. All that was needed was permission. Publishing without his approval was out of the question. The moment it was discovered she had submitted papers without institutional approval she would be fired, and rendered permanently unpublishable.
“How much would the teaching pay?” she asked weakly.
“Each lecture comes with the small honorarium we normally grant guest speakers. And you would be developing new contacts, expanding professionally.”
“Dr. Ganz. The last time my pay increased was when the twins were born. If my work is not valued, then perhaps it’s just as well if I move on.”
“Imogen, please.”
It was the first time he had ever called her by her first name. Ganz took a deep breath and held it, as if deciding whether to continue, then let out a sigh. “There is something coming up that may be of interest to you. It would suit your research talents, and it should pay quite well. But it involves a bit of travel.”
“What is it, exactly?”
Dr. Ganz swivelled his chair and opened a drawer. He pulled out a book, shut the drawer, and handed the book across the desk to Imogen.
“Hav
e you heard of this man?”
13
The author was Rupert Bingham, director of the Trenton State Hospital, and the book was Towards a New Treatment of the Insane. Imogen had not heard of the book, but she had heard of Bingham—she had even met him once, at a conference in Boston. They hadn’t talked much, just long enough for her to form an impression of a rather odd individual. Bingham was about forty-five, pale and puffy, with sad, suspicious eyes.
His book was an explication of the focal-infection theory, the idea that, contrary to the concept of psychogenesis, the cause of mental illness might well lie in infections of the teeth, tonsils, colon, or other sites. It was a theory that had been gaining ground in Europe, notably in England, where it had several distinguished champions. But Bingham’s book was dry and full of jargon, which may have been why it hadn’t attracted much notice.
Imogen read late into the night, Carl softly snoring beside her. In painstaking detail, Bingham laid out the context in which the theory of focal infection had developed. After thousands of years there had been discovered to date exactly one cure for madness, a drug called Salvarsan, which followed on the Germans’ discovery that syphilis was caused by a spirochete. Paul Ehrlich found that if he dosed the patient with this compound—even someone in the tertiary stages of the disease, who was hallucinating, delusional, with the beginnings of paralysis—he could cure them. Overnight, half the long-term beds in the asylums emptied out. The cure made headlines around the world, and it was the beginning of the near certainty that all mental illness would eventually be found to have a biological cause that could be treated. (It had also been one of the reasons Imogen had dreamed of working in a laboratory as well as with patients.)
It made perfect sense that other forms of mental illness—manic-depression or schizophrenia—could stem from similar infections. The teeth and tonsils, Bingham pointed out, were proximal to the brain; infection could easily migrate from one locus to another. Or it might be located in the bowel, the womb, or other large organs, where it would infect the whole bloodstream and thus the brain. Imogen found his thinking both clear and reasonable. He was not ruling out psychogenic causes of madness, but seeing them as likely catalysts rather than causes. A broken heart or a financial reversal, say, might cause endocrine reactions that in turn sparked a chronic low-grade infection to become virulent.
Bingham gave credit to Frank Billings and others for their work, but Imogen quickly realized that what made Bingham unique was his position as the director of a major state hospital and his determination to transform it into a research centre. At Trenton, he was treating chronic patients with radical dental extractions, sometimes removing all of their teeth, and abdominal procedures that included hysterectomies, bowel resections, and, in extreme cases, removal of the gonads. The results were astonishing. Trenton now claimed a cure rate of 87 percent, an unheard-of figure.
* * *
—
Imogen couldn’t wait to hear more from Ganz on the subject, but he was unavailable until five o’clock. They met in his private office.
“Here is the situation,” he said. “The budget for the Trenton asylum is up before the state legislature. Dr. Bingham has lately taken to the newspapers and magazines announcing his results in public, rather than in the appropriate journals—no doubt hoping to encourage approval.”
“He’s certainly getting dramatic outcomes,” Imogen said, “assuming the numbers are correct.”
“Exactly. And the legislature wants to be sure they are accurate before approving an increase, so the board has asked me to appoint someone to conduct a scientific study and deliver a report.”
“This would mean evaluating discharged patients to verify results?”
“Yes. It could be quite time-consuming. But you’d be well paid, and your report is guaranteed an interested audience. Remuneration and publication could come together nicely. Would you like to take it on?”
* * *
—
Carl came home late, when the twins were already asleep. Imogen told him her news as she was setting out his supper for him on the kitchen table. She expected him to be happy for her—for what it meant to her career and, not least of all, what it would mean for the household income. But he astonished her by becoming angry, even raising his voice, something he had never done with her.
“Trenton? You’re going to Trenton? That’s half a day on the train—you’ll have to stay overnight.”
“It’s about five hours. I checked the schedule. There’s a train every hour on the hour.”
“You’ll still have to stay overnight.”
“At least two nights, sometimes three, I imagine.”
“It may have escaped your notice,” he said, “but we have two children to raise. Bad enough you insist on having a job and leaving them in the care of a Negro.”
“Oh, for God’s sake. Negroes have been caring for white children forever.”
“That’s not the point. The point is, you are going to vanish from their lives for three days a week and you don’t even seem to care.”
“Of course I care. Do you think I want to travel every week? You think I’m dying to work in a state asylum? I’m doing this for the children and for us. We need the money, Carl.”
“But you’ve already agreed to take it on, and we haven’t even discussed it. You’ve never even mentioned Trenton State Hospital to me.”
“I only just heard about it. I’ll be conducting a major study. It will get me published, possibly even noticed, and that will mean a higher position.”
“Ganz promised you this? A higher position?”
“Not exactly. But I’ll never get one if I don’t publish. You know I have to. You publish all the time.”
“Because I do a lot of experiments.”
“Because you don’t have to go through Jonas Ganz. He’s been sitting on my research for years. Literally years, Carl, and I don’t know why. It’s not personal—he does it to other people, too—but he won’t be able to sit on this, because someone else is paying for it. The Trenton medical board. They need independent verification of Bingham’s results and they’re willing to pay.”
“And you’re just going to take off. Just like that. Leave me, leave the kids.”
“Carl, this is upsetting for me too. I hate being apart from you.”
“Apparently you don’t.”
“Please don’t say that. I don’t want to be away from the children either.”
“If that’s true, why did you rush back to work a few days after they were born?”
“Carl, it was five weeks, not a few days.” Thinking, dear God, it was years ago. Can he really be harbouring such resentment all this time?
“They’ll be in kindergarten five days a week,” she said. “Myra can pick them up and look after them in the afternoon and early evening.”
“And I’m to be their nanny the rest of the time.”
“No, you’re their father all of the time. If you don’t think that carries any responsibilities then you’re not much of a father, are you?”
She’d said it gently, but it provoked white heat.
“You dare say that to me? I take my responsibilities seriously, Imogen. It’s why I work day in and day out—all the extra hours I work—it’s to try and make some kind of life for us. Don’t you dare lecture me about responsibilities.”
Carl was sullen for days, leaving the house early and coming home even later than usual. Imogen took to keeping his supper in a double boiler for him to heat up when he got home. In his absence, she read the children stories, hiding her sorrowful heart behind the works of Hans Christian Andersen, Beatrix Potter, and Lewis Carroll. She read to them from the beautiful edition of Alice that Quentin had given her, and when they fell asleep she rested her fingers on the inscription Quentin had written in his machinelike script, To Imogen, with all my love.
That Friday, Carl came home around nine. She heard him setting out his dinner and then putting the dishes in the sink bu
t when he came to bed he opened a book and barely responded to her. It was as if she had damaged her exuberant husband with the brute force of her selfishness, and it pierced her with guilt.
She reached over and touched his arm.
“I’m sorry,” she told him. “I’m sorry I didn’t discuss the Trenton offer with you before accepting it. I should have, and I’m sorry.”
Carl gave a noncommittal grunt. His gaze remained on his book but she could see he was no longer reading it.
“If you really want me to, I’ll tell the chief I can’t take it. He knows I need some time to arrange child care and to read up on Bingham’s work and so on—he won’t have told the Trenton people yet. If my taking this job makes you think less of me, I won’t take it.”
Carl closed his book and looked at her.
Neither spoke for a while. Then he said, “I won’t think less of you. I don’t know why I reacted the way I did. I think I was just shocked and scared. I mean, I was unprepared, you know.”
She squeezed his arm. “I’m sorry.”
“And I hate being apart from you. And I’m terrified the kids will be miserable and I won’t know what to do.”
“They adore you. They’ll be perfectly happy.”
“They won’t. You know that.”
“Look, they love Myra, and Cynthia can look after them if you need to get out once in a while.”
“I know. But they’re going to miss you terribly.”
“They’ll get used to it. It’ll only be for a few months. I’ll always be home on weekends, and I’m going to try to never be gone more than three days at a time. But still. I’ve come to see it from your side and I’m prepared to give this up if you think I should.”
“Well,” Carl said, “first of all, you’re right that we need the money. Second of all, you’re right that it’s an excellent career opportunity. Third, I reacted with panic and I’m sorry too.”