by M. J. Cates
“Imagine my surprise, Dr. Ganz, to find myself, at the age of fifty-eight, attacked in the most vicious manner by a woman of thirty-two. And who is this woman? How many papers has she published? One. Which is neither about schizophrenia nor manic-depression nor paranoia but about syphilis. I, at the age of fifty-eight, have been director of a state asylum for over ten years. I have published dozens of papers, performed hundreds if not thousands of operations, yet I am called upon to defend myself to a junior member of your staff. A female.”
Ganz tried to interrupt but Bingham was already red-faced and did not notice.
“Here I am dragged away from important work for this utterly trivial exercise. We cure people at Trenton, you know, we actually cure people—and I’m not talking about the society neurasthenics and adolescent suicide attempts you truckle with here at the Phipps. No. I’m talking about hard-core, chronic, full-blown schizophrenics—now able to go home, some even able to work—released from a living death on the back wards. And I am taken away from this work to answer the spurious objections of a girl.”
“Dr. Bingham, please. Dr. Lang is hardly—”
“I don’t see what my sex has to do with anything,” Imogen put in.
Bingham talked right over her. “And a suffragette, no doubt. A professional complainer.”
“Or my age. Or my politics—if I had any.”
“You see how she speaks to me!”
Ganz raised his hands, palms out, for calm.
“Dr. Bingham. Please. Let us conduct ourselves in a spirit of inquiry. Dr. Lang is a highly respected member of my staff and an experienced researcher and clinician who was approved for this task by your medical board and by yourself.”
“At your recommendation. Obviously we had nothing else to go on.”
“Let us discuss the facts of the matter,” Ganz said, “and see where we are. Dr. Lang, perhaps you could begin by outlining how you selected the cases and how you came up with the data in your report.”
Imogen couldn’t help noticing Dr. Ganz’s hands were trembling as he spoke.
“The general plan,” she began, “was to review older cases first, so that enough time had elapsed to judge longer-term results; then to review current cases to illuminate the immediate effects of treatment; and finally to study a group whose results were especially good—by which we hoped to reveal the possibilities of the treatment, the best course.” Bingham was glaring at her like some jungle creature about to pounce, and pounce he did.
“Right there,” he said, jumping to his feet, “right there you have a major error. How can you have any meaningful findings if you don’t first study the rates of discharge before I got to Trenton?”
“My brief was not to study the results of your hospital, but the effects of your treatment. I chose 1920 as the starting point because by then the surgical and dental procedures had been in use for two years and more—time enough to work out the kinks and improve procedures.”
“What do you know about it?” Bingham said. Then, to Ganz, “What does she know about surgery and focal infection?” And back to Imogen. “Do you know the first thing about medicine? How many bones are there in the human body?”
“Really,” Ganz protested mildly, “I don’t see how this will—”
“Let her answer!”
Ganz, apparently cowed, made a note on one of his ubiquitous index cards.
“I don’t remember the exact number,” Imogen admitted.
“You see! Not the first thing! She doesn’t know the first thing!”
“But I can name them. Starting from the cranium, there’s the frontal, parietal, temporal, occipital, sphenoid, and ethmoid. In the face we have mandible, maxilla, palatine, zygomatic—”
Dr. Ganz cleared his throat noisily. “Thank you, Doctor. I think that will—”
“Nasal, lachrymal, vomer, the inferior nasal conchaie. In the ear, the malleus, incus, and stapes—”
“Dr. Lang, thank you. Please resist the urge to continue and let us move on.”
“Rote memorization,” Bingham grumbled. “Proves nothing.”
“The hyoid, the clavicle, the shoulder blade—”
“Dr. Lang, please! The first group?”
Imogen adjusted her glasses and peered at her summary.
“The first hundred were purely consecutive. Of these, I found a 12 percent recovery rate.”
“What absolute trash,” Bingham said. “You can’t expect me to listen to this.”
“Dr. Bingham, please allow Dr. Lang to lay out her findings.”
“Findings? These are pure invention, Ganz! She doesn’t even say what she means by ‘recovered.’ ”
“I do, actually, and the appendix with patient summaries shows clearly what it is not. It is not, for example, Frank Spica—now a vagabond given to tantrums. Nor is it Yolanda Watts—unable to work or even remember where she lives. Nor Miles Conklin, actively paranoid and a neighbourhood pest given to frightening fits of anger. Bessie Jones is catatonic.”
“You spend most of your time in a lab. What do you know about diagnosis?”
“Now is not the time to question Dr. Lang’s credentials,” Dr. Ganz pointed out. “I repeat: she was approved by yourself and your medical board.”
“Twenty-six of these patients are currently in hospital,” Imogen noted, “either at Trenton or elsewhere.”
“Which does not mean they are unimproved.”
“One could not call them cured.”
“They might be cured of functional paranoia and now be suffering from Korsakoff’s.”
“They aren’t. Check the appendix.”
“Twelve percent, Ganz. It’s libellous.”
“Dr. Bingham,” Imogen pressed on, “fully thirty-five of these hundred patients are dead.”
“Meaningless, unless you compare it to other hospitals.”
“Indeed, it is not much out of line with expectations for the severely mentally ill. However, it renders impossible any claim of 85 percent recovery—unless you count death as a positive outcome.”
“Are you being sarcastic with me?”
“I’m simply stating a fact.”
So it continued for the next two hours. Every finding, every assessment, every atom of arithmetic only served to fuel Bingham’s rage. Ganz for the most part remained silent, leaving Imogen to state her case and suffer the fury of Bingham’s replies. She felt like a sapling facing a hurricane, and through it all Dr. Ganz, pale and agitated, made notes on his index cards. They adjourned at four o’clock, having made scant progress, and it was only after Ganz’s repeated entreaties that Bingham agreed to meet the following day.
Imogen went home exhausted, almost stuporous, unable to give the twins the attention they needed. When she failed to stop Aubrey from once again abducting one of Charlotte’s dolls, Charlotte thumped him on the head and cascades of tears, male and female, ensued.
She slept badly. She woke in a sweat from a dream in which a team of surgeons was dismembering a live pig. It had a cat’s face, and turned pleading, human eyes to Imogen, who was unable to do anything but observe. Shaken, she climbed out of bed, heart pounding, and went to the window, pulling the curtains aside. The backyard mulberry tree, slick with rain, looked twiggy and disconsolate. It came to her with three-o’clock-in-the-morning certainty that Bingham was never going to sign her report. He had nothing to gain by doing so, and everything to lose. Her future was slipping from her grasp, and she thought how illusory her sense of control had been. Whether or not her Trenton study would be published, her status, her income, her romantic life (now over for good) were all shaped by forces entirely beyond her control. She curled up once more and prayed for sleep, quick and dreamless, to return.
The Friday meeting went no better. Bingham bridled at every number, took issue with every diagnosis, and insisted on revisiting the arithmetic behind every table. He accused Imogen of extreme bias and, repeatedly, of slander.
“Dr. Bingham,” she said at one point, “you
noted yesterday that I spend a good deal of my life in the lab. Why? Because I too believe it quite probable that underneath every psychosis some somatic cause lies hidden. Infection might yet turn out to be one of those causes, but the question before us is, ‘Do your surgical and dental treatments help, harm, or have no effect on psychotic patients?’ You say they help in 85 percent of cases. My findings say no—those changed for the better being so few that their improvement cannot be ascribed to your treatment.”
“Rubbish,” Bingham snarled. “You’ve adopted idiosyncratic selection methods and ignored standard practice, which is to go by admissions and discharges.”
“Those cannot be reliable,” Imogen countered for the third time, “because administrative changes may increase or decrease discharges where there is no change in mental condition.”
“You’ve picked all the worst outcomes and hold them up as representative.”
“That would be reprehensible, if true, but it isn’t. One group was entirely selected by you personally. Sixty-two patients who, you thought, had shown the greatest improvement. Seven of them are now in other hospitals, fourteen are back in Trenton, and twenty-seven are dead.”
“That’s right, ignore the rest. Very fair.”
Ganz looked up from his index cards but said nothing. What spell had transformed her formidable chief into this dormouse? Imogen fought an impulse to thump him on the head the way Charlotte had hit her brother and send him wailing to another room.
She took a deep breath. “Of the other cases, five are living at home but unimproved.”
“According to whom?”
Imogen read from the summaries.
“Lisa Mark—no initiative, flat affect, deteriorated interests. Mel Perkins—actively hallucinating, delusional, paranoid. Marvin Poole—marked deterioration, memory loss, delusional. They’re all in the appendix, Doctor.”
“Yes, yes. I suppose no one has recovered, in your view. You see, Ganz? She sees nothing but failure.”
“Five patients recovered,” Imogen said. “Three of these, upon admission and according to records, are manic-depressive. Their symptoms display the usual periodicity.”
“And you therefore don’t count them!”
“I do count them, but I note that recovery in such cases is the expected outcome, regardless of treatment. The other two appear to have made excellent recoveries.”
“Very generous of you. Thank you so much.”
“Tabulations for this group are 15 percent recovered or improved, 40 percent unimproved, and 42.5 percent dead.”
“Listen to her, Ganz. She’s a one-woman lynch mob. Tell her she’s got it all wrong. How can you sit there in silence while she tars me with these accusations?”
Ganz roused himself. “You mustn’t see it in that light, Dr. Bingham. These are scientific findings. We are discussing facts, not accusations. We simply want you to—”
A look of horror contorted Bingham’s features and he emitted a choked squeal. Imogen feared a heart attack but he pointed to the bookshelves where a white rat scurried back and forth.
“Oh, for God’s sake,” Ganz said, and called out, “Mr. Penn! Mr. Penn, we’ve got another one!”
Mr. Penn appeared at once, armed with whisk broom and tennis racket. He moved toward the shelves but the rat scuttled between his legs and out the door, Penn bobbing after him in pursuit.
“I must apologize, Dr. Bingham. Some miscreant let the rats out of our psychology lab. They’ve been turning up everywhere.”
“Perhaps we should call Mr. Kromer,” Imogen said. “He has a certain affinity with rats.”
Bingham got up from his chair, red-faced and sweating, and left the office. Dr. Ganz rose and followed him as far as the door. Dr. Bingham was in the outer office fighting with the sleeves of his overcoat.
“We still have more ground to cover,” Ganz said. “No doubt we can all use a break over the weekend, but let’s finish up on Monday.”
Bingham muttered something Imogen didn’t hear and Ganz followed him out into the hall. Imogen packed up her papers.
“What did he say?” she asked when Ganz came back.
“Two-thirty, Monday afternoon.”
“All right then,” Imogen said with a cheeriness she did not feel. “I’ll see you Monday.”
“That went a bit better today, don’t you think?”
“No. I can’t say that I do.”
“Bingham just needs time. It’s hard for him to see things objectively.”
“Till Monday then.”
“Yes, yes. Till Monday. Enjoy your weekend, Doctor.”
* * *
—
Imogen spent all her spare moments of the weekend thinking about the next meeting. She recognized that Bingham’s arrogance and bluster hid a fragile man who truly wanted to help the victims of mental illness. She wanted to reach that man with her findings, with logic, with evidence. But that inner man was defended by a threatened ego that would use every available weapon to defeat that purpose. She empathized with his pain. She too hated to be shown she was wrong, hated to be corrected, and Bingham’s torment was vivid. His agony suffused the room, the fiery flush of his cheeks screaming humiliation.
She examined her conscience to see if she had been disrespectful, or peremptory. She had not. The facts themselves tortured Bingham, no matter how gently she tried to present them. Dr. Bingham, the facts said, you have been a fool—worse, a kind of monster. You are maiming and sometimes killing people who have come to you for help. How could one soften such an indictment?
In the end her fretting was to no purpose. Bingham sent Dr. Ganz a message on Sunday evening saying that his wife was not well and he would be returning to Trenton forthwith.
“I’ve written to the Trenton board,” Ganz informed her Monday morning, “and asked them how they want to proceed. One thing is certain—the report cannot be published until Bingham signs it.”
“If that’s truly the case then you are telling me the whole exercise was pointless—because he is never going to sign it.”
Ganz must have heard something new in her tone. He squinted at her over his reading glasses. “I don’t think we need be quite so pessimistic, Dr. Lang. Perhaps the board will help him see the—”
“And Carl is here to stay, is that the case?”
“I beg your pardon?” Ganz looked puzzled by the sudden change in topic.
“Carl Kromer,” Imogen said. “My husband? You won’t be dismissing him, despite his affair with a student and despite policy and precedent?” She heard, with some alarm, the flint in her tone.
“I told you, Dr. Lang, my hands are tied on that matter.”
“I see. Then I’d best get back to the lab.”
She left his office and walked out past Mr. Penn and into the corridor. She pressed the elevator button but then decided to take the stairs. She was halfway up the first flight when she paused, gripping the marble rail. A minute went by, perhaps two, before she reminded herself to keep calm, to take a deep breath and count to ten. Having done this, she turned and went back down the steps and back to Ganz’s office. Mr. Penn stood up. “Did you forget something?”
Imogen went by him and into Dr. Ganz’s office without knocking. He was standing with his back to her, staring out the window, wreathed in cigar smoke.
“It’s wrong,” she said. “It’s wrong, Dr. Ganz, and you know it.” Her heart was pounding high in her chest and she had to fight to keep her voice normal.
“I’m sorry,” Mr. Penn said from behind her, “she walked right by me.”
“It’s all right, Mr. Penn. Thank you.”
Mr. Penn withdrew and shut the door behind him.
Dr. Ganz puffed on his cigar. “Go on, Dr. Lang. You were saying?”
“It’s wrong to let Bingham continue with his surgeries, knowing what we know. People’s teeth are being torn out, leaving them unable to eat, unable to smile, and stigmatized for life.”
“Many surgeries have unfortunate sid
e effects. Obviously Dr. Bingham is going to weigh those beside the possible benefits of extraction.”
“There are no benefits. You know it and I know it, and now the Trenton board should know it.”
“The agreement with Dr. Bingham was—”
“Why are you hiding behind this ridiculous agreement? Who ever heard of requiring agreement from the subject of a study that finds him incompetent or dangerous? Did you have Donna’s agreement when you fired her?”
“Dr. Lang, you are overstepping. Matters concerning other personnel are hardly—”
“We’re not talking about Phipps personnel. We’re talking about a man who is killing people.”
“His mortality rates are no higher than any other abdominal surgeon’s.”
“Abdominal surgeons are attempting to treat abdominal problems, not mental problems. There are no indications in favour of his performing such surgeries. There is no evidence of benefit and ample evidence of harm. He is wounding and killing helpless people—my study proves it beyond a doubt, and yet you sat there and let him yell at me and call me unqualified the whole time. You let him brush it off as if it were nothing.”
“You exaggerate, Doctor, and your tone is approaching insubordination.” Ganz gave her a hard stare, and she remembered how his eyes had frightened her years ago. She was too angry to be frightened now.
“Bingham isn’t curing anyone. He’s killing people. You must allow me to publish.”
“I have told you—our agreement with Trenton precludes it, under current circumstances.”
“Those circumstances will not change. Dr. Bingham cannot accept the truth. He will not. Are you going to let him continue lying to himself, the world, and his victims? These are helpless people, Dr. Ganz. Utterly defenceless against him.”
Ganz stubbed out his cigar, and looked her up and down. “You are highly excited, your complexion is florid, your voice is raised, and you keep pointing a finger at me. In short you are in the throes of rage and the reason is perfectly clear.”
“The reason is injustice.”
“It isn’t me you’re angry at, Imogen. You’re finally venting your rage against your father. You think it’s against me, but it’s against your father who wronged you so long ago.”