A week later Martin received a letter from the former church auditor stating that he was going through hard times and that he imagined Martin might ensure allocating some of Edina’s estate to provide for him.
Martin rarely felt anger but, on reading the letter, his hands shook with anguish and fury, and, for the first time since Edina’s death he cried uncontrollably.
BELLA’S DEPRESSION
Bella had been feeling very depressed after a colleague at work had outwitted her in attracting a client. Depression was a common state for Bella and generally marked by her going to her unmade bed with a box of chocolates. Chocolates for gorging and then disgorging. In the past requiring a finger or two down her throat, but now almost by will. Into the basin. Although, in more severe states of depression, Bella would just vomit into a towel beside her bed, not averse to the smell of semi-digested chocolate.
MARTIN’S DEPRESSION
Martin’s deep grief lasted two weeks. During the first week he read Joan Didion’s book The Year of Magical Thinking. Just as she advocated – that those grieving should Read, learn, work it up, go to the literature – he sought to intellectualise the process and get distance from the raw pain.
His grief was physical. He was aware of tightness in his belly – as if something was gnawing away at it – and a cavity in his chest, with the cavity expanding into the world. To create a void. As captured by Didion: A single person is missing for you, and the whole world is empty. He no longer had his rock, the person who had always been there corporeally for him, respecting every major decision he made in his life and caring for him unconditionally.
During that fortnight he worked more intensely at the practice, finding that caring for others reduced the sense of emptiness. Friends had Martin and Sarah to dinner most nights, with their camaraderie lifting the chill that would occasionally cause him to shiver. At night in bed his grief became agitation and he hugged Sarah tightly – his lifebuoy – to feel her strength and settle the waves of profound perturbation.
After a fortnight his grief turned more to a sense of sadness. The rosy glow he had carried through life had been lanced and deflated by the deaths of his sister, father and mother, as well as by the reality that he would never be a parent and it was, in Oscar Wilde’s terms, a time when sorrow seems the only truth. Each of those losses had stripped him of some of his definition.
To his patients (and he had asked the secretaries to inform only some about his circumstances) he appeared fine or perhaps just a little sad, to his work colleagues he was a bit preoccupied as would be expected, while Sarah felt a deep sadness emanating from him and she tended to call him Martin rather than Sunny. Later she would say that it was ‘as if he had entered a labyrinth’.
Sarah felt lost and apprehensive. Apprehension made worse by her intention to fly to London to give a conference talk in a few weeks – a mark of her increasingly successful career as a health administrator. She now contemplated cancelling the trip.
Some two months after Edina died Martin woke having a panic attack. While he had never experienced one previously he knew the characteristics. He took a shower to see if this might ease the profound panicky feelings. His heart was racing and he checked his pulse. Eighty-five. Higher than his usual sixty. He felt quite nauseous. There were tingly feelings in his arms, a sense that ice was running through his veins, while his chest was pounding and he felt he couldn’t breathe – sensations that caused him to overbreathe. He felt like the walls were closing in on him. Increasingly, he felt lightheaded and faint. He thought he was actually going mad. He wondered whether to wake Sarah but decided not to worry her. His analytical brain raced across options that he might recommend to patients, but his innate fight-or-flight impulses made it hard for him to decide what he might best do.
He dashed to the kitchen, found a paper bag, made a funnel and started to breathe in and out, seeking to raise his level of carbon dioxide, although he knew that this traditional strategy was no longer recommended.
After three minutes the panicky state had settled somewhat. He tore on his running clothes and sneakers, opened the house gate and started running – at times sprinting – around the streets of Turramurra.
Runners coming from the other direction signalled their communal status, sometimes with a gesture or sometimes a monosyllabic word of greeting. They all appeared intense and Martin wondered how many of them were also trying to abort a panic attack. After thirty minutes Martin felt exhausted and he sat down, panting heavily but otherwise calm. He walked home slowly, showered again and went to work, leaving Sarah asleep.
He felt rather strange that day, and somewhat cut off from the patients. It was harder to feel their distress. It was also harder to feel the joy radiated by a woman who had brought her baby to the surgery for his immunisation needles and was clearly delighting in being a new mother.
When he joined two of the doctors for morning tea in the kitchen he found them too chirpy and he felt more like an observer than a colleague. He slipped out quietly before finishing his tea. A sense of panic was swelling again and he checked his pulse several times. He tried to refocus by taking detailed histories from the next few patients but was aware he felt quite foggy. It was hard to take in information or to retain it. He was aware that his work performance was somewhat compromised, presumably a residual effect of the panic, and he thought it might be wise to cancel tomorrow’s Saturday surgery and try to get on top of the panic by strenuous exercise over the weekend.
That night he felt a deep sense of foreboding and he was struck by a profound sense of what he described as ‘psychic analgesia’, a sense of numbness. He felt he was falling into a bottomless pit. There was a complete lack of joy, as his mood ranged across a field marked by poles of sadness and total despair. He was unable to experience any pleasure, even to taste. Sarah had cooked cutlets, one of his favourite meals. After three bites he had no appetite for the meal, even when he added extra mint jelly. Worse, the meat seemed offensive, giving off a slight metallic taste that made him want to gag. He pushed away his plate. Sarah looked quickly at him. Astutely.
‘Martin. I’m concerned…’ and stopped as he turned his head towards her and she saw directly the unmasked despair in his face. Martin patted her arm.
‘Thanks, Sar. I’m in a bad space but having you around does ease it.’
She hugged him, seeking to infuse warmth, bodily chicken soup and her love. ‘I don’t think I’ve ever seen grief so severe, so tormenting, Martin.’
‘We’ll get through it.’
She nodded her head. ‘I’ll cancel my trip.’
‘Don’t do that, Sar. It’s important for your career.’
‘There will be other meetings.’
‘But London…Not go to London?’
She waved one hand. ‘It’s not important in the scheme of things.’
Martin sought to smile. ‘Decide later. I beg of you.’
Sarah reached out and rubbed his hand. ‘Can I get you something?’
‘I’m not sure.’ Martin stood up to walk but immediately felt a sense of being weighed down, of dragging his own shadow behind him. He felt impelled to lie down. He lay on the lounge, fidgeting with the sound system, trying to find some background music to ease his sense of being in a Hadean prison. Sarah hovered in the kitchen, washing up, tidying the larder, looking over at Martin every few minutes. Later in the evening he asked her to come and lie with him, and he pulled her close to him for a minute before sighing and letting her go, as if even she could no longer sustain him.
‘I’ll sleep in the other bedroom, Sar. You take our bed. I don’t want to disrupt you during the night.’
‘Are you sure?’ While Sarah was aware she was being rejected she did not judge it as personal but almost entirely as a reflection of Martin’s awareness that he was somewhat beyond her help and, being considerate of others as ever, not wanting to impose his pain on her.
‘Absolutely. Sleep well.’ Martin turned over, his right hand
hanging limply from the couch. Sarah retreated, slowly.
‘Call me if you need anything.’ There was no response.
A few minutes after Sarah left, Martin rose and began to pad around the living room, the hallway and then their spare bedroom. He went to the bathroom several times. Looked in the mirror.
It was him in the mirror but not quite him, more a shell, with his inner him – or core – lost.
Over the night he oscillated between agitated pacing and trying to sleep. In bed, he lay looking up at the ceiling for long periods before raising his upper body and slumping to one side or the other, as if sleep would come if he found the right position.
Their dog, Captain, who usually slept in the kitchen, moved into Martin’s bedroom and nuzzled him during the night on several occasions. The noises coming from the street appeared magnified and further stopped him falling asleep. He contemplated whisky, even sleeping tablets, but decided he had to overcome this state himself. On several occasions he whispered a mantra that he offered to many patients. This too will pass. But to what point if everything seemed pointless and futile?
The clock near the TV seemed so loud. He wanted it to stop. He put the clock under a pillow on the floor and filled the ensuing silence with worrying thoughts. He needed to pay a bill online the next day, the lawn needed mowing, several patients needed urgent reviews of their pathology results and should he ask Sarah to cancel her trip? He needed her but when she was around he felt a need to stay away from her. Partly his need to be alone and partly feeling he might be toxic if not infectious. He mused that he was feeling a profound feeling of doom. What was the cause of this sense of dread? It occurred to him that doom was mood spelled backwards.
At three a.m. he jolted awake and knew he was sentenced to no more sleep. At six a.m. he truly appreciated the aphorism that the night was darkest just before dawn, and in that dark room he continued to develop negatives, about himself, his future and the world. He became aware of birds fluttering their wings in the trees, imagined now by him as dead trees giving no shelter in a T.S. Eliot wasteland world.
The birds were making their early morning calls. Usually chirpy and uplifting, but now more like mourning calls. The crows sounded particularly forlorn and Martin counted their cries. Would they be grouped in threes, the Celtic harbinger of death?
Just after seven Sarah appeared, still in her pyjamas, clearly worried. Martin looked so much older.
‘Did you get some sleep, Martin?’
‘Some,’ he responded, trying to override his disconsolate voice tone. ‘I’m so irritated with myself, irritated I’m not pulling my weight.’
Sarah hugged him, covering his shrivelling body. She stated that she was going to get him an appetising breakfast and they would then go for a drive – she would drive – to get out of Sydney.
On their way back – having spent several hours on the ferry cruising Pittwater with the sun shining and the skies a cloudless blue – Martin expressed his concerns.
‘I have a pervading sense of dread. And when I see people going about their day, getting pleasure from simple things, it seems so foreign to me.’
‘Are you sure it’s grief?’
‘It’s grief.’ Stated abruptly and with such an emphasis as to disallow any further discussion. And I’m concerned about my capacity to work next week.’
‘You don’t have to go to work. You are allowed to have time out.’
‘But what reason could I offer? “Grief” sounds so insipid.’
‘Say you’ve got a migraine.’
Martin shuddered inwardly. That was his father’s excuse for going to his bedroom and not being able to get to work.
‘It wouldn’t cut it. I’ve never had a migraine before.’
‘Should you talk to Dave? Or would you like me to talk to him?’
‘No. He’d feel he had to pitch in and take my patients. That wouldn’t be fair.’
Martin chose to go to work. It was a week marked by nights of little sleep. He dreaded going to bed, fearful of the endless nights, eased minimally by the vigilant Captain sitting at the side of his bed, occasionally pushing himself against Martin’s leg when he got out of bed. He might fall asleep for an hour or two – with sleep not cancelling the negative self-talk and irrational thoughts. Then, almost invariably between three and three ten a.m. he would be completely awake. One night he morbidly recalled the Scott Fitzgerald observation that In a real dark night of the soul it is always three o’clock in the morning. The watching hour. The hour when some malevolent predator would attack. Martin’s mood was black, bleak and sometimes Blake – ruminating over Blake’s mantra that Some are born to endless night. And other T.S. Eliot allusions came to mind. He felt he was one of the hollow men, the stuffed men…showing shape without form, shade without colour, occupying the dead land and that This is the way the world ends. Not with a bang but a whimper. Over that period of the night he felt he existed only as a shadow, between the essence and the descent. But, an hour or two later, he would force himself out of bed, go straight to the shower, turn the tap on at full force, at times too hot, seeking to feel something, preferring pain to his psychic analgesia. After a slice of toast and a cup of coffee he would be out of the house, out before dawn, out before the lamentations of the crows, at the practice before six, determined to spend the hours before seeing patients catching up with the paperwork. While he could readily turn on the computer it was hard for him to boot his brain, his mind being mushy, his thinking slowed by mental flotsam, and finding even the tap of the keyboard irritating. He would try to process the paperwork for an hour but then, frustrated by the mindlessness of most of the tasks, and by his sense of impotence, he would sweep papers into his desk for handling the next day and lie inert and Hopperesque on the examination couch until the receptionist buzzed him for the first patient of the day. He could only crawl this marathon.
Patient consultations continued to distract him partially. He might repeat a question on occasions, stutter in talking to a patient or be less precise in offering his diagnosis and management recommendations. Sometimes his hand would shake when he was writing a prescription and he developed some postural strategies to prevent the patient from noticing. He avoided the tea room – and Dave Bradbury. At lunchtime, he went for a solitary walk. Once home he went straight to the lounge or the spare bedroom. His nihilistic reports to Sarah about his day were repetitious.
After a week of this, on a Monday morning Dave Bradbury took the place of a cancelled patient, gliding into Martin’s consultation room as a patient left, hoping that Martin might wish to talk things over. He said nothing for ten seconds, just looking at Martin.
‘Hey, Sunny. Have you been reading Kafka again?’ His tone overly light-hearted.
Martin smiled gently. ‘I don’t know what to say.’
Dave spoke gently. ‘I’m worried about you, mate. Your lights have gone out.’
A possible diagnosis? thought Martin. ‘What do you mean?’
‘You just don’t look OK. You’re too in yourself, in your own world. You look as though you’ve stopped being yourself…if that doesn’t sound too Irish.’
Another nobody home reference. Martin was aware he’d lost the one thing he thought could never be taken. Himself. But he simply offered, ‘It’s been a bit of a rough month.’
‘Sure, Sunny, but you look so dark that I’ve been actually thinking that you might be depressed…’
Martin cut him off. ‘It’s grief.’
‘It may well be, mate. I’m no shrink, but I think you should at least consider the possibility. Is there any way I can help? Have a chat? Go on a pub crawl? Hit a few golf balls?’
‘I’ll get on top of things, Dave.’
‘I’m sure you will, mate, but we doctors are poor at looking after ourselves. Patients assume we’re immortal and they need us to be rock solid. They can feel rattled if we’re discombobulated. Even if our hands shake.’
Martin smiled wanly again. ‘Thanks, Dave.
I’ll get back to you…and I really appreciate you dropping by.’ A gentle sign off.
He clearly wished Dave to leave. Dave stood up, walked to Martin, shook him by the hands and cupped one arm on his shoulder. ‘You look after yourself, old mate. Silence isn’t always golden. I’ll check in with you this arvo.’
Martin sat down, troubled and dismayed. He felt his heart racing and quickly started counting his pulse. Depression? He had contemplated the possibility but considered it unlikely. Much more likely to be grief. Severe certainly. Grief was normal while depression was pathological. His had been made worse by the panic attacks. And he now felt even more panic. He checked his pulse again. The Les Murray quote about the depressive’s salute came to mind…when you’re holding your pulse. He could not remember whether Murray was referring to depression or simply to panic. He googled and found a 2006 Kerry O’Brien interview of Les Murray – the poet who had been invited to draft a preamble to the Australian Constitution. Murray described his depression as a black dog that hunted me fairly badly in the 1980s and ’90s and I’m trying to get out of the habit of feeding him. And detailed the depressive’s salute. Holding your pulse and wondering, Am I going to drop dead this minute or next minute?
Martin hunted through the literature on depression during his lunchtime that Monday. He had no appetite for lunch. He remembered how struck he had been by William Styron’s description of his depression. He had kept a copy of the Vanity Fair essay ‘Darkness Visible’ in his files of ‘Memorable Scribbles’, and after finding it, he flicked through it again. Phrases were underlined but he could not remember why he might have done so. Or why he had filed the copy.
In Two Minds Page 7