In Two Minds

by Gordon Parker

  He re-read how Styron had set out to describe the indescribable – a feeling that he was suffocating or drowning, becoming like a zombie and not able to walk or talk properly, confusion with memory lapses creating a helpless stupor, intense self-hatred, all turning the individual mad, stricken by their brain malfunction – now an organ in convulsion. Styron ruing that the term brainstorm had already been taken.

  Martin then went to one of his psychiatric textbooks and read the sections on depressive disorders, searching for the classification that best fitted. Major depression was too nebulous. Melancholia seemed more likely, replacing endogenous depression. Yes, this was the diagnosis given to his father. But melancholia was quite variably defined. Hippocrates described it more than two thousand years ago. Martin was intrigued that his original description including panic attacks as well as mood despondency. Key features seemed to be psychomotor disturbance, anhedonia, anergia, insomnia, even abulia – the last, a lack of volition and will. He had them all.

  Martin rarely swore. Now he did. Shit, shit, shit! The swearing loosened the brakes on his emotions. Things fitted. His grief must have morphed into melancholia at some stage. Melancholia, a genetic condition. It had led to his father’s death. It was a lethal disorder. In the last few weeks he had contemplated death – in fact he had longed for death at times – but had not been actively suicidal. The qualifier was central. It was the difference between life and death.

  He smiled quietly at the irony of having treated patients with melancholia and not diagnosing it in himself earlier. Most of those patients had done well over the years, although three had killed themselves. One woman had responded completely to a tricyclic antidepressant on four occasions. When she had consulted him during her fifth episode, he had reassured her that it would again bring her out of the depression in a week or so. It was rare for someone to respond so quickly but she was certainly one of the lucky ones. She – and her husband – had appeared reassured. And yet, a week later she had killed herself. Had taken an overdose of his prescribed antidepressant. A mother of three adolescent children. He remembered visiting her home to offer his condolences to the family and how each of the children had stared at him with disdain. He had failed. And Robert, his father, a committed believer, a man with extraordinary resilience, and yet he had set out to kill himself and even take Martin with him in some apocalyptic depressive psychosis. Might that not be his fate?

  Martin knew what he had to do. He went to his drug cabinet, the drawer where he stored medications brought by pharmaceutical company representatives or returned by unsatisfied patients. He fossicked about and shortly found what he wanted. Packets of a tricyclic antidepressant, both the 25 milligram and the 75 milligram capsules. He placed them in his briefcase and then asked the receptionist to send through his next patient. He was scheduled for a long Monday afternoon surgery and wondered how he might escape that responsibility.

  Morbid thoughts multiplied in his head until a quote arose from Dylan Thomas’s villanelle. He remembered Edina giving him the academic grounding. The structure, Sunny, has been used by so many famous poets. Auden, Thomas, Plath, even Joyce. A nineteen-line poem, in the English form at least, two repeating rhymes and two refrains, five tercets followed by a quatrain, first and third lines of the opening tercet are repeated alternately in the last lines of the succeeding stanzas, and…

  Despite his mental fogginess he remembered her definition word for word, and now he rolled Thomas’s opening words to his great villanelle round in his reflective thoughts. Do not go gentle into that good night. The words became a challenge to Martin. He felt a sense of peace and of resignation. He would not go gently. If he’d go, it would be with a bang.

  FORTUNE FAVOURING THE FORTUNE HUNTERS

  The Trophettes had survived as a quasi-informal club for over a year. They had their own motto – Where there’s a will there’s a way. It was impossible for most members to attend regularly as most spent months overseas, and there were other distractions such as weddings and divorce court actions (their major hold ’em and fold ’em events). But as they had so many women on their waiting list they had been able to grow the membership. So much so that it had led to a debate on whether or not to set up satellite clubs or even establish a franchise.

  Nancy had argued persuasively against both propositions. ‘Small is beautiful,’ she counselled them. She was also against the suggestion that had come from their biggest stirrer – that they set up an online social networking site, qua faceliftbook. In relation to social media, her policy was ‘We zip our lips.’ It was hard enough controlling their own meetings. Their first door bitch had been excellent at checking off Trophettes as they arrived but had walked off with their one and only membership list after having a hissy fit with Olivia, their Mistress-at-Arms. Their recently appointed door bitch was less skilled in recognising arrivals. Hair changes, cosmetic surgery and what time of the month it was for their botox injection made it hard at times to know who was who. But the bigger problem was in recognising co-members off site. This had led to a lengthy discussion about having their own signature greeting, akin to the Mason’s handshake.

  ‘How about a double air kiss but just to one side of the face?’ one Trophette had suggested, then wondered why people appeared puzzled.

  ‘How about three air kisses?’ a rather green Trophette had offered.

  ‘Or four. With a pike,’ laughed another.

  Eventually it was agreed that, instead of a double air kiss followed by the trendy but so blah mwah, they would tweak that vocal to meow as at times they did like taking the piss out of themselves and it fitted with their commitment to pussy power.

  Bella had attended only the inaugural meeting, when she had felt patronised by Nancy. In recent weeks she had wondered whether she had overreacted, and a recent picture of a serene Nancy in a newspaper gossip column rekindled her interest in Nancy as her mother figure. And so she went to the July meeting, keen to see if Nancy would apologise to her, and hopeful that Nancy might allow a special friendship to grow.

  Nancy noticed Bella enter the room but was preoccupied by three women demanding her attention. Bella picked up words from one flushed woman, ‘I’ve never met a more rude, abrasive, dismissive and condescending…ungrateful bitch… masquerading…utter disgrace,’ with the other two adding riders in softer voices. Nancy let them talk themselves out, offered a comment in summation and excused herself. She walked towards Bella but then veered off to get her speaker notes.

  Bella called to her. ‘Nancy! Do you have a moment?’

  Nancy turned. ‘Not really, Bella. Sorry.’ Her face was set firmly. ‘I hope you enjoy today’s meeting,’ and she waved her finger as she walked on. ‘And no fireworks I hope, Bella.’

  Bella’s blood boiled and she felt like punching the wall. Instead she went to a toilet cubicle and stayed there for fifteen minutes, alternately crying and seething, before going to the meeting room and taking a seat in the last row.

  After the tutorial – on ‘How to pre-empt a pre-nup’ – had finished, Nancy presented her News and Notes. She overviewed the year and her plans for the next twelve months. She was going to invite Kathy Lette, author of How to Kill Your Husband and Other Handy Household Hints, to give a talk when she was next in Australia. Next month’s scheduled talk would be by Carol, and Nancy indicated she wanted to brief the Trophettes in some detail as the content might involve a legal precedent. Carol had married an elderly accountant, which enraged his children. They had hired detectives and lawyers and been delighted to find that Carol was already formally married. Carol was irritated with herself for such a slip but furious with the children for having notified the police, which resulted in Carol being charged with bigamy. Carol’s plan was to plead guilty to the charge but to have her barrister present a mitigating argument. To wit, that she had a dual personality, with one persona being quite unaware of the other persona and of their respective partners. Her barrister would argue – after presenting multiple psychia
tric reports about her split personality – that she had not engaged in any culpable misbehaviour as her persona were prone to vary from day to day and that she had acted according at the time of the proposal to her conscious unmarried persona. Nancy went on to note that this was the first case for the Trophettes to act collectively, and invited volunteers to appear in court over the next fortnight and give evidence they had observed her showing different personalities. ‘As a bonus, girls, there will be lots of media attention. It should be a real hoot.’ And, of course, Carol was sketched in to give the first talk of the year on ‘The Life and Lives of a Plural Wife’. Nancy made them all laugh by wondering aloud whether Carol One or Carol Two would give the talk and as to whether she would need one or two seats in court. Nancy finished by announcing she was keen to initiate a Trophettes Annual Trophy Challenge Award (first prize being a gold digger trophy) and that she would appreciate options for the contest.

  Bella mused. Asinine really. Like girls at school. But she had recorded Nancy’s detailing of Carol’s strategy on her phone. She would send a copy to the prosecutor after Carol had given evidence. Nancy had no need to worry about fireworks. She’d soon know she had stepped on her own landmine.

  ONE MINUTE TO MIDNIGHT

  At three p.m. on that Monday afternoon, Martin asked a receptionist to cancel the rest of his afternoon list, aware that, in the preceding hours, he had been unable to feel anything towards his patients. He was no longer for others. It was an inflection point, when his nature changed and his thinking moved to a non-rational domain.

  Dave had just popped in. ‘Hey Sunny, everything all right?’

  Martin said, ‘I’m fine. Leave me alone. I’ll deal with it myself.’

  ‘No problem, old mate,’ Dave said, closing the door behind him.

  Martin’s world became entirely self-focused. He would determine what he had to do and, if that confused others, they would have to work it out themselves. He had lost himself and become a victim. He was in autopilot survival mode. Did he really want to survive? His life force was spluttering, at risk of being snuffed. He was not able to think about other people, unless cynically. He ruminated about Sarah leaving him, travelling overseas to some meaningless conference. He was compromised as a medical practitioner, risking harming rather than helping patients. He should report himself to the Medical Board as a medically impaired doctor. But, if he did, he would be deregistered. He would lose his vocation, his passion, and he would be left with contempt for himself. Which would be made even worse by the contempt Sarah would feel for him. No, he would not self-report to the Board.

  Martin left the practice and sat in his car for several hours, contemplating options. One minute to midnight, was his thought as he finally started the ignition with the intention to drive out of Sydney. Initially without any destination, but then drawn towards the northern beaches. Examining trees and telephone poles on the side of the road. He had the tablets in his bag. Melancholia had killed his father. After years of fighting it, it had brought about his death. Was that not his fate? If so, why fight it?

  His mobile phone rang, startling him, the volume set too high.

  It was Sarah. She spoke softly but urgently.

  ‘Martin. I’m worried about you. You haven’t called all day. Please come home.’

  She was crying. It punctured his self-focus. He responded softly. ‘Thanks, Sar.’ After a few seconds he added, ‘I’m on my way.’

  Martin pulled the car over and wept. His tears gave way to sobs, shuddering wails accompanied by a jumble of thoughts, memories and images. He smacked himself across the face and gave himself a minute to get under control.

  Now driving in the direction of home, Martin gripped the wheel, the muscles in his forearm flexing.

  Sarah was waiting in the drive, wiping her eyes as he arrived.

  ‘I’ve been worried. I hadn’t heard from you and it’s late. Nearly eight o’clock.’ She smiled at him, clasped his hand and walked him into the house. ‘You’re cold,’ she said with concern.

  He hugged her, and they walked inside arm in arm, before sitting around the kitchen table – the usual setting for their now rare deep and meaningful talks. While he still felt on autopilot, Martin recounted his talk with Dave and how he had come to the realisation that he was now experiencing a severe depression.

  He added quietly. ‘Melancholia I believe.’

  Sarah cried again. ‘Sorry. But I’m relieved.’ She shook her head and appeared bemused. ‘You’re a doctor, and yet you made the diagnosis from a poet and an author. Styron?’

  Martin smiled wryly and spoke with hesitation. ‘The textbook helped but I had to feel it…from people who had actually experienced it and could put it into their words and…’ He shrugged.

  Sarah smiled back. ‘So you need to see someone, Sunny.’

  ‘I’m not going to discuss issues with Dave or anyone in the practice.’

  ‘No, I meant a psychiatrist. You know who’s good and, being a doctor, you’ll get in fast.’

  Martin looked directly at her. ‘I’ll toss around some options tonight.’

  He got up, put his arms around her and the two rocked for a minute. Sarah seeking to infuse some life into Martin who, in turn, wanted to draw some élan vital from Sarah but knew he could neither receive nor transmit. He pulled back slowly and indicated he would read in the spare bedroom that had become his cave in recent times. Sarah asked him to guarantee that he would call her at any time.

  In the bedroom Martin paced around for a while. He lay on the bed for periods, picking up a book and reading a page or two. But then he would get out of bed, seeking to keep morbid thoughts at bay. Captain would try to nudge him back into bed.

  Martin contemplated a paradox – while lacking real feeling, he had become even more empathic than usual to several of his really struggling patients. He wanted to cry with them. Abruptly he remembered a colleague with depression who, in the weeks before he had killed himself, had gone to drink with some of his skid row patients in their doss house. Such behaviour had appeared inexplicable to his colleagues, but it now made sense to Martin. It struck him that one antidote to self-pity was compassion but he failed to understand the real nature of the paradox.

  At eleven p.m. that Monday evening he opened his medical bag and took out the tricyclic capsules, debating how much rather than how many he would take. He would usually prescribe a starting dose of 25 milligrams and build it up to 150 milligrams over two to four weeks. But his agitation fuelled his desperation. He wanted to take a 75-milligram capsule but, concerned that it might be too sedating and prevent him getting to work the next morning, he chose the 25-milligram option. After pacing and trying to read for another hour he turned off the light and lay on his back, arms behind his head, preparing himself for another night without sleep and trying to remember the drug’s side-effects.

  He woke at five a.m., his mouth dry and, when he slid slowly out of bed, was slightly giddy. He had slept for much of the night, drugged sleep admittedly but without T.S. Eliot nightmares. He felt a frisson of expectation as he showered.

  Driving to work his mood was a little lighter. But, by eleven, he had reverted to the depths that he had occupied for weeks. He had, however, a sense of hope. That night, arriving home, Sarah asked him about his mood and he reported the slight improvement. She spoke softly.

  ‘Have you made an appointment to see a psychiatrist?’

  Martin looked past her. ‘Not as yet.’

  Sarah responded with some urgency. ‘Why not?’

  ‘I will. Just give me time. As I said, my mood was somewhat better today.’ Martin was deliberately resisting. There was a risk the psychiatrist would report him to the Medical Board as an impaired practitioner. He could not take such a risk, one that might prevent him from practising. Having undertaken courses for general practitioners in managing depression and looked after many depressed patients, only referring the more severe and treatment-resistant ones to a psychiatrist, he felt confide
nt prescribing for himself but was reluctant to argue that case with Sarah. But he also felt guilt and some shame because he had prided himself – as a man of integrity – on not keeping secrets from Sarah. He told himself he would consult a psychiatrist if his mood did not improve. Telling Sarah about his strategy would just worry her further.

  ‘And I’m still thinking through the best options,’ was what he finally offered.

  ‘All right,’ she said, looking unconvinced. ‘But remember, I’m with you. The two of us in this together.’

  Later that Tuesday night, and after a minimal internal debate as to whether he would take a 25-milligram or 75-milligram capsule, he chose the latter. The lower dose had helped, it had given him a whiff of improvement and he had slept.

  The following morning he did not wake till six a.m. He was quite groggy when he dragged himself out of bed, nearly falling over in the shower. But, when the grogginess had worn off at mid-morning his mood was better. And on that day, the mood lift lasted till the early afternoon. When he arrived home that Wednesday, he smiled at Sarah.

  ‘I’m better, Sar. The mood is definitely improving. I’m coming out of it.’ He hugged her.

  ‘What a relief.’ Each of the three words enunciated slowly and firmly. ‘But how? Doesn’t depression continue for a while?’

  ‘Everyone’s different. For some, melancholia can last decades, for others it’s brief. I seem to be one of the lucky ones.’ He smiled again, wanting to communicate reassurance but more seeking to abort any further questioning. He was feeling even more guilt about not telling Sarah about his self-medicating.

  Sarah rubbed the back of his head and gave him a cuddle. ‘Do you still feel that I can fly out on Friday? I’m very comfortable about cancelling.’

  ‘You have to go, Sar, and I’m clearly going into remission. I’ll drive you to the airport on Friday after you’ve shown me where the stove is and how the fridge door opens.’