by Robin Cook
Cassi sat up and swung her legs over the side of the table. Her right eye was beginning to correct itself from the trauma of the bright light, but her vision remained blurry from the drops used to dilate her pupils. She watched Dr. Obermeyer’s back for a moment, digesting his comment. She’d expected him to be annoyed that she’d canceled her last appointment, but she hadn’t thought it would be this bad.
Only after he finished writing and closed his chart did he turn back to Cassi. He was sitting on a low stool with wheels, and he glided over to face her.
Cassi’s line of vision from her perch on the exam table was a good foot higher than the doctor’s. She could see the shiny area on the top of his head where his hair was thinning. He wasn’t the world’s best-looking man, with his full, heavy features and a deep line in the middle of his forehead. Yet the whole package was not unattractive. His face exuded intelligence and sincerity, two qualities that Cassi found appealing.
“I think I should be frank,” he began. “There is no sign of the blood clearing from your left eye. In fact it appears as if there is new blood.”
Cassi tried not to betray her anxiousness. She nodded as if she were listening to a discussion of another patient.
“I still cannot visualize the retina,” said Dr. Obermeyer. “Consequently I do not know where the blood is coming from or if it is a treatable lesion.”
“But the ultrasound test…” began Cassi.
“It proved that the retina is not detached, at least not yet, but it cannot show where the bleeding is coming from.”
“Perhaps if we waited a little longer.”
“If it hasn’t cleared by now, it’s extremely unlikely that it will. Meanwhile we could lose the only chance we have to treat. Cassi, I’ve got to see the back of your eye. We must do a vitrectomy.”
Cassi glanced away. “It can’t wait for a month or so?”
“No,” said Dr. Obermeyer. “Cassi, you have already gotten me to postpone this longer than I wanted to. Then you canceled your last appointment. I’m not sure you understand the stakes here.”
“I understand the stakes,” said Cassi. “It’s just not a good time.”
“It’s never a good time for surgery,” said Dr. Obermeyer, “except for the surgeon. Let me schedule this thing and get on with it.”
“I have to discuss it with Thomas,” said Cassi.
“What?” questioned Dr. Obermeyer with surprise. “You haven’t told him about this?”
“Oh yes,” said Cassi quickly. “Just not the timing.”
“When can you discuss the timing with Thomas?” asked Dr. Obermeyer with resignation.
“Soon. In fact tonight. I’ll be back to you tomorrow, I promise.” She slid off the table and steadied herself.
Cassi was relieved to escape from the ophthalmologist’s office. Deep down she knew he was right; she should have the vitrectomy. But telling Thomas was going to be difficult. Cassi stopped at the end of the corridor on the fifth floor of the Professional Building, the same building where Thomas had his office. She stared out a window at the early December cityscape with its leafless tree-lined streets and densely packed brick buildings.
An ambulance was screaming down Commonwealth Avenue, its lights flashing. Cassi closed her right eye, and the scene vanished to mere light. In a panic she reopened her eye to let the world back in. She had to do something. She had to talk with Thomas despite the difficulties they’d had since her visit to Patricia.
Cassi wished that Saturday two weeks previously had never taken place. If only Patricia had not called Thomas. But of course that had been too much to ask. Expecting Thomas to come home angry, Cassi was shocked when he didn’t come home at all. At ten-thirty, Cassi had finally called Thomas’s exchange. Only then did she learn that Thomas had an emergency operation. She left word for him to call and waited up until two, finally falling asleep with book in hand and light on. Thomas finally came home on Sunday afternoon and, instead of screaming at her, refused to talk to her at all. With deliberate calm he moved his clothes into the guest room next to his study.
For Cassi the “silent treatment” was an unbearable strain. What little conversation they did have was just chatter. Dinner was the worst, and several times Cassi, pleading a headache, took a tray to her room.
After a week, Thomas had finally exploded in a rage. The triggering event had been insignificant; Cassi had dropped a Waterford glass on the tiled kitchen floor. As Thomas rushed over to her and started yelling, he accused Cassi of being deceitful and maneuvering behind his back. How dare Cassi go to his mother and accuse him of drug abuse?
“Of course I’ve taken an occasional pill,” said Thomas, finally lowering his voice. “Either to help me sleep or keep me awake if I’ve been up all night. I dare you to name a single doctor who never took any of his own drugs!” He’d stabbed at her with his finger to make his point.
Having taken an occasional Valium herself, Cassi was not about to contradict Thomas. Besides, intuition told her to be quiet and let Thomas vent his anger.
In a more controlled tone Thomas asked her why in God’s name had she gone to Patricia. Cassi, of all people, knew how much his mother nagged him without anyone giving her such a potentially frightening subject.
Sensing that Thomas had yelled himself out, Cassi tried to explain. She said that having found the Dexedrine, she’d been scared and had mistakenly thought that Patricia would be the best person to help if Thomas did have a problem. “And I never said you were an addict.”
“My mother said you did,” snapped Thomas. “Who am I to believe?” He threw up his arms in disgust.
Cassi didn’t answer although she was tempted to say that if Thomas didn’t know the answer after forty-two years of living with Patricia, he was never going to. Instead, Cassi apologized for jumping to conclusions after finding the Dexedrine and worse still for going to his mother. Tearfully she told him how much she loved him, silently acknowledging the fact she was more terrified of Thomas’s leaving her than she was of his possible drug abuse. She wanted their relationship to return to normal. If the strain had started with her complaining about her diabetes, Cassi decided she would shield Thomas from any knowledge of her problems. But now her eye was forcing the issue. The arrival of another screaming ambulance brought Cassi to the present. As much as she did not want to upset Thomas, she knew she had no choice. She could not go into the hospital and have an operation without telling him even if she somehow found the courage to do so. With terrible foreboding Cassi pushed the elevator button. She’d see Thomas now. Knowing herself, she was afraid that if she waited until they were at home that evening, she would not be able to broach the issue.
Trying not to think anymore lest she change her mind, Cassi made her way down to Thomas’s office and pushed open the door. Fortunately there were no patients in the waiting room. Doris looked up from her typewriter and, as usual, turned back to her work without so much as acknowledging Cassi’s presence.
“Is Thomas in?” asked Cassi.
“Yes,” said Doris without interrupting her typing. “He’s with his last patient.”
Cassi sat on the rose-colored couch. She couldn’t read because the blurring effect of the drops in her eye had not yet worn off. Since Doris didn’t look at Cassi, Cassi did not feel uncomfortable watching her. She noticed that the nurse had changed her hairstyle. Cassi thought that Doris looked better without the severity of her usual bun.
Presently a patient emerged from the interior of the office. Brimming with good cheer, he smiled at Doris. “I feel terrific,” he said. “The doctor told me that I’m completely better. I can do whatever I like.”
Pulling on his coat, he said to Cassi, “Dr. Kingsley’s the greatest. Don’t worry about a thing, young lady.” Turning to Doris he thanked her, blew her a kiss, and left.
Cassi sighed as she got up. She knew Thomas was a great doctor. She wished she could elicit the kind of compassion that she believed he gave to his patients.
&nb
sp; Thomas was dictating when Cassi stepped into his office. “Thank you again, comma, Michael, comma, for this interesting case, comma, and if I can be of any further assistance in his management, comma, do not hesitate to call. Period. Sincerely yours, end dictation.”
Clicking off the machine, Thomas swung around in his chair. He regarded Cassi with calculated indifference.
“And to what do I owe the pleasure of this visit?” he asked.
“I’ve just come from the ophthalmologist,” said Cassi, trying to control her voice.
“That’s nice,” said Thomas.
“I have to talk to you.”
“It had better be short,” said Thomas, glancing at his watch. “I’ve got a patient in cardiogenic shock that I’ve got to see.”
Cassi could feel her courage falter. She needed some sign that Thomas would not become irritated if she once again brought up her illness. But Thomas’s posture just suggested an aggressive nonchalance. It was as if he were daring her to cross some arbitrary line.
“Well?” asked Thomas.
“He had to dilate my pupils,” said Cassi, skirting the issue. “There’s been some deterioration. I wondered if we could go home a little earlier.”
“I’m afraid not,” said Thomas, standing up. “I’m pretty sure the patient I’m seeing will need emergency surgery.” He slipped off his white jacket and hung it on the hook on the door leading to the examining room. “In fact, I may have to spend the night here in the hospital.”
He said nothing about her eye. Cassi knew she had to bring up her own surgery, but she couldn’t. Instead she said, “You spent last night in the hospital. Thomas, you’re pushing yourself too hard. You need more rest.”
“Some of us have to work,” said Thomas. “We can’t all be in psychiatry.” He pulled on his suit jacket, then stepped back to the desk to snap the tape out of the dictating machine.
“I don’t know whether I can drive with this blurry eye,” said Cassi. She knew better than to respond to Thomas’s pejorative implication about psychiatry.
“You have two choices,” said Thomas. “Hang around until the drops wear off or stay the night in the hospital. Whatever you think is best for you.” Thomas started for the door.
“Wait,” called Cassi, her mouth dry. “I have to talk to you. Do you think I should have a vitrectomy?”
There, it was out. Cassi looked down and saw she was wringing her hands. Self-consciously she pulled them apart, then didn’t know what to do with them.
“I’m surprised you still care about my opinion,” snapped Thomas. His slight smile had vanished. “Unfortunately, I’m not an eye surgeon. I don’t have the slightest idea of whether you should have a vitrectomy. That’s why I sent you to Obermeyer.”
Cassi could feel his rising anger. It was just as she feared. Telling him about her eye condition was only going to make matters worse.
“Besides,” said Thomas. “Isn’t there a better time to talk about this kind of thing? I’ve got someone dying upstairs. You’ve had this problem with your eye for months. Now you show up when I’m in the middle of an emergency and want to discuss it. My God, Cassi. Think about other people once in a while, will you?”
Thomas stalked over to the door, wrenched it open, and was gone.
In a lot of ways Thomas was right, thought Cassi. Bringing up the problem of her eye in Thomas’s office was inappropriate. She knew when he said he had a patient “dying upstairs,” he meant it.
Her jaw clenched, Cassi walked out of the office. Doris made a show of typing, but Cassi guessed she’d been listening. Walking down to the elevators, Cassi decided to go back to Clarkson Two. It would keep her from thinking too much. Besides, she knew she couldn’t drive, at least not for a while.
She got back to the ward while the afternoon team meeting was still in progress.
Cassi had arranged to take the rest of the day off and did not feel up to joining the group. She was afraid if she were among friends her delicate control would crumble and she’d burst into tears.
Thankful for the unexpected opportunity of reaching her office unobserved, she slipped inside and quickly closed the door behind her. Stepping around the metal and Formica desk, which practically spanned the width of the room, she settled herself into the aged swivel desk chair. Cassi had tried to liven the cubbyhole with several bright prints of Impressionist paintings she bought at the Harvard co-op. The effort hadn’t helped much. With its harsh overhead fluorescent lighting, the room still looked like an interrogation cell.
Resting her head in her hands, she tried to think, but all she could concentrate on were her problems with Thomas. She was almost relieved when there was a sharp knock on the door. Before she could answer it, William Bentworth stepped inside.
“Mind if I sit down, Dr. Cassidy?” asked Bentworth with uncharacteristic politeness.
“No,” said Cassi, surprised to see the colonel entering her office on his own accord. He was carefully dressed in tan slacks and a freshly pressed plaid shirt. His shoes evidenced a spit-and-polish shine.
He smiled. “Mind if I smoke?”
“No,” said Cassi. She did mind, but it was one of those sacrifices she felt she had to make. Some people needed all the help they could get in order to open up and talk. On occasion the process of lighting a cigarette was an important crutch. Bentworth leaned back and smiled. For the first time his brilliant blue eyes seemed cordial and warm. He was a handsome man, with broad shoulders, thick dark hair, and angular, aristocratic features.
“Are you all right, Doctor?” asked Bentworth, leaning forward again to examine Cassi’s face.
“I’m perfectly fine. Why do you ask?”
“You look a bit distraught.”
Cassi looked up at the Monet print of the little girl and her mother in the poppy field. She tried to collect her thoughts. It frightened her a little to realize that a patient could be so perceptive.
“Perhaps you feel guilty,” offered Bentworth, considerately blowing smoke away from Cassi.
“And why should I feel guilty?”
“Because I think you have been deliberately avoiding me.”
Cassi remembered Jacob’s comment about borderline personalities being inconsistent, and she contrasted Bentworth’s current behavior with his previous refusal to talk to her.
“And I know why you’ve been avoiding me,” continued Bentworth. “I think I scare you. I’m sorry if that’s the case. Having been in the army so long and being accustomed to giving orders, I suppose I can be overbearing at times.”
For the first time in Cassi’s short psychiatric career, something that she’d read in the literature was occurring spontaneously between herself and one of her patients. She knew, without any doubt, that Bentworth was trying to manipulate her.
“Mr. Bentworth…” began Cassi.
“Colonel Bentworth,” corrected William with a smile. “If I call you Doctor, it’s only reasonable you call me Colonel. It’s a sign of mutual respect.”
“Fair enough,” said Cassi. “The fact of the matter is that you have been the one who has made it impossible for us to have a session together. I’ve tried, if you can remember, on numerous occasions to schedule a meeting, but you have always professed to have a prior commitment. Now I understand that you get more out of the group milieu than private conversation, so I haven’t pushed the situation. If you’d like to meet, let’s schedule it.”
“I would love to talk with you,” said Bentworth. “How about right now? I have the time. Do you?”
Cassi was not willing to fall prey to Bentworth’s manipulation, thinking that it would ultimately have a negative effect on their relationship. She wasn’t prepared now and Bentworth did frighten her despite his newly found charm.
“How about tomorrow morning?” said Cassi. “Right after team meeting.”
Colonel Bentworth stood up and stubbed out his cigarette in the ashtray on Cassi’s desk. “All right. I’ll look forward to it. And I hope whatever is tro
ubling you works out for the best.”
After he was gone, Cassi breathed the smoky air while her mind envisioned Colonel Bentworth in a dress uniform. She could imagine he would be gallant and dashing, and his mental problems would seem fictitious. Knowing the depth of his disorder, she found the fact that it could be so easily camouflaged disturbing.
Before she could even dictate her notes, her door opened again, and Maureen Kavenaugh came in and sat down. Maureen had been admitted a month previously for recurrent major depression. She’d had a serious setback when her husband had come in and slapped her around. Seeing her out of her room was as much a surprise as having William Bentworth voluntarily pay a visit. Cassi wondered if some miracle drug were being secretly added to the patients’ food.
“I saw the colonel go into your office,” said Maureen. “I thought you said you weren’t going to be here this afternoon.” Her voice was flat and emotionless.
“I hadn’t planned on it,” said Cassi.
“Well, since you are here, can I talk to you for a moment?” asked Maureen timidly.
“Of course,” said Cassi. She watched Maureen advance into the room, closing the door and sitting down.
“Yesterday when we talked…” Maureen hesitated and her eyes filled with tears.
Cassi pushed the box of tissues toward the woman.
“You… you asked me if I’d like to see my sister.” Maureen’s voice was so low that Cassi could barely hear. She nodded quickly, wondering what Maureen was thinking. The woman had not shown much interest in anything since her relapse even though Cassi had started her on Elavil. At team meeting several people had suggested electric shock, but Cassi had argued against it, thinking the Elavil and supportive sessions would be adequate. What amazed Cassi was Maureen’s insight into the dynamics of her condition. But for Maureen an understanding of her illness did not automatically give her the power to influence it.
Maureen acknowledged her hostility to her mother, who had abandoned both Maureen and her younger sister when they were toddlers, and the repressed jealousy she felt toward that pretty younger sister who had run off and married, leaving Maureen to live by herself. Out of desperation she’d married an inappropriate man.