“Keep going.”
“Well, I ate the sandwiches. I even ate them the way I used to when I was a kid—by sucking out the egg salad filling. But they didn’t help. I needed something stronger. This letter was too devastating. Finally, I stowed it away in a drawer in my study.”
“Still unopened?”
“Yes, unopened. And still unopened. Why open it? I know what’s in it. To read the exact words would only tear open the wound even more.”
I didn’t know what Saul was talking about. I didn’t even know about his connection to the Stockholm Institute. By now I was itching with curiosity, yet took a perverse pleasure in not scratching. My children have always kidded me about the way I rip open a present as soon as it is handed me. Surely my patience that day was a sign of having arrived at some degree of maturity. What’s the rush? Saul would fill me in soon enough.
“The second letter arrived eight days later. The envelope was identical to the first. I put it, also unopened, on top of the first one in the same desk drawer. But hiding them didn’t accomplish anything. I couldn’t stop thinking about them, yet I couldn’t bear to think of them. If only I had never gone to the Stockholm Institute!” He sighed.
“Keep going.”
“I spent a lot of the last couple of weeks lost in daydreams. You sure you want to hear all this?”
“I’m sure. Tell me about the daydreams.”
“Well, sometimes I thought about being on trial. I’d appear before the members of the institute—they’d be wigged and robed. I would be brilliant. I would refuse counsel and dazzle everyone by the way I answered every charge. Soon it would be clear that I had nothing to conceal. The judges would be thrown into disarray. One by one they would break ranks and rush to be the first to congratulate me and ask my forgiveness. That’s one kind of daydream. It made me feel better for a few minutes. The others weren’t as good, very morbid.”
“Tell me about them.”
“Sometimes I’d feel this tightness in my chest and think I was having a coronary, a silent coronary. Those are the symptoms—no pain, just difficulty breathing and thoracic tightness. I’d try to feel my pulse but could never find the damned thing when I wanted it. When I finally got a beat, I’d start to wonder whether it was coming from my radial artery or from the tiny arterioles in my fingers squeezing my wrist.
“I’d get a pulse of about twenty-six in fifteen seconds. Twenty-six times four is one hundred and four a minute. Then I’d wonder whether one hundred and four was good or bad? I didn’t know whether a silent coronary was accompanied by a fast or a slow pulse. Björn Borg’s pulse is fifty, I’ve heard.
“Then I’d daydream about slicing that artery, relieving the pressure, and letting the blood out. At one hundred and four beats a minute, how long would it take to enter darkness? Then I’d think about speeding up my pulse to let the blood out faster. I could exercise on my stationary bicycle! In a couple of minutes, I could get my pulse up to one hundred twenty.
“Sometimes I’d imagine the blood filling a paper cup. I could hear each spurt splatter against the waxed walls of the cup. Perhaps one hundred spurts would fill a cup—that’s only fifty seconds. Then I’d think about how to slice my wrists. The knife in the kitchen? The small sharp one with the black handle? Or a razor blade? But there are no more slicing razor blades—just those safe injectable ones. I had never before noticed the passing of the razor blade. I thought that’s the way I, too, will pass. Without a ripple. Maybe someone will think of me in some freak moment just as I think of the extinct single-edged razor blade.
“Yet the blade is not extinct. Thanks to my thoughts, it still lives. You know, there is no one alive now who was grown-up when I was a child. So I, as a child, am dead. Some day soon, perhaps in forty years, there will be no one alive who has ever known me. That’s when I will be truly dead—when I exist in no one’s memory. I thought a lot about how someone very old is the last living individual to have known some person or cluster of people. When that old person dies, the whole cluster dies, too, vanishes from living memory. I wonder who that person will be for me. Whose death will make me truly dead?
For the past few minutes Saul had been speaking with closed eyes. He opened them suddenly and checked with me: “You asked for this. You want me to go on? This is pretty morbid stuff.”
“Everything, Saul. I want to know exactly what you’ve been going through.”
“One of the worst things was that I had no one to talk to, nowhere to turn, no confidant, no trusted friend with whom I could dare talk about this stuff.”
“How about me?”
“I don’t know if you remember, but it took me fifteen years to make the decision to see you the first time. I just couldn’t bear the disgrace now of coming back to see you. We had done so well together, I couldn’t deal with the shame of coming back defeated.”
I understood what Saul meant. We had worked together very productively for a year and a half. Three years ago, as we ended therapy, Saul and I had taken great pride in the changes he had made. Our termination session was a high-spirited graduation—it lacked only a brass band accompanying his triumphant march out into the world.
“So I tried to deal with it on my own. I knew what those letters meant: they were my final judgment, my personal apocalypse. I think I’ve been staying just ahead of them for sixty-three years. Now, maybe because I’ve slowed down—my age, my weight, my emphysema—they’ve overtaken me. I’ve always had ways to delay the judgment. You remember them?”
I nodded. “Some of them.”
“I’d offer profuse apologies, prostrate myself, spread innuendoes that I had advanced cancer (that has never failed). And always, if nothing else worked, there was always the cash payoff. I figure that fifty thousand dollars will cure this whole Stockholm Institute catastrophe.”
“What changed your mind? Why did you decide to call me?”
“It was the third letter. It arrived about ten days after the second. It put an end to everything, to all my planning, to any hope of escape. I guess it put an end, too, to my pride. Within minutes of getting it, I was on the phone with your secretary.”
The rest I knew. My secretary had told about his call: “Any time the doctor can see me. I know how busy he is. Yes, a week from Tuesday would be fine—no emergency.”
When my secretary told me about his second call a few hours later (“I hate to bother the doctor, but I wonder if he could fit me in, even for a few minutes, just a little earlier”), I recognized Saul’s signal of great desperation and called him back to arrange for an immediate consultation.
He then proceeded to summarize the events of his life since we had last met. Shortly after termination of therapy, about three years ago, Saul, an accomplished neurobiologist, had received a distinguished award—a six-month fellowship at the Stockholm Research Institute in Sweden. The terms of the award were generous: a fifty-thousand-dollar stipend, no strings attached, and he was free to pursue his own research and to do as little or as much teaching and collaborative work as he chose.
When he arrived at the Stockholm Institute, he was greeted by Dr. K., a renowned cellular biologist. Dr. K. was a great presence: speaking in an impeccable Oxonian dialect, he refused to be bowed by seven and a half decades and employed every one of his seventy-six inches in the construction of one of the world’s great postures. Poor Saul strained chin and neck to reach five foot six. Though others regarded as endearing his antiquated Brooklynese, Saul cringed at the sound of his own voice. While Dr. K. had never won a Nobel Prize (though had been, it was well known, runner-up on two occasions), he was unquestionably made of the stuff from which laureates come. For thirty years Saul had admired him from afar and now, in his presence, could barely summon the nerve to look into the great man’s eyes.
When Saul was seven his parents had died in an automobile accident, and he had been raised by an aunt and uncle. Since then the leitmotif in his life had been a ceaseless search for home, affection, and approval. Fai
lure had always inflicted terrible wounds, which healed slowly and deeply intensified his feeling of insignificance and loneliness; success offered stupendous but evanescent exhilaration.
But the moment Saul arrived at the Stockholm Research Institute, the moment he was greeted by Dr. K., he felt strangely convinced that his goal was within his grasp, that there was hope for some final peace. The moment he shook Dr. K.’s powerful hand, Saul had a vision, redemptive and beatific, of the two of them, he and Dr. K., working side by side as full collaborators.
Within hours and with insufficient planning, Saul put forward a proposal that he and Dr. K. collaborate on a review of the world literature on muscle cell differentiation. Saul suggested they offer a creative synthesis and identify the most promising directions for future research. Dr. K. listened, gave cautious assent, and agreed to meet twice weekly with Saul, who would do the library research. Saul threw himself passionately into the hastily conceived project and treasured his consultation hours with Dr. K., in which they reviewed Saul’s progress and sought meaningful patterns in the disparate basic research literature.
Saul so basked in the glow of the collaborative relationship that he failed to notice that the library research was not productive. Consequently, he was shocked when, two months later, Dr. K. expressed his disappointment about the work and recommended it be abandoned. Never in his life had Saul failed to complete a project, and his first reaction was to suggest he continue on it alone. Dr. K. responded, “I can’t prevent you, of course, but I consider it ill advised. At any rate, I wish to dissociate myself from the work.”
Saul hastily concluded that another publication (lengthening his bibliography from 261 to 262 entries) would be far less nourishing than some continued collaboration with the great doctor and, after a few days’ consideration, suggested another project. Once again, Saul proposed to do 95 percent of the work. Once again, Dr. K. gave guarded assent. In his remaining months at the Stockholm Institute, Saul worked like a demon. Having already overscheduled himself with teaching and consultation commitments to younger colleagues, he was forced to work much of the night preparing for his sessions with Dr. K.
At the end of his six months, the project was still unfinished, but Saul assured Dr. K. he would complete it and see it published in a leading journal. Saul had in mind one edited by a former student who often solicited articles from him. Three months later, Saul completed the article and, after obtaining Dr. K.’s approval, submitted it to the journal, only to be informed, after eleven months, that the editor was gravely ill with a chronic disease and that the publishers had regretfully decided not to continue publication of the journal and were therefore returning all submitted articles.
Saul, by now growing alarmed, immediately dispatched the article to another journal. Six months later, he received a rejection note—his first in twenty-five years—which explained, with deference considering the stature of the authors, why the journal could not publish the article: in the previous eighteen months, three other competent reviews of the same literature had been published, and, furthermore, preliminary research reports published in the last few months did not support the conclusions Saul and Dr. K. had reached about promising directions in the field. However, the journal would be delighted to reconsider the article if it were updated, the basic accent altered, the conclusions and recommendations reformulated.
Saul did not know what to do. He could not, would not, face the shame of telling Dr. K. that now, eighteen months later, their article was not yet accepted for publication. Dr. K. had, Saul was certain, never had an article rejected—not until he had teamed up with this short, pushy, New York fraud. Review articles, Saul knew, age quickly, especially in fast-moving fields like cellular biology. He had also had enough experience on editorial boards to know that the journal editors were merely being polite: the article was beyond salvage unless he and Dr. K. put in massive amounts of time revising it. Furthermore, it would be difficult to complete a revision by international mail: face-to-face collaboration was necessary. Dr. K. had work of far higher priority, and Saul was certain that he would prefer simply to wash his hands of this whole pestilence.
And that was the impasse: for any decision to be made, Saul had to tell Dr. K. what had happened—and that Saul could not bring himself to do. So Saul, as he was wont to do in such situations, did nothing.
To make matters worse, he had written an important article on a related subject that was immediately accepted for publication. In that article he had credited Dr. K. for some of the ideas expressed and had cited their now unpublished article. The journal informed Saul that their new policy did not permit him to credit anyone without that person’s written consent (to avoid spurious use of famous names). Nor, for the same reason, could it permit citations from unpublished papers without the written consent of the co-authors.
Saul was stuck. He could not—without mentioning the fate of their collaborative venture—write Dr. K. to obtain his permission to credit him. Again, Saul did nothing.
Several months later, his paper (with no mention of Dr. K. and no citation of their collaborative work) appeared as the lead article of an outstanding neurobiology journal.
“And that,” Saul told me with a great sigh, “brings us up to now. I’ve been dreading the publication of this article. I knew that Dr. K. would read it. I knew what he would think and feel about me. I knew that, in his eyes and in the eyes of the entire Stockholm Institute community, I would be a fraud, a thief, worse than a thief. I waited to hear from him, and I received the first letter four weeks after publication—right on schedule—just time enough for the journal issue to reach Scandinavia, for Dr. K. to read it, to pass judgment, to deliver sentence. Just time enough for his letter to reach me in California.”
Saul stopped here. His eyes pleaded with me: “I can’t go on. Take this all away. Take away this pain.”
Though I had never seen Saul so abject, I was convinced that I would be able to render help quickly. Hence I assumed my efficient, task-oriented voice and wondered what plans he had made, what steps taken? He hesitated and then said that he had decided to return the fifty-thousand-dollar stipend to the Stockholm Institute! Knowing, from our previous work, that I disapproved of his penchant for buying his way out of difficult situations, Saul left me no time to respond but rushed ahead, saying that he had yet to decide upon the best method. He was considering a letter stating that he was returning the money because he had not used his fellowship time productively at the institute. Another possibility was to give a simple outright gift to the Stockholm Institute—a gift that would appear to be unrelated to anything else. Such a gift might be a deft move, he thought—an insurance policy to quell any possible censure of his behavior.
I could see Saul’s discomfort as he revealed these plans to me. He knew I would disagree. He hated to displease anyone and wanted my approval almost as much as he wanted Dr. K.’s. I felt relieved that he had been willing to share so much with me—the only bright spot I saw in the session so far.
For a short time we both lapsed into silence. Saul was spent and leaned back, exhausted. I, too, sank back in my chair and took stock of the situation. This whole story was a comic nightmare—a tar baby saga in which, at every step, Saul’s social ineptitude glued him more tightly to the impossible predicament.
But there was nothing funny about Saul’s appearance. He looked awful. He always minimized his pain—always fearful of “bothering” me. If I multiplied every sign of stress by ten, I would have it: his willingness to pay fifty thousand dollars; his morbid, suicidal ruminations (he had made a serious suicide attempt five years before); his anorexia; his insomnia; his request to see me sooner. His blood pressure (he had told me earlier) had risen to one hundred ninety over one hundred twenty; and six years before, at a time of stress, he had had a severe, nearly fatal coronary.
So it was clear that I must not underestimate the gravity of the situation: Saul was in extremis, and I must offer some immediate help. His o
verwrought reaction was, I thought, totally irrational. God knows what was in those letters—probably some irrelevant announcement, a scientific meeting or a new journal. But I was certain of one thing: those letters, despite their timing, were not letters of censure from either Dr. K. or the Stockholm Institute; and, without doubt, as soon as he read them, his distress would evaporate.
Before proceeding, I considered alternatives: Was I being too hasty, too active? What about my countertransference? It was true I felt impatient with Saul. “This whole thing is ridiculous,” some part of me wanted to say. “Go home and read those goddamn letters!” Perhaps I was annoyed that my previous therapy with him was showing signs of wear. Was my piqued vanity causing me to be impatient with Saul?
Though it is true that on that day I regarded him as foolish, in the main I always liked him very much. I had liked him from the moment I met him. One of the things he said at our first meeting endeared him to me: “I’m going to be fifty-nine soon, and some day I’d like to be able to stroll down Union Street and spend the afternoon window shopping.”
I have always felt drawn to patients who struggle with the same issues I do. I know all about the longing to take a noonday stroll. How many times have I yearned for the luxury of a carefree Wednesday afternoon walk through San Francisco? Yet, like Saul, I have continued to work compulsively and to impose a professional schedule on myself that makes that stroll impossible. I knew we were both chased by the same man with a rifle.
The more I looked into myself, the surer I was that my positive feelings for Saul were still intact. Despite his offputting physical appearance, I felt very warm toward him, I imagined cradling him in my arms and found the idea agreeable. I was certain that I, even in my impatience, would act in Saul’s best interests.
I also realized there are certain disadvantages in being too energetic. The overactive therapist often infantilizes the patient: he does not, in Martin Buber’s term, guide or help the other to “unfold” but instead imposes himself upon the other. Nonetheless, I felt convinced that I could resolve this whole crisis in one or two sessions. In the light of that belief, the perils of overactivity seemed slender.
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