Because I Come from a Crazy Family

by Edward M. Hallowell

  I should go say goodbye. I told the resident in charge of rotation that I needed a few days off because my father was dying. He said sorry to hear that, take all the time you need. This was fourth year of med school, no pressure.

  I flew to Boston, rented a car, drove up to the hospital in New Hampshire. At the information desk, I asked the volunteer where Mr. Hallowell’s room was. It seems as if all of that happened in about ten minutes.

  The next image is me walking into Dad’s hospital room. There he was, sipping something out of a paper cup through a straw, the upper half of the bed elevated, propping him up. He didn’t look almost dead.

  The moment he saw me he put his cup down on the bedside table and beamed. In as strong a voice as he could muster, trying his best to sound like his usual self, he said, “Oh, John, thanks so much for coming!”

  Dad mistook me for my brother. Missing only half a beat, I jumped right in and said, “Hi, Dad,” as I gave him an awkward, bedridden hug.

  “It’s so good to see you, John. It’s been too long.”

  The fact is that he hadn’t seen Johnny in years because he couldn’t accept Johnny’s being gay, nor could Johnny accept Dad’s difficulty with it. If either one of them had made an effort, I’m pretty sure they could have made peace in a matter of minutes. But they hadn’t.

  My father’s mind played a lovely trick on him at the end, like a mental white lie. Maybe influenced by the medications he was on, he transformed me into Johnny. He was at peace with me, Ned, he knew I loved him and he loved me, so there was no unfinished business between us, but with his son John, there was a searing need to reconcile. With me filling in, Dad did it. I’m just glad I was quick enough not to correct him.

  In the car, driving back to the airport, I felt like crying but couldn’t. I’ve never been a good crier. It was good that you let him believe you were Johnny, I said to myself. That way he can die feeling at peace with his three sons. Too bad he couldn’t make peace with his brother.

  The funeral was held at Mount Auburn Cemetery. I would later learn that most of the teachers at the public school in Pelham, New Hampshire, where he’d taught for many years, had wanted to come to the funeral. The principal called the district superintendent for permission but was told only four teachers could go because the school day had to go on, and it would be hard enough to find subs for four.

  The teachers got together and went to the principal, saying that either the superintendent had to close the school and let all the teachers travel to Boston for the service or the entire faculty would go on strike.

  Not only did the school close for the funeral, but the superintendent supplied two school buses to transport all the faculty and staff who wanted to attend. We were dumbfounded when two yellow school buses pulled onto the grounds of Mount Auburn Cemetery and dropped off a huge contingent from Dad’s school.

  “He was beloved,” as assistant principal told me. “We never had a better teacher or a more cherished teacher. We really would have walked out if they hadn’t let us come.”

  47.

  All my life I’ve had a terrible habit of telling the truth as I see it, blurting it out, you could say, regardless of how inappropriate it might be. It’s gotten me into more trouble than I care to recount.

  “Why do you want to become a psychiatrist?” That was the question I was asked in every interview at every training program I applied to during my fourth year of medical school.

  This was the time to say something like “Because I have always been interested in the workings of the mind,” or “I had a great mentor in medical school who got me excited about psychiatry,” or “The brain is the last frontier of human discovery and I want to join the exploration.” All of those are solid, sane responses to the question. One of those, or one similar to those, is what I should have said, and what I would have said had I learned the practical skill of being politic and appropriate. But that skill never came easily to me. Being honest came so much more naturally.

  So my answer to that question was “Because I come from a crazy family.” Most interviewers stopped dead in their tracks, as if I’d just farted. Then they’d find some excuse to pause and regroup.

  I remember one man in particular, who looked to be a junior faculty member, only a few years older than me, nattily dressed, wearing a bow tie. When I told him I came from a crazy family, he took off his eyeglasses and nervously started to clean them with the balled-up hanky that he pulled out of his trouser pocket as he tentatively asked, without looking at me directly, “Crazy?”

  “Oh, yes, crazy,” I replied emphatically. “They were definitely crazy. Lots of my type are. My family were all interesting people, just often drunk or crazy, or both.”

  This interviewer, having no clue as to what a fitting response might be, simply stared back at me. But telling him some of my story seemed important to me. I felt then what I’ve continued to feel my entire career, that psychiatry shies away from the real story and tries to dress it up in jargon and scientific-sounding nomenclature, as if to make it presentable to a general audience. Also, the point of an interview is for the program to get to know the actual candidate, not the tidied-up version, so I saw no need to tiptoe.

  “My father was bipolar but first was misdiagnosed schizophrenic. He went crazy when he came back from World War II. He’d been an All-American hockey player at Harvard, led the nation in scoring, married my mother after a storybook romance straight out of Love Story, got a job at Goldman Sachs, had my two older brothers, but then went off to the war.

  “When he came home, ‘he wasn’t right,’ as they used to say. The fact is, he was nuts. So he was put in a hospital where he got insulin shock and electric shock. It was gruesome, but the doctors were just trying to help, that’s what you did back then.”

  My bow-tied interviewer nodded, confirming a historical fact. I was glad at last to make some connection with him. But the next part of what I had to say really threw him for a loop. I told him the story of how I was conceived, complete with the dead crows and the summoning of the police.

  That about finished him. He had clearly heard way more than he’d wanted, having twice taken off his glasses, wiped them, and put them back on while I was talking. I’m surprised he didn’t break them in two, he polished them so aggressively. Now he was back to his default position, staring and at a loss.

  “Of course, that was in Massachusetts,” I said, “so you wouldn’t know the hospitals where he was treated.”

  My interviewer said nothing.

  Feeling the acute and throbbing awkwardness between us, which threatened to take the interview clear into the Twilight Zone, I tried to help out. “I’m sorry. I was just trying to be honest. You know, these interviews get pretty boilerplate, so I was just trying to be a little bit real. This is my third one today. I don’t know. I hope it’s OK. I probably shouldn’t have said so much. But it is psychiatry, after all. But anyway, I’m sorry. I can understand if this all feels like too much. I have a habit of going overboard.”

  The man heaved a sigh, and his whole being seemed to defervesce, as if a mental abscess had just been drained. I could feel his relief as if it were a hug. “You’re right!” he said. “This is my third interview, too. They are so boilerplate. You have no idea how tedious they can become. So thank you for changing it up a bit. Yes, you did that for sure.” He chuckled, having regained control of the situation.

  The tension broken, we ended up having a great interview, talking no more about my crazy father or crazy anybody, but safe topics like theories of the mind and the Yankees versus Red Sox.

  Telling the truth—or your own version of the truth—is a bad habit if you want to get ahead in this world, but it’s also a habit that—in spite of many punishments—I’ve not been able to shake. I wanted to become a psychiatrist because I wanted to understand my people in particular, and crazy people in general. I felt totally at home with crazy people, but I knew the world at large didn’t understand them at all and felt a
nything but at home with them. I wanted to do something about that.

  Based solely on statistics, the interviewer—any interviewer—should have rejected me from the program. The Adverse Childhood Experiences study provides a score based on the number of specific adverse events in a person’s childhood—like parental divorce, alcoholism in the family, mental illness in the immediate family, and seven others. A score of 4 or higher strongly predicts terrible outcomes in adulthood, like major depression, chronic unemployment, inability to stay in relationships, alcoholism, early death, and suicide. My score is 8.

  Fortunately, statistics does allow for outliers. A few people—like me—beat the odds. I was accepted into that residency program and many others. Thankfully, the people in charge of these training programs paid more attention to my academic record and what I was like as a person now than they did to what the statistics based on my childhood would predict would happen to me as an adult.

  Most people with my background who do survive do not thrive. They become cynical and pretty weather-beaten. They tend not to trust, to put it mildly. I, however, became a gullible, wide-eyed optimist. The price I paid is that I carry a lot of sadness inside me. But that also gives me a deeper understanding of other people’s sadness that lectures and books can’t provide.

  Without knowing exactly why, I heeded the inner voice that persisted even after initially getting rejected from medical school, the inner voice that had visited the little boy that hot day in Chatham. My career path wasn’t so much a choice as it was a necessity, a tropism, like a sunflower turning toward the sun.

  48.

  It was gloriously sunny in New Orleans the day of my medical school graduation in June 1978. Thank God the ceremony wasn’t outdoors, as the weather was, of course, hot and humid, and we graduating seniors all wore black robes and caps with green tassels.

  I was chosen by my classmates to give the student address at the ceremony, so I sat on the stage. The audience was packed with proud parents, grandparents, siblings, godparents, and other supporters. No one in my family was able to come, but that was OK, I would see them soon enough.

  Graduation day at Tulane Medical School was a victorious day for me and for us all. We shared the can-you-believe-it feeling of wow, I’m actually a doctor now. Of course, we had a lot of work to do to live up to that title, but at least now we were in position to take on the task.

  The transition from being a medical student to being an intern was intense. The first day of my internship I went into the men’s room at the hospital, looked in the mirror, and said to my reflection, “Tell me why I shouldn’t quit right now.” My reflection said nothing back. I splashed cold water on my face and said out loud, “People dumber than you have done this, you can do this.” So off I went, out onto the wards, hoping and praying I could pull my weight. The year turned out to be one of the best years of my life.

  Of course, people died during my internship. People die in hospitals every day. For such a big deal, it’s no big deal. One day I was talking with Lyn about it.

  “Why is it like this?” I asked her.

  “I don’t know,” she said.

  “People die, and it’s like just another event in the day,” I said.

  “But remember,” Lyn replied, “you don’t know them well, at least most of them. It can’t matter to you as much as it does to their families or their friends.”

  “I know,” I said. “It’s just that I never thought dying would become such a routine event.”

  “It’s all a matter of context,” Lyn said. “You’re working in a hospital. In a hospital, dying is pretty much an everyday occurrence.”

  “I know. I’m being stupid. I just can’t get used to it.” Then I paused. “Do you believe in heaven?” I asked.

  “Heaven is bullshit,” Lyn replied without a moment’s hesitation.

  “Oh, c’mon, no one knows for sure.”

  “Well, I’m pretty sure, Toots.”

  “But you don’t know for sure. No one knows. I don’t know. Don’t you wish God would just make a big announcement so we all could rest easy? It would make life in this hospital a lot easier, I can tell you that.”

  “That would be nice,” Lyn replied, “but didn’t God supposedly already do that? There’s this book that tells all about it, it’s called the Bible, as I recall. Marnie called it the world’s longest fairy tale.”

  “I don’t know,” I said. “I wish I did. How about if we make a plan? Whichever one of us croaks first”—that was Marnie’s word, “croak”—“if they get to heaven, they have to do all they can to contact the other person, OK? So if I die, I have to send you some sign and let you know the good news, and vice versa.”

  “OK,” Lyn said. “That’s an interesting idea. But if I die first, it makes me sad to think of you waiting and waiting for a sign that will never come. Marnie was right. It’s blackness, blackness.”

  “I know what Marnie said. So what’s a good sign for us to use?”

  Lyn paused. “Your mother always liked the British saying ‘Pecker up!’ How about if whoever dies first somehow sends the message ‘Pecker up!’ to the other person?”

  “Pecker up. That’s perfect,” I said. “No way that could be mistaken for anything else. If I die, I send you a pecker up message, and if you die you send me a pecker up message.”

  “Sure. But as I told you, this is an amusing little deal we’ve made, but that’s all it is, an amusing little deal. No one is going to be sending or receiving messages from the Great Beyond, I can guarantee you that. I don’t know why you believe this nonsense. It’s a crutch is all it is.”

  “I’m not sure I believe it,” I said. “I’d just like to know. Let’s just hope we have a long time to wait, that’s all.”

  “Don’t worry about that,” Lyn said. “We do.”

  My whole family thought my musings about God were a waste of time. Jamie was the most avowedly atheist, while the rest were more agnostic. God was not a topic that came up much.

  But I did turn it over in my mind quite a bit. I saw more death as an intern than in any other year of my life. Death almost became routine, but not quite. I’d always look down at the dead person and half expect him or her to wake up. And I’d want to say something, like “Good luck,” or “Bon voyage,” but I never did. I’d think those words, though, as I was disconnecting the lines.

  Going from alive to dead can be sudden and dramatic if you get shot in the street or collapse of a heart attack while jogging, but most of the deaths I saw in the hospital were rather serene. The patient would often be alone. The moment of death only became dramatic when we decided to do an all-out code and use the full tympani section to keep the patient alive.

  But when we let nature take its course and let the patient quietly slip away, the moment that separates life from death is as imperceptible as the moment when love, once and for all, finally ends.

  49.

  Remember that last day of my internship at the West Roxbury VA Hospital that started this book? I made rounds on that breezy sunny Saturday morning, wrote up my notes, and said goodbye to the nurses and my favorite patients, especially the slowly dying Mr. Cavanaugh. He had end-stage everything but was fighting his last battle with all the cussing and flirting with nurses he could muster. I said goodbye to the medical interns and residents who’d been on call with me, people I treasure to this day, and walked out of the VA hospital for the last time, the most intense year of my life complete. Finito.

  I felt sad to be leaving behind the exactitude of internal medicine. But my calling was psych. I now had less than twenty-four hours to get ready for the next shift, which would last the rest of my life.

  That Sunday, July 1, 1979, I would report to the hospital that I would embrace with a passion I’d never felt for any institution (except maybe the Boston Red Sox). Innocuously called the Massachusetts Mental Health Center, or MMHC, it was built in 1912—ironically, the same year as Fenway Park. Originally called by a more colorful name, th
e Boston Psychopathic Hospital, or “the Psycho” for short, it was renamed the blander MMHC in 1967 in the interest of reflecting a more 1960s-ish community-based mission. But to the old grads, which include some of the most illustrious psychiatrists throughout the country, it will always be “the Psycho.”

  A shrink is a hodgepodge of a job at the bottom of medicine’s totem pole, a job most people, often for good reason, make jokes about or flat-out scorn. Yet for me it was the Big Leagues, Broadway, the Show. People told me, don’t romanticize it too much because you’re bound to be disappointed. But I ignored that advice. I romanticized the hell out of it.

  Signing on at MMHC was the logical continuation of talking with Uncle Jimmy about why he went into farming instead of finance, and why he hated hypocrites so much; it was the logical continuation of fervent discussions in English classes around Exeter’s round tables, the logical continuation of the unexpected excitement I felt while listening to Walter Jackson Bate bring Samuel Johnson to life, the continuation of talking about people around the dining room table, sizing them up, commenting on their oddities and charms, which is what my family liked to do more than anything else. We were a bunch of gossips and critics of the petty ways of people, including our own, as long as the person being discussed was not in the room.

  Entering psychiatry, I dreamed of nothing less than decoding human nature. Just about everyone who came to MMHC dreamed that the place would cure whatever ailed them emotionally and reveal the answers to their most fervent questions about life. I was no exception. I dreamed of a world where, at the feet of great teachers, I would learn about what the rest of medicine couldn’t have time for, what the interns I trained with and all the others in mainstream hospitals simply could not (and should not) squeeze into their day, namely how to delve deeper into another person’s mind, another person’s story, with an eye toward “curing them up,” as Dr. Bill Beuscher, my attending, or what we called superchief, used to say.