by Rafik Schami
282. Hanna Bishara
When Dr. Bishara came into the consultation room on Monday morning after two weeks of vacation, the staff were discussing the new admissions: one was a case of emotional menopausal depression in a recently divorced woman patient of fifty-two, with abuse of medicaments and suicidal tendencies. The second case was one of acute recidivism of chronic schizophrenia with delusions, patient not responsive at present.
Hanna Bishara was not asked to take on either of these two new patients that morning. Nor did she offer to; she was thinking of her old patient in the closed women’s ward who had jumped out of a window two days earlier, breaking a leg and three ribs.
After a short discussion, her colleagues left the room. Dr. Salam beckoned to Hanna Bishara to follow him into his office.
“Young woman, late twenties, married, no children, chronic depression and severe lack of appetite, borderline anorexic with a weight of forty-three kilos and height of one metre sixty, high degree of anxiety,” explained Dr. Salam, glancing several times at the papers in front of him. He seemed very glad to have this particular patient here. A slight smile showed on his face. “Rana Shahin is my patient. You’ll need to go particularly carefully with her. Her father – an excellent lawyer – is a good friend of mine, her husband a high-ranking army officer. Would you please get to know the young woman? And tell me how you’re doing with her now and then,” he said in an unusually gentle tone, making preparations for his daily rounds.
Dr. Bishara knew that Edward Salam had a particularly soft spot for young women patients, whom he treated with paternal care. He had always wished he had a daughter, but his wife gave him four sons, and he didn’t get on well with any of them. However, that wasn’t the only reason for Rana’s preferential treatment. The medical director needed her and other patients with relatively slight mental disturbances to raise the reputation of his psychiatric hospital and rescue it from the derogatory associations of a “nuthouse” – not altogether easy in view of the condition of the majority of patients, about whom no one asked any more.
Hanna Bishara, a specialist in neurology, also saw a good opportunity for herself in these endeavors of the medical director. She had spent years doing further training in psychoanalysis and psychotherapy, and Salam had made her his closest confidant, in preference to five older doctors. And she would get no chance at all outside this hospital. There wasn’t a single private psychiatric practice in the whole of Damascus.
283. Mother
When Hanna Bishara entered the room she saw a deeply disturbed young woman: the curtains over the window were drawn, leaving only a tiny gap between them, and Rana was sitting in a corner in the semi-darkness. When the doctor came in she visibly took fright, but immediately tried to recover her self-control and sit up straight in the chair at the small desk. At the same time, however, she turned away and said nothing, so there was no eye contact between them, and no conversation. Dr. Bishara was clearly surprised by the sight of the fragile, delicate figure, sensed her great fear of all intruders, and sat down at a suitable distance. After a while she broke the silence and spoke gently: she’d like to get to know Rana, she said, so that she could form a picture of her life and the time before her admission, and then perhaps she could help her to understand the inner reasons for her own suffering better. Rana stood up as if she felt pressure being put on her, and took refuge on her bed, where she sat wrapped in a blanket to protect herself from further questions. The doctor said quietly that she respected Rana’s reserve, and then rose, adding as she left the room that she would look in again that afternoon.
But she had no luck that afternoon either. I’m getting nowhere at all, thought Hanna Bishara in the evening, feeling disappointment and perplexity. A beautiful young woman from the best circles of society, practically without a care in the world – and now this happens to her. What could have caused it? In the corridor she met her older colleague Hisham.
“Well, how are you doing?” he greeted her, as usual.
“It’d be easier opening an oyster with your bare hands,” she said, quoting his own dictum about mute patients. He smiled. “Just as I always say. I’ve come from a similar case. Two hours, and it’s not just my tongue that’s all furred up.”
Hanna Bishara went to the ward office to take a closer look at Rana’s case notes and the medical director’s admission report on her. But they were not much help either over the next few days. Dr. Bishara felt Rana’s distrust as a personal failure, particularly as the young woman reacted to the medical director himself in a remarkably positive, almost confidential way. Hanna Bishara began to suspect that on a deeper plane Rana’s distrust of her related to her mother.
This idea was fully confirmed in their next session. The doctor very cautiously broached the subject of Rana’s childhood and her relationship with her mother. At first the young woman just shook her head with a wry twist of her mouth, but then, after a silence, she began to talk after all, and at the end of their hour together she found relief in a fit of tears.
“I suspect your mother felt so hurt that her first child was ‘only’ a girl that she never forgave you, and was always taking her disappointment out on you,” said Hanna Bishara.
Rana looked up. She felt that the doctor was not just quoting from medical textbooks but speaking from her own experience. She smiled at her.
When Hanna Bishara came next afternoon, everything seemed just the same as at their first meeting – except for her patient’s shy, questioning look, as if the young woman had been waiting for her.
Hanna Bishara recollected that, in passing, Rana had told her how as far back as she could remember her mother had never let her have anything she said she wished for. So she began by asking if there was anything that Rana would like just now. After a short pause the answer came in a soft but very clear voice, “Could someone tell Dunia I’d like to see her?” Dr. Bishara learned that Dunia was a very good friend whom Rana had known since childhood. The doctor promised that she would see about it. “But perhaps we ought to discuss your medicaments first, and work out a plan together to improve your appetite,” she said, and was astonished when Rana quietly but audibly agreed with her.
Unfortunately the experienced Dr. Salam was right when he said he doubted whether Rana’s friend would comply with her wish. Dr. Bishara had been more optimistic, but her phone call to Dunia was a disappointment. Dunia wasn’t going to visit a psychiatric hospital; like many Arabs she seemed to be afraid of them, although she didn’t say so. But still, she was ready to talk to her friend on the phone.
Rana smiled quietly when the doctor said that, sad to say, Dunia couldn’t visit her. “I ought to have known it,” she murmured, “but I was being silly.”
284. Liking
“Would you like to go into the garden?” she asked. Rana looked up, and was surprised to find the doctor reading her own thoughts. A little later she was walking in the garden with Dr. Bishara, shyly exchanging greetings with the other patients.
No, she had certainly not been a highly gifted girl, Rana thought, before carefully answering that question from the doctor out loud. She’d just worked hard, that was why she had done well in school and passed all her examinations without much difficulty.
Had she been popular, Dr. Bishara asked? No, she replied. The doctor did not press her further. That was kind of her, but the way Rana had answered at once, as if “no” were the answer only to be expected, alarmed them both.
Rana fell silent. The doctor felt as if she were standing in a dark wood, and must grope her way out of it laboriously. Her questions were probing fingers. Rana replied briefly, with long silences in which she often seemed to have entirely forgotten both the doctor and herself.
But then a moment came when their conversation reverted to mothers. Rana remembered moments in her childhood when she had felt something like affection for hers.
“Did your mother kiss you often?”
“Kiss me?” Rana actually laughed for the first ti
me. “My mother’s mouth isn’t made for kissing. She could never bring herself to do it.” She felt silent again and ignored all further questions. The doctor sensed deep sadness behind her withdrawal.
Hanna Bishara, said the male nurse Adnan, was Dr. Salaam’s right hand. She came from a rich Christian family, and was the first woman doctor to work in this mental hospital. He liked her. Head Nurse Kadira did not. That was another reason to like Hanna Bishara, though Rana. She herself disliked Kadira and her cold manner.
Head Nurse Kadira was not tall, but she was strong, with masculine features and fiery red hair. She wore shoes with crescent-shaped iron reinforcements at their toes and heels, so that as she walked down the corridor she sounded like a soldier on the march, but with a curiously teetering step. She said little, and her eyes were windows with no curtains over them; you looked straight into a void.
There was a lot of talk about the head nurse. People said she was wedded to the hospital, and crazy herself. One woman patient told Rana that she had seen Kadira urinating, and she was a man below the waist, female only from the waist up.
285. An Outing
Had Rana been particularly afraid of being with boys, the doctor wanted to know. Hesitantly, she said no, and then preserved a long silence. Thinking about it, she decided her answer was not quite right. Then she remembered the incident in the summer of 1954, when she was fourteen. There was to be a family outing, with a picnic on the river, one Sunday in July. At first it seemed a delightful idea, but then she found out that Jack had been allowed to ask two friends, the Interior Minister’s twin sons. Rana suspected that her mother was trying to ingratiate herself with their powerful family by inviting the boys. Or perhaps she only wanted to be able to mention at her coffee mornings what good friends her son was with the Minister’s twins. Rana would have preferred to stay at home. Then she could have phoned Farid, or gone to the cinema with Dunia, but neither her mother nor her father would allow it. Her father waxed enthusiastic about the beautiful river that flowed into a lake. “Water as clear as glass, just the thing for a little fish like you.” He knew that Rana loved to swim.
But during the outing something happened that she couldn’t forget. The twin brothers were nice boys, but they kept looking at Rana in an odd way. The day was hot. Her father invited her and the others to swim, and soon she had left everyone else behind. The lake was deep, and her father had been right: the water was clear as glass and refreshing. Her mother was already setting out the picnic in the shade of a tall oak tree.
When her father was tired of swimming he climbed out of the water and told the boys to keep an eye on Rana. All three of them laughed, and soon they were playing catch and diving under the water. They formed into two groups, Rana and Jack against the twins, but before five minutes were up all three boys were chasing her. She was surprised, furious with her brother, and tried to get away. But Jack held her firmly by one hand, and one twin by the other. Suddenly she felt the third boy’s fingers under her swimsuit. He was grinning at her. Rana saw in his face that he knew exactly what he was doing. He boldly squeezed her nipples. Rana couldn’t defend herself. Pleading, she turned to her brother. “Let go of me!” she cried. But Jack pretended not to hear her. The boy’s hand was now sliding down over her stomach to her vagina. “No!” cried Rana, kicking out at both her brother and the other twin, and finally she managed to free herself. She dived down, swam through the waterweeds in the depths of the lake, swallowed water, and came up again a long way from the other three, coughing and crying.
The boys went on playing. They laughed. But Rana swam far out, to keep a safe distance away from them. When she finally came out of the water, they were already sitting by the camp fire lit for the picnic, laughing. None of them took any notice of Rana.
That was over fourteen years ago, but suddenly it seemed like yesterday. Her throat felt tight. She said goodbye to the doctor, who had borne her silence patiently.
286. Brightly Coloured Birds
Of all the patients in the hospital, Sami was the strangest. He kept raising his hands and announcing his name and job to some invisible inspector. Then he would assure his unseen interlocutor that he was innocent, and wasn’t a bird. But he was a completely different person when someone in a white coat appeared, even if it was only the porter. Then he spoke thoughtfully and reasonably, and you might have thought him completely sane. Sometimes his “reasonable” manner intrigued strangers, who took him for one of the staff until he began telling them about the experiments being made underground here to turn human beings into birds and fish. He had told Rana in confidence that Dr. Salam was giving him pills so that in due course he would be able to fly like a bird. It was being done for the benefit of the air force. But he only pretended to take the pills, said Sami. As soon as the doctor turned his back, he spat them out again. “And one day the pill hit a worm, and what do you think? It sprouted wings and flew away.”
But Rana found it difficult to draw the line between being crazy and acting crazy in other patients as well as Sami, and sometimes even in herself. It was a balancing act. At least, she reassured herself, the part of her brain where Farid lived was still sane, and that was a large part. She checked every day when she got up to see whether she could recall every detail of a given meeting with Farid, and always felt better when she found that it worked.
And in some ways she felt that the world of this hospital was more honest than the sane world outside. Rana thought of the women in her neighbourhood who gave up all their own desires out of fear, and just did what other people expected them to do.
‘I’d rather be with these brightly coloured birds here,” she whispered, and smiled at the gardener, who was doing a little dance with his rake.
287. Second Report
Dr. Salam, chief medical director, 3 July 1968, 17.00 hours.
Patient to some extent responding to medication, shows more energy, thinks and speaks with less inhibition. However, mood still very despondent. Feelings of guilt and failure, in particular lacks any idea of future prospects. Affect clearly less labile, but still potentially suicidal. Seems to have settled down well, helps the staff where she can, is solicitous of weaker women patients. Nursing staff say that a kind of friendship has developed between patient and male nurse, Adnan. According to Sister Sahida, is now also sleeping through the night without chloral.
Imipramine can be increased by 50 mg, for the time being continue levomepromazine at the same dosage. May be permitted to go for walks alone now, only for an hour at a time to start with.
Dr. Bishara satisfied. Two months after their first meeting, patient laughed for the first time, a few days ago began painting (watercolours). On warm summer days spends more time outside than in her room. Patient does not seem very anxious for her family to visit her. Keeps her distance from husband in particular. Ward nurse says he has visited only twice. Conversations with Dr. Bishara seem to mean a good deal to her, she tells me they talk about her childhood most of the time. Dr. B. has learned that patient’s mother also had phases of severe depression.
288. Opening Up
Psychiatry was his domain. No medical director in the Republic had such a high reputation as Dr. Salam, but only within the walls of his own hospital. Hanna Bishara had a free hand there. It was she who had arranged for soft classical music by Bach or Mozart, to be played in all the wards.
Hanna Bishara always gave a straight answer when Rana asked her a question. Dr. Salam phrased his answers so carefully that sometimes Rana wasn’t sure whether he meant yes or no.
“Why do many of the patients here have burn marks on their temples?” Rana asked. Hanna Bishara told her about the electric shocks that such patients needed to cure them.
Dr. Bishara was a happy woman, but in general she didn’t mention her private life much. However, when Rana asked to see photographs of her husband and her children, she brought some next day. They talked about the wedding night, and the doctor asked if Rana had been prepared for that first t
ime with her husband. She didn’t feel like telling the doctor yet that he had raped her, but confined herself to a “no”. “My mother can’t talk about either love or sex,” she added. The doctor nodded, and wrote it down in her little notebook.
When Hanna Bishara left that afternoon, Rana watched her go, and felt that it wasn’t fair for her to leave this woman in the dark. A woman who helped her, who didn’t ask insistent questions, and she, Rana, was leaving her to puzzle over the reason for her sadness. A little later she got to her feet and ran after her, but the doctor was not in the ward any more. The nurse on duty tried to reach her by phone, and was in luck.
“There’s something important I’d like to tell you. When will you have time?”
“Any time, for you,” replied the doctor. She sensed that the gate which had been closed to her so long had just opened at least a crack, and hurried back to the ward.
Then Rana told her the whole story of herself and Farid, and Hanna Bishara listened for four hours. She made not a single note, but every word was imprinted on her mind.
289. Two Doctors and One Patient
December 1968 brought more rain than the country had seen all year. A strong wind whipped heavy raindrops against the window. Dr. Salam was watching one of the male patients who had been dancing in the garden, and was now being led back indoors by two male nurses.
“Go on. I’m listening,” he prompted Dr. Bishara, who had briefly paused in the middle of reading her report.
“After a difficult start, a definitely productive mental process has now developed, one in which Rana can admit to her grief over her forbidden love for Farid, her fears and uncertainty since his arrest, and can carry on without falling into despair. She also feels able to stand up to her conflicts with her own family, in particular her mother, who offered her neither protection nor emotional warmth. Equally positive has been her overcoming of her anorexic tendencies, with slow but steady weight gain, and she is becoming physically stronger. So we are reaching a phase of stabilization which makes it seem appropriate to prepare her for discharge in the near future …”