by Dave Eggers
"The usual—three to five days. Unless you become anxious and stressed—stress will exacerbate the bruising, as you know."
"Yes—yes!—'stress.'" Mrs. Druidd spoke as if repentant. Chloe had brought in an ice pack for Mrs. Druidd to take away with her, for a minimum extra charge—standard procedure in Dr. Brede's office and much appreciated by his patients.
Badly he wanted this pathetic woman to depart. He was tugging off his latex gloves impatiently—"Be sure to keep the ice pack on your face as much as possible. If you do—as you know—your face will heal much more quickly." The latex gloves seemed to be sticking to his fingers; he tore them off in haste, as if suffocating. As Mrs. Druidd left his office, pressing the ice bag to her reddened and swollen face, walking as a dazed or drunken woman might walk, the sobering thought came to Dr. Brede I will never see her again. She will never call.
His 5:15 P.M. patient, his last of the day, Mrs. Drake, another of his long-term patients, proved even more difficult. There was an edgy querulousness about Mrs. Drake as she climbed up onto the examination table, lay back stiffly, and allowed Chloe to position her; she failed to relax as Dr. Brede indicated on her face in Magic Marker ink, where the injections would be; instead of squeezing the rubber balls Dr. Brede gave her, to deflect pain, as Dr. Brede began the injections she sat up abruptly, touching her face—"That hurts! That burns! It doesn't feel like last time."
Calmly Lucas assured her that certainly, it was the same solution—the identical solution—Botox—he'd given her in the past—"You must be more tense today. Tension heightens sensitivity to even mild discomfort." He was holding the syringe with the two inch needle in his hand that trembled slightly—though Mrs. Drake was too distracted to notice.
"Doctor, are you blaming me?"
The woman spoke so aggressively, Lucas was taken by surprise. Long he'd been accustomed to the tractability of his female patients; it was like them to murmur apologetically for wincing with pain. But Irena Drake was the wife of a Dutchess County supreme court judge, a woman with a strident voice and accusing eyes. Her chestnut-colored hair was synthetically lightened and her skin that had once been luminous and creamy seemed to be now drying out, though she was only in her late forties. Lucas "lifted" Mrs. Drake's face several years before and attended to it at three-month intervals; between patient and doctor there had arisen a quasi-flirtatious rapport, not so much sexual as social, or so Dr. Brede had imagined. Now Mrs. Drake was wincing with pain, though he'd hardly touched her.
It was Formula X he was using, having decided to dilute it just slightly after his experience with Mrs. Druidd. Lucas was certain that this liquid solution couldn't possibly be causing a "burning" sensation—the hypersensitive woman had to be imagining it. But when he began to inject her forehead—where fine, white wrinkles had formed unmistakably since Mrs. Drake's last injection six months before—Lucas felt the needle slip, and strike bone—the hard bone just above the eye. Mrs. Drake screamed and shoved him away. "Dr. Brede! You did that on purpose!"
"I—I certainly did not."
"You did! You did that to hurt me—to punish me!"
"Mrs. Drake—Irena!—why would I want to hurt you?—punish you? Please try to be calm—take a deep breath and release slowly..."
"Have you been drinking, Dr. Brede?"
"Drinking? Of course not."
He'd had only a twenty-minute break between patients, at 2:00. Eating a late lunch at his desk, on the phone with his accountant who was preparing his New York State tax documents, he'd had just a double shot of Johnnie Walker he kept in a cabinet in his office, and he'd rinsed his mouth with Listerine afterward. He was certainly not drunk. Nowhere near drunk. This hysterical woman could not smell alcohol on his breath.
"Then you're—drugged. You're taking something. I've seen TV documentaries—doctors like you. You've hurt me—look at me."
On Mrs. Drake's furrowed forehead was a bright blotch like a birthmark. Where he'd been injecting, with enormous care, minuscule quantities of Formula X to plump out the wrinkles and to "freeze" the nerves, to prevent such unattractive furrowing. All this was routine procedure, or nearly—still it was troubling, the patienfs face was hot and swollen to the touch after only a few injections.
"Dr. Brede! I will report you to the county medical board—I will tell my husband. He will know what to do. I am leaving now, and I am not paying for this treatment."
"But, Irena—I haven't completed the injections. I haven't half-completed the treatment. Chloe can put ice on your face and wait a few minutes before proceeding—"
"No. I'm finished. Let me out."
"You can't possibly want to leave without—"
"Yes. I do. I want to leave now."
Like a child in a tantrum, Mrs. Drake tore off the sheet of white paper covering her to the chin and threw it onto the floor. On this paper was a fine lacy pattern of blood-specks like overlapping cobwebs, of a kind Lucas had not noticed before.
"You signed a waiver, Mrs. Drake. Before coming into treatment, you signed a waiver with me."
"'Signed a waiver'! Of course I 'signed a waiver'—doctors like you won't treat patients otherwise. But would such a waiver stand up in court, if I can prove negligence? Malpractice? If I have photos taken of my injured face? I doubt it."
"Your face—is not 'injured.' Swelling and bruising is perfectly normal as you must know..."
Dr. Brede was stunned by the woman's unprecedented hostility. In his nineteen years of practice no patient had ever spoken to him like this. Some change had occurred, almost overnight; he couldn't think that it had exclusively to do with him but with the era itself—the plummeting economy, the ongoing wars, the malaise of a protracted winter. He thought I will have to stop this madwoman. Someone must stop this madwoman, but the prospect of touching Mrs. Drake, trying to restrain her, was distasteful. If he tried to prevent her leaving—in order to speak to her reasonably—she would react by screaming, and Chloe would hear.
"Goodbye! I'm never coming back! And— I am not paying."
Indignant, Mrs. Drake left the examination room, kicking at the sheet of paper she'd thrown to the floor. Her harridan-face was luridly bruised as if she'd been tattooed by a whimsical and erratic tattooist.
"Dr. Brede?"—there was Chloe gazing at him with concerned eyes.
"It's all right, Chloe. Mrs. Drake had to leave suddenly."
"But—"
"I said it's all right."
"But—shall I send her a bill? Or—"
"No. Don't send her a bill, please. Expunge her."
It was both flattering to Lucas, and discomforting, that his nurse receptionist behaved at times as if she were in love with him; Lucas was too gentlemanly to take advantage of her, though since his separation from his wife, Chloe's tender solicitude toward him was more marked. Now he would have turned away impatiently except Chloe dared to restrain him, as an older sister might—"Dr. Brede? Let me get this"—stooping to swipe at something on his trouser cuff with a tissue—a dark, damp stain? Blood?
Then, as she straightened, Chloe noticed a similar, smaller stain on a cuff of Dr. Brede's white shirt and this, too, she hurriedly swiped at with the tissue.
"A drop of something," she murmured, frowning as if embarrassed, not quite meeting her employer's eye, "—wet."
To his wife he'd pleaded Have faith in me!
"'Trepanning'—you know what that is, Doctor?"
"Yes. Of course."
"It's a—controversial medical procedure, I think?"
"Not controversial. Not a 'medical' procedure."
Ms. Steene was a stranger who'd called to make an "emergency appointment" with Dr. Brede for a consultation. He'd assumed that the woman wanted to discuss possible cosmetic treatments to restore a look of youthfulness to her creased face that appeared to be prematurely weathered; she was slender, if not markedly underweight, and wore sweatpants and a sweatshirt embossed with shiny green letters— Harmony Acres for a Better World. On the form she'd filled o
ut for Dr. Brede's files she gave her age as fifty-six. Emphatically she'd crossed out the little boxes meant to designate sex and marital state as if in objection to such queries into her personal life.
With an air of correcting the uninformed physician Ms. Steene said reprovingly, "Not a medical procedure, Doctor. A spiritual procedure."
How unexpected this was, and annoying. One of Dr. Brede's long-term patients had also asked him about trepanning the other day, and Chloe reported calls to the office with similar inquiries. There must have been something about trepanning on television recently, on one of the morning or afternoon interview shows aimed at women viewers. Politely Dr. Brede said, "Trepanning is not a 'spiritual' procedure, any more than it's a medical procedure, Ms. Steene. It's medieval pseudo-science in which holes are drilled into the skull to reduce pressure or to allow 'disease' or evil spirits to escape. It's a thoroughly discredited procedure that's very dangerous—like exorcism."
Stubbornly Ms. Steene said, "It isn't 'medieval,' Doctor. You can say that it predates the history of Homo sapiens—there is evidence that Neanderthal man practiced trepanning. Throughout the ancient world—in the East, in Egypt—trepanning has been practiced. In 1999 it was revived, in several parts of the world simultaneously. There are no practitioners in this part of the country, however. I was wondering if—"
"Ms. Steene, no reputable doctor would 'trepan' a patient. That is just not possible. There's no medical purpose to it, and as I said it's very dangerous, as you can surmise. I don't quite see why you came to me..."
Ms. Steene wasn't an unattractive woman, but her voice set Lucas's nerves on edge, like sandpaper rubbed against sandpaper. She seemed to be peering at him with an unusual avidity, as if indeed there was a reason that she'd made an appointment to see him, which he wasn't willing to acknowledge. "I came to inquire whether you might administer this treatment to me, Doctor. It's very simple—a single hole to start with. The recommended size is three-quarters inch in diameter in this area of the skull"—with bizarre matter-of-factness the woman indicated a portion of her scalp several inches above her right eye.
Brusquely Dr. Brede said, "I'm sorry. No."
"Just—'no'? But why not? If you do 'face-lifts'—'liposuction'—procedures for mere vanity's sake—why won't you do this, for the sake of the spirit?"
Because there is no such entity as "spirit." Because you are a madwoman.
"I'm afraid not, Ms. Steene. And I don't recommend that you look around for another 'surgeon' to do this ridiculous 'procedure' for you."
On this note the consultation ended abruptly. With a forced courteous smile Dr. Brede showed Ms. Steene to the door. How his face ached, like a mask clamped too tightly in place! Though he was incensed and indignant from the insult to his professional integrity, yet he managed to behave courteously to Ms. Steene; even now the woman left his office reluctantly as if, despite the doctor's unambiguous words, he might change his mind and summon her back.
Chloe complained that Ms. Steene hadn't paid the consultation fee but had simply walked out of the office, rudely. Dr. Brede assured her it was all right, the consultation hadn't taken long—"Just expunge Ms. Steene from our records. As if she'd never been."
This season of dark-pelting rains! That seemed never to be ending except in patches of ferocious sunshine so blinding Dr. Brede had to wear dark glasses when he stepped outside, and was forced to drive his car—a silver Jaguar SL—with unusual concentration, for fear of having an accident. He was disturbed by frequent FOR SALE signs in the more affluent areas of Hazelton-on-Hudson; even at Weirlands, where once there'd been a waiting list for tenants, there were beginning to be vacated offices. It was a shock to see that the Hazleton Neck and Spine Clinic had departed with rude abruptness from its large suite in an adjoining building.
Yet more troubling, Dr. Brede's patients were canceling appointments, often failing to make new appointments, and failing to pay their bills. One of these patients had moved to Arizona—"No forwarding address!" Chloe lamented—and one was reputedly hospitalized after what might have been a suicide attempt. It wasn't likely that Dr. Brede would be paid what he was owed by these women—more than nineteen thousand dollars had accumulated in the past six months in unpaid patients' bills. Turning such delinquent accounts over to a collection agency was a desperate move Dr. Brede hesitated to make: even if the agency collected, he'd receive only a fraction of the money owed him.
Civilization is faces, "appearances": when these collapse, civilization collapses as well.
His last patient of the day. In fact, late Friday afternoon, Dr. Brede's last patient of the week.
"'Trepanning'—you've heard of it, Dr. Brede?"
The woman spoke in a thrilled, lowered voice. Her bright, fanatic eyes were fixed on Lucas's face.
"Doctor, I realize—it's a controversial procedure. It's—unorthodox."
Lucas stared at the woman, dismayed. Was this some sort of cruel joke? The image came to him of carrion burns circling a fallen creature not yet dead.
Irma Siegfried, the divorced wife of a rich Hazelton businessman, was a long-term patient of Lucas Brede. For the past decade she'd seen him faithfully—collagen injections, Botox and Restylane—face-lift, "eyelid lift"—liposuction; and now, unexpectedly, to Dr. Brede's chagrin it was a very different sort of procedure— trepanning—about which she'd come to consult with him.
Lucas knew that Irma Siegfried was devoted to him; yet he had reason to suspect that from time to time, especially when Irma spent part of the winter in Palm Beach or in the Caribbean, she'd had work done on her face by other cosmetic surgeons. The woman's fair, thin, dry skin—the skin of a natural, if now faded blond—was the sort of skin that aged prematurely despite the most diligent cosmetic precautions, so now Irma's naïve-girlish manner, a childlike sort of seductiveness that had been so effective only a few years before, was increasingly at odds with her appearance. In her eyes a hurt, wounded, reproachful glisten that touched Lucas Brede to the heart— Help me, Doctor! You alone have the power.
Initially Irma Siegfried pleaded the case for trepanning in a reasonable tone. She wasn't the sort of patient—like the contentious Ms. Steene—to bluntly confound her doctor's professional wisdom, still less his integrity. Irma told him that she'd reached a "spiritual impasse" in her life—she'd had "serious doubts" whether the Christian God existed during this seemingly endless winter, in the last months of the Bush administration—"And Mr. Bush was a man I voted for, Doctor—my family has always been Republican, but now"—in a tremulous voice telling Lucas that she'd come to the conclusion that only a "radical"—"revolutionary"—alteration of her spirit-consciousness could save her: trepanning.
Lucas asked what on earth she knew of trepanning. He did his best to disguise the astonishment and disapproval he felt.
Irma said that she'd learned through books and the Internet—"The New World Trepanation Order"—and had only just the previous week realized how essential it was for her to have the procedure. "It isn't for everyone, of course. But I know it's for me. I need to relieve the terrible stress of my nerves and certain 'noxious memories'—as trepanning has done for so many others."
"Really? What others?"
"On the Internet—they've given testimony. I've been corresponding with some of them—women like myself—'pilgrims.' I signed a pledge to establish an 'endowment—at the New World Order—which is based in Geneva, Switzerland. The director is 'medically trained'—his teaching is that we are living in a debased 'Age of Lead' and radical measures are required for our salvation. And trepanning is very simple: a hole bored in the skull."
Lucas listened with disdain, disbelief. How casually the woman uttered these words— a hole bored in the skull.
"Doctor, I know it's 'dangerous'—of course! All that is courageous in our lives is 'dangerous'—even 'reckless.' I've come to you because I know you, and I trust you. All that you've done for me—which has been considerable, Dr. Brede—won't begin to compare with what I am
asking you to do for me now, if you will find it in your heart to help me! If you can't, I will have to turn to a nonmedical practitioner of some sort—unless I fly to Geneva—there are trepannists who advertise on the Internet. The procedure is painless, it's said—or almost—but there is a risk of infection if amateurs perform it. And if the dura mater is penetrated in some way to cause hemorrhaging, that could be serious. But in recent dreams..."
Yet more bizarre, the matter-of-fact way in which the woman alluded to dura mater, as if she had the slightest idea what she was talking about, and how disabling, if not fatal, such a wound, carelessly executed, might be.
Bizarre too, that Lucas was listening courteously to her, and not bringing their conference to an abrupt close. If he insulted Irma Siegfried, he might never hear from her again; this was a risk he must take. His professional integrity! His common sense! Yet it was difficult to interrupt Irma, who spoke with such naive hope of having a hole drilled in her head to release "toxic" thoughts, emotions, and memories that had been accumulating since her childhood—"Like a well that has been slowly poisoned."
It was touching that for her visit to Dr. Brede, Irma Siegfried was wearing elegant clothing—cream-colored cashmere, a strand of pearls around her neck, glittering but tasteful rings. Yet disconcerting when she began to speak more forcefully, like a balked child, charging that physicians like Dr. Brede made careers out of concentrating on the "physical" and neglecting the "spiritual"—the procedures she'd had on her face had been "stop-gaps" with no power to satisfy "spiritual yearnings."
And how did she know this?—she'd had "numinous dreams" since the New Year.
"Doctor, I'm not happy—not any longer—with just 'appearances.' The face-lifts, the injections—have created a 'false face'—what is necessary for us, to transcend our 'fallen' selves, is to return to the 'original face'—the 'original soul'—that is the child-soul, unblemished by the world. Trepanation has been a sacred ritual in many cultures, you know—as ancient as the Egyptians long before Christ—in prehistory, practiced by Neanderthals. There are 'trepanned' skulls to prove this—I've seen evidence on the Internet. It's believed that this is what poets mean by 'trailing wisps of glory'—'memory'—this return to the pure child-self. I remember my 'child-self,' Doctor—I was so happy then! Yet it hardly seems that that child was me, so many years have passed."