Mount Misery

by Samuel Shem

  Six men had cornered Split Risk Harrison, the patient I’d let out. He was screaming, ‘You crucified Christ, you crucify sweet Bill Clinton, don’t you realize who you’re crucifying now?’

  The six mental health professionals rushed him. He ran full-tilt and hurdled the net, only to find the gate locked. He turned, spread his arms against the chain-link fence, and said, ‘Listen. This relationship is not working. You’ve got to get to know your crucifixee, OK?’

  They jumped him, tied him up, and carried him away.

  ‘Wrong coast,’ Solini said, looking up at me.

  ‘Wrong coast?’

  ‘On the West Coast he’d be pretty normal, no problem. All my life I’ve been trying to expand the definition of normal.’

  As we drove out to Ike White’s house, Solini hunched over the steering wheel of his brash red Geo with the North Dakota plate reading ‘Discover the Spirit: Peace Garden State,’ he told me about himself. He’d been born of Italian-Czech heritage and raised in Mandan, North Dakota, where his family ran Ideal Cleaners. ‘I grew up with wheat farmers and Lakota Sioux. My best Indian buddies would sit around town with their legs cut off from falling asleep drunk on the railroad tracks on their way back to the reservation in Fort Yates.’

  ‘Sounds pretty bad.’

  ‘No foolin’. I have this idea that the dry-cleaning fumes stunted my growth.’ With a sorrowful glance at me he said, ‘I’m only five-two.’

  He’d escaped to Reed College, then med school and internship in San Francisco. His medical internship, which he’d finished just the month before, had been every bit as horrifying and disillusioning as my own in the hospital nicknamed ‘The House of God,’ with the added hell of his caring for large numbers of AIDS patients. Many of his friends had died of AIDS.

  ‘Man, I am worn out,’ he said. ‘Not only from the internship, but from singing at funerals.’

  ‘You sing?’

  ‘Reggae. I’m the only white man who ever was lead vocalist in Jamaica Juice. I mean medicine is one thing, but Bob Marley and the Wailers is something else.’ He flipped on the tape deck and for a while we listened to the hard-driving revolutionary joy. I asked why he’d gone into psychiatry.

  ‘I love working with crazy people,’ he said. The little guy rolled his hands around on the steering wheel, his rolling hands rolling his arms, his arms, his body, until he was almost dancing in the seat and I had to grab the wheel myself.

  ‘But why’d you come to Misery? It’s like the Wall Street of psychiatry.’

  ‘Misery’s cool. I need a rest. Three thousand miles from my ex. I heard Ike White speak once, out in Berkeley. He was cool. I didn’t get to meet him in person, just talked on the phone. I came here for him.’

  ‘Yeah, me too.’ Looking at his ponytail and earring, I asked, ‘But how did you get accepted?’

  ‘Geographical distribution and good C.fuckin’ – V.’

  ‘But what about the photo? The application photo?’

  ‘No problem. Sent ’em one from my yearbook.’

  ‘Med school?’ He shook his head no. ‘College?’

  ‘Get real. I had hair down to my waist and three earrings. One in my damn nose. High school. The Mandan High Braves. Basketball. Crew cut. No jewelry. No problem. So what about you, Roy-babe?’

  I told him that during my year in the House of God I’d gotten pretty cynical about medicine, feeling something was missing in my being a doctor, not to mention in my life. ‘I’ve had enough poodling around in diseased bodies. I can do bodies now. But I never feel I really understand. I want to understand people, that’s all.’

  ‘Well, it’s been a month. You understand anything yet? I mean really?’

  I thought about this. ‘Starting to, a little, with Ike. But that’s gotta be a good thing to do in the world, right?’

  ‘Pretty noble, man. Pretty high hopes. Could be trouble.’

  Inside Ike’s house Henry and I headed for the bar and poured bourbons. We met in a living room, which, in contrast to Ike’s office at Misery, was tidy and formal, all urethaned hardwood and Laura Ashley, implying Mrs Ike. Ike offered cigars. Henry and I were the only takers, aside from Ike himself. Ike leading, we walked into Freud.

  I had read the evening’s paper, ‘Mourning and Melancholia,’ during my medical internship. As I listened to Ike lead us through it, I was impressed. It wasn’t only that Ike was brilliant, he was so damn modest. He almost apologized for even teaching us this arcane Viennese stuff in the era of high-tech psychiatry. Ike sparkled.

  The monograph was about the grieving process. Freud dissected the difference between normal neurotic grief – ‘mourning’ – and pathological grief – ‘melancholia,’ or depression. ‘The heart of the difference between normal and sick,’ Ike said, ‘is captured in a single remarkable line.’ With passion, Ike quoted, ‘“The shadow of the lost object falls across the ego.’”

  Between the bourbon and the sleep deprivation I soon had a buzz on and drifted in and out. My fellow residents soon were sounding very intelligent about this mourning, this melancholia, this Freud.

  Saying good-bye to me, Ike seemed concerned. ‘Are you O-OK?’

  ‘Sure. Just a little wiped.’

  ‘That p-patient Harrison splitting – was that d-difficult for you?’

  ‘No,’ I said, surprised that he knew about this. ‘Not really.’

  ‘Working with sick people is p-pretty stressful.’

  ‘Can’t be more stress than doing straight medicine.’

  A slight delay – about two seconds – and then Ike said, ‘It’s a different k-kind of stress.’

  Creeping home in the cozy red Geo, soon Solini and I were singing along with Bob Marley’s ‘Them Belly Full (But We Hungry).’

  After Solini dropped me off I stumbled roughly up the narrow and trickily reversing three flights of stairs to my loft on the top floor of an old turreted Victorian and found Berry asleep in a chair. I hadn’t seen her in a few days. How lovable she looked, that long, tan Modigliani face tucked snugly into her bared shoulder, her blouse unbuttoned, the lace of her bra bulging bright and white against her deep tan, her short dark hair mussed and long black lashes two crescents on her cheeks. Her full lower lip was a pillow for her upper, both curled in a half smile, as if her dream was sweet. Knowing her recent pain, her struggle with self-confidence and her vulnerability, I felt glad for that half smile.

  I’d been with Berry for almost a decade. After my hellish year of medical internship and her hellish one as a child psychologist at another high-powered hospital, we’d decided we needed time together, to get to know each other again, and to try to heal. We’d taken a year off and traveled around the world, beginning in southern France, ending just a month before in southern China. During our year of freedom, our relationship had deepened. We’d talked about getting married. Yet we each felt that first we had to see what it would be like back in the high-test rocket of America.

  Berry too was trying something new, teaching four-year-olds in a preschool. Her internship in child psychology had crushed her, a few red-hot supervisors making her feel that she was ‘too sensitive’ and didn’t have the ‘critical discipline’ to be an academic. She had rebelled against a central part of her training: doing psychological testing on kids, labeling them as ‘sick.’ For her refusal, she was constantly made to feel like a failure.

  Yet she loved being with children. Wherever we stopped in our travels, I would volunteer as a doc, she as a teacher. She’d decided that when we got back she would work with ‘normal’ children, in a preschool.

  I bent and kissed her.

  ‘Where’ve you been?’ she asked, her half smile replaced with worry as she awakened. I told her. ‘You never said you had a seminar tonight.’

  ‘I forgot.’

  ‘Haven’t you ever heard of telephones?’ I said I had in fact heard of them, yes. ‘I’ve been worried. How was your day?’

  ‘My day and night and day? Loved every minute of it.
Being a shrink’s a snap. It fits me perfectly: a Jewish doctor who can’t stand the sight of blood.’

  ‘Sure, if you go through it drunk.’

  ‘I’m not drunk.’

  ‘Fine,’ she said, getting up, ‘and I’m not staying.’

  ‘C’mon, give an inch, willya?’

  ‘Try me tomorrow.’

  ‘Wait, wait, how was your day?’

  ‘One thing I’ve learned,’ she said, ‘is not to try to talk to a drunk.’

  ‘Hey, come on, I’m not your father, I’m your—’

  ‘Tomorrow,’ she said, and left for her own apartment.

  ‘Hey, I’m sorry,’ I called after her. Too late. She was gone. In bed I read a letter from my own father, the dentist, one of the world’s great optimists, a master of the conjunction. All his sentences were in the pattern of phrase-conjunction-phrase:

  … Glad you are done with your year off and it was a loss of a year’s income and not normal. Psychiatry is a waste of your talent and you will soon find out and go back to real medicine. Dentistry was always an intellectual challenge and a secure income. I still hope that someday we can have our family foursome and Mom has such a smooth short swing. I am playing well and try to concentrate on keeping loose my arms like ropes …

  Two

  HUNGOVER AND RAW, the next morning at nine I trudged into the Farben Building and up the grand stairway to my secretary Nancy’s office. The Cherokee-Schlomo matter seemed far away and phantasmal, like a faded dream. Nancy wore a cheery pink top, which exposed her tanned shoulders. Her eyes were red with tears.

  ‘What’s wrong?’

  ‘Didn’t you hear?’ Her eyes widened.

  ‘What? Hear what?’ She started to sob horribly. ‘What?’

  ‘Ike White’s dead. He killed himself last night.’

  ‘What? He … he couldn’t have. I saw him last night. We all did.’

  ‘After you left.’

  Things went blank. I heard her sobbing, but in the distance, as if she were one floor down. My legs were watery. I found myself in a chair.

  How could this be? It was impossible. I was talking to him, shaking his hand. He was smiling. He was going on vacation, for Chrissakes. I mean he seemed a little burnt out, but basically he’d been cheerful.

  ‘Are you sure it was suicide?’

  ‘Totally.’ She sobbed even harder.

  I felt a cold grinding in my chest, a metal fist around my heart. My whole body was heavy. Then I saw all over again as if it were yesterday the stain on the parking lot of the House of God where one of my buddies, a fellow intern named Potts, had landed from his leap from eight floors up, and tears broke, hot and sharp, searing my eyes. Ike? Not Ike.

  Word spread, and by the time Solini and I pushed our way into the standing-room-only Misery daily report at nine-thirty that morning, everyone not only knew that Ike White had killed himself with an overdose of sedatives, but also knew the kind and rough number of pills, and that on that last afternoon he had called the hospital benefits office to check on his insurance coverage – the return call I myself had heard on the answering machine. He’d popped the pills at about eleven, not a half hour after he and I had grasped hands limply without eye contact and I’d told him to enjoy his vacation. He’d died in the emergency room of a local hospital, with his wife and his new psychoanalyst at his bedside, and with his psychopharmacologist in constant touch by beeper.

  As we stood packed together at the back of the old auditorium, most of us knew the terrible truth. We were looking for help in how to handle it.

  Dr Lloyal von Nott stood up on the small stage, his funereal suit and dark hair and brows a picture of sad decorum. Here was a man not only in control, but in charge. He was the Chief of Misery, and like other chiefs of other institutions, he had that dazzling sincerity that meant you couldn’t trust a word he said. The meeting was a daily half-hour report from various wards of Misery on the events of the past twenty-four hours, including new admissions and current problems. With the calm dignity of his high British accent, Lloyal handled the usual business of running the hospital, proceeding as if nothing had happened, right up until the grandfather clock in the corner struck the hour with ten mournful bongs. The last bong died, leaving an ominous hush. Lloyal cleared his throat. The tension was incredible.

  ‘Thank you very much,’ Lloyal said, and started to leave.

  Unreal. For a second no-one said anything. Then the meeting started breaking up. Suddenly someone called out, loudly, ‘Excuse me. Dr von Nott?’

  Lloyal paused. The meeting coalesced. Heads turned to locate the speaker. A tall, gray-haired woman wearing dark glasses was standing, chin raised in that Stevie Wonder posture – clearly she was blind. ‘Dr Geneva Hooevens here. We are all very upset about Dr White’s death. Perhaps you could give us some information?’

  ‘We are sorry to announce the death of Dr Isaac White. He died of a fatal disease. The new director of residency training will be Dr Schlomo Dove. The time of the memorial service will be announced, anon.’

  Fatal disease? It was suicide. What the hell was going on?

  ‘But,’ Dr Geneva Hooevens said, ‘we are hearing a rumor of suicide.’

  ‘There is no truth to that rumor. Dr White died of a fatal disease.’ Lloyal turned and left. The meeting ended.

  Solini and I walked along slowly in the still, untroubled sunlight toward our wards on Emerson. With us was Hannah Silver, the only woman in our first-year resident class. I’d known Hannah at the BMS. She was a delicately featured woman with black hair spinning down to her shoulders, intense eyes set in a thin, Sephardic face, and a body that seemed to get more and more hefty as it descended, as if built low to the ground, for speed. A New Yorker with a sensitive soul, during an intense Upper East Side analysis she’d given up a promising career as a cellist, for medicine. She and I had worked together with Ike on Emerson 1.

  ‘What do they mean “fatal disease”?’ Solini asked. ‘Are they talking existential? Or is it some medical disease the poor guy had?’

  ‘He was in perfect health,’ I said. ‘He was only forty-one. Nancy spoke to a nurse friend of hers who saw the lab report: massive overdose of barbiturates. It was suicide, no question.’

  ‘Why won’t they admit the truth? Why the cover-up?’

  ‘I don’t know,’ I said, feeling ghostlike, the grip of that small, stammering hand. It was stunning to think that while he was shaking my hand he had already put everything in place to kill himself an hour later. What had he said, so fluently? They go out seamless. I looked at Hannah. She too had chosen Misery because of Ike, had decided to specialize in Ike’s specialty, depression and suicide. Now she was trudging along like a robot, in shock.

  In my month with Ike, dealing with the most depressed people on the face of the earth, I’d come to believe in him, in what he said and what he did. He was always calm, never saying much or doing much, but giving Hannah and me the feeling that he knew what he was up to, that walking the walk with these poor depressed souls would bring them out the other side. Ike had been the wise, calm, all-knowing doctor.

  Now something in me cracked open, calling into question who and what I could believe, or not believe. With Ike, I had believed in my own experience of him, and it was totally false. The ground under my feet took on the feel of gauze, the heat made my head spin. I said to Henry:

  ‘But I thought psychiatrists are supposed to be able to face the hard feelings, help you get through them, you know, alive?’

  ‘No joke, man. Maybe they’re trying to teach us that we’re better off mentally if we pretend that what really happened didn’t really happen. That we don’t feel what we do feel?’

  ‘But if you can’t even keep the doctors from killing themselves,’ I said, ‘how the hell can you keep the patients from killing themselves too?’

  Henry scrunched up his face in puzzlement. ‘Good question man, yeah.’

  ‘I feel so bad,’ Hannah said, rolling her eyes up towar
d the sky. She often did this eye roll-up when she spoke. One day when I’d asked her about it, she was surprised that she still was doing it, and explained that it came from her being in psychoanalysis for so many years. She’d gotten into the habit, from lying there on the couch with her analyst behind her, of looking back toward him whenever she said anything she thought he’d think she should think was important. ‘I came here to work with Ike, and when I asked him to be my teacher, he said …’ She stared to cry, so that Ike’s words came out in a kind of wail, “Nothing would make me happier.’”

  Emerson’s high walls and locked doors seemed sinister. On the first floor, Hannah unlocked the door to her ward, Emerson 1, Depression. Solini left me on the second-floor landing and continued up to his ward, Emerson 3, Psychosis. Noting the Split Risk sign, I opened the door to my new ward, Emerson 2, Borderline, with caution, shielded the opening with my body, back-flipped in fast and threw the door closed. It shut with a tremendous wham!

  ‘Dickheads Slam Doors!’

  The same sandy-haired young man as before. I went into a slow burn, wanting to respond, but stopping myself. About twenty other patients were sitting around the living room, staring at me. I saw the two tennis players. The normal, older man, in a crisp summer suit, was reading the Wall Street Journal. The younger, thin man – the manic one – was reading a tabloid and eating a carrot. He took a bite. In the tense silence the crunch seemed enormous. No doctors were in sight. The patients – teen to senior citizen, dressed from high fashion to rags, many with bandages around their wrists or heads or legs, one in a neck brace riveted into her skull, one in a wheelchair – seemed like so many wounded, shell-shocked refugees, waiting for a war to end so they could move on. These were the dread ‘borderlines.’

  I asked the ward secretary where I could find Dr Malik.

  ‘The one with the carrot. Hall meetin’s just about over.’

  This was a surprise. I stood and watched. He was speaking:

  ‘Like I said, Ike White killed himself. Nobody knows why. Hard to take. But we gotta face reality. Game’s over for him, but not for us. I’m here. You wanna talk suicide, I’ll talk suicide. But do sports! Catch ya later.’