Mount Misery

by Samuel Shem

  Malik walked over to us. He was wearing a short-sleeve white shirt and a slender red tie, khaki trousers, and well-worn Nike running shoes. His wiry athlete’s body seemed too small a container for his energy. He had jet-black hair, parted carefully and slicked up and over in front. In his long tan face, his hawk’s nose was bridged by black-framed glasses whose lenses were tinted amber. We shook hands. His was large for his size, and, though tight with tendons, gentle. An athlete’s hand.

  ‘I saw you playing tennis yesterday. I thought you were a patient.’

  ‘So y’think there’s a big difference between doctors and patients? Sometimes your patients are better than you.’ He fixed me with his eyes. I had a strange sense of being seen into. He glanced at my suit. ‘Boy, you got it bad.’

  ‘What do you mean?’

  ‘You know what I mean, doncha?’

  ‘Sort of,’ I said, sensing him sensing my discomfort wearing a suit.

  ‘So if you know what I mean, you don’t ask what I mean. To be a shrink you still got a lot to unlearn, like all us kids who went to med school. ’Specially us hot-shit high-achiever Jews.’

  I wanted to ask what he meant but stopped myself.

  ‘You stopped yourself. Good.’ He took another bite out of his carrot, closed his eyes and chewed carefully, savoring it.

  ‘What’s with the carrot?’

  ‘A carrot a day keeps colon cancer away.’ I laughed. ‘No joke. Studies have proved it.’

  ‘And just where is it you put the carrot?’

  ‘Ha! Haha! Good. So. You play any sports?’

  ‘Tennis, basketball, and golf.’

  ‘You do OK in psychiatry as long as you keep playing sports and use what you know from sports. Anything else before I show you what’s what?’

  ‘I was surprised you told them the truth about Ike White. I’ve been trying to figure out what von Nott meant by “a fatal disease.’”

  ‘That’s bullshit. Lloyal means he was biologically depressed, but depression never has to be fatal. Never. All this fatal-disease bullshit is so they don’t have to admit they killed him.’

  ‘They killed him?’

  ‘Places like this kill guys like him right and left, and a lot of the dead don’t even know when they’re dead ’cause their souls die first.’

  ‘That seems pretty bitter—’ I started to say, but then stopped, for Malik had tears in his eyes, amber-tinted wetness. One tear, escaping from under his glasses, ran down his cheek, translucent, losing form as it ran, leaving a trace behind, like a snail’s. Looking away, he chomped his carrot mournfully, giving out several forlorn crunches. He gulped down sobs, his Adam’s apple shuttling up and down his thin neck. I asked, ‘You must’ve known Ike really well?’

  ‘Nobody knew Ike well.’ He removed his glasses, squinted like a mole in the light, and wiped away the tears with the back of his hand. ‘Nobody alive knows a suicide at all.’

  ‘Why’d he kill himself? Is there some dirt, some secret? Why?’

  ‘Maybe, maybe not. “Why” questions don’t work too good in psychiatry. What can I tell you? Psychiatrists specialize in their defects.’

  ‘And Ike specialized in suicide?’

  ‘Wrote the classic papers, yop. Maybe we’ll find out more, with time, and the more you find out about a person, the more sense they make, never less. Lloyal was crushing him. He died of death.’ He blinked, looked around in puzzlement. ‘Why’m I preaching to you? Jesus! C’mon—’

  ‘Wait.’ He waited. ‘If the other shrinks are lying about him killing himself, and you’re telling the truth, aren’t you gonna get into trouble?’

  ‘So what else is new? They don’t like me teaching you new guys, ’specially not here on Blair Heiler’s ward. Eleven months of the year Heiler terrorizes these patients, so nobody else wants to deal with the mess in August when he’s on vacation in Stockholm. Sucking Nobel Prize butt.’

  ‘Terrorizes!’

  ‘Yop. So. Emerson Two. Know anything about it?’

  ‘It’s the borderline ward,’ I said. Ike had given me a lecture on borderlines, patients who were on the border between normal – or neurotics – and crazies – or psychotics. The lecture was based on the DSM – the Diagnostic and Statistical Manual – the bible of psychiatric diagnosis published by the prestigious American Psychiatric Association. The DSM described borderlines as suffering from a pervasive instability in interpersonal relationships, self-image, and feelings. The official diagnosis of Borderline Personality Organization, or BPO, was defined by thirteen Krotkey Factors, created by the borderline world expert Dr Renaldo Krotkey. Dr Blair Heiler, local borderline expert, was a follower of Krotkey. Some of the Krotkey Factors were: impulsivity (BPOs were dramatically impulsive about sex, shopping, gambling, substance abuse, reckless driving, binge eating, etc.), fear of abandonment, unstable relationships, suicidal or self-mutilating acts, mood swings, feelings of emptiness, and a fierce, withering rage. Borderlines were emotionally labile, sometimes seeming completely normal, sometimes really crazy. They could change in an instant, seemingly for no clear reason. Most borderlines were women. Ike had painted me a dire picture, and now I quoted Ike to Malik, ‘Borderlines are hell. They make your life as a psychiatrist miserable. They’re almost impossible to treat. Borderlines are the worst patients in all of psychiatry.’

  ‘Yeah, well, don’t hold your breath, but borderlines don’t exist.’ I laughed, thinking he was joking. ‘No joke. Problems with relationships, self-image, feelings, impulsivity? We all got that! Your job is to resist brainwashing as long as possible and just try to help these poor people. Being lied to about Ike’s death has got ’em bullshit! All three floors of Emerson are rumblin’, ready to blow! Try to help ’em and play sports! Listen up.’

  Heiler had left the ward full. Malik said that most of the patients would be better off out of Misery and that we would discharge as many as possible. Given the fact that insurance companies were now dedicated to not paying out insurance, this wouldn’t be difficult. The ones who needed to stay, he’d go to bat for. He started dialing a phone.

  ‘How do you get insurance to pay for them to stay?’ I asked.

  ‘Allora! Testa di catzo!’

  I turned, and then realized once again who it was. I’d just been called a dickhead in Italian.

  ‘Thorny,’ Malik said, ‘meet the new resident, Roy G. Basch.’

  I looked into the eyes of the tall, sandy-haired, baby-faced man. He wore jeans, suspenders, blue work shirt, and bow tie. A row of fresh sutures, like a tiny barbed-wire fence on his forehead, overlay other old scars. I shook his hand. It was as boneless as Ike White’s had been the night before.

  ‘What’s that?’ Malik asked, talking into the phone. ‘You ain’t gonna pay for another day of Mr Thorne’s stay here in the hospital?’

  ‘They gotta pay or else I’m dead!’ Thorny said frantically.

  ‘Yeah, well, he’s extremely paranoid and dangerous and—’ He listened for quite a while and then said, ‘How can we prove it? Well, Ms Tillinger, he just told me that unless you let him stay he’s gonna come right down there to your office with a gun and— That’s right, a gun, and, in his words, “blast them insurance fuckers to smithereens.” Now, where exactly are you located, dear?’ Covering the receiver, Malik shook with laughter. He said, ‘Managed care, I love it. Basch, go talk to Thorny.’ I hesitated. Malik made shooing-away motions, saying, ‘Go, go. Move.’

  Thorny was glowering at me. He walked away and sat down. I felt a strange fear. Malik hung up. ‘What am I supposed to do with him?’ I asked.

  ‘Be human,’ Malik said. I stared at him. ‘Human? Human being?’

  ‘But he’s so pissed off, suppose I say the wrong thing?’

  ‘Think these people are fragile? Just try ’n’ change ’em. But hey, I know you’re scared. I was too.’ His eyes locked in again. I felt a kind of rush, a ‘click’ – he was the first person since I’d been there who had talked to my fear. ‘Weird, ain’t i
t,’ he said, ‘to be so scareda just sitting down and talking to somebody? Image is a killer, and self-image is a killer killer! So listen up, if you need me, call.’ He squeezed my arm and walked off, stooping to pick up a piece of litter.

  ‘Dickheads Save Planet!’

  ‘Yeah,’ Malik shot back, ‘for assholes like you.’

  I walked over to Thorny, thinking about how to be human.

  ‘So, Dr Dickhead, tell me about yourself,’ Thorny said.

  Uh-oh. Surely this was backward – I was supposed to be asking about him. ‘I’m the new resident.’ I felt a sharp pain in my palm. I was clutching my key ring so hard the keys were biting into the flesh. ‘You?’

  ‘Got here a month ago from New Orleans. My daddy’s rich, made a fortune burnin’ trash down Cancer Alley. Calls himself the Bum King of the Bayous. I did OK till I was eighteen, ’n’ got sent north to Princeton. Lasted but three months. You look kinda tentative, Doc. Scareda me?’

  I was, but I wasn’t going to let him know it. ‘Nope.’

  ‘Sure is sad Ike White killed himse’f, ain’t it?’

  ‘They say he died of a fatal disease and—’

  ‘Oh, pleeeeze!’ he said, disgusted, getting up. ‘Hey, patients! Hey, borderlines!’ They all looked at him. ‘This new doc is pitiful! We got ourselves a real loser in this Roy G. Dickhead Basch!’ He walked away.

  Not a good start. If this wasn’t a borderline, who was? Humiliated, I decided to interview another new patient of mine named Mr K., whom I recognized as the kindly old gentleman who’d been playing tennis with Malik. I found him on the sun porch, finishing the Wall Street Journal. We had a wonderful talk. He was, he said, the last survivor of an old Yankee family. Only recently had things gone awry. His golden retriever, Duke, had died. His son had come out as gay. His wife was drinking again, and his daughter had run off with a drug dealer. He’d come to Misery a month ago for a rest.

  ‘You seem so sad,’ I said, touched by all this recent misfortune.

  ‘’Tis cause for weeping, yes.’ He started to cry.

  ‘We’ll discharge you soon. Maybe even next week.’

  ‘That would be grand!’ he said happily. ‘Thank you for your time.’

  Time that had flown by. I was excited at this, my first good interview of a borderline. At the nursing station I told Malik about it. The head nurse and social worker listened in. I said that Mr K. seemed about ready for discharge. When I stopped, no-one said anything.

  ‘Ever hear of a mental status exam?’ Malik asked. Someone giggled.

  ‘Oh shit,’ I said. ‘I blew it?’

  ‘Big-time. Let’s go.’ He led me back to Mr K.

  ‘Gonna ask you two proverbs,’ Malik said. ‘Tell me, Mr K., what do people mean when they say, “A rolling stone gathers no moss”?’

  ‘They mean that I have never been happier!’ he said, and started to sob uncontrollably, on and on, in horrific pain.

  ‘And, “People who live in glass houses shouldn’t throw stones”?’

  Abruptly he stopped sobbing, began laughing hard, and said, ‘It’s a big cry, a big big cry!’

  ‘And who’s the president of the United States?’

  ‘Herbert Whoever.’

  With Mr K. listening, Malik told me that when Mr K. was six, driving with his mother, a car hit them and she was decapitated. Her head landed in his lap. ‘At ten he was institutionalized. From then on, because he’s rich, he was assaulted by whatever treatment was at the leading edge of American psychiatry: insulin shock, cold water dousings, being strapped into the Benjamin Rush restraining chair and given emetics and whirled around till he puked his guts out, enemas and high colonic irrigations to get it out from the other end—’

  ‘Woo-wheeee!’ Mr K. cried, shaking his head in amazement.

  ‘—enough electroshock to light up Iowa, the most toxic drugs ever concocted, two first-rate psychoanalyses – one for each hemisphere, for the left, Freudian, for the right, Jungian – and a prefrontal lobotomy.’ Malik made a stabbing motion up through his own eye socket, and then a slashing wiggle. ‘An ice pick, stuck in his brain?’

  Sickened, I said, ‘Thank God they don’t do that anymore.’

  ‘Oh, it wasn’t that bad,’ Mr K. chided.

  ‘Oh, but they do!’ Malik said. ‘Lobotomy’s making a comeback! Check out Archives of General Psychiatry, June ’ninety-one. Big article proving that lobotomy is the treatment of choice for refractory obsessive compulsives.’

  More sickened, I said, ‘But we had a great talk, Mr K., didn’t we?’

  ‘Thumbs up!’ Mr K. said, putting his thumbs down, smiling sweetly.

  ‘Yes, you did. Luckily, they botched his lobotomy. Left half a frontal lobe. Lloyal’s his therapist. Fifteen-minute sessions, a hundred twenty bucks a shot. They talk finance. Mr K.’s trust fund will keep him in Misery till he dies. He’s been here forty years.’

  ‘But he was just transferred over here to Borderline yesterday.’

  ‘Heiler had an empty bed. Empty beds mean stalled careers. He ’n’ von Nott agreed Mr K. needed a trial of BPO with HFL – Half a Frontal Lobe.’

  ‘That’s quite funny actually,’ Mr K. said, chuckling normally.

  ‘They can’t touch you,’ Malik said. ‘As a shrink, Roy, you gotta be able to tell when something’s organic – medically treatable – as opposed to mental. You don’t treat brain tumors with psychotherapy. Proverbs can help find out which is which. Read Mr K.’s chart. It’s a memorial to the harm done by shrinks trying to fix people. Now we gotta protect him.’

  ‘From what?’

  ‘This.’ He spread his arms. ‘All this. The more I see, the more I think that if all the shrinks in the world were to die of heart attacks at once, all the patients in the world would be a helluva lot better off.’

  ‘Including you?’

  ‘If and when I act like a shrink, yeah.’

  ‘But you are a shrink.’

  ‘You gotta know it to let go of it. You tell me if and when, OK?’ I nodded. ‘And when I’m gone in a month, protect him from Blair Heiler and you.’

  ‘Me?’ I asked, stunned. ‘You don’t know what you’re talking ab—’

  ‘Kid, you’re gonna go for Heiler like America goes for stars! C’mon, we got Case Conference. Heiler set it up before he went on vacation.’

  Malik left, but I couldn’t, yet. A cloud darkened the quiet porch. I turned back to Mr K. In silence, he was weeping. Two glints of tears were running sadly down his old man’s old damaged man’s cheeks. I felt really bad. ‘I’m sorry, Mr K.,’ I said. ‘Are you sad, hearing all that?’

  ‘Hahaa!’ he said, his laugh crackling and high-pitched, like a child finding a favorite toy, say a stuffed zebra. ‘Doctor, I’ve got some advice for you: always keep a low center of gravity sometimes.’

  ‘Deal,’ I said, relieved.

  Laughing, he gave me a thumbs-down and a high five.

  Case Conference was designed to try to get a fresh look at a problem patient by bringing in a world expert to talk things over. Waiting in the conference room was Dr Errol Cabot, the world expert of the day, his world expertise being the drug treatment of mental illness. Errol was a chunky thirty-five-year-old man with a square-jawed flat face and eyes that seemed to bulge out of a sea of thyroid. This drug doctor was so restless and hyper he always struck me as being on drugs. His dark red hair was cut back like the helmet of Winged Victory, and he wore a long white lab coat.

  With him was his protégé, a new first-year resident named Win Winthrop. I knew Win from medical school. Though fat, he was energetic and optimistic, with the keen intelligence I had always associated with people with his fiery red hair and freckled, alabaster skin. In med school he had been doing special projects on the uses of computers in surgery, and using the internet and medical telecommunication to bring surgical supervision to distant parts of the globe, even, once, to a needy hospital in Tierra del Fuego. Early in medical school he had discovered, for the first time, a
sex life, stimulated by a hot web-site e-mail with a surgical nurse several years his senior, who turned out to be just as hotly optimistic as Win, especially in bed, where Win had had little experience. She was soon pregnant. They married and had a baby boy. Now she was pregnant again. Given his surgical bent, I’d been surprised when Win declared for psychiatry. He had explained that he would be combining fields, hoping to use computer-driven, stereotactic surgical techniques on the human brain, and, in his words, ‘using drugs with surgical precision, making surgical strikes against our common enemy, mental illness. You see, Roy, Mother has been bipolar for years, untreatable, much to Father’s chagrin. I’m working on a cure.’ Win’s father was a Boston Brahmin, a well-known lawyer at Hale and Dorr, and he had been disappointed in Win’s choice of psychiatry, for he had been hoping against hope for the only honorable medical specialty, surgery.

  After only a month, Win, like a dog with its master, had become much like Errol: both were hyper and manic with eyes wide as boys eyeing an electric train set; both had their red hair cut like Prince Valiant; and both were bulky under their long white lab coats. They were rocking in their chairs as we entered the room. I was to find that Errol – and Win too – had two traits that would prove remarkably useful as they threw drugs into people: unawareness of self, and unawareness of others.

  That day the patient was Mary Megan Scorato, admitted several weeks before to Emerson 1. For those weeks, Ike had been her therapist. I remembered that she was the ‘acutely suicidal patient’ Ike had needed to see the day before as I’d left his office. Mary Megan was one of those ‘salt of the earth’ people whom everyone loved, a kindhearted woman of Irish descent married to an Italian who, in her weeks on Depression, had taken to ‘mothering’ all of us, patients and doctors alike. Hannah had formed a special bond with Mary Megan. ‘I love that woman!’ Hannah always said, rolling her eyes way up. ‘She’s a great mother – prefeminist and unconflicted – and boy is it nice. Like eating whatever you want and not gaining weight. My mother, on the other hand, had a sign on the refrigerator: “A Moment on the Lips, Forever on the Hips”.’ Mary Megan baked cookies for us all, listened to other depressed patients’ problems, cleaned countertops, and did laundry. Everybody loved her. How could you not?