Mount Misery

by Samuel Shem

  ‘Yeah, to help her.’

  ‘Did it help her?’

  ‘Oh yeah, Malik,’ I said sarcastically, ‘it really helped her.’

  ‘Exactly.’ He sighed. ‘It’s so fuckin’ hard to just face the pain. We get a hit of pain, we go, “It’s her fault, or my fault, or my mother’s fault or my father’s fault or God’s fault,” and we try to do something to it, to fix it – it all happens in a second! Pain—’ He snapped his fingers. ‘—judgment! Push away that pain! Fight that suffering as if it’ll destroy us, when the truth is, if we stay with it, it’ll heal us.’

  ‘Like they say, Doc,’ Primo said, pointing his soggy Stim-U-Dent at me, ‘“Don’t just do something, stand there.” Key principle of Misery Security.’

  ‘Shit. It all seems so obvious now.’

  ‘Don’t feel bad, Doc,’ Primo said. ‘The one thing I learned, in all these years in Security with all youse young docs? If there’s one obvious thing that any man on the street woulda asked a patient about, you can be sure that’s the one thing the first-year resident will not ask about.’

  ‘Even Malik, when he was first-year?’

  ‘Malik was for shit.’

  ‘At best,’ Malik said, ‘for shit.’

  ‘So how’d you stop being for shit, Malik?’

  ‘I was so for shit, I had a lotta room to learn. First, I got sober. Then, I married an Israeli. She was a doctor in the Israeli Army. Is she tough?’ He and Primo rolled their eyes.

  ‘Like the sweet pain of a toothpick,’ Primo said, ‘against a tender gum.’

  ‘It’s all so clear,’ I said, ‘I think I’ve got it now.’

  ‘No you don’t,’ Malik said.

  ‘Well, I’ve got something.’

  ‘You got the idea that you got something. Remember that “click,” kid, ’cause you may not feel it again for a long long time.’

  ‘Why not?’

  ‘’Cause when you’re with patients from now on, you’re gonna think about how to make that “click” happen again, and if you’re thinking about it, you can’t be there with it and it won’t happen. You’re gonna psych yourself out. So listen up: just in case you do get to be Zoe’s therapist, I’ll do the physical. Once you lay your hands on a patient, therapy’s over.’

  ‘What do you mean “in case” I am?’

  ‘She’s rich. Even as we speak the Rich Patient Referral Network is humming – the worst shrinks in the world are gonna try to steal her. I’ll do my best ’cause you’d be good for her. Put her on five-minute checks – she’s at risk.’

  ‘Think we can help her?’

  ‘Help her, hell,’ he said excitedly. ‘Cure her!’

  ‘Cure? In psychiatry? Come off it, Malik, you can’t—’

  ‘No joke. People think that in medicine you can cure people and that in psychiatry you just foozle around. Fact is, it’s the reverse. You don’t cure heart disease or kidney disease, you palliate it. With a basically healthy young woman like this who wants to kill herself, if you can connect with her right now, at this shit-moment in her life, she’ll probably never try to kill herself again! If that ain’t cure, what is? I’m heading home. I live five minutes away. You’ll do OK, long’s you know when to ask. Ask for help.’

  ‘I can’t believe I didn’t ask her the main thing—’

  ‘Lotta room to learn, Basch. See if you can do it without marrying an Israeli.’ He rolled his eyes. Primo rolled his eyes. I rolled mine.

  ‘But it’s like there’s a whole other world,’ I said, surprised to see all at once how this work relied not on what I’d always been educated to do – think logically and analytically to solve problems, to chop up the world into either/ors or if/thens – but on ‘ands,’ on subtle, intuitive hunches and senses, on messages sent from uninhabited regions, acted upon in realms beyond words or even beyond actions themselves. ‘Like there’s a whole other way of being with people. Is it the world of the kishkees?’

  ‘L’intestini e testiculari,’ Primo said. ‘You get me, Doc?’

  ‘Starting to.’

  Beaming like a proud parent, Malik sang to me, ‘“Had an angel of mercy to see me through all my sins …’” and walked off, totally into Aerosmith.

  While doing Zoe’s write-up I took many phone calls, including one from a man saying, ‘Yuk yuk I’m a duck quack quack quack,’ another from a woman convinced that her cat was wearing a fur coat and fur gloves, and then my beeper went off and out came Viv’s voice, for an emergency:

  ‘Emerson Two, stat, Cowpoke. I’ll hold your calls, good luck.’

  As I ran down the road, my heavy black bag tugging at my arm socket as if it wanted to get away from what awaited it, I felt a rush of cool wind swooping up the hill and saw a jagged knife edge of lightning, and I counted the seconds till the crack of thunder – six miles off and coming fast. I ran into Emerson and up two flights and opened the door.

  ‘Dickheads to the Rescue!’

  ‘Fuck off!’ I screamed back, losing it completely.

  ‘Dickheads Lose It Completely!’

  ‘What the hell is wrong with you?’ I asked. He fell silent.

  ‘Roy! Over here!’ Jill said, down the hall, in the doorway of Mary Megan Scorato’s room. I ran there and went in. Blood was splattered on the bed, the walls, soaking the towel that Jill and the night nurse were holding to Mary’s wrist. Mary seemed dazed, glassy-eyed, a little twitchy. Somehow, despite being off sharps and on five-minute checks, she’d gotten a razor. I unpeeled the caked towel from the wrist. The blood started oozing – not spurting, which to my relief meant vein, not artery – and the sight, to my surprise, made me feel queasy. Having seen so much blood and gore in the past two years, why would I feel sick at this? I probed the wound, Mary jumped, nudging Jill up against me. I felt Jill’s shoulder, her hip, and sensed a body that was big and pliant and strong. Our eyes met.

  ‘You work nights too?’ I asked, hungry for contact with sanity.

  ‘The money’s better. What a mess. How’re you doing?’

  Thinking, You are incredibly attractive, how ’bout we go out for a drink and talk? I said, ‘Fine, fine,’ and tried to focus on the blood. Jill and the nurse left. As I sutured, I asked Mary why she’d done it. She said nothing. Knowing her grief, I felt for her. How could you call this her fault? If I had been born her, I might not have done as well. Do people by nature do their best?

  ‘You shouldn’t cut yourself, you know,’ I said, feeling parental – she was, after all, someone’s child. She didn’t answer. I wrapped the soft, clean gauze around the prickly row of sutures, and did it carefully, thinking that the quality of my touch might determine something. ‘Didn’t it hurt?’

  ‘It hurt more t-t’feel d-d-dead,’ she said, twitching. ‘D-D-Dr White d-d-dead.’

  ‘Yeah,’ I said, ‘he screwed us all.’ She stared, and twitched, in silence.

  Jill and I sat in the muggy nursing station, at opposite ends of the large table piled with charts and styrofoam cups and Burger King wrappers and cans of Diet Pepsi and a woman’s yellow tank top. I pictured us as husband and wife, dining in. ‘Well, darling, shall we ring for the help, to clear?’

  She smiled, and reddened. ‘I blush easy,’ she said. ‘Look, I feel really bad – it’s my fault – I was a few minutes late, on checks.’

  ‘I’m sure you did your best.’ Her blouse was wet with blood. Bumpy lace lay underneath. I was desperate to quit this on-call shit and touch her.

  ‘What if that’s not good enough?’

  ‘My mother always told me,’ I said, wondering Why the hell am I bringing her into this now? ‘that if you do your best you can’t be wrong.’

  ‘And my mother always told me to do what my father said – and, to watch out for men. Which, if you think about it, is pretty screwed up.’ My beeper. Viv’s voice:

  ‘Hate to do this, Cowboy. You got med trouble on Heidelberg West.’

  I groaned, got up, took her hand. The palm was rough. ‘Manual labor?’

>   ‘Horses. My passion.’

  ‘Lucky horses.’

  The thunder crunched and blasted above and the rain finally came. Being there with her was a comfort; we were fellow night warriors in Misery. I said good night. Thorny, standing in front of the door, said to me contritely:

  ‘Wish I knew, Doc.’

  ‘Knew what?’

  ‘What you asked – what’s wrong with me. That I keep calling you a dickhead? Maybe has to do with my daddy polluting half of Louisiana and a lot of the Gulf – talk about a dickhead! Y’all can see how a successful guy like you, to me, well, I reckon you’d be a dickhead too?’

  Amazed at actually having this talk, I said, ‘Sure, but I’ve got to—’

  ‘I started askin’ myself: How am I poisonin’ things? And how’re things poisonin’ me? Man, you start askin’ those questions, you see there ain’t much out there that’s not poisonin’ the world. We’re all dickheads, dickin’ around with the planet. At Princeton, I did my first term paper on this shit, and got an F – “Off the subject,” the Prof said. So I dropped out. Just when you was startin’ to excel at ol’ Harvard, right, Doc?’

  ‘I’d like to talk now, but I’ve got an emergency. Tomorrow, we’ll talk—’

  ‘Damn! Wish I had a damn emergency somewhere. Or even somethin’ to do.’

  ‘Volunteer. Get privileges, work for Greenpeace. We’ll talk, OK?’

  We shook hands on it, like real men, even like fresh new frosh in crisply fall Cambridge at the Princeton-Harvard game when, in football weather, you’d flow down from the Square across the bridge toward the stadium with a girl on your arm and a flask in your pocket and the world at your feet. I walked to the door, feeling good about him.

  ‘Dickheads Take the Bait!’

  I turned and stared at him in disbelief. He winked. I left.

  The skies had cracked, and up there the lightning was dancing and the thunder was banging big kettledrums and with a whoosh the sulfurous cool air was sweeping up and was met by lowering curtains of rain, with fiery streaks of hail that popped off the roofs of the cars like oil off hot skillets. The hair on the back of my neck stood on end with the static electricity, and my drenched and bloodied shirt felt clammy, making me shiver. I had to get way up the ravine through the woods above the Farben to the Heidelbergs. To avoid getting drenched, I took to the tunnels.

  I’d heard about the tunnels, a labyrinth under Mount Misery connecting all the buildings. Moving toward the Heidelbergs, the first stretch was long and twisting and going up and down like a roller coaster, badly lit and damp and smelling of sewage, the next section straight as a railroad and lit with the latest fluorescence and with that glorious scent of freshly fluffed laundry. Sometimes where bulbs were burnt out I would miss the signs telling me where I was, so that I lost my way, and found myself heading up toward a crest in a dark, scary aboveground stretch, the rain pouring in through a window, the thunder making it hard to concentrate on which way to go. Then, from over the crest ahead, I heard, of all things, a reggae band. Solini?

  No Solini. Something Solini had told me about. A crazy black man who’d shown up the night before when Henry was on call, and who’d formed a psychotic attachment to Solini on the basis of their shared interest in reggae. The guy had no insurance, and Henry hadn’t the heart to turf him to Candlewood State, so he gave him a map of the Misery underground. There he lay, on a piece of cardboard imprinted with ‘ogress Is Our Most Impo.’ From a small tape deck came some Bob Marley, but soft and fuzzy, as if Bob and the Wailers were lying exhausted and hungry on their own ‘ogress’ cardboards in their own tunnels somewhere else. He stared at me, his face scarred and pocked, the hard gravel roadbed of the poor.

  ‘Solini?’ he mumbled, struggling up on one elbow, smelling of stale wine.

  ‘No, no – no Solini,’ I answered, ‘go back to sleep.’

  On Heidelberg West, the Drug Unit, I patched up a drug mess that Win Winthrop had made. Back in Toshiba, while writing up Zoe, I took a few calls – ‘Storm calls, Cowboy’ – and it was true – the storm had people under beds and in closets thinking cancer and AIDS and downsizing and gerbils.

  As the sun came up, I found myself copying over, into the chart, a part of Zoe’s suicide note:

  They say I’ve got everything but it’s all plastered on my life like a smile on my face and inside I’m dying. Maybe, Mom, if you gave my diaries to some mental institute they could find what I couldn’t and help someone else. People don’t leave notes because it’s hard enough to do it without making it so definite and thought-out – that’s why I slept with the light on sometimes Mom, it wasn’t like I was really going to sleep.

  Strange, I thought, for me to write out these words calmly, words written in torment a few hours before. Same hand motion, same words, but now, words only. How light words seemed, riding the fire underneath. Ike had left no note. Suddenly I felt pissed. The fucker! He was a fucking expert in this, he knew the pain he was going to cause!

  All at once I felt so alive! With Malik, with Zoe and Mary Megan and Thorny, there had been flickers of understanding, yes! I walked out into the fresh wet morning feeling powerful.

  It didn’t last. Exhaustion came down on me like solid thunder. The day was a blur, filled with fuzz.

  I remember sitting with Solini and Hannah at lunch, staring dully at the way the mental health workers, nurses, social workers, psychologists, and Buildings and Grounds all intermixed with each other for lunch, yet the psychiatrists mixed with no-one but other psychiatrists. They all sat together at two central tables, and as in a film, a black-and-white art film entitled ‘How Shrinks Eat,’ they moved like wind-up toys in dark suits and white shirts: fork-to-food, food-to-mouth, fork-to-food, food-to-mouth, fork-to …

  Solini had been called in that morning by Lloyal von Nott and raked over the coals for his ‘looseness’ on his admitting night. Now Henry said, ‘Y’know, when they accepted me here, I thought I was fooling them, by getting in? But now I know that they knew I thought I was fooling them, by getting in, and so they fooled me, by letting me in.’

  ‘I know,’ I said. ‘It’s infuriating, the way there’s so much crap and then, once in a while – like last night with Zoe – you really help somebody.’

  ‘Maybe, Roy-babe, the problem is you expect too much, and have to settle for less, and I expect too little, and have to settle for more?’

  ‘So why the hell are you doing this, Henry?’

  ‘Because it beats dry cleaning?’

  Hannah took out a bottle of pills, extracted two and gulped them down. I asked what they were. ‘Zoloft. I’ve never been so depressed in my life.’

  ‘Does it help?’ I asked.

  ‘It’s cosmetic,’ she said. ‘I’m putting all my patients on it too.’

  ‘What?’ Henry said. ‘You’re putting all of them on Zoloft?’

  ‘Why not? They’re all more depressed now, having me as their psychiatrist.’

  Arnie Bozer, the resident who’d seen Christine run out of my office, walked up. His bald head, full-moon face, chipmunk cheeks, and plump lips made him look well scrubbed. Arnie was a chipper fellow from the wooden Midwest, a young man who didn’t seem to know the meaning of the word ‘unhappy,’ and who for all you knew might just be an ax murderer underneath. ‘I’d love to join you, guys, but I’m power-lunching with our chief. Jeez, Roy, I overheard the end of your session with Christine. God, you were in a tight spot, with her demanding that you disclose your personal feelings to her.’

  ‘You were eavesdropping?’ I asked. Then, remembering I still hadn’t heard anything from her, I felt a jolt of fear.

  ‘You didn’t close the inner door. I myself have a policy on personal disclosure: I tell my patients everything I’ll allow them to know about me right away before they say anything. Then, that’s it. I tell them that I will never tell them anything personal ever again. That’s my policy.’

  ‘How can you have a policy, man,’ Henry asked, ‘when you haven
’t really had any patients yet?’

  ‘Policy is my area of expertise. I’ll be doing my third year at business school – the B.B.S. But that Christine is neat. Maybe I’ll call her.’

  ‘To be your patient?’ I asked.

  ‘Gosh no. I’m a stranger in this neck of the woods. I’m from Indiana. Same state as her.’

  ‘You want to date her?’ I asked.

  He nodded, and blushed. He actually blushed, a dull pink bulb.

  ‘Arnie, that’s unethical!’

  ‘Thanks for sharing,’ he said, and, whistling ‘Dream the Impossible Dream,’ he left.

  Hannah was playing with her food, the lo-cal option, the Misery Catch of the Day. ‘I’m so depressed. I still can’t believe Ike killed himself. And Mary Megan slit her wrist? I love that woman! It’s like suicide’s in the air, like it’s contagious. I keep having the fantasy I’m going to a funeral tomorrow.’

  ‘Whose funeral, girl?’

  ‘Mine.’

  Henry and I looked at each other.

  ‘But you don’t seem that bad, Hannah-babe,’ Henry said.

  ‘Look at me funny, I’ll start to cry. Do you know what it’s like to be working on Emerson One now? A whole ward of severely depressed patients? And who was their hero, their only hope for living a normal life?’

  I knew who their hero was, but I asked anyway.

  ‘Ike White. It got so bad last night I called up my old analyst.’ She rolled her eyes up to the recessed lighting and said, ‘He said my problem is that I’m not being self-centered enough. “Narcissism is good,” he said, “a good good thing.” He’s in L.A. now, head of the IHN.’

  And what was the IHN?

  ‘The Institute for Healthy Narcissism. He was great: in twenty minutes he drilled out the unconscious forces under my depression.’

  ‘Sounds like a visit to the dentist,’ I said.

  Hannah stopped chewing her fish. ‘Isn’t your father a dentist?’

  ‘Retired. So?’

  ‘So you need a psychoanalysis, to work through your feelings about your father, your attitude toward authority figures.’

  ‘You mean my mother?’