by Samuel Shem
‘Your mother?’
‘The authority figure.’
‘The authority figure?’
‘Is there an echo in here?’
‘What about your mother as authority figure, Roy?’
‘Could someone as wonderful as me,’ I said sarcastically, ‘have a good mother, Hannah?’
‘See? Work it through, or you’ll act it out. Your unconscious is coiled down there – like mine, like Henry’s – just waiting to attack! My only hope is that Zoloft keeps me afloat till after Labor Day, when Schlomo gets back and finds me just the right new analyst – and that there aren’t any more disasters with my patients. I can’t take another disaster with any of my patients.’
Another disaster with one of her patients, in fact her favorite patient, Mary Megan Scorato, was awaiting her fifteen minutes later on Emerson 2. As the three of us walked in, Mary Megan was pacing back and forth in little shuffling steps like a robot, the budding twitchiness I’d noticed the previous night now blossoming into whole-body convulsions and tongue-flappings and slappings and – as if in mockery of Hannah’s own eyes – eye-rolls up and down and around and even seemingly over, like egg yolks frantic to escape beating. Her white-bandaged wrist twitching up and down made her look as if she was directing traffic, or practicing samurai chops, or waving like Miss America in a convertible. Periodically she shouted out:
‘ACCEPT! REJECT! WAIT LIST!’
Hannah’s own eyes got big as yolks and her mouth fell open and I thought she was going to die. What we were seeing was something called TD, Tardive dyskinesia, a side effect of drugs. But what drug? Malik had written in the chart that Mary Megan refused all drugs. Hannah began trailing Mary Megan up and down the ward, trying to get her to talk to her, but all Mary would say was ‘ACCEPT! REJECT! WAIT LIST!’ On one pass I asked Hannah if she’d put Mary Megan on any drugs. It turned out that yesterday Win Winthrop, Errol’s slave, had convinced Hannah to try Mary Megan on their experimental drug, Placedon. He said this new wonder drug would cure her depression and that it had no known side effects, none whatsoever, whatsoever.
‘But I broke the pill in half,’ Hannah said pleadingly. ‘And I broke that half in half. I gave a tiny dose!’ She hurried off after Mary Megan.
‘Unbelievable,’ I said to Henry, ‘a quarter dose, full-blown Tardive. That experimental Thai shit is murder.’
Malik arrived, sized up the situation and got some Cogentin, which sometimes worked to relieve the symptoms of Tardive.
‘She’ll never take another drug,’ Hannah said. ‘I killed her!’
‘People are pretty resilient,’ Malik said. ‘Let’s check it out. Sit.’
We sat together in the living room watching Mary pace and twitch and shout and flap her tongue like a frog. While it was bad enough that this sweet sad woman had been turned into a kind of amphibian, it turned out that Hannah had neglected to get her to sign the informed consent to be in Win and Errol’s experiment and get the Placedon, and if she didn’t snap out of it, everybody involved would get sued to hell. Malik talked about Tardive, about how in the fifties when the major tranquilizers came in, they were tested for a few years and then used on everybody, and how, as time went on – more time than they were tested for – it turned out that these drugs produced horrific side effects, this tongue-snapping frog-shit called Tardive.
‘Tardive’s a disease caused by treatment, but there’s no treatment for Tardive!’ he said. ‘And just you watch: if they find a cure for the second disease they caused by their failed cure of the first disease, it’ll be a worse disease! All these new drugs – it’s like the Drug of the Month Club, for Chrissakes – are only tested for a few years. The lifetime of a lab rat is only three years. For all we know, Prozac and Zoloft, five years down the road, are gonna turn people into lizards! All these nice housewives and teachers and bus drivers and pilots turning into lizards? Prozacians? Zolofters! It’s sick!’
‘ACCEPT! REJECT! WAIT LIST!’
Mary Megan was standing before us twitching and snapping and snorting, quite lizardlike, a Placedonian, why not? But she was listening.
‘If you take this pill, this Cogentin, you’ll stop twitching,’ Malik said.
‘REJECT!’
‘OK,’ Malik said. ‘But are you hearing voices, Mary?’
‘ACCEPT!’
‘What are the voices saying?’
‘ACCEPT REJECT WAIT LIST WAISTLINE!’
‘Like in the Harvard Admissions Office, right?’
‘AW GEE ACCEPT!’
‘And then who calls? Your baby boy.’ Mary Megan twitched and stared. ‘Isn’t it sad, Mary. To lose that little baby boy. It’s not fair.’
‘N-not fair n-no,’ she said through gritted teeth.
‘Yes, it’s like death. So sad,’ Malik said softly, sincerely.
No-one spoke. No-one moved, not even Mary. For a moment we were still, like birds caught, still, in a pocket of wind. You could almost touch the stillness, as if it were alive. It’s hard to put into words what Malik had actually done, because it seemed so obvious but it was in fact so magical.
Suddenly Mary Megan’s eyes pumped out tears, big fat globules that her twitchy hands couldn’t wipe away, and Malik took a fresh tissue out of his pocket and unfolded it and dabbed the tears away as best he could from her jerky cheeks and eyes. He put a Cogentin in her palm. She moved it toward her mouth but at the last second twitched and plastered it on her forehead, where it stuck in sweat, and its edges started to ooze. He picked it off and, timing it between tongue flicks, popped it into her mouth.
‘I’m sorry, Mary,’ Hannah said, ‘really sorry.’
‘We regret to inform you that your application for admission to HARVARD! Has been denied Dr HANNAH Silver you FUCKING ASSHOLE!’ She shuffled away.
‘Congratulations, Hannah,’ Malik said, ‘your therapy with her has begun.’
‘I care for that lady so much! I’m in agony.’
‘Good. People like Mary do good with young therapists who care in agony.’
‘But I have no idea what to do.’
‘Forget “do,” Hannah,’ Malik said. ‘“Be.”’
‘Be what?’
‘Basch? Solini?’
‘Human,’ Henry and I said. ‘Be human.’
‘How?’ she asked.
‘Ever been in love?’ Hannah nodded. ‘Ever lost the person you love?’ Hannah said nothing, but her eyes teared up. ‘With Mary just now, when everything went quiet, dincha feel it?’ We looked at each other. All of us nodded. ‘There it is, kids,’ Malik said.
‘“Love”?’ Hannah asked with a touch of skepticism.
‘Like us all. All this is, really, is a lesson in love.’ He smiled, and walked into the nursing station. We followed. He got a fresh carrot out of the fridge and started chomping contentedly. The ward secretary handed Malik a stack of pink messages, saying that they were from insurance companies and he had to call them back right away or else the patients on the pink sheets of paper would be discharged. She left. He threw them into the garbage.
Picking up Mary Megan’s chart, Hannah asked, ‘One more thing, Malik. Medical Records is bugging me for a diagnosis on Mary Megan.’
Malik chewed his carrot, picked up Sports Illustrated, and said, ‘Yeah, yeah, put down whatever bullshit you want.’
‘That is really really cynical, Malik,’ Hannah said hotly.
‘Oh yeah?’ he shot back angrily. ‘Did they make a perfect diagnosis on Ike White? Yop. Endogenous depression. Did they give Ike White perfect treatment? Yop. Industrial-strength drugs and world-expert psychoanalysis.’ His face red with rage, he was almost shouting. ‘And nobody got with that poor bastard’s pain! Where’s this lady’s pain, Hannah? Fucking Ike couldn’t get with it with her, now you’re her therapist so you get a shot. Be there!’ He breathed a few times. ‘We’ll help. Pray that Placedon shit wears off.’
‘Oh God,’ Hannah said, staring at Mary shuffling. ‘It seems hopeless.’
‘Yeah, it may be the worst moment of her life. But think of your own worst moment. Go on, all of you. Think: What’s the worst moment of my life?’
We did. Malik asked us to tell them. Mine was looking out the eighth-floor window of the House of God, seeing the body of my friend splattered on the parking lot below. Solini’s was just last year when his best boyhood friend, a Sioux named Everett Chasinghawk, had run off with his wife. Hannah said hers was too terrible to tell.
‘But if you think of your whole life, it’s just a moment, right? And that worst moment, if someone’s right there right then with you and there’s a “click,” is the moment you move!’ He seemed to crackle with energy, all electric and jazzy, and even though I was dead tired I caught some, crackling a little inside, like a spark in the ashes. ‘So listen up. We gotta start to discharge these patients, ’cause a lot of ’em’ll get worse with Heiler. We gotta empty beds.’
‘Man, how do we empty beds?’
‘We keep the drug fascists away and we throw the insurance into the garbage and we discharge like crazy.’
‘But we can’t just throw people out,’ Hannah said, ‘without aftercare.’
‘The LAMBS!’ he said, that tight, slender face crackling with happiness.
We asked what was the LAMBS.
‘The Leonard A. Malik Buddy System. Listen up. The big problem in society is that there’s no more community. Parents don’t live where their kids live, neighbors aren’t friends. Where are your closest buddies? At least three hundred miles away, right?’ We thought, and we nodded. ‘’Member when you were kids at camp, the buddy system where, when you went swimmin’, you had a buddy and you raised your arms and counted off? Felt great, right? So why don’t we keep doin’ it when we grow up? Each patient gets a buddy.’ He handed out computer sheets. ‘I matched ’em up by where they live. Matched you up too.’ Solini and I were buddies. Hannah and Arnie Bozer were buddies.
‘Have you ever tried this out?’ Hannah asked skeptically.
‘Yop, on my group for depressed men, and it works! These guys were diagnosed depressed, tanked up on drugs, and now they’re not! They threw down their Prozacs! They’re better – their shrinks hate me!’
‘Why, man?’
‘’Cause they’re better! No more drugs, no more therapy, no more money!’
‘And you really think,’ Hannah asked, ‘that it’ll work with borderlines?’
‘Borderlines don’t exist. Will it work? It’s got to. Eacha you, start calling up your buddy on the phone every day.’
‘Sounds simplistic,’ Hannah said, ‘and unorthodox. Freud would never—’
‘Hannah!’ I said, excitedly.
‘What?’
‘You! You’re looking me right in the eye!’
‘Mary Megan Scorato needs a trial of meds,’ said a voice in the doorway.
‘To cure her Tardive dyskinesia,’ said another, beside the first.
Errol and Win, in their long white lab coats.
‘Zephyrill,’ Errol said. ‘It’s experimental.’ He held up a lavender sheet of paper. ‘She’s just signed her informed consent to be in our study.’
Hannah shot to her feet, eyes blazing now, and screamed, ‘I will not give that poor woman any more drugs! Placedon made her crazy and gave her Tard—’
‘Because you gave her a low dose,’ Win said. ‘I said high dose.’
‘High dose would’ve killed her!’
‘Wrong. Principle of Paradoxical Effect: the higher the dose, the lower the effect.’
‘Quiet!’ Malik cried out, and then, his voice filled with reverence, he asked, ‘Errol, did I hear you right? You’ve found a drug to cure Tardive?’
‘May well have done,’ Errol Cabot said modestly. ‘Yes.’
‘Fantastic. Think of the millions of people who have it. Roy, Henry, Hannah, this may be a historic moment. If this is true, this is – don’t let me jinx you here, Errol – this is Nobel Prize stuff, wouldn’t you say?’
Errol’s eyes seemed to film over, as if he were going into a trance. ‘Yes, yes,’ he said dreamily, ‘if my clinical trial works. And Mary is—’
‘Perfect to try it on,’ Malik interrupted. ‘Cure her, Errol, you’re in.’
‘Zephyrill,’ Errol said dreamily. He took out a bottle of pills, handling it carefully. ‘Brand name for phenyl-isotonerylamine. Brought ’em back from Zimbabwe. Only pills in the West. High-tech psy—’
‘Great,’ Malik said. ‘Nurse Hall? Handle that baby with care. Lock ’er up with the narcotics, understand?’ The nurse took the bottle, handling it as if it were plutonium. ‘I’ll stick that consent form in her chart.’
Errol handed it to him. Chests puffed like chickens, he and Win left.
Malik took the pills from Nurse Hall and threw them into the garbage. He tore the lavender consent form into confetti and threw it into the garbage too. ‘We already got one drug treatment worse than the disease,’ he said, ‘why go for two? It’s the NPT – the Nobel Prize Technique. Mention the possibility of the Nobel Prize and they go limp. Won’t hear anything you say for five minutes. Everybody go home.’
‘To my husband?’ Hannah said. Six months earlier, after her analyst had discovered healthy narcissism and moved to L.A., she’d impulsively married Billy ben Lube, a Lubavitcher Hasid, in a ceremony with a cast of thousands in Brooklyn. She had confided in me that the marriage was not going well.
‘You can stay at my place tonight, Hannah,’ I said. She said she might, though I didn’t believe she would.
My exhaustion-induced fuzziness had gotten even more fuzzy, and a while later I found myself pacing up and down in front of my secretary Nancy, saying, ‘I’m not normal.’
‘Oh come on, Dr Basch, you are so normal.’
‘Not so normal,’ I said, transfixed by her vaccination mark, lying like a flattened flower, say a white poppy, on her bronze deltoid. ‘Call me Roy.’
The phone rang. Nancy handed it to me.
‘Dr Basch,’ a voice said, ‘this is Christine. Your patient?’
‘Oh hi!’
‘What’s wrong?’
‘Why nothing, nothing, what’s wrong with you?’
‘I didn’t say there was anything wrong yet.’
‘Are you OK?’
‘No. But I would like to see you next week.’
‘Great.’ We set a time, and hung up.
‘Of course she called,’ Malik was saying out on the lawn after I’d signed out. He was in shorts and a new LAMBS T-shirt, getting ready for a game of tennis with Mr K., finishing an organic radicchio, and drinking coffee from a styrofoam cup.
‘How’d you know?’ He started juggling three orange Day-Glo tennis balls.
‘She saw that your following her down to the tennis court was dumb for a shrink but basically human. Her feeling your caring helped keep her alive. Zoe too. She’s the real suicide risk. She’s gonna be tough. But if we can just stop acting like doctors, then they stop acting like patients, and things move. The potential in humans is amazing! An incredible mystery of nature!’
‘Yeah, well right now I’m not into the incredible mysteries of nature.’
He laughed. ‘Sorry, I get carried away. You did good. Go home.’
I didn’t move. Feeling exhausted and confused, I was reluctant to leave him yet. He noticed, and asked me what was the matter. ‘I’m feeling a little lost.’
‘’Course you’re lost, you’re finding your way. It’s called “learning.” We all used to do a lot of it as kids.’
‘But can’t you give me something to take home with me?’
‘Hey, good asking! Listen close: stay on the side of the angels.’
‘Angels? You’re crazy!’
‘Y’gotta be crazy to do this, ’n’ you gotta be deft. Like in sports!’
‘Wait. Why’d you stay with me last night? You didn’t have to.’
‘Gotta show ya what I understand.’
‘Okay, red-hot, what do you understand?’
>
‘I understand “psychiatrist” in Greek means “Healer of the life-breath, the spirit.” And that maturity is a topspin backhand. Catchu later.’
‘But if shrinks specialize in their defects, what do you specialize in?’
‘I’m eclectic.’
‘No defects?’ He was doing jumping jacks, raring to go, and said nothing. I pointed to the styrofoam coffee cup. ‘Want me to throw that away?’
‘Away? Cowboy, Cowboy – you still think there’s an “away”?’
‘Into the garbage?’ Berry asked, amazed. ‘This Malik seems a little strange.’
‘Who isn’t?’
It was later that night and I was lying naked on my bed in the seven-sided turret of my loft. I watched Berry reach around and unhook her bra and then shrug her shoulders to let the loops drop and free up her breasts, and my exhaustion was overcome by excitement. I thanked God that after all our years together our sensuality was still somehow mostly new. She quickly slithered down her panties and feigning modesty covered herself as best she could and lay down beside me, my kishkees echoing to that thick lush black triangle, a furry pillow for my cheek. Side-by-side skin-beside-skin, the air lush with her perfume which called up our time in France the Dordogne the previous summer tonight maybe even the anniversary of same the cemetery high above our hill village and river valley the headstones strewn with wildflowers wild poppies roses daisies, and the air tonight tingling with imagination, it was thrilling and I wanted it to last as long as death. I knew I was idealizing her and part of that was sexual but if an exhausted burnt-out man can’t idealize a woman sometimes what is there to live for?
And so Berry and I lay side by side and naked in bed in the hot silky night, staring out the five windows of the turret, listening to the sounds of a suburban summer evening: TVs, marital strife, kids, cars, and the last malignant shrieks of power tools of many sorts.
‘How was your day?’ I asked.
‘Great. I just love being with these four-year-olds, it brings it all back – childhood, the energy, the incredible curiosity! And they’re so funny! This one little girl, Katie, she’s so smart and she thinks she knows everything, and she was going on and on about something so I said to her, “Katie, you’re perseverating,” and she looks at me and says, “Yeah, I know.’”