by Samuel Shem
Therapy with Christine was hard. She was a fantastic weeper, like my mom. She’d spend the first five minutes sizing me up, and then talk about her newly dead father and other men and start to weep. She would weep for at least the first half hour, two lines of mascara streaking down her cheeks as if in a sad race. Five minutes from the end the weeping would stop, the makeup would be blotted into raccoon eyes and, knowing we had only five minutes left, she would demand to know why I wasn’t helping her. Every time she left, she made me feel like a failure. She was my last patient on Tuesday, and the rest of every Tuesday I spent awash in guilt that I had let her down. Tuesday nights were hell.
I’d resisted seeing Christine in terms of the Borderline Theory. It would be like applying Heiler to your child. Yet now, staring at her, a bleached blond Madonna sitting there dressed all in black – from the tip of her black pointy shoes through her black skirt and suit jacket and up to her black beret aslant over her freckled face, encircling her bleached blond hair like a hellish halo, her black mascara and dark lipstick and nail polish, and her legs in black tights not only crossed but recrossed toe-under-ankle – watching her go in an instant from rage to tears and back to rage, it was hard not to notice that she fit many of the Krotkey Factors, hard to resist the idea that here before me was no normal neurotic but a BPO with HF – Hysterical Features – and also with the classic Borderline Sign, BTP – Black Toenail Polish.
‘I’m totally stressed out!’ she cried. ‘Why won’t you give me Valium?’
‘You smoke pot and drink every day, and you think I’d give you Valium?’
‘I smoke dope because you won’t! Why?’
‘Why yourself?’
‘I just asked you that. What’s wrong with you today?’ Suddenly she smiled coyly. ‘I’ve started dating Dr Arnold Bozer. Your colleague?’
Arnie Bozer was the optimistic blockhead from the wooden Midwest who’d asked me for Christine’s name and number. Just that afternoon in Resident Support Group, Arnie had announced, excitedly, ‘I’ve started my psychoanalysis with Dr Schlomo Dove. I went to his home office for the first time this morning and lay down on his couch. Holy moley, you shoulda heard my first associations!’
None of us asked to hear Arnie’s associations.
At the end of the Resident Support Group, Arnie had taken me by the elbow, like a guy trying to sell you a chicken or something, and said, ‘Roy, I just wanted to tell you you’re doing a great job with your patient Chrissy.’
‘How do you know that, Arnie?’
‘I’m dating her. A really nice gal.’
Now Christine was stroking the outside of her thigh with an index finger whose nail was the dark shade of venous blood. ‘Arnie and I made love last night for the first time. Fannntastic. I’m used to guys who just want to fuck, but he kisses great. Said he wanted to make love with me, not to me.’
She stared, challenging me. I felt that radar, scanning my weak spots. Classic borderline. Tightly, I said, ‘So what did you do?’
‘Do?’
‘Sexually.’ She smiled. I blushed.
‘You’re blushing!’
‘Am not.’ A bead of sweat slid down my forehead into my eyes.
‘Think I don’t know that you’re attracted to me? That first day, the sexual vibes in the air?’ I said nothing, sensing now the fierce hunger of the borderline. ‘Can’t you say anything? You’re acting so weird today. Why?’
OK. It’s every man for himself. I’m not sick, she is. Be firm. With a cut of Heiler anger, I said, ‘Why are you always trying to manipulate me?’
‘Me manipulate you? Jesus Christ!’ She uncrossed her legs. ‘I’m leaving.’ She got up, went to the door, and grasped the doorknob. ‘And this time I won’t be back. I’ll get what I need from Arnie. He has potential. You don’t. Your heart is a block of ice.’ She turned quickly and opened the inner door and marched out. Or tried to, for she forgot that there was an outer door too, to soundproof us from the Bozers in the hallways. She bashed her face into it, and cried out in pain. She put her hand to her nose, checked her fingers for blood, and found it. ‘Terrific – a bloody nose. And still no Kleenex!’ She stormed out, slamming the door behind her, about a three on the Heiler scale.
Should I chase her? No. She’s not ruining my Tuesday night, hell no.
My night was hellish nonetheless, in all the ways that humans can be hellish around their health. It’s nerve-racking to be alone in charge of a mammoth mental hospital at night, all the while sensing that something is deeply amiss in nature and not quite knowing what. For several hours Viv had me running all over the place tending to emergencies, doing admissions, and answering phone calls from anyone on the planet who, as they sensed in their bones the sinister darkness of autumn and saw with more fear than romance the full moon rise, heard the murmur of mental illness and dialed toll-free to Misery. Finally, some godless hour long after midnight, as I was walking through the parking lot outside of the Farben, Viv beeped me:
‘Emerson-Two, Cowboy. Zoe pulled out her feedin’ tube.’
Zoe was in bad shape. Blair Heiler had restricted her from jogging. In retaliation, Zoe had cut herself and tried to throw herself through the plate-glass window between the living room and the nursing station. Without telling her, Blair replaced the glass with Plexiglas so that the next time Zoe jumped into what she thought was glass, she just bounced, much to his satisfaction. From that humiliating bounce on, Zoe had refused food entirely. Blair had force-fed her through a feeding tube. Her weight had plummeted to seventy-three pounds. Her electrolytes were so screwed up that she was dazed and vomiting and in danger of kidney and liver failure and death. I still felt a special link to Zoe – my first inpatient – and was scared for her. I’d urged Blair to transfer her out to a medical hospital. He had refused, and laid down the law: force-feedings by feeding tube. Now, for Zoe to miss even one feeding might be catastrophic. The tube had to stay in.
Reluctantly I turned around, and slowly, heavily, feeling really pissed off at the huge effort that replacing her feeding tube would require, I started walking back through the woods toward Emerson.
‘Tough night?’ said a voice at my elbow. I turned. L. A. Malik, in white short-sleeve sport shirt and khaki pants, munching soy nuts. He looked fit and tan. His tone was concerned.
‘What are you doing here?’ I asked.
‘Hung around to talk to the guys, after the AA meeting.’ It was almost two. The meeting ended at nine.
‘That’s a long hang-around.’
‘Not when you’re with your buddies.’ He was not smiling. The only time I had seen him since being with Heiler was a few weeks before, when he and I had played tennis. I was the better tennis player, but his persistent, energetic style pissed me off, and somehow he beat me in straight sets. Afterward he’d been somber, even distant, and had started to just walk away.
‘Wait. You’re not gonna ask me how things are going with Heiler?’ I’d asked.
‘Don’t have to. See you around.’
‘What do you mean?’
‘Y’can tell everything about a guy,’ he’d said, ‘by how he plays a sport.’
‘Gotta go,’ I said now. He asked if he could come with. I said OK.
We walked down the winding road, several arms’ lengths apart and in an awkward silence, our cartoon puffs of breath empty, past the handsome nineteenth-century brick buildings, mostly quiet and dark, around the head of the lake, which was calm and yet, in its moonlit, quicksilvered dark, ominous. As we came over the last hill toward Emerson, the sheer surface of the night was broken, first by screams, and then, as we turned the last corner at the edge of the lake, by light, for many windows were still lit up. In the chill autumn moonlight the new brass plaque over the lintel gleamed: BORDERLINE HOUSE.
As we climbed up through the wooden-railed stairwell, the enveloping shouts and screams made it feel like we were in the warp of a nightmare. We stopped on the landing of Emerson 2. Sounds of shouting, angry people su
rrounded us, slipping out under the door, raining down from Psychosis above, blasting up from Depression below. The Split Risk sign, previously a temporary thing made of cardboard and stuck to the door with tape, was now a small brass plaque screwed in. Carefully I unlocked the door. The living room was packed with my patients, pacing, growling, shouting, threatening.
‘And now, folks, the Dickhead of the Decade, Doctor Roy G.…’
Silence, one of, Could It Be?
‘Dr Malik, I presume?’ Mr K. asked.
‘Malik!’ Thorny cried. ‘Hot damn!’
As the patients flocked around him, I walked to the Quiet Room. A pathetic sight. Zoe was faceup on the mattress, tied down in four-point restraints, moaning. She was so emaciated, barely hidden by a loose tank top with a picture of Snoopy, that I could see, as if on X ray, the clavicle, acromion, the coracoid process. The fatty breast tissue had been mostly reabsorbed, an attempt by the body to find sustenance.
All at once I felt immense fatigue. I was tired of dealing with all the shit of the night, and angry and disgusted at having to put a new feeding tube down.
‘Sorry, Zoe, but I have to put a feeding tube down.’
‘No!’ she cried. The struggle began. The mental health worker held her head still; I put Lubafax on the green tube and put it into her nose. A feeding tube is easy if the patient will swallow it down; if not, it’s hell. The tube popped back out. I put it in. Out. In. Amazing, her strength. Out. ‘You can control yourself, you can eat – why won’t you?’
‘Because!’
‘Why?’ I shouted, losing it. ‘Why?’
Suddenly she quieted, looking past me, as if stunned. I turned.
Malik was in the doorway, staring at us.
Looking at him, I too was stunned, and fell silent. His face was filled with sorrow. He glanced at me. I felt a rush of shame. Not that he made me feel ashamed for what I was doing. Rather, I had a sense of him taking in the scene as a whole. Not Zoe and the mental health worker and me, but, somehow, the squalor of one human being tied down like an animal in a white harsh box of a room, in pain, part of the pain being inflicted by two other human beings, untied, but just as sorrowfully caught up in the squalor. He seemed to have entered full into the scene, and yet to have stepped back from it too. In his sorrow I could see his seeing it in every particular, and yet as part of a whole world that had somehow against its natural inclination gotten perverted.
He stood there, still, for the longest time – the other Emersonians were standing, still, behind him – his stillness not only making this perverted piece of reality whole, but his still center like the mystery called ‘the eye of the storm,’ being a center of reality, drawing everything to it, expanding everything from it, making every everything, from the storm to the mystery, more real. Muffled screams came down from above, and up from below.
‘Mind if I come in, Zoe?’ he asked.
Malik came in and stood against a wall. ‘Mind if I sit down?’
‘No.’
He slid down the wall and perched on his heels, in that universal posture men take when they are finally ready to talk. ‘Pretty rough, eh?’
Her lips trembled. Her starved eyes filmed with tears. It was that ‘click’ I’d seen him have with people – the one I too had had with Zoe that first night on call. I realized that I’d never seen Blair Heiler have this ‘click’ with anyone. With alarm, I realized that since that one time with Zoe, I’d never had it again. Zoe clenched her teeth and said, ‘Tell them to leave.’
Malik looked at me and the mental health worker. We left and walked through the clustered patients, back to the nursing station. For the first time in a long time, there was not a sound on Emerson 2.
‘Are you saying that Blair willfully mistreats patients?’ I asked Malik.
It was almost four in the morning. We sat in the nursing station. Zoe had eaten and was asleep. The hall was quiet.
‘’Course not. Heiler believes the theory – that’s his problem. Deep down he feels trapped in himself, an object to others. He doesn’t feel things much, so he provokes intense feeling in others, to feel a little. He never feels with. Theories about people are great, to protect you from being with people. The poor guy thinks that the way to be loved is by what he does, not who he is. The report card, not the kid bringing it home. The Nobel Prize, not how his own kids don’t know him. It’s classic American, it’s Ike White, and man it is deadly. There’s never a reason to treat patients cruelly. Never.’
‘What happened?’ I asked, picking up on something.
Our eyes locked in. He nodded. ‘Good, real good.’ He sighed. ‘My first year, when I worked here with Heiler, I got into myself and Heiler big-time. He hooks people like us – competitive, high-achiever types. I was still drinking, treating people pretty bad. And then, this one patient of mine—’ He choked up, closing his eyes, breathing deeply to get control. ‘One day in my office, I trashed her. She ran out, slammed the door. On the way back to Emerson, in the tunnels, well … she looped her belt over a pipe and hung herself.’
‘Oh my God.’
‘Yeah. Still hurts. Bad.’ He wiped his nose and took off his tinty glasses, squinted like a mole in the light, and wiped the tears off the lenses with the tail of his sport shirt.
‘Haven’t had a drink since. But it’s hard to make amends to the dead. So …’ He reached out and put his hand on my shoulder. It felt hot. ‘Your patients are worse, a lot worse. And worse is worse, not bullshit better – you know that now, right?’
Suddenly I saw it: Zoe was worse and Thorny was worse and Mary Megan was a lot worse and Cherokee and Christine were worse – worse than worse, maybe gone! – and Berry was going, and the only ones not worse were Mr K., who was a half-pint low on frontal lobes, and Jill, who was high on temporals. ‘Yes, I know that.’
‘Sure you do.’ He rubbed my shoulder, then let go his grasp. My shoulder felt warm, as if he hadn’t let go. He put his amber glasses back on.
‘But what can I do about it?’
‘Lie to him.’
‘Lie to him?’
‘Lying to supervisors – key concept in learning psychiatry. Listen up: You’ve been lying to patients and being truthful to doctors, right?’ I nodded. ‘Reverse it. Lie to the doctors and be truthful with the patients. What a radical idea, eh?’ We laughed. ‘And when he’s off at one of these bullshit meetings, discharge like crazy.’
‘Into the garbage!’
‘There you go. Jeez, it’s late. Bronia will kill me. Tough?’ His eyes rolled. ‘We’re flying to Tel Aviv tonight, for a month.’ He stretched, and looked out at the living room. About a third of the patients were sitting there, wide awake. ‘What the hell are they doing up at this hour?’ I told him about the big Department of Defense study, which caused insomnia in some Emersonians and narcolepsy in others. Malik said, ‘Stop the drugs. You gotta.’
‘I can’t. The nurses give them their meds.’
‘Yeah, well, I betcha Mr K.’s doin’ good though, right?’
‘Yeah. It’s strange, but he’s doing great.’
‘Let’s go.’ We went to see him. He was sleeping peacefully. Malik woke him up, took out a mother-of-pearl pillbox and asked Mr K. to take a pill. Mr K. opened his mouth and Malik popped it in. Mr K. swallowed it, and smiled. ‘Open your mouth.’ Mr K. opened his mouth. Malik gestured me to look in. Nothing. ‘Tongue up on the roof of your mouth.’ Mr K. put his tongue up on the roof of his mouth. Nothing. ‘Pill.’ Mr K. produced the pill. Magic. Malik asked him, ‘Ever try to teach that to other patients?’
‘In the fifties, when the major tranquilizers came in, I taught a lot. I enjoy teaching. Shall I take it up again?’
‘Talk to Dr Basch.’ We walked out. ‘For decades he’s tongued pills, avoiding every major assault of the drug docs. Get him to teach the others.’
‘Heidelberg West, Cowboy. The Lady Who Eats Metal Objects just swallowed the charge nurse’s car keys and you gotta get her to throw ’em back up.�
�
Our walk back up the hilly moonlit road to the Farben retraced our steps geographically but felt profoundly different – we were buddies once again. Malik’s meticulously restored antique VW bus sat in the parking lot. Under the harsh argon its dents stood out in high relief.
‘So,’ I said, yawning, ‘we tell the truth to patients, lie to Heiler, and get Mr K. to teach everybody to tongue their meds. It’s not going to be easy.’
‘Yeah, but because Heiler’s got all different kinds of people under one roof in the name of “borderline,” they can come together as a real team! Once they sense you’re with ’em, once they’re less foggy from the drugs, they’ll start to play off their differences, and there’s a lotta good energy in that! They’ll pull together and do good. I bet you can even do LAMBS again without that jackass noticing. Talk about exciting!’
The puffs of his breath seemed alive, the words in them exciting the molecules to dance the fine edge between water and air. How excited he was, his sharp eyes blinking, his smile broad! How he loved people! I could see, in this thirty-some face, the shy thirteen-year-old Chicago kid who – locked up in math and science and isolated from his family and from girls, his only real friends being the elephants and their keepers in the Lincoln Park Zoo – had found a way to be with others as buddies and had gotten so excited about it that all these years later he was out under a full moon just before dawn in a forlorn parking lot of a mental hospital hopping up and down like a lunatic.
‘Lincoln Park Zoo?’ I asked, realizing that I had just felt that ‘click’ with him, my own radar locking in. The words seemed to hang there, condensing in the crystalline puff of my breath before dissolving in the solution of the air, easing away with all the languorous freedom of a sleepy baby’s sigh.