by Samuel Shem
‘What do you mean “who”? I am!’
The personal pronoun came out like a bullet, echoed off a rockface and dropped. I shivered, sensing that maybe she was right, that there were depths of self-centeredness in me invisible to me, coming not only from my own decades of life, but from millennia of manhood. Depths of self unseen by self? Unable to be seen by self? Was this what Malik had meant?
Staring at her, I sensed that for once I was taking in who she actually was, from the purple bandanna tied around her hair, through her brown eyes set in her long face and her plump lips and swan neck and purple Pendleton work shirt and patched jeans, to the leaf-red laces on her hiking boots and the searing yellow of the birch leaf stuck to one sole. Startling, how new she seemed right there right then – new yet known, like an old friend you haven’t seen in years.
‘I get it,’ I said. ‘So tell me about yourself.’
‘Maybe I will,’ she said coyly. ‘But now we hike.’ She smiled, took my hand, and pulled me to my feet. We started off up the crowded old trail.
Later that night, after a dazzling dinner at the Wildcat Inn in Jackson, we hiked, aching, up the narrow tilted stairs to our room under the eaves. The floor slanted in one direction and the ceiling in another and the mattress in a third, but we were happy and tipsy and full. I undressed her, unbuttoning, unclasping, nuzzling, overwhelmed by how newly attractive she seemed, her eyes wet with love, her body full and soft. I was careful not to Krotkey.
Lying side by side, cooling in the cooling evening, listening to the sound of sawing wood coming from the other side of the thin wall – a rickety bed being severely tested by romance – and despite her carelessness with a match and candle, which had set fire to a doily – I said, ‘You’re wonderful. I love you.’
‘It’s so easy,’ she murmured, snuggling in, ‘when we’re both just here.’
I got to Emerson extra early Monday morning, and sat in the Malik rounds chair. The patients were friendly, even cheery to me. The cheerier they were, the more apprehensive I became of Heiler’s seeing them so cheery.
Heiler entered and stood for a moment inside the door, staring down at us all with palpable contempt. A dismayed shake of his head seemed to set his pelvis in motion, and one leg kicked out from his hip, and then another, as he marched toward his sanctuary to masturbate the INSURANCE executives.
Suddenly Thorny was in his face, screaming – ‘All you are is a life-support system for a dickhead’ – and Zoe too, and then all the others. To their rage, his reaction was a cruel smile. By the time he’d shut the door behind him, the ward had once again been transformed into two dozen Borderlines from Hell, the worst patients on earth, proving the Borderline Theory.
I relaxed. When Heiler was with patients, no matter how they really were, they would act toward him like classic Heiler borderlines, lurching into rage, fear, projection, and all the other Krotkey Factors. It was like the Heisenberg Uncertainty Principle: Heiler’s observing destroyed the observed. Not only do psychiatrists specialize in their defects, I thought, they evoke them in their patients, creating patients whom they can then doctor, and make a good living off of. Had Ike White done that with depression? He’d given the impression of being calm and happy, interested in us, his residents, his patients, interested in living. But his calm, orderly attention had been amidst the piles of debris of his office, the buried shit of his life. The most sensitive of his patients, like Mary Megan Scorato, may have sensed it, and his lie may have depressed her more than his depression. The sonofabitch had been lying to us all. We could’ve taken his misery; the killer was the lie.
‘Thorny’s doing badly,’ I lied to Heiler, with Solini, that day in supervision. Hannah no longer met with us. She had supervision alone with Blair.
‘Good,’ he said coolly. ‘Pretty well on schedule.’
‘Can’t even tie his own shoes.’
‘Bet you had a ball, confronting him on that one.’ We all laughed, that hearty man-to-man laughter that Blair was really good at. ‘You’re not being too “nice” to him, are you?’ he asked suspiciously.
I was staring down at my lap, and realized that if I looked back up into his eyes I might not be able to hide my lying, so I decided to try a Berry and ask him about himSELF: ‘We heard that you really kicked ass in Germany.’
‘You did?’ he said, perking up. ‘From whom?’
‘Everybody,’ Solini said, in on it. ‘It’s all over Misery, what you did to Gunderson and the rest of the McLean Hospital borderline boys.’ These borderline researchers were Heiler’s rivals, from Harvard Medical School. He was crazy with envy of them.
‘Yeah, it was a dogfight, but I beat the hell out of those Harvard jerks.’
‘That’s exactly what we heard,’ I said. ‘And Renaldo Krotkey saw it all?’
His face fell. ‘No. Krotkey was a no-show. Which, as far as I was concerned, was a brilliant way of showing his latent hostility. He sent a paper. It was so brilliant that most people there couldn’t understand much of it.’
‘How much did you get?’ I asked expectantly.
He closed his eyes. ‘Thirty-five percent? Maybe thirty-seven percent?’
‘Incredible! You hear that, Henry?’
‘Thirty-seven percent?’ Henry said, awed. ‘I never heard a percentage like that.’
‘I know,’ Blair said, nodding off, eyes half closed in admiration for himSELF. But suddenly he came to and sprang back, asking me, ‘What about Zoe?’
Startled, worried he might find out she was eating again, I stalled for time. ‘She met with me twice this week.’
‘Too soon. Too soon for her to fall in love with you, activate the Latent Positive Transference, and get erotic. What’s going on, Basch?’
‘Hey, wait a sec, Roy,’ Solini said. ‘Blair, is it true that you and Renaldo Krotkey are going to be on the same borderline panel together? In Lima, Peru?’
‘Krotkey’s not a definite,’ he said modestly, ‘Krotkey’s a maybe.’
‘Quite an honor, though,’ Solini said, ‘even to be on the same brochure?’
‘Have you seen it?’
‘Hey no, babe. Do you have one?’
‘Do I ever.’ And did he ever. He rose and with that legs-shooting-out-from-hips stride crossed the office to a stack of full-color brochures. With pride he handed us each one, then two. Machu Picchu was on the cover, and in fake Mayan script was the title: ‘Borderline Pre-Columbians: Psychopathology Among the Peruvian Indians.’ Heiler’s photo and endless C.V. were inside.
‘Nice photo,’ I said admiringly, ‘isn’t it, Henry?’
‘I never saw a photo like that!’ he said with awe, as if at a sighting of a life-sized photo of the Virgin Mary hovering somewhere over North Dakota.
‘Has to be. In the borderline field, appearance is everything. I went all out on that photo. Professional photographer. Cost a grand.’
‘That’s all?’ Henry said. Blair nodded. ‘Well worth it.’ I noted that, while Heiler’s photo was underneath Renaldo Krotkey’s – Krotkey’s bowling ball head covered with shocking red hair, his big bent nose, pendant lower lip, warped white collar, and severe bow tie making him look like nothing so much as a waiter in a kosher deli – it was not directly underneath. In fact, directly below Krotkey, directly above Blair, were the McLean borderline experts. With sick delight I employed Heiler cruelty:
‘I didn’t know that the Harvard experts would be there too?’
‘Those fuckers. I’m going to blow them away with my drug work.’
‘You’re presenting it?’ I asked.
‘Presenting the preliminary.’
‘But no-one knows which patient is on what drug,’ Henry said.
‘I do. I broke the code, for the preliminary. I call the paper, “Being ‘Nice’ to Borderlines: Random Blind Trials of Placedon and Zephyrill.’” He smiled. We smiled back. ‘I made you guys fourth and fifth authors.’
‘Thanks, big fella,’ I said, knowing how much he valued his hei
ght, which, he had informed me, was one inch greater than the tallest other borderline researcher in the world, the seemingly kind, and yet, for all the seeming, dreaded Shneero.
‘Big fella, thanks!’ Henry said. ‘I never heard of being an author like that.’
‘I wanted to,’ Heiler said. ‘My students’ careers reflect on me.’
The rest of the session was spent on his research and his SELF. Attuned to the word ‘I,’ we were amazed at how often Blair used it. I’s popped up like little flags to stand tall in front of us, one after the other until the stuff in between got lost, as when, on Memorial Day in a cemetery, you get distracted from the graves by the flags and the flowers.
Many of the Emersonians got better, and Heiler either never noticed or figured that better was worse. It was amazing to Solini and me how, even on a matter as concrete as Zoe’s gaining weight, Blair could be so blind: He never saw it. Whenever we were with Heiler, we’d massage his ego and he would fall into a narcissistic narcolepsy, a SELF-stupor, and forget about us or the patients. Occasionally we’d have to use heavier weapons. Upon his return from Peru, his SELF seemed a little damaged. We went right for it.
‘No Krotkey?’ I asked.
‘No Krotkey. He sent another paper.’
‘Bet you got almost forty percent this time,’ Henry said, ‘eh, big guy?’
‘At least forty percent, yeah.’ But then he attacked. ‘Solini. You were on call last night and you refused to admit a borderline? Great INSURANCE? A charismatic leader of a Satanic cult? Ritual sacrifice? Publishable! Why?’
‘I don’t do body parts, Blair.’
‘You do gay little dicks just fine. And you just hung up on her?’
‘Nope, I turfed her to an Angelic cult. Down the street from McLean.’
‘McLean’ hit Heiler hard, and he attacked me: ‘And you, Basch. You turfed out a borderline too? It says here she was three hundred fifty pounds. At least three fifty! Violent and hypersexed? Came in overdosed on Prozac?’ He was almost drooling at this, the Mother of all borderlines. ‘Why?’
‘I cured her.’
‘Bullshit. How?’
‘Sent her home on a low-Prozac diet. Cured.’
‘Bullshit!’ he cried, and picked up the census sheet. Enraged, waving it at us, he screamed, ‘Empty beds on my unit? Why?’
‘These darn borderlines!’ I sneered angrily. ‘They terminate too soon!’
‘Way too soon!’ Henry said. ‘Never saw soonness of termination like tha—’
‘What’s the matter with you jokers?’ Heiler said suspiciously. ‘Solini?’
Heiler stared hard down at Solini, as if accusing him of conduct unbecoming an Armenian or something. Solini fidgeted silently. We were going under.
‘INSURANCE!’ I cried out. ‘Those INSURANCE fuckers stopped paying!’
‘I never heard INSURANCE like that!’ Solini cried.
‘Don’t give me that shit – I taught you guys how to do INSURANCE—’
‘But when you left,’ I said, ‘they changed the payment protocols.’
‘What?’ Heiler asked. ‘WhatWHATWHAT?’ He was screaming.
It was true. INSURANCE was fighting back. I hesitated, deliciously, letting him twist in the breeze. ‘Changed the protocols. Payment for borderlines is down. Payment for dissociatives is up.’
‘They can’t do that!’ Blair cried out, apoplectic.
‘Life’s full of little surprises,’ I said.
‘Little surprises, yeah,’ Henry echoed, ‘and this is one.’
‘Get out of here, you idiots, I’ll straighten those assholes out mySELF.’
‘That’s cool,’ Henry said, and we left.
After that, Solini and I got more and more bold. Playing Blair like an instrument, time and again we were amazed at how sightless those blue eyes could be when focused in on himSELF. Whenever he seemed to come out of his stuporous nod and hone his razor eyes in on us, one or the other of us would play the trump card, the NPT – Nobel Prize Technique. After mentioning that we’d heard his work was Nobel Prize quality, we’d watch as he tuned out for at least five minutes and talked totally about himSELF while Henry and I floated, as nearly invisible to his mind’s eye as those tiny flecks that come out in summer on the beach, coalescences in the vitreous humor, unseen but in the brightest light.
Many Emersonians were discharged. Lloyal made sure that Heiler’s beds refilled quickly, so that Henry and I would be presented right away with yet another poor person labeled BPO with SOO, Something Or Other, or DD (Dissociative Disorder) with SOO. But such was our freed-up excitement, our rebelliousness, and our daring, and such was the support we felt from each other and from the spirit of Malik and from the just plain good feel we had with our patients, that we actually found ourselves looking forward to new admissions. Working like crazy, we learned to encounter a person in emotional pain, all of our senses and mainly our ‘sixth’ on alert for what Malik had called ‘a mutual encounter with the psychological facts.’ This, according to him, might in some cases bring a ‘click’ of understanding, that understanding prompting further understanding which would prompt still further until – like a skier leaning out over the tips of the skis – moving through and toward our understanding would generate a momentum which he called healing. Of course, a lot of our patients were out of reach of this healing – Malik had a healthy respect for how crazy, and unreachable, some people were, and for them he suggested that ‘if you can’t help ’em, at least don’t hurt ’em. Don’t spread more suffering around.’ But with many of the others, as long as we were open to something happening and free of thought and not too focused on chasing that ‘click,’ sooner or later the ‘click’ would be there. Then we would see that what a person in the solitude of terror had always thought of as his or her secret and unique sickness – what psychiatry labels ‘psychopathology’ – is in fact, when opened up to plain view, not such a terrifying sickness at all and not even all that unique, but more or less commonly held, and just a part of being human. These people might tap into their childish yearning for life, might even start moving toward vitality. Then we would see that better is better, yeah.
We hadn’t seen all that much healing yet, but Malik had yet to steer us wrong, and besides we’d be damned if we’d follow Heiler’s orders, ever again. Not that it was easy. We were still having a bitch of a time moving out Zoe and Thorny, who were reconstituting from cruelty slowly, in fits and starts, and Mary Megan Scorato, still acutely suicidal, and of course Mr K., who, thanks to the buoyant surgeons, was always sinking just that one little frontal lobe shy of discharge.
* * *
Mary Megan Scorato was being presented by Hannah to Heiler at the final Case Conference of our Emerson rotation. It was mid-November, and in a week the three of us would be leaving Emerson, for various other rotations in Misery: I would be going to Toshiba, the Admissions Unit; Henry to Thoreau, the Freudian Family Unit; and Hannah to Heidelberg West, Psychopharmacology. Now, sitting beside each other in the conference room, Henry and I were reading a memo each of us had gotten that morning from Lloyal von Nott:
Misery Capital Campaign Luncheons
Mount Misery is embarking on a capital campaign. Each of you will have a luncheon with Dr Lloyal von Nott to identify any of your patients who are potential donors. You will not be asked to solicit your own patients for monies. Rest assured the contacts will be made by us.
‘Give them the names of our rich patients?’ I said. ‘Isn’t that unethical?’
‘So what else is new?’ Henry answered.
Into the garbage.
I had been on call the night before, and at some ungodly hour I’d been called to see Mary Megan Scorato. In a panic about Heiler conferencing her the next morning, she was having fantasies about hanging herself. Staring at her, at the bags under her eyes almost as black as her grandmotherly sweater, watching a vestigial Placedon twitch slither across her cheek like a dim recollection of her beloved therapist Ike White, I sensed h
ow deep her depression was and how far she’d fallen since Heiler’s reign of terror had begun. I liked her immensely, and felt immensely sad. I wanted to help her.
‘What’s your worst fear about tomorrow’s conference?’ I asked. She sat quietly, wringing her hands, and did not answer. ‘Are you worried that Dr Heiler will be nasty to you again in public?’
‘No, I know from Dr Hannah Silver that he’s just trying to do the best for me.’
‘What, then?’
‘That Dr Heiler will discharge me.’
‘If there’s one thing you can count on,’ I had said, patting her hand, ‘it’s that he won’t discharge you. You’ve still got plenty of time left on your insurance.’ This had comforted her. She thanked me as I left.
Now, we sat in the jammed conference room as Hannah presented the case. Mary Megan was brought in. Heiler took a tack I’d never seen him use before:
‘Why are you still here?’
‘I … I don’t know.’
‘You’ve been here over four months, for a simple depression. Why?’
‘I’m not feeling b3etter. I’m thinking of killing myself.’
‘I doubt that. How do I know you’re not just manipulating me?’
‘I’ve never manipulated anyone. I don’t want to live. I want to die.’
‘Sounds like manipulation to me.’ They went on like this, Heiler accusing Mary of manipulation, which made her try harder to convince him that she really did want to kill herself. Finally he said, ‘I’m discharging you tomorrow.’
Silence, one of, What? Before Her Insurance Runs Out?
‘Please,’ Mary Megan said, ‘please don’t. I’m not ready. Hannah, please don’t let them do this. It is wrong, and I’m afraid. Hannah, please?’
Hannah, shaken, said, ‘Oh Mary, I’m really sor—’ but then she glanced at Heiler, and, a good soldier, went on, ‘Dr Heiler is in charge. I’ll continue with you as an outpatient, when I get back from my vacation next week.’
‘No!’ Mary Megan shouted.
‘Now, now,’ Heiler said. ‘Now, now. It’ll do your SELF-confidence a world of good to get out of here. I’ll write the order myself. Right now. Goodbye.’