Mount Misery

by Samuel Shem

  Crushed, Mary Megan was escorted from the room. Solini and I couldn’t believe what had just happened.

  ‘But she still has insurance!’ I said.

  ‘Nope. Yesterday her HMO changed the protocol. Payment ran out today.’

  ‘And you’re not gonna go to bat for her?’ Henry asked.

  ‘When she’s actively suicidal?’ I chimed in.

  ‘Suicidal, hell. Manipulative. Think I don’t know when a borderline is manipulating me? Read my article: “Thirteen Ways of Looking at a Borderline.’” Heiler kicked out over to the nursing station and wrote the order himself.

  An hour later, with many hugs and kisses and best wishes and tears, all of us Emersonians said goodbye to Mary Megan Scorato. In her eyes was terror. I unlocked the door and helped carry her suitcases downstairs. Her husband Joey and six-year-old Down syndrome son Tommy – in that shortened face, those epicanthal-fold eyes streaming tears of joy – helped her to the aging Isuzu whose defective roof rack had started her trip into Misery. Waving bravely, she left.

  Heiler flew off for his week conferencing in the rain forest near Kuala Lumpur, where Krotkey’s status had been upgraded from a ‘maybe not’ to a ‘maybe.’ Hannah flew off for a week in Sun City, Florida, with her Holocaust survivor parents.

  Solini and I, appalled and enraged, went into high gear, discharging as many of the healthier Emersonians as possible before Blair returned. Our mission was to leave as few patients as possible at Heiler’s mercy after we were gone from Emerson.

  By now we’d learned a great deal about how to discharge people, how to prepare them for the terrors of freedom – learned just how pragmatic an art psychiatry was – how getting someone back to the ‘real’ world was not a matter of THEORY or TECHNIQUE or SELF or OBJECT but of the nuts and bolts of where will they live and how will they eat and what will they do all day long and who will they have for support to keep them from the killer isolation and thoughtless savagery that we have numbly come to call ‘civilization.’ Malik’s LAMBS network was a blessing, and by the end of the week we had discharged almost half the Emersonians, each hooked up with a buddy.

  Our greatest coup was Zoe and Thorny. Having been on Emerson so long, they were stuck tight to it. They were too opened up, too human for ‘normal’ life: too kind to fight through traffic, too compassionate to pass a panhandler by, too believing around salesmen, not to mention religions. Their day passes into ‘normalcy’ had made them realize how unpracticed they now were in the cruelties of daily life. Henry and I had tried everything to pry them loose. No luck. Finally I saw that to leave Mother Misery felt, for each of them, just too damn lonely.

  ‘Henry, I’ve got it. Thorny and Zoe as buddies.’

  ‘Cool. Let’s ask ’em.’

  We did. Sitting on the half-deserted ward, we watched as they turned their radars on each other, sizing each other up as potential buddies. We saw them suddenly see each other as sex OBJECTS, what Heiler had labeled the TET (Total Erotic Transference) in each of them sizzling, like meat on adjoining barbecues. Having sizzled, it quickly fizzled. Zoe said:

  ‘I’ll room with you but I won’t fuck you.’

  ‘Dickheads Off the Hook!’

  ‘If you promise to protect me from other men,’ Zoe said, ‘I’ll try it.’

  ‘And I’ll try it,’ Thorny said, ‘if you promise to protect me from other men too. And help keep me away from dogs and cough syrup?’

  ‘And you’ve both got to find work,’ I said, ‘either for pay or volunteer.’

  They agreed. The deal done, they got on the phone to find an apartment.

  The two of them walked out triumphantly the next morning, to cheers from us all. Henry and I called them that night at Misery Garden Apartments. Behind their dead-bolted door and barred windows, they were eating pizza and watching Star Trek reruns. When I asked Thorny how it was going, he said:

  ‘Dickheads Make Great Americans!’

  The drug blackshirt Win Winthrop was sitting with Solini and me a few days later in the nursing station on Emerson. Win would be rotating in to take my place with Heiler in a few days, and was telling us all about ‘psychiatric infomatics,’ some computer bullshit or other that he thought was going to make him rich.

  ‘Outside call, Cowboy. Urgent. From a psychiatrist in Kansas.’

  It was a staff psychiatrist at the Menninger Clinic in Topeka, Kansas.

  ‘I believe you recently discharged a patient named Mary Megan Scorato?’

  ‘Yes.’

  ‘She was admitted here yesterday. I’m sorry … there’s bad news.’

  ‘What?’

  ‘She hung herself last night.’

  ‘What?’ I cried out, feeling the same sick punch in the gut I’d felt with Ike White. The Menninger psychiatrist repeated the news. Feeling sicker, I asked a few more questions, and then said, ‘Wait a second. Her insurance had run out. How did she pay for admission?’

  ‘Her son paid for it, out of his own pocket.’

  ‘Her son?’ Her son was six years old and had Down syndrome. Then, suddenly, I saw it all, saw all thirty-one years of it, and a chill ran through me. ‘You mean the son she gave up to the nuns – put up for adoption – when she was a girl?’

  ‘That’s right. She spent the day with him here, before she was admitted. He lives just outsida Topeka. I’m sorry. She seemed like a real sweetheart.’

  ‘Yeah. She is. I mean was.’

  I hung up. In shock, I told Solini and Win. By the end I was crying, hard, really shaking with sobs, as was Henry. We’d kind of loved her, and we were crying for her and crying with rage, at Heiler and her Health Maintenance Organization, for murdering her. We just sat there in that ridiculous cruddy nursing station and cried.

  ‘Really rough, Roy,’ Win said. ‘Death is so final. Can we have her brain?’

  ‘What?’

  ‘Her brain, for the Misery Brain Bank. Errol and I are doing a new study on brain changes in borderlines on Placedon and Zephyrill. Can you get us permission from the next of kin – I guess it’s her husband?’

  ‘Get out of here.’

  ‘It may seem insensitive but brains go to mush real fast and we have to get online and tell them how to preserve it in Kansas.’

  ‘Hey, man,’ Solini said, ‘don’t you have any fucking feelings at all?’

  ‘Exactly. Feelings have no place in the science of psychiatry.’

  ‘Go fuck yourself,’ I said to Win. ‘And get the hell out of my face.’

  ‘If you won’t talk to her husband, we will.’

  ‘After what Heiler did to his wife, you think the husband would give you jerks permission to grind up her brain? Are you insane?’

  ‘Errol’s an expert in permissions for brains for the Brain Bank.’

  ‘No way, man, and fuck off.’

  ‘Errol’s incredible. The toughest cases, the man brings home the bacon.’

  The funeral was held in the Scoratos’ own church, the Most Holy Redeemer. A memorial service, to give those who knew her on the Misery campus a chance to say goodbye, was held in the Misery Chapel, a small stone replica of a famous Lutheran church in the Ruhr. The chapel was packed with those whose lives Mary Megan had touched while she was at the hospital, mostly patients, some staff. I sat with Solini. Heiler had been notified in Kuala Lumpur, and was due back, but we hadn’t been able to get in touch with Hannah in Florida. Music was played. Mary Megan’s husband, their misshapen six-year-old son beside him beneath the cross which was hung on invisible wires from the nave like a solid gold plus sign, read a poem filled with rage, which segued into ‘All Things Bright and Beautiful,’ which my sick, numb feeling did not allow me to actually sing. Deaths echo deaths. Ike White was right there.

  At the end, the husband and son rose and walked slowly up the aisle to the exit in the front, the father’s hand a dead white on the son’s dark suit coat shoulder. People were filing out to pay their respects to them at the door when all at once a sense flickered throug
h the crowd that Heiler was there. Everyone turned. There he was, standing alone at the business end of the chapel, arms akimbo under the suspended cross, as if he owned it.

  Then a strange thing happened. Without anyone initiating it, everyone began standing aside, opening a long aisle from the front entrance all the way back to Heiler. In silence we stared at him. He was presented with a choice, either to stand there, under everyone’s gaze or to walk the silent gauntlet to the front, to get out. He did the latter, those legs kicking out as if it were the most normal thing in the world to walk through a community of people who hate you and blame you for the death of someone they loved. As he walked through, the line closed in after him. Solini and I were too far back to see what happened when Heiler came to the husband and son on his way out, but we heard a sharp curse, and then a deformed wail, before we began moving slowly forward again, to pay our respects to the survivors of this tragedy.

  That afternoon Heiler called us three Emerson residents into his office for a last meeting. Hannah had just returned. Despite her tan she looked bad. Heiler, despite his tan, looked worried. Could it be? Could he be hurt by having driven Mary Megan to suicide? Seeing what I took for pain about the tragedy in his face, my heart opened to him, a little. Maybe Solini and I were wrong. Maybe in the privacy of his office he wasn’t so vicious, he really was human, maybe even a good therapist. Patients did keep coming back to him, did they not? Their Mercedeses and Porsches and limousines rivaled Lloyal’s own.

  ‘You three are leaving my service tomorrow,’ Heiler said, ‘and there are things we need to talk about.’

  Good, I thought. At least, before we leave, we’ll talk about this mess.

  ‘You’ve done a fairly bad job. Solini and Basch especially have fallen off lately, discharging patients too soon. Zoe and Thorny? Paying out of pocket and you discharge them? I’ve never had so many empty beds. Why?’

  Solini and I looked at each other in disbelief. He was upset about beds?

  ‘You’re the one who discharged Mary Megan,’ I said, ‘not us.’

  ‘Borderlines kill themselves. But you’re right – it always looks bad.’

  It was vile. Heiler was less hurt by the death of the patient than by the insult to him. He would be seen as having failed – by his Harvard rivals, by Renaldo Krotkey. His SELF had gotten hurt. It was sickening to see, so close up, how for Heiler being a great psychiatrist was more important than helping a patient. I said, ‘I hear there’s going to be an investigation.’

  ‘Who said that?’ he asked, startled.

  ‘It’s all over Misery,’ Solini said. ‘They got the transcript of your last interview with her. We’ve been talking to lawyers and shit.’

  ‘With me away?’

  ‘You were away, big fella, what did we know?’

  ‘It wasn’t just me,’ Heiler said, with the slightest hint of fear. ‘Very wise men are making these decisions.’

  ‘Who?’ I asked.

  ‘And like about what?’

  Heiler got up from his desk and stood before Solini and me. He thundered down on us, ‘Something’s fishy. What have you two been doing?’

  ‘Did Krotkey make it to the rain forest?’

  ‘Shut up.’ He stared at us. Hannah recrossed her legs. Heiler’s laser eyes bored in on us. ‘Have you two little pricks been being “nice” to me?’

  Silence, one of: Well, You Found Us Out.

  ‘Have you two little pricks been lying to me?’

  ‘Go fuck yourself, Heiler!’ I shouted, jumping to my feet. ‘Fuck you!’

  ‘Asshole!’ Solini cried, jumping up at my elbow. ‘You zygotic oaf! Up yours!’

  Heiler moved closer. I saw what looked like bite marks on his neck. He stood over us, like a pile of rock. Then he nodded. ‘Good, good. Even if you two little dickheads did discharge them all too soon.’

  ‘On time?’ I cried out. ‘Heiler said they were discharged on time?’

  ‘Quite on time, as per Heiler Theory,’ Chief Lloyal von Nott was saying that afternoon, in that high British accent. We sat in his office in the Farben. Henry was next. It was the first time I had met with Lloyal alone. In person he seemed reptilian, his office cool, he cooler, so that I actually shivered. His blackish eyes, set as narrowly as a red setter’s, were unfathomable. The lines of his skin revealed him to be older than he tried to appear. ‘Blair said that you and Dr Solini had worked through the LNT so efficiently that your borderlines were discharged quite on time. Good work.’

  ‘It was nothing,’ I said, startled at Heiler’s neat lie, wondering suddenly if all along he’d assumed we’d been lying and had been lying right back.

  ‘It proves Borderline Theory and Technique work rather beautifully on borderlines. The downside risk is empty beds. Half our beds on Emerson are empty. McLean Hospital, today, has no empty beds. None. How can I run my hospital if people like you insist on discharging patients?’

  ‘It does make trying to treat patients difficult.’

  ‘We don’t treat patients anymore, actually. We process them.’

  ‘It’s good to know.’

  ‘Dr Heiler’s evaluation says you are too self-centered, too confronta—’

  ‘I was upset about a patient’s suicide, a woman named Mary Megan Scorato.’

  ‘Yes, and I called you in here to talk about the luncheon.’

  ‘The luncheon?’

  ‘The Misery Capital Campaign Luncheon. You have yet to respond.’

  ‘You see, Dr Heiler abused Mary Megan Scorato in front of all of us, and three days later she got admitted to Menninger’s and killed herself. As chief you need to know about it. Here’s the report.’

  ‘Yes,’ he went on, dropping it onto his desk, ‘and as her administrator, she was your responsibility. Now. About the luncheon—’

  ‘Dr Heiler says that since I reflect on him, he’s responsible for me.’

  ‘Yes, quite. He informs me that he takes full responsibility. So—’

  ‘He can’t.’

  ‘Why can’t he?’ Lloyal said, with the British pronunciation, ‘cahnt.’

  ‘Because he reflects on you, and you reflect on Misery, and Misery—’

  ‘Yes, yes,’ he said, narrowing those red setter eyes even further. ‘Now, about the luncheon—’

  ‘You see, Heiler is so vicious to patients that people won’t refer patients to him anymore – which means empty beds. I’ve heard there’s a movement to ban him from seeing patients or teaching residents and med students at all.’

  ‘Ah, but he publishes. The Zephadon/Placeryll data are rather smashing.’

  ‘I thought the preliminary data were inconclusive,’ I said.

  ‘Quite – the preliminary. But about a month ago the patients on Emerson Two and Three began improving. Not on Emerson One, though, Depression. These medications work – though not in depression. Because of our work – Blair’s, mine, and yours – borderlines all over the world will soon be put on these medications.’

  ‘Which one worked?’ I realized that Mr K.’s taking everyone off the drugs on Emerson 2 and 3 might result in everyone being put on the drugs worldwide.

  ‘Both. Both worked equally. An elegant study.’

  ‘And both worked better than the placebo?’

  ‘Slightly. The placebo effect in borderlines is quite strong. Dr Errol Cabot is doing a more sophisticated statistical analysis to heighten the difference. I don’t understand these maths. I was born in Luxembourg and—’

  ‘Were you?’ I said, as if impressed, trying male station-identification.

  ‘I am European,’ he began, his eyes drifting toward a coat of arms on the wall that looked like nothing so much as a Rorschach of two birds of prey joined at the waist clawing each other to shreds, ‘born in Luxembourg, raised in—’ But then he caught himself, and I saw that he hadn’t risen to the top of Misery by falling for such blunt flattery. Lloyal specialized in psychopaths and money. He was so skillful in slipping the knife into your back that you di
dn’t know you had been stabbed until a few days later, when, as if a fuse had burned down, your balls fell off or guts plopped out onto your shoe tops and you realized that what you thought of as a benefit to you was in fact a detriment, a promotion a demotion, a rise a fall, a good a bad, and the most skillful part of it was that you couldn’t remember who did it to you, and at the top of the list of suspects would not be Lloyal von Nott. Your memory of your interaction with him might in fact be pleasing. You would gladly pay his astonishing fee. ‘But more of that some other time,’ he said. ‘Just think: all over the world, borderlines will soon be put on these medications, and Misery will get the credit. All over the world. Just think of that.’

  I just thought of that and felt slightly ill, and slightly nodded.

  ‘Yes, psychiatric disease is every bit as predictable as medical disease.’

  ‘Medical disease isn’t predictable,’ I said.

  ‘Who says?’

  ‘In my year as a medical intern, nothing was predictable. Mostly the ones who ought to have died lived, and the ones who ought to have lived died.’

  ‘Sounds quite predictable to me. Yes, psychiatry is a medical science. Ordered and predictable. Like a healthy self. Like America itself.’

  Did these guys really believe this shit? In order to rise to the top of the Mount Miserys of the world, did you have to leach out your heart of care and concern, your head of doubt, so we’re left with ventriloquists’ dummies for leaders in business and religion and government and education, leaders with an eleven-year-old boy’s sense of what matters in life? What do all our chiefs have in their head – Swiss cheese?

  ‘Actually I called you in to address the luncheon. The Capital Campaign Luncheon. You’ve not signed up for a luncheon.’

  ‘My lawyer says it’s unethical to reveal the names of my wealthy pa—’

  ‘Your lawyer?’ A startled reaction. I wanted to laugh.

  ‘Ever since you and Misery lost that malpractice suit to the tune of 3.2 million, we all have to be extra careful, don’t we?’

  ‘We have paid out nothing. It is under appeal. Chief Counsel to Misery, Nash Michaels, has it well in hand. Misery is robust today. Robust.’