by Samuel Shem
Panting, I followed Errol and Win into the foyer of the West. Rather than going in the main door, they turned right through a door marked STAFF ONLY, into the nursing station. I found myself staring through the open top half of a Dutch door, out at the ward. It was packed with patients and was filled with that tomblike quiet you feel under significant water.
Dozens of patients were either lying down asleep or trudging around the thickly carpeted floor or twitching horribly from Tardive dyskinesia, the incurable disease caused by the drugs each had been given to cure them of their curable disease. All wore long white nighties with the Misery logo – pine tree, moon, and duck rampant – as if they were players on a team. The nursing station was a space-age bubble where a nurse in a white uniform stood framed by the open upper Dutch door, a tray of drugs beside her. She would call a name, a patient would rouse him- or herself, come up, get drugs, and go away. No other staff were to be seen. The nurse smiled at me. Her whites were starched. Her teeth glistened amidst lipstick as red as Jill’s. Ruffles fluffed down the front of her nursing costume. She seemed immaculately cheerful.
‘Welcome to the West, Doctor. I’m Deedee. There’s fresh coffee inside.’
Inside, instead of the usual steel table and those uncomfortable plastic airport chairs, was a gleaming mahogany table and stressless leather chairs.
‘Hello, Doctor,’ said another nurse, also in a white uniform, one that seemed to be covering her body only with reluctance, unbuttoned a touch too much at the top and stretched a touch too tight in the bust and raised a touch too high on the thigh and all in all reminding me of my medical internship where such uniforms were a statement of life and sex in the midst of disease and death. ‘Welcome to the West.’ Her voice was calm and soothing, as if she were taking the same drugs Win and Errol were on, to bring them down closer to human. ‘I’m Gloria, the head nurse.’
‘Roy Basch. Call me Roy.’
‘Roy. Call me Glo. Shall I brew you a fresh cappuccino?’
‘Cappuccino?’
‘Courtesy of Pfizer Chemical. And a fresh-baked croissant, courtesy of DuPont?’ I nodded. ‘Chocolat or amande?’
‘Chocolat.’ I noticed that her uniform was Courtesy of Dista.
‘Good choice. Now. In your cappuccino – cinnamon or cocoa?’ I chose cocoa. ‘Chocolate addict, eh?’ she said, and played a big copper espresso machine, making steam hiss. I sank down into a stressless chair (Upjohn) and stared into an inner chamber (Glaxo) where Win and Errol were ripping quickly through charts, Win signing notes, passing them to Errol, who signed and tossed them down onto a table. In another room other nurses and mental health workers sat around, chatting softly or reading magazines. Stressless.
PROZAC, declared the cup Glo handed me. She raised hers in salute: RITALIN. I took a sip. Excellent, bringing back a memory of long mornings sitting with Berry in the Piazza Navone in Rome, now in another lifetime. The DuPont croissant was delicious – fresh, crisp, and with a slippery ooze of butter and fine dark chocolate.
‘—tricyclics!’ Win cried, crashing out of the back room with Errol.
‘Dialing for Dow dollars!’ Errol answered. ‘Let’s fucking move!’
‘Are we doing rounds?’ I asked Errol.
‘I don’t do any goddamn rounds.’
‘Not even insurance rounds?’ He said no. ‘Well, what shall I do?’
‘Just stay outta my way. We just got burned by that quitter – what was her name, Win, that women’s libber who ran away to Wyoming? What was it, “Francine”?’
‘Hannah.’
‘Yeah. Once burned, twice shy.’
That whole first day I stuck close to Errol. His pace was frantic, the myriad aspects of his empire making my head spin. He first ripped through the charts on the West 2 and 3, above. These two wards were also packed full of patients. Most showed ritualistic behaviors – hand-rubbing, hair-pulling, one lawyerly-looking man scratching his rump incessantly. Finished with the charts, Win and Errol blasted past me, out. Cornering tightly on the stairs, Errol elbowed Win to his knees. Helping him up, I asked about the ritualistic behavior.
‘OCD,’ Win said. ‘Obsessive Compulsive Disorder. A psychosis.’
‘But obsession has always been a neurosis, not a psychosis.’
‘Now it is. As of last Monday it’s official: they’re nuts. Insurance pays for thirteen days. Since last Friday eighty percent of our admissions have OCD. We’re getting in on the ground floor. Obsession is biological. With drugs it gets better.’
‘Which drug?’
‘Drugs, the plural. Six drugs. Read our paper.’
‘You’ve published already?’
‘Got to.’ Win raced outside, into the harsh dazzle of the April day, but instead of trailing Errol down the ravine toward the Farben, he peeled off into the dark and muscular Misery woods, motioning me not to follow. I watched him crash through brush where there didn’t even seem to be one of those nature trails a grateful Misery alumna had donated for birding.
I tailed Errol down into the basement of the Farben, to ‘Computer Lab,’ and then to ‘ECT Suite.’ Errol ran the Electro-Convulsive Shock Therapy concession at Misery. Donning a space suit outside something called PET Lab, he asked me, ‘Do you have a dog?’
‘No. Why?’
‘This is a PET scanner.’
‘You scan your pets?’
‘Positron Emission Tomography.’ He vanished into a room with a huge tubelike chamber, the size of a coffin for a dolphin. Dry ice vapors misted up. Errol and a lab tech in a space suit banged on it, tapped it, shouted at each other across it. In response it emitted a purple glow like you see in movies when the aliens arrive. Nearby I heard pitiful barking and whining, and peeked around a corner at row upon row of dogs in small cages.
Suddenly we were moving through the lunch line. Errol took enormous portions of all the worst foods – hamburgers and french fries and fried onion rings and Schlomo’s favorite, ‘Misery Mystery Meat,’ and Swiss cheese and cheesecake and refined sugar. He seemed to be on a high-fat, high-cholesterol, high-sugar diet. I started to follow him to his table but he said he wanted to eat alone. As he ate, he made call after call on his cellular phone. Gloria sat down with me.
‘Who’s he calling?’
‘His private patients. Drug consults. A hundred bucks a shot.’
‘But he’s eating lunch!’
‘Awesome, isn’t it? You make good money, in drugs.’
As we talked I was amazed at Gloria’s healthy outlook on life in Misery. Despite having worked with the most violent and psychotic people in the harsh world of the hospital for many years, she seemed peaceful, appreciative of life. After barely nine months here I was cynical and worn. I asked her how she managed it.
Her eyes flickered away. Malik had said that this was a sign of a person about to tell you a lie. ‘To tell you the truth, Roy,’ she said – another sign of lying – ‘I guess I’m just a pretty happy camper.’
After lunch, Errol let me sit in on his private practice. His office was on the top floor of the Farben, with a fantastic view of the panorama unrolling to the north, where the line of white smudges on the horizon was maybe snow on the mountaintops, maybe clouds. The office too was a kind of museum of the drug trade, everything ‘Courtesy of’ somebody, from the Brazilian-leather couch and chairs courtesy of Ciba-Geigy/Brazil, through the immense rosewood desk courtesy of Smith-Kline/Thailand, to a tiny working model of the blood supply to the human brain, bubbling and gurgling bright red cartoon blood in through the arteries and draining sludgy blue venous blood out through the veins, the lips contorting, seemingly at random, into kisses or smiles, with a flashing sign that said, ‘Zoloft Keeps You Aloft.’
A series of well-heeled patients marched in, one after the other. Errol spent at most ten minutes with each and treated each exactly the same way: asking about their drugs – usually they were on three to six drugs – side effects, improvements, and then adding or subtracting drugs before saying goo
dbye. He asked a question or two about their symptoms. He asked nothing about their psychological state. The patients were treated with a courteous benevolence, like, say, good dogs.
It was astonishing to see how, being treated with total, authoritarian objectivity, they responded with total, submissive gratitude. Errol gave the impression of being absolutely sure. While he was sure about everything, he addressed but one thing: drugs. If his patients wanted to talk diagnosis, he talked drugs. If they wanted to talk symptoms, he talked drugs. Stress? Drugs. Suffering? Drugs. Family problems? Drugs. Job? Drugs. The love, yes, the adulation his patients felt for Errol was palpable. How could they love him? They could love him because not only did he convey to them that he was sure about their drugs, and, by implication, about all the other things they mentioned – diagnosis, symptoms, stress, suffering, family, job – but in addition he always said to each patient at the end of the ten-minute interview:
‘This will make you feel wonderful and make you better.’
Most patients loved hearing this and thanked him.
A rare patient might ask, ‘Are you sure?’
‘Absolutely. This will make you feel wonderful and make you better.’
Virtually everyone got an antidepressant, often Prozac, and a pseudo-amphetamine, often Ritalin. Errol regarded these drugs with contempt. ‘Placedon makes Prozac look like popcorn, Zephyrill makes Ritalin look like Rice Krispies. Family doctors prescribe Prozac – a “mood brightener,” Clairol for your brain. Cosmetic psychopharm, like nose jobs. Prozac’s like pissin’ in the wind, and Ritalin’s like vending machine coffee.’ Most patients also walked out on Placedon and/or Zephyrill, giving a baseline total of four drugs. Not that Errol was dogmatic. As long as a patient wanted a drug, he didn’t much care which drug it was. Many patients, having heard of drugs other patients were on – family or friends, or patients they met in Errol’s waiting room – would come in and ask Errol for a prescription for the same drug they’d heard of. Errol congratulated them on the wisdom of their choice and wrote them a ‘scrip.’ As a fiercely cheery Lilly saleswoman had once told me, ‘Prozac sales topped two billion last year!’
The most heart-wrenching were the children.
Parents would bring their children in.
The children would always go out on Ritalin, and sometimes on Prozac.
Errol was doing his best to add to the 1.5 million American schoolchildren who were now on Ritalin, in a way a kind of speed, to treat something, some ‘disease,’ that hadn’t even much existed five years before.
Over the course of the year, especially by working with Malik, for most people I’d come to see many of the lesser psychiatric drugs – especially Ritalin and Prozac and Zoloft and the other serotonin-uptake inhibitors – as symptoms. They were symptoms of the disconnections in the society, symptoms that in fact increased the disconnections, which led to more Ritalin and Prozac and newer versions of the same. Especially with kids, it was obvious that the cure was in creating the connections, not in giving them drugs that disconnected them further, and destroyed them. But that was more difficult, and hey – Errol was considerate: for the really young ones, he gave them their Ritalin in an elixir.
Finished with his private practice, Errol shot to his feet and bolted for the parking lot. Trying to keep up with him, I screamed out, ‘But a lot of them come back from their last visit with you not better.’
‘And then I give ’em a new drug and it makes ’em feel wonderful and better.’
‘But what if it doesn’t make them better?’
‘I try a newer drug. Let’s go!’
‘Don’t you ever run out of drugs?’
‘You never run out of mixtures. Principle of “the Drug Cocktail” – c’mon!’
The gull wings of his red Ferrari spread up and out as if just dying to catch the alluring spring breeze. A bumper sticker read:
RESEARCH TAKES BRAINS,
DONATE YOURS. CALL
1-900-BRAIN BANK.
‘Nice car,’ I said. The seat welcomed my body like a perfect orthotic a foot.
‘Ferrari Mondial. Sterling/Italia cut me a deal. Only 197 K.’
‘Still a lot.’
‘Not if you maximize your billability. Everything you saw, I bill for. Ten minutes, a hundred bucks. Ten bucks a billable minute.’
‘It’s mind-boggling.’
‘No, it’s modern psychiatry. Your little “talk therapy” is now a minor subspecialty. A hundred twenty an hour, tops. Chump change. No cars like this. Managed care and insurance won’t pay for talk. They pay for drugs. Pretty soon they won’t even bother to teach you residents how to talk anymore. I sit on the President’s National Health Care Task Force. The government doesn’t believe in talk. It believes in drugs. If my patients want to talk, I send ’em to a social worker. Cheaper, and better. Placebo effect. No cars like this. Drugs aren’t just a career, they’re a lifestyle.’
He slipped us into gear. The Ferrari growled along at the Misery 15 mph limit angrily, as if there were a hundred hungry Italians under the hood, late for their primo piatto.
‘You bill for everything?’ I asked.
‘Everything,’ he said, dialing his car phone.
‘Even the patients on the wards?’ He nodded. ‘But you didn’t see them.’
‘I saw them. You saw them too.’ He was talking into a patient’s machine.
‘You saw them, but you didn’t meet with them, or talk with them.’
‘Saw enough to bill ’em. Saw their charts. You want to see something? See my alimony. I’m working on the wife from hell number three.’
‘But it’s illegal,’ I said as we crept growling up to the wrought-iron gate out of Misery, ‘to bill insurance without actually seeing the pa— yeow!’
He’d hit the accelerator and suddenly the occipital lobes of my brain seemed to have flattened against the back side of my skull. My eyeballs flattened back against their sockets. The road blurred. I caught a whiff of swamp gas. Suddenly he downshifted and I was thrown forward. My frontal lobe crashed against my maxillary sinus, my eyeballs against my lids. Nausea.
We were passing under a falling-down arch and growling along again through the neglected mud and debris of the grounds of what looked like a medieval fortress: all turrets, walls, and pointed spires in stark relief against the suddenly lowering sky – we were in Candlewood State Hospital. Errol also owned the drug and shock concession at this state facility and was in charge of our first-year resident Misery rotation there – one morning a week for a month – which Schlomo Dove had demanded, as a token gesture to the Great Unwashed.
The contrast with Misery couldn’t have been more stark. In place of manicured grounds and pointed fresh brick, here were crumbling walls and dumping grounds. I raced Errol into his office, the desk and furniture classic public sector, cheap alloy and imitation wood, the air thick with the stench of stale overtime, which brought back the memories of my long nights on the graveyard shift as a toll collector on the Rip van Winkle Bridge over the Hudson, back in Columbia. Errol was furiously signing a pile of state documents, in triplicate. I asked what he was doing.
‘Signing discharges. The governor is cleaning this shitbox out.’
‘Discharges to where?’
‘To wherever. Nobody cares about these people anymore.’
‘But you haven’t even seen them.’
‘What the fuck’s with you with this seeing? Take these keys to the wards. Get an education in the public sector. I leave in one hour.’
I wandered long corridors, peering into empty wards. At first the doors were labeled ACUTE MEN’S 1, or ACUTE WOMEN’S 3. As I walked farther into the fortress, suddenly I was in CHRONIC. I peered into a ward that seemed full, CHRONIC WOMEN’S 9. I unlocked the huge door and went in.
It was like walking into a nightmare, a ring of hell. Filling the ward were forty women in ratty, stained hospital johnnies. Some were twitching and walking. A few were smoking, and a line of women trailed after eac
h smoker. As I watched, one smoker finished and threw the butt on the linoleum. The other women dived for it and fought over it. The smoker turned and watched the scramble. Her fingers, where she had grasped the cigarette, were stained by the nicotine – not tan, or brown, but black, pitch-black. Lying on ripped couches, some women were masturbating. An old woman was repeatedly taking her nightie off over her head, as if getting ready for the day, and flashing pendulous withered breasts and a scraggly thicket of gray pubic hair before putting it back on, as if getting ready for the night. Several women were praying, crossing themselves, and another was blessing them.
The room was filled with a stench of feces and urine and sweat. Four staff members, all women of color, were sitting at a rickety table playing cards, occasionally glancing at a soap opera on a TV set screwed high up on a yellow-green wall and protected from assault by thick wire mesh. As I watched I heard, ‘In a moment, back to One Life to Live.’
Seeing me, some of the chronic women shrank back, but some came toward me, so that I caught the stench close up. Their eyes were both dull and wild. A few clutched at me, or picked at my clothes like starved but wary birds at a blue-berry bush. I fled to the nursing station. A broad-beamed, gray-haired woman, dressed in a plaid skirt and white blouse, looked at me with a startled expression on her wide friendly face.
‘Who are you?’ she asked.
‘I’m a doctor.’
‘What are you doing here?’
‘I’m from Mount Misery, doing my rotation here. One morning a week.’