“Daddy’s furious, but he decided not to give up his golf date for you.”
“Harry’s prone to furies. Any special reason?”
Becca hugged her knees. “Because Piero Benedetti called him at two this morning to get you out of jail.”
She felt a jolt behind her diaphragm. Jail? Her hands shook as she picked up the mug of coffee and a large pool slopped onto the table. Becca went to the sink for a sponge and mopped the table.
“Darling, is this what teenagers do for fun these days? Make up stories to shock the older generation?”
“Mom said you’d probably pretend not to remember.” Becca’s green eyes were tinged with worry.
“What am I supposed to have been in jail for? Trespassing on the Minsky scrap heap?”
Years of training allowed her to produce a mocking trilling laugh despite the giveaway trembling of her hands. “And what on earth does Piero have to do with it? The last I heard he was in New York closing out the Met production of The Ghosts of Versailles.”
“You called him. Or somebody called him, and he called Daddy, who had to drive all the way into Chicago to get you. Daddy says he should have just let you rot there, it would have done you good.”
“Oh, Jan—oh, good, you’re up.” Karen had come in and was washing mud off her hands at the sink. “We need to talk. About last night.”
“Becca has been spinning me some kind of ghoulish teenage tale,” she said lightly. “But I don’t think you should encourage that kind of prank. And I don’t think you need to involve yourself in my activities.”
“Don’t need to involve myself?” Pots as well as glassware rattled at Karen’s shriek. “Piero Benedetti called us in the middle of the night after you had woken him at home. Don’t you remember any of it? Look at me, and don’t smirk in that oh-I’m-so-superior-to-you way! You made a spectacle of yourself at La Bohème last night. Even without the arrest, two of my neighbors already called to tell me. You hummed loudly throughout the first act, and then, deciding that the poor girl getting her chance to debut in a miserable community production didn’t deserve to be the center of attention, you actually got up and sang over her voice in the third act. And now you sit here in my kitchen, eating my food, after dropping dirty towels all over the house, trying to pretend you don’t remember a damned thing about it.”
“I don’t think she does remember, Mom. We read about it when we covered alcoholism in our health class this spring. You can be so drunk you can’t remember what you did, especially if it was embarrassing.”
“Becca! Are you—is it possible that you are calling me an alcoholic?”
“Oh, please!” Becca’s eyes, which used to watch her in adulation, held so much misery she had to look away. “It just makes it so much worse when you lie, when everybody knows that’s why you’re in Chicago instead of New York. It’s nothing to be ashamed of. You can’t help it. It’s a disease, and if you could only admit—”
She swept the dishes off the table, enjoying the crash and the alarm in Karen’s and Becca’s faces when they shattered. “If you’ve quite finished your extraordinary remarks, will you find some clean clothes for me to wear? I’ll call someone to come out and pick me up.”
“Be my guest. But you can’t borrow any more of my clothes. You took my Donna Karan suit the last time you were here and when I finally got you to return it, you’d spilled something on it that the cleaners couldn’t get out.” Karen took a breath. “And Harry wants you to get a job. He’s tired of supporting you.”
“Does he want me to drive a truck at the scrap heap? Now that would be a sight worth seeing.”
“Janice, you can do what every other retired diva does: you can—”
“My name is Luisa Montcrief, and I am not retired!” She wished she hadn’t wasted the dishes on Becca’s childish remark: her fury was real this time, and needed a physical vent. “I am just as eager to leave this town as you are for me to go, but my manager has so far been too lazy to get me the engagements I desire.”
“Well, call him, and take something you don’t desire.”
“And have everyone join you in saying I’m a has-been? I think not!”
“Look, even if you’re not retired, would it kill you to give a few lessons? There must be people in Chicago who think you have something worth saying about singing.” Karen’s tone didn’t hold out much hope at the prospect.
“Very well: I will call my manager in the morning and remind him that I’m getting impatient.” She swept from the room, every inch a diva.
“What were you doing making her tea? I thought I told you not to wait on her.” Karen fetched the broom from the utility closet and stabbed at the broken crockery with it.
Becca pulled a strand of hair straight and sucked on it. “She misses all the attention.”
“But it’s not your job, miss, to be her maid-audience-secretary, or whatever it is she thinks she needs at the moment.”
“She made the glasses ring for me,” her daughter offered.
“It’s just like your father to go off golfing and leave me to deal with her,” Karen grumbled. “She’s his twin, after all, not mine, I married him for better or worse, not her.”
“She’s your worse,” Mom, that’s all. Anyway, Daddy did try to talk to her, but she locked herself in the bathroom for hours.”
Karen forced her face into a tight smile. “I know, sweetie: your aunt makes me feel helpless and that brings out the worst in me.”
“It was fun when she was famous,” Becca said. “Remember when we got to have dinner with Jackie Onassis? Corie didn’t believe me—I had to show him the photographs. You looked so tough in that red dress. Of course, I looked like a little porker, a seven-year-old porker with an Orphan Annie fright wig.”
“Darling, you looked adorable. As you do this minute, although you know I’m not crazy about those combat boots.”
“So why do you call her Janice when she hates it so much she changed it decades ago?”
“People have been encouraging your aunt to deny reality since she was seventeen. She doesn’t need help from me along those lines—in fact, just the reverse. It’s time she stopped playacting and faced up to her drinking problem.”
“But even before she, well, stopped getting engagements, you and Daddy insisted on calling her Janice. Janice Minsky, what a name. I wouldn’t be a star with that name, either. Not that someone like me will ever be a star. Why couldn’t I take after her, or you, and be tall and skinny? Why do I have to look like Daddy, the short squatty toad side of the family?”
“What is with you and the animal kingdom today? First you look like a porker, and now Daddy is a squatty toad.” Karen dumped the fragments into the waste can with a bang. “Minsky’s good enough to pay for your riding lessons, young lady! If your aunt had been able to accept being a Minsky, maybe she wouldn’t turn to gin to get her through what else she doesn’t like about herself.”
The diva swept back into the room in the rumpled black shantung. Karen tried not to notice the white blouse: it was out of her own closet, but she wasn’t up to fighting her sister-in-law for possession.
“I called my car service. They should be here shortly.”
“Do you have money to pay for that car?” Karen demanded, hands on her hips.
“Don’t worry: it’s not coming out of Becca’s college fund. Someone will reimburse the man when I get back into town.”
Becca sucked in her breath at the sight of the blue Rolls when it pulled into the drive. She ran upstairs to call Corie, to urge him to run over to watch her aunt’s triumphal exit.
But when the diva got back to the city, the man she’d been staying with opened his apartment door only long enough to dump her suitcases outside. He would not pay for the limo. He would not ‘lend’ her money to pay for it, let alone a hotel room: he knew what a deadbeat she was. And if she could get the money from her brother to pay him back, then she could just go to her brother and get it up front, right now. He had bee
n beaten up by the police last night for trying to defend her honor when she’d made a total fool out of both of them. He didn’t think his kidneys would ever be the same. He did not want to see her again.
She left the cases in the hall and went back down to the car. She was not an alcoholic, despite Becca’s ill-natured remarks. Just the shock of the man’s totally rude behavior made her want a drink to calm down. And now here was the driver demanding payment in a truly rude fashion. She would have to call her manager and tell him never to use this service again. Come to think of it, she needed her manager to give her an account number to charge the rental to. And her address book was in one of the cases still upstairs in the hall. It was all too complicated for words: Harry would have to pay for the car after all. Maybe for a place to spend the night as well. In the morning she would call New York and get them to wire her any new royalties that had come in on her recordings. Her manager ought to do something for her: she had made his career, after all. She gave the driver Harry’s MasterCard number and told him to collect her bags and take her to the Ritz.
2
Resident in Purgatory
Utilization management is God, and Hanaper is its prophet. This morning paramedics brought in a guy who wanted to launch himself from the sixteenth floor of the State of Illinois building onto the atrium below. He thought he was a chicken and could fly—a secretary grabbed him as he was teetering on the railing. A homeless man who often wanders through State of Illinois building, the medics say.
Hanaper, conducting rounds, was called to emergency room, dragging me along since it was my patient we were seeing when he was paged. The ambulance crew filled Hanaper in on what had happened, told the great doctor they thought the guy was schizophrenic.
H cut them off: “Does either of you have a license to practice medicine? I thought not. I’m the head of psychiatry here at Midwest and don’t need paramedics to make diagnoses for me.”
The homeless man was sitting on a gurney, twitching, muttering, rolling his eyes in panic. Hanaper walked up to him. While nurses and other patients looked on, he bellowed, “You know you’re not really a chicken, don’t you, my man?”
Poor devil, frightened at surroundings, people staring, white man in doctor’s gown shouting in his face, mumbled “no.” Hanaper turned to the paramedics, told them there was nothing wrong with the guy, to take him home.
Paramedics said, man homeless. They didn’t think he belonged on streets, couldn’t look after himself—survives by foraging for scraps in garbage cans. And Hanaper, bless him for consistency, said that proved he knew how to find food.
All this time I’d hovered in the background, part of the scenery like one of the gurneys. But at that point I tried protesting. The meek stammering protests of a resident worried about his job? Or just of Lily’s son, nervous of anyone in authority?
Either way it didn’t matter. H cut me off: “If you are willing to assume financial responsibility for this man, Dr. Tammuz, you may make all the diagnoses you want. If not, let’s get back to the patients we pay you to look after.”
And so on to the dreary round of trying to recommend hospitalizations that are too expensive and therefore unnecessary, or even worse, long-term outpatient psychotherapy. Even the hint of wanting to talk more to a patient brings out the Fear of Freud in Hanaper.
When I accepted this residency, thought of it as great opportunity to learn real psychotherapy on the job. Of course, Dr. Boten was still here then. Didn’t know that he and Hanaper were engaged in great battle over direction of psych dept—the outcome never in doubt as the utilization management team was backing Hanaper. Now Boten is gone, forced to leave, concentrating on private practice. The hospital grudgingly runs outpatient clinic on Weds, afternoons. Group therapies on Friday nights, but they love those—big moneymakers, treating alcoholism among rich overworked businessmen. No room for the kind of patient who needs more than Prozac or a shot of Haldol.
Hector, writing in an upper bunk in the on-call room at the hospital, using a tiny reading light to keep from rousing his sleeping colleagues, put his pen down in sour memory of the day’s frustrations. He and Hanaper had returned from the emergency room to the ward, where Melissa Demetrios, the senior resident, was waiting with a new rotation of medical students. They had stopped outside the room of a woman Hector had admitted the previous afternoon. A worried daughter brought her in when she found her mother with her possessions piled around her in the middle of the living room, saying only that she was gathering strength for the journey.
Hector recited the bare facts, then added, “Her cat died last month and that seems to have upset her, maybe heightened an existing sense of anomie. I’ve ordered a general workup to make sure she’s not just suffering from a vitamin B deficiency or thyroid problems, but I would recommend talking to her several more times before—”
“Prozac, Tammuz. Have you ordered a trial dose for her?”
“Not until I have a better sense of—”
“Prozac is the recommended treatment for compulsive collectors and hoarders.”
“She’s not really a hoarder, sir; she’s making these clay figurines, at least according to her daughter, or—”
“Writing on scraps of paper, isn’t she, collecting them around herself? Sounds like an obsessive-compulsive disorder. Obsessive-compulsives respond well to antidepressants. Twenty milligrams a day, you’ll find it effective.”
And as Hector stood stubbornly in the hall Hanaper said impatiently, “Have you written that down, Tammuz?”
“I think it’s premature, sir. What if her problem turns out to be—”
“When you’re responsible for this ward you can make that decision. I want her started on twenty milligrams of Prozac. Stat!”
It was typical of Hanaper to punctuate routine pronouncements with medical jargon. Tammuz sometimes wondered if the department head had forged or stolen the diplomas ostentatiously framed in his office, learning the little he knew about medicine from medical shows on TV.
When Tammuz had still not written down the order on the woman’s chart, Hanaper pulled him to one side for a confidential chat, making sure to speak loudly enough for the new students to overhear. “Dr. Tammuz. We have an obligation to cure people as fast as possible. Contrary to your emotional pleas, that obligation is not just to the institution, or our management team, but to the patients themselves. And, really, Tammuz, if you could choose between a pill that solved your problems in ten days, versus an analysis that might take a decade, wouldn’t you choose the pill? Oh, no, come to think of it, you wouldn’t.”
Hanaper gave the students a would-be hilarious account of Tammuz’s interest in—“infatuation with”—psychoanalysis, then swept the group into the new patient’s room, where he informed her with loud cheeriness that Dr. Tammuz would be giving her a pill that would make her feel good as new.
“Not that those big black eyes of his can’t help you, too, eh?” And Tammuz, hating himself, had written out the order.
The woman, from the middle of a nest of torn-up paper towels on which she was writing, said, “I don’t take pills. They’re against my religion,” and went back to rearranging the paper towels.
Tammuz had been unable to suppress a smile. Fortunately he was standing behind Hanaper. Melissa and the students stirred restively, not wanting any of the department head’s wrath deflected toward them.
“I thought her name was Herstein.” Hanaper whirled around to look at Tammuz. “Isn’t she Jewish?”
The resident Jew. “I don’t know, sir: you’d have to ask her.”
“How can pills be against your religion if you’re Jewish?” Hanaper asked one of the other students, not the patient, whom he typically discussed as if she weren’t present.
“It’s in the Mishnah,” Mrs. Herstein said unexpectedly from behind her barricade. “You think you’re an expert on life’s vexing problems, young man, but you would do well to study the Mishnah.”
Hanaper flustered to be call
ed “young man,” promptly takes it out on us. Melissa gets chastised for sending a patient to long-term care without running it past review panel: insurance denied, now what do we do, family may bring malpractice suit if she commits suicide after discharge as Melissa thinks she’s in danger of doing.
A relief to go to afternoon clinic. At least people with anxiety disorders admit they have a problem.
At the end of his stint in the outpatient clinic, Hector tried to slide out of the hospital for a walk along the lakefront. He hoped that half an hour in the May sunlight would wake him up enough to get him through his looming on-call shift tonight. Melissa Demetrios intercepted him as he was heading to a back staircase.
“Dr. Stonds wants to take a look at our caseload,” she said. “Hanaper likes all the residents to be present—in case Stonds blows up we can take the blame.”
“Stonds?” After seven months at Midwest, Hector knew the neurosurgeon wielded enormous power in the hospital, but he didn’t understand why Stonds cared about psychiatry cases.
“Dr. Stonds cares about everything that affects the well-being of Midwest Hospital and its patients,” Melissa intoned, lowering her voice a register in an attempt to mimic Hanaper.
Hector laughed. “Yes—but does he look at all the admissions? When does he have time to scoop out brains?”
“I can’t believe this is the first time we’ve been summoned to the master’s office since you’ve been here.” Melissa looked around to make sure they weren’t in anyone’s radar range. “Stonds’s grandfather—the original Dr. Stonds—was one of the founders of this hospital, back in the 1890s, so the family has always had a lot of clout here. When Abraham—our Dr. Stonds—was a neurosurgery resident, neurology and psychiatry were one department, and they learned how to treat ‘diseases of the nerves.’ That’s still how Abraham thinks of mental illness. Somehow he persuaded the hospital to let him review all the neurology and psychiatry cases.”
“Oh, a kind of droit du seigneur,” Hector said. “It fits in with the medieval atmosphere this whole hospital exudes.”
Ghost Country Page 2