A History of the Present Illness

by Louise Aronson

  At their introductory meeting, Dr. Sung said that her job was to provide the judge and jury with an accurate portrait of the defendant and that they’d see a lot of each other because she wanted to understand how Robert came to be the person he was. Robert told her that most people saw what they wanted to see, and precious little in life couldn’t be looked at from a variety of equally valid angles.

  Though a tape recorder captured his every word, Dr. Sung wrote that sentence down. And so Robert added that one of the reasons he was a doctor and not, say, a lawyer was that suffering was universal while the law varied by state and country, and as a result, sometimes what was right wasn’t legal.

  Dr. Sung wrote that down too.

  Earlier that week, Robert’s attorney, Nick Barton, had told him that most prisoners didn’t get wireless electronic readers or the time and attention he would get from Dr. Sung, and that he would get Dr. Sung’s attention because he was paying for it, and he was paying for it because the usual rapid and ruthless forensic psychology evaluation led to just one conclusion—crazy or not—which in his case wouldn’t be useful.

  “Why not?” Robert had asked.

  “You’re not crazy,” Nick replied.

  “So why the psychiatrist?”

  “The DA will try to argue that this sort of thing is always murder—”

  “Nick, for Christ’s sake, she was dying, and then she died. All I did—”

  Nick held up a hand. “I know. Save the next go-round for the headshrinker.”

  For their first real session, Dr. Sung wore a red suit that didn’t quite fit at the shoulders and hips and two-inch heels that might have been weapons in a courtroom or bar but left her vulnerable on the worn, under-waxed floors of the county jail.

  Robert was seated when she arrived, but he stood—an awkward, ungraceful effort because of the shackles—when the guard let her in.

  “No, no—” she said, trying to wave off his gesture and failing because of the briefcase she carried in one hand and the stack of case files under the other arm.

  She didn’t look at him until she had deposited her belongings on the floor where he couldn’t see them and extracted a blank legal pad and pen. Once settled, she seemed transformed, her body taut and attentive, her brown eyes lit with an intensity she could apparently turn on or off at will.

  Interesting, Robert thought. So that’s what it looks like.

  His ex-wife, Cate, used to accuse him of shifting into doctor mode. He could yell at her one minute and answer a page the next, his voice calm and suffused with concern and compassion. “Why can’t you talk to me that way?” she had asked more than once, and for a while he’d try. But she wasn’t his patient; she was family, one of the few people with whom he was supposed to be able to be his uncensored self.

  “Okay,” Dr. Sung said. “Let’s start.”

  He told her he didn’t know where to begin.

  “Just start. Whatever comes to mind.”

  For most of the last year of their marriage, Cate went to therapy twice a week and never said a word in her sessions. When Robert asked her why she continued going, she told him she kept hoping it would help.

  “What comes to mind is that I don’t know where to start.”

  “Try the beginning.”

  Beginning of what? he thought. My life?

  Dr. Sung put down her pen and sat back. “It’s simple,” she said. “What do you think of when I say, tell me how you came to be here with these particular charges against you?”

  “I think it sounds like you want endings, not beginnings.”

  Dr. Sung looked at him, her expression neutral.

  Robert glanced at his watch. On average, doctors filled silences after just two seconds and interrupted their patients after less than twenty, but psychiatrists were different. Dr. Sung waited without apparent effort or impatience. After a thirty-six-minute standoff, Robert noted the faintest glow of sweat on her nose.

  “When you’re in training,” he said, “you think the worst possible outcome is if the patient dies. But it’s not, not nearly.”

  Dr. Sung slid the pen through her fingers. He could tell she wanted to write that bit down but was afraid to derail his train of thought.

  He leaned forward. “Have I considered how I came to be wearing an orange jumpsuit and living in a cell? Of course I have. I have gone over the events dozens of times in my head and several more times with Nick Barton in a room just like this one. I can list facts and events, miscommunications and errors in judgment, but what I haven’t been able to do is find an answer to the most important question by far: Why doesn’t anyone understand that I’ve done nothing wrong?”

  Dr. Sung scribbled on her pad, then made two slashing motions and stood up. “Sorry,” she said, “but we’re out of time.”

  In preparation for their second meeting, Robert read The Executioner’s Song and In Cold Blood, but the session began inauspiciously. Dr. Sung wore a white blouse and tan slacks, colors that made her look pale and tired. No sooner had she uncapped her pen and crossed her legs when they heard a scream and something slammed against the other side of the locked door to the visit room. They both startled, and Dr. Sung’s pen flew upward, glancing off her sleeve before clattering to the floor. There was another, even louder thump a second later, followed by a muffled protest, but the door didn’t open, and soon enough it was quiet again.

  Simultaneously, Robert and Dr. Sung noticed the black stain on her blouse. She swiped at it and swore, her voice not quite a whisper.

  It wasn’t even ten thirty. She had a full day ahead of her.

  Robert picked up her pen and passed it to her, his handcuffs clattering against the table. Since the fabric appeared to be synthetic, he recommended that she wet it, then apply a fine mist of hair spray and a few drops of white vinegar.

  “I’ve read a lot of manuals and how-to books,” he offered by way of explanation for his esoteric knowledge. Cate had sometimes questioned his choice of reading material, but after a long day with patients he enjoyed the straightforward prose and unambiguous solutions to problems.

  “Thanks,” Dr. Sung said. Her tone suggested that he’d done something inappropriate, if not outright annoying.

  “I didn’t—”

  “Let’s just get started,” she said. “We’ve lost enough time already.”

  In the papers, they were calling him the death doctor, which was at times technically accurate but also completely misleading. “Some patients you remember,” he told Dr. Sung. “Some patients you can’t forget.”

  She pressed Play on her tape recorder and folded her arms to cover the stain on her sleeve.

  The day the DA claimed Robert tried to kill her, Consuela Alvarez had arrived at his office wrapped in her granddaughter’s handmade blanket, though the temperature outside was over one hundred degrees. She hadn’t walked in five years, hadn’t wiped her own bottom in two, but there was nothing wrong with her mind.

  Remembering, Robert felt a primal surge; he wanted to escape to some other, better world, with Consuela’s tiny, frail body clutched to his chest like an infant.

  Dr. Sung shifted, uncrossing then recrossing her legs. “Out loud please,” she said quietly.

  “Consuela Alvarez first came to see me just after her husband died. This was years ago, in the nineties. Back then, my Spanish wasn’t what it is now, but it didn’t matter, because she always had someone with her, a daughter or nephew or cousin.”

  Robert smiled, remembering Consuela as she had been. “She couldn’t have been more than four foot ten in heels, and whoever was interpreting told me she supposed she’d grown up poor, though having no experience of anything else, she hadn’t realized it at the time. For generations, her family had farmed the sloped coffee fields of northwest El Salvador, and that’s what she had done too, when she wasn’t having miscarriages or busy with her seven children. But times changed, and once they were grown, her kids didn’t want any part of that life. Eventually, they all came nor
th. By the time I met Consuela, she was sixty-two years old and her household included three generations, two teachers, an attorney, five grandchildren, and a one-and-a-half-pound long-haired Chihuahua called Mouse. At that first visit, her only complaints were a left-handed tremor and a tendency to lose her balance.”

  Dr. Sung took a deep breath. “Okay,” she said. “I see where you’re going. And I’ll want to return to Mrs. Alvarez later. But what we need to talk about first is your earliest professional experience with death. Slow down. Start at the very beginning. You’ve skipped way ahead.”

  “I really don’t see how—”

  “Please,” she said. “I know what I’m doing.”

  Robert stood and took a few steps, but there was nowhere to go, so he sat back down. “Thelma. Thelma Mae Watson, age forty-eight. I was a medical student—”

  “Sorry,” Dr. Sung said. “Before that. The first person you ever saw dead.”

  Robert explained that, before medical school, he’d seen a dead frog, several dead goldfish, the usual modicum of road-kill. Really, nothing at all.

  “Then start at the beginning of medical school. You’ve skipped at least one.”

  He’d forgotten. She was a doctor too.

  The beginning, then.

  Like every medical student’s first patient, Robert’s was dead. Four of them shared him, a man so tall his feet dangled off the far end of the metal table, so old he had great gray bristles of hair sprouting from his nose and ears but only a few lonely wisps left on his scalp. Not that theirs was the oldest; the next table over, a team worked on a woman so ancient her skin hung off her body like tissue paper.

  It hit him while he was talking. “Almost all of them were old,” he said to Dr. Sung. “Our cadavers. Were yours?” He couldn’t believe he’d never noticed.

  “Keep going,” she said.

  “I asked you a question.”

  “My answer isn’t relevant.”

  Robert shook his head. “You’re wrong.” He leaned forward. “Imagine there’s a policy—an unwritten rule—that cadavers need to be people of a certain age. Think of the message that sends.”

  “Medical school policy doesn’t interest me. I want to hear about you.”

  Robert laughed. Couldn’t she see how it all amounted to the same thing?

  “During the arm dissection, a bunch of us went over to the next table to check out the woman’s bicep. It was thinner than a pencil. No one could believe it. One of the guys at my table commented that she must have been past due.”

  “Past due?”

  “To die. She looked starved, and her joints were contracted.” Suddenly he remembered other details, a bald spot on the back of the old woman’s head, his own cadaver’s long, curved toenails. “Of course, we didn’t know what a contracture was back then, but we could see that her hips and knees and elbows wouldn’t completely straighten. She’d probably been bed-bound for years.” He rubbed his face. He hadn’t shaved in a week, and his cheeks and neck itched where the hairs were coming through the skin.

  “It was obscene. No one wants that kind of ending.”

  Dr. Sung nodded, not a yes but a go on.

  Robert leaned back in his chair, eyeing his hired expert, possible enemy, and potential savior. His colleague, first name unknown. “Whaddya think?” he asked. “Should we sign you up to go out like that?”

  Dr. Sung didn’t bite. “What makes a life worth living?” she asked. “And who has the right to make that decision?”

  He refused to answer such a facile question, to make her job so easy. He closed his eyes. In his head, he recited the differential diagnosis for dementia. After a while, their time was up and Dr. Sung pressed the button for the guard to let her out.

  Cate’s psychiatrist practiced in Pacific Heights, on the sixth floor of a building with views of the San Francisco Bay. Robert had gotten the man’s name from a former intern of his who’d gone into psychiatry. The intern had made a lousy neurologist, unable to elicit reflexes, once missing the easy vertebral landmarks on a spinal tap by so many inches he accidentally stuck the patient’s liver and nearly killed her, but Robert trusted his judgment of people.

  Cate supposed a psychologist would do, but Robert argued that a real doctor would be more likely to understand their situation.

  Maybe that was why therapy left her mute. She thought the doctor would take his side.

  “I just stare out the window,” she told him. “I can see Angel Island, Alcatraz, Tiburon, and the Headlands.”

  Robert pictured his wife sitting in a soft leather recliner in a tastefully furnished room with throw rugs over the carpeting, floor-to-ceiling bookshelves, and walls hung with discreetly framed abstract art. Cate would offer a polite hello, then avoid looking at the doctor. She would decide on a menu for dinner and make a mental grocery list while twirling a few highlighted strands of hair around her left index finger, creating that one surprising curl in her otherwise straight hair, afraid to speak lest the words dismantled her life in such a way that it could never be put back together.

  Robert sometimes wondered whether, if they’d had children, things might have worked out differently. Cate had been willing to consider adoption. He hadn’t. He had insisted that they keep trying for one of their own, not because he had anything against adoption, but because he believed Cate would be happier with a little person who was part her, part him, and he thought that if they just kept trying, they’d eventually succeed. By the time it became clear that he’d been overly optimistic, they had settled into a routine that seemed to work well enough.

  Robert finished Crime and Punishment just in time for his third session with Dr. Sung. She arrived at their usual room in a green dress, belted at the waist, that clashed with the walls and reminded him of one Cate had worn often in the year before she left. Dr. Sung’s shoes matched her belt, and her earrings and necklace were the same color as the dress. Cate’s dress matched her eyes. Hers had started out as a bridesmaid’s dress, and then she’d transformed it. She was clever that way. Dr. Sung’s dress bunched at her hips, too tight in some places, too loose in others. Aesthetically, Robert decided, this was not his psychiatrist’s finest moment.

  They spent the forty minutes in silence. Robert thought of Cate. He couldn’t imagine what Dr. Sung was thinking.

  Nick Barton had suggested that Robert keep a diary of his life in jail—“just in case”—and Robert was fairly sure he’d been following the letter but not the spirit of the project. That week, he wrote:

  Sun—PBJ x 2, warm milk, soggy bread; Forty Niners 21, Giants 28; Stanford 14, USC 35; Invisible Man

  Mon—warm milk, The Sound and the Fury

  Tues—warm milk, greasy hash browns, bruised apple; Dr. S., black suit, bad shoes, silence; Bleak House

  Weds—more Dickens; frozen milk; a call from Nick to say he’s hired not one but two forensic pathologists who will independently review the records and find the evidence needed to prove my contentions, “IF IT EXISTS”

  Thurs—Dr. S. navy skirt/sweater, silence; Slaughterhouse-Five; warm milk; CSI, Without a Trace

  Fri—Dispatches; letter to Cate (not mailed); The Things They Carried; milk actually refrigerated (!!!)

  Sat—warm milk, more PBJ; Catch-22

  Nine months before she left him, Cate found a new therapist in a public clinic in the Tenderloin, a neighborhood Robert was fairly sure his wife had never been to before even though it was just blocks from some of her favorite department stores. Cate had been in her refugee phase then; previously, there had been rain forest, endangered species, decorator’s showcase, and lost art of the American high desert phases as well. She had gone to the Tenderloin Family Health Clinic to set up distribution for a program that gave out children’s books with each well-baby check. The therapist (a latter-day hippie type who had a master’s degree in social work, not an M.D.) had a no-show and started helping out. They got to talking, and before she left the clinic that evening, Cate had scheduled her first appointm
ent with “Lenore.” That night at dinner, what Robert had later come to refer to as the Lenore-isms began, and Cate had told Robert that her new therapist seemed like a real person, something about the woman having an inspiring mix of empathy and humor, traits Cate apparently found lacking in doctors.

  By the time of Robert’s arrest, Cate lived in Wyoming, where she cooked for a dude ranch that catered to Californians in winter and New Yorkers in summer. He knew this because she’d sent him a postcard a few weeks after the Tuesday he’d arrived home from work to find her gone. She’d threatened to leave the weekend before, but she so often got agitated when he worked late that he hadn’t taken her particularly seriously.

  The postcard pictured an empty dirt road, distant snowcapped peaks, and lots of bright blue sky. In the foreground stood one of those green-and-white road signs that read:

  Owl and Eagle Ranch

  Population 18

  Elevation 4,527 feet

  On the back were three sentences in the elegant cursive Cate had perfected during her years at the French American Bilingual School. Reading it, Robert decided that her parents’ decision to send her there had served her well from the standpoint of daughterly handwriting, if not in terms of the development of the basics of interpersonal etiquette such as saying good-bye to your husband of over twenty years face-to-face.

  There was no Dear Robert—no salutation at all—though his name did appear above the address.

  Beautiful here and gloriously unpredictable—t-shirt weather one day, three layers of fleece plus down jacket the next. People coming next week for my things. They have key and will leave it on mantel when done. C

  Dr. Sung arrived late, breathless and apologetic, for their sixth session. Robert kept reading. He’d moved into a Latin American phase and had just transitioned from Borges’s Labyrinths to Márquez’s One Hundred Years of Solitude.

  When she had settled herself and her usual extravaganza of papers and case files, Dr. Sung said, “Sitting here not talking is just wasting your money and both our time.”