Diagnosis

by Alan Lightman

  Bill began circling the block, traversing one narrow street after another, crawling behind other automobiles that seemed to lack any destination. After ten minutes, he spotted a parking place on a little road called Dunby Street, littered with garbage and old tires. When he attempted to squeeze in, however, he discovered that the space was too small. Cars honked behind him. His telephone rang. It was Robert. “I won’t be in until late this morning,” he shouted into the phone. “I’m on my way to a meeting at Braxton International.” He lied, as he’d been doing for weeks, to cover his absences for doctors’ appointments and examinations, and he hated himself for lying. See what I’ve been driven to? he thought to himself. “Enough, enough,” he screamed at the honking motorists behind him. Without looking, he threw his car in reverse, slammed his foot on the accelerator, and backed his vehicle off the curb and into the street.

  When at last he had found a questionable parking place several blocks away, run through the hodgepodge of streets trying to find his way back, and arrived, panting and sweating, at 37 Planton Street, it was 9:01. Sixteen minutes late. He groaned and wiped his face and straightened his tie.

  Number 37, a peeling, two-story wood structure, differed little from the other houses in the neighborhood. A small wooden plaque beside the front door said “E. R. Kripke, M.D.” As Bill stood reading this sign, catching his breath and still incredulous that a professional could meet clients in such a house, two barefoot boys ran up to him and began giggling. “Are you here to see the shrink?” one of them said. “We haven’t seen you before.” They scampered around the side of the house and brazenly stared into a window, then ran back to Bill. “We can’t see who’s in there now. Is it your turn? How much do you pay him for shrinking your head?” The boys hopped a short distance down the sidewalk, where they began whispering and throwing stones at a stray cat.

  Bill was about to reprove the children when he noticed that two women were leaning out of a second-floor window and staring at him with an offensive curiosity. He glowered back and they vanished like squirrels up a tree. Dabbing his face again with his handkerchief, he hurried up the stairs and knocked on the front door. “Mister.” “Sir.” The two boys, now joined by a third, appeared on the stairs close behind him. “That’s not where you go in,” said the smallest of them, a dimpled, blond-headed boy with a mischievous smile. “We’ll show you where you go in.” They ran to a door on the side of the house. “This is where you go. But you don’t come out here. You come out there, around the corner.” “Let us go in with you,” one of them pleaded.

  “No, you can’t come with me,” Bill said, trying to wedge between the boys without seeming overly eager.

  “Please. We’ll be quiet. We know how to behave.”

  Bill looked at his watch and discovered that it was now 9:03. A radio next door began blasting with such ferocity that he put his hands to his ears. At that moment, the side door opened to reveal a rather small man, immaculately dressed in a bow tie and starched collar, with facial features so delicate and slight that they seemed ready to evaporate entirely. He took one step out of his house. “Off with you,” he said to the boys and waved his arm at them. They stood gazing at him as if he were an uncle about to give them candy. “Off with you, or I’ll speak to your parents.”

  “And what will you say?” one of the older boys retorted fearlessly.

  “I’ll say you’re a nuisance and you should be punished,” said the psychiatrist, failing to make himself sound angry. He turned to Bill and smiled sheepishly.

  “You should pay us,” said one of the boys. “We show people where to go. We showed him where to go.”

  “Your services are much appreciated,” the psychiatrist said. “Now run along.” The boys retreated only to the low fence at the edge of the lot.

  “I apologize for those little pests,” the psychiatrist whispered to Bill. “I am certain that some of my patients have stopped coming to me because of them. I hope they haven’t overly insulted you.”

  “No, not at all,” Bill whispered back. He would start off on the right foot with the psychiatrist, imperturbable.

  “You are Mr. Chalmers, I presume,” the psychiatrist continued. “I am Ethan Kripke. You must be disappointed to have gotten me when you were scheduled with Dr. Pasternak. Am I right?” He paused a moment and raised his eyebrows and smiled vaguely at his new patient. “But we had better get started. I’m afraid that we have only forty minutes now. Please.”

  As Bill entered the house, he could not resist looking back over his shoulder. The two nosy women had reappeared and stationed themselves at another window, where they could get a better view.

  Bill was led through a closet-sized waiting room into another room, barely larger. Instantly, he could smell dust. Tinkertoys and magazines and old shoes littered the floor. There was a second door and a third, both closed, and a desk. On one of the outside walls a single half-shaded window admitted a slender shaft of sunlight, the only natural light in the room. Amidst the clutter, two chairs sat facing each other, heavy and dark like the walls.

  “Do you prefer the sound of waterfalls, oceans, or forests?” asked the psychiatrist.

  “Waterfalls,” said Bill, without stopping to consider the oddity of the question.

  “Good,” said the psychiatrist. “Waterfalls are also my favorite. The forest is nice too. Whatever you prefer.” He pressed a button and an electronic device on the wall began quietly gurgling, blocking out all noise from the street. For a moment, the psychiatrist stood listening to the sound of the waterfall, and a satisfaction touched his face.

  “Do you know Armand Petrov?” asked Bill. He was monitoring himself carefully and concluded that his tone was suspicious. Abruptly, he smiled.

  “I know of him,” said the psychiatrist. “Certainly. A thorough physician.” Dr. Kripke painstakingly removed his jacket and placed it in a dark corner. “Please,” he said and gave his head a little tilt in the direction of the chairs. “I see a look of mistrust on your face, Mr. Chalmers. Am I right? Maybe you think that because of my disheveled surroundings, the toys and what not, I myself am disheveled as well. That would be a natural reaction. It happens that some of my patients are children, and I must amuse them.” The psychiatrist waited, his hands clasped in front of him, then sat on the edge of his chair. “Please, sit down, Mr. Chalmers. I’m not going to bite you.” He took out a beige notebook and glanced at the clock on the wall. “Please. Tell me what’s going on.”

  This Dr. Kripke did not seem so forbidding, Bill thought to himself. As he began explaining his symptoms and the various medical tests, his nervousness diminished and the psychiatrist nodded sympathetically, quietly scribbling in his notebook. Apparently, he did not consider anything in Bill’s presentation to be unusual or alarming. And why should he? Most likely, he saw patients with rather serious psychological conditions, people hysterical or in tears. Indeed, a box of tissues sat prominently on a table between the chairs. It would quickly become obvious that Bill’s problem was physical and not mental. He was handling himself well, and he even permitted himself to let his legs twitch back and forth, as they often did, and to gaze casually around the room. In doing so, he became aware of a small red light on the desk, popping on from time to time, the telephone answering machine silently recording calls.

  The psychiatrist looked up from his notebook, a distant, self-absorbed expression on his face. “I’ve noticed that you repeatedly refer to your numbness as a … problem.” He studied his notebook, as if to verify his observation.

  Bill nodded, unsure of the meaning of the comment. “So?”

  “It might be significant,” the psychiatrist said softly. He gave Bill a brief, inquisitive look and then went back to his notebook. “I don’t want to make a mountain out of a molehill here, especially when we have barely started, but … Let me put it this way: a problem is generally a small thing, a difficulty that has a straightforward and rational solution. Balancing my checkbook is a problem.… Someone with ext
ensive numbness for … How long did you say that it’s been? Six weeks? Illness might be another word.”

  “Call it whatever you like,” said Bill pleasantly. It then occurred to him that the psychiatrist had possibly hit something deep. But what was it?

  “Of course, you want to be treated, you want to be well,” said Dr. Kripke. “I admire your optimism. Illnesses are vague and ambiguous, omnipresent, interminable, often without any cure. But problems … problems are definite. Problems have beginnings and endings.” He nodded thoughtfully. “I like your word problem. Let’s get back to your problem, then. What’s the last thing you remember before you lost your memory on the subway? Were you feeling upset or confused?”

  Bill shook his head no. “It was a normal day. I know that after everything started, I panicked. I was afraid of being late for work. I had appointments that morning.”

  “Of course. What’s the nature of your work?”

  “I process information,” Bill said after a long pause.

  “Yes. What’s the information about?” Dr. Kripke did not look up from his notebook. Bill stared at him, writing so quietly and self-assuredly, and was envious.

  “All kinds of information,” Bill said. “It’s mostly business information. Not all.”

  “For whom?”

  “For all kinds of people. We have dealings all over the world.” This line of questioning seemed unwarranted, Bill thought to himself, and he started to protest. But he checked himself. He should not show the slightest concern about any of the psychiatrist’s questions. In fact, he now stood prepared to offer any amount of random information, simply to establish his mental equilibrium. Dr. Kripke was a necessary obstacle across the road to further tests and eventual treatment. That was all.

  Dr. Kripke’s beeper went off, and he jumped from his chair. “I’m extremely sorry,” he said, pressing buttons, “but this happens from time to time. It could be an emergency. Please excuse me.” He hurried through one of the doors and carefully closed it behind him.

  Bill leaned back in his chair, relieved to be alone for a few minutes, and listened to the pleasant gurgling of the waterfall. It was a soothing sound in the stillness and closeness of the room. Vacantly, he noticed a faded plaque above the psychiatrist’s desk that read: “The mind is its own place. It can make a Heaven of Hell or a Hell of Heaven.” Although he had intended to stand up and stretch, Bill now found himself unable to move from the chair. His eyelids began to grow heavy and he let his head drop back. The room dimmed. Far away, the tiny red light of the answering machine flickered and glowed like a firefly.

  Something pinched his side. Bill found himself curled up in the chair like a dog with his eyes closed. Maybe he’d been asleep. He quickly straightened out his suit and glanced at his watch.

  Shortly, the psychiatrist returned, with apologies. He peered at the clock on the wall and reviewed his beige notebook.

  “Was it an emergency?” Bill asked with a little smile. He would show the shrink that, among his other worthwhile qualities, he had a sense of humor.

  “I’m sorry,” the psychiatrist said softly, “but I never talk about other patients. I’m sure you understand. Everything here is completely confidential.”

  “You had two calls while you were gone. Maybe three.”

  “Oh,” said the psychiatrist. He stared for a moment at the answering machine. Then he returned his attention to Bill and lightly tapped his pen against his notebook. “You were telling me about your work. You analyze information. Do you also gather the information?”

  “No, there are other people and companies that gather it. We don’t have researchers as such.” We don’t have researchers as such? Bill repeated silently to himself. What an absurd comment. Was it true? No, surely he himself did research from time to time. He’d researched the Conflow deal.

  “If you’re only sending information from A to B, what’s the value added?” asked the psychiatrist, so softly that Bill could hardly hear him over the gurgle of the waterfall. “It sounds like you’re a middleman. I’m afraid I don’t understand.”

  Now Bill felt a definite twinge of suspicion. Was Dr. Kripke intentionally insulting him, hoping that he would become angry and lose his composure? Possibly the psychiatrist was only politely suggesting that Bill’s job was boring, a claim not without some validity. Now that he thought about it, Bill recalled reading somewhere that boredom could cause various neuroses. Possibly Dr. Kripke was pursuing that line of thought. Let him, if he wished. The clock was ticking.

  “Is all this relevant, Doctor?” Bill said finally, using a measured tone of voice.

  “I’m not sure,” said the psychiatrist. He had put down his notebook and folded his hands carefully in his lap. “There’s certainly a question here. If your primary physician isn’t sure you have a neurological problem … and already it seems as if he’s removed the big ones like brain tumors, MS, and so forth … among the repertoire of possibilities … If it’s not neurological, then something else happened. There was a lead up to it clearly.” The red light popped on. The psychiatrist’s eyes darted to his desk for a few moments, then back. “You’ve already suggested that you were under stress. When you describe what you do, I don’t get the sense that you’re fully comfortable talking about it. There may be something going on there.”

  To his surprise, Bill found himself agreeing with some of what the psychiatrist said, although he did not understand it. Something going on there, he repeated to himself. He wrinkled his face and began pondering these new aspects of his condition.

  There followed a series of questions about Bill’s father and mother and his childhood, during which the gurgling from the waterfall seemed to gain in intensity. Bill looked at his watch. It was 9:33. In another twelve minutes or so he could leave. He was still conducting himself well. However, the questions about his parents had disturbed him and raised additional considerations. With a sudden wave of guilt, Bill realized that he hadn’t yet told his mother anything. Shouldn’t he tell her, even though she would immediately forget? He was her son, she was his mother.

  “You mentioned that you always wanted brothers and sisters as a child,” said the psychiatrist, “that you hated being an only child. Then why did you have only one child yourself?”

  Bill was stunned by the question. “Alex.”

  “Yes. Why did you and your wife have only Alex? Why not more children?”

  Why? Bill thought to himself. It seemed like they’d always had one child. “We never discussed it.”

  “You never discussed it? You never discussed having more children?” Dr. Kripke put down his pen.

  “I don’t think we ever discussed it,” said Bill, straining to remember those early years of their marriage. “Maybe Melissa was too busy for another child and I didn’t want the responsibility. I can’t remember.”

  Kripke looked at Bill for a moment, nodded his head, and wrote something in his notebook. “How would you describe your relationship with your wife?” he asked without looking up.

  “Good,” said Bill, still thinking about why he and Melissa had only one child.

  “How about sexually? … Are you intimate?”

  “Yes, of course,” Bill answered uncomfortably. “I don’t know how intimate the average couple is.” That was the truth. He didn’t believe a word that his colleagues and friends told him.

  The psychiatrist nodded. “Tell me more about your work.” Now Dr. Kripke was writing very rapidly. “Have you had any problems with negative feedback at work, any clashes with people?”

  “No.” It was 9:44. The time was almost up.

  “Do you like your work?”

  Bill paused. “I’m good at what I do,” he said slowly.

  The psychiatrist said something so softly that it was inaudible. Then, “Are you angry at anyone?”

  “No.” He had answered too quickly. He’d lied. Ridiculously, he felt guilty. Why should he feel guilty? The psychiatrist had put his pen down and seemed to be waiting.r />
  “Yes, I’m angry,” Bill said.

  “At whom?”

  “I don’t know.”

  “Ah,” said the psychiatrist, looking up and nodding. “We will need to come back to this. And what do you do when you’re angry?”

  Bill shrugged his shoulders.

  It was 9:48. “We’re out of time,” Kripke said and laid his pen down on his notebook. “But we were interrupted. I’d like to give you some kind of summary of my impressions … just a few comments.”

  Bill was anxious to leave, but he found himself eager to hear the psychiatrist’s analysis. He stood up, sat down.

  Dr. Kripke studied the door to the waiting room, as if looking straight through it at the next patient in line. “I can quickly say a few things at this point,” he said quietly, “although I don’t yet know you very well. You’re angry, that’s clear. You seem to have a vague frustration that’s been building over time. For some reason, you don’t want to say much about your job. So there’s some anxiety there. You’re probably under stress. There’s certainly a lot of stress out there. But it’s possible to adapt to stress. We all adapt to stress. The human being is amazingly adaptive. We need to develop strategies for you to adapt. On the anger, everybody has to put their anger somewhere. Some people get diarrhea, some people get headaches. You could be putting your anger into numbness. It’s interesting that you’ve developed precisely those symptoms that make it the most difficult for you to work.”

  “So you think this is mental?” said Bill, realizing that the interview had to end in this way. “You think my numbness is mental?”

  Someone was knocking at the door to the waiting room, a frantic, shrill rap like a woodpecker’s beak. It was 9:55, ten minutes past the official end of his session. The psychiatrist rose from his chair with a silly, blushing smile and indicated that Bill should leave by the middle door. “What you’ve described sounds like a complicated problem, Mr. Chalmers. I sense that we’ve glimpsed just the tip of the iceberg.” He hurriedly wrote something down on a piece of paper and handed it to him. “Let’s start you on some medication to eliminate the numbness. We’ll review your progress in a couple of weeks.”