Sanity's Only Skin Deep

by Adam Aust

VI

  “Hi—Sarah?” Dr. Robert Margolis stepped toward her in the sterile examination room and extended his hand. With his white lab coat, delicate wireframe glasses, salt-and-pepper beard and combover, he seemed like an idealized-prototype psychiatrist sent from some Hollywood casting agency.

  “Yes,” she said, gripping his palm. “Nice to meet you.”

  “Sorry about the room. I normally hold consultations in my office, but I understand part of why you’re here is to determine when your condition began. Since that requires a medical exam, it was just easier to meet here. Want to tell me a little more about why you wanted to meet?”

  I didn’t want to meet. I’m doing this as a favor to my meddling, paranoid family. “I have self-harm disorder, and I can remember cutting myself and seeing counselors about it since I was in high school. But my parents and sister don’t remember any of that. In fact, it was total news to them that I cut myself at all. My therapist said that a small percentage of his patients experience minor memory revisions and that may be what happened to me. He also said that’s normal and nothing to worry about. My family isn’t convinced, though. What do you think?”

  Tissue paper crinkled under Sarah’s backside as she adjusted herself on the examination table. The patient gown she’d been asked to wear was starting to untie in the back.

  Dr. Margolis drew a slow breath, his gaze fixed on Sarah’s face. “I’m skeptical that your long-term memory alterations are related to your condition. And, with all due respect to your therapist, I wouldn’t consider them to be minor.”

  Sarah’s face tensed. “What do you mean?”

  “Just that I don’t think we should assume your memory alterations are a benign side effect. In my view they deserve closer scrutiny.”

  Of course you would say that. And I bet this “closer scrutiny” will involve a battery of expensive tests that my insurance conveniently won’t cover, too . . .

  “Where do you normally cut yourself?” he continued.

  “On my legs and . . . my rear,” she said nodding backwards over her left shoulder and looking at him quizzically.

  “I’d like to see the scar tissue in the affected areas. It may give me a sense for how long this has been happening. Please stand on the floor with your legs spread shoulder width apart.”

  She stood and did as he asked, facing him when she finished, bare soles pressed against the cold linoleum. He donned purple latex gloves, which gave her a strange sense of déjà vu. He sat on a wheeled stool, clicked on a small pen light from the breast pocket of his lab coat, and wheeled behind her to begin his examination.

  “How do you normally cut yourself, Sarah?” he said into the back of her left thigh.

  “What do you mean?”

  “Do you use specific instruments? Is there a particular time of day you prefer? Are you usually at home? Any information along those lines would be helpful.” He had moved to her right thigh now.

  “I . . . don’t know.”

  He wheeled in front of her, and, prodding something on her upper right thigh, said, “What do you mean you don’t know?”

  “I usually don’t remember doing it. It just kind of happens and I discover it later.”

  He flicked off the pen light and wheeled back a foot or so, looking up at her as if he were wrestling with his thoughts. He said, “Why don’t you have a seat on the examination table?”

  She did as he asked. He wheeled his stool in front of her.

  “Do you own any medical instruments? Scalpel, surgical knives, anything like that?”

  Her brow furrowed. “No, why?”

  “Normally what we see with self-harm patients are either puncture wounds—from a pin, a pocket knife, or something along those lines—or irregular slicing lacerations made with kitchen knives, razors, scissors, and the like. The scars on your legs and backside look more like the latter, except you seem to go so far as to remove chunks of yourself. That’s very atypical. It’s also why your legs are pocked the way they are.”

  Chunks? Pocked? My legs aren’t pocked.

  “The other unique thing I’m seeing here is the precision of your scars. Usually, when an emotionally distraught patient cuts herself, the wounds are inflicted quickly and violently, leaving rough, erratic scarring. Your incisions, by contrast, appear to have been made smoothly and dexterously, and the shapes that were removed look like regular polygons—squares and rectangles and the like. They’re very . . . exact, which is not what we normally see.”

  Her head swam and she felt defensive. Half pleading, she said, “What are you talking about? My legs aren’t pocked.”

  For a moment, Dr. Margolis sat motionless, still looking up at her over the rims of his glasses. Then he said, “I thought you might say that. Do you always wear dark leggings, or pants, Sarah, or something covering your legs?”

  A jolt of anger radiated from her core. “Most of the time I do, but so do most women. Not everyone has great skin. Sometimes we ladies need a little help.”

  He paused again, for longer than the last time. “Hold out your arm, please,” he said neutrally.

  Sarah did, and Dr. Margolis pressed a gloved hand into the skin of her inner bicep and slid it slowly toward her wrist. “What do you feel?”

  “Your hand moving down my arm.”

  “Nothing out of the ordinary, right? No vibrations from my hand rubbing over bumps or scar tissue or anything like that?”

  “Right. It just felt smooth.”

  “And the sound as my hand ran down your arm was continuous, right? Smooth?”

  “Yes.” This guy is wasting my time.

  “Now I want you to sit at the edge of the examination table. Dangle your left leg over the side, but keep your right leg extended along the table’s edge.” She complied.

  He pressed his gloved hand into the soft flesh on the inside of her upper-right thigh—high enough that she felt uncomfortable about it—and he slid his hand down toward her knee. Her skin stretched and then released in quick jolts beneath the latex, accompanied by irregular vibrations, as his gloved hand slid down her leg. “What did you notice about my hand sliding down your leg?”

  She stared at her limb, breathing heavier. It was the same leg—exactly the same—but something about it was terribly wrong now.

  “Sarah?”

  She glanced at Dr. Margolis and looked back down. The skin on the inside of her leg from her right hip to her knee now resembled a huge burn scar—there were pink splotches and blanched areas, and the skin was alternately sunken and raised. Was that there before? What the hell? Looking closer, she saw geometrical skin indentations—square, rectangular, like Dr. Margolis said. Her left inner-thigh bore the same disfigurations. She reached back and felt the left side of her rear end. Same texture. Oh my god!

  She was hyperventilating. She pressed her head into her palms, leaning over her extended limb.

  “Sorry about the shock,” Dr. Margolis said, putting a hand on Sarah’s shoulder. “Some patients create complex mental blocks to avoid dealing with the damage they’ve caused themselves. It’s a form of cognitive dissonance. The phenomenon is similar to, but more intense than, what people experience when they realize they’ve been misperceiving an optical illusion—the observer first sees only the distorted image that the illusionist intended to convey, but later, when someone familiar with the illusion reveals the ruse, the observer realizes there is much more he or she is missing. Depending on how long that person has held the misinformed belief, it can be very difficult for her to see the truth when it’s finally presented.”

  “I don’t believe this,” Sarah said, shaking her head and pressing her palms into her eye sockets. “I can’t believe this.”

  Dr. Margolis took a deep breath and said, “There’s one more thing you should know, Sarah.”

  She stopped, pulled her left hand away from her face, and trained one eye on Dr. Margolis. Her chest rose and fell in strained, heavy motions.

  “Almost all of
your scars are recent,” he said. “There’s very little chance you’ve been doing this since high school, maybe not even since college.”

  Her field of vision pulsed as her heart pounded the inside of her ribs. A pressure built behind her eyes. She thrust her palms back into her face.

  “I’d like to bring you back in soon for further testing. Given the severity of your wounds and your having no memory of inflicting them, there’s a chance you’re suffering from multiple personality disorder or something similar. If it’s that serious, we want to make sure we get you the right treatment sooner rather than later.”

  She looked up at Dr. Margolis and tried to stand. Then everything went black and she collapsed.