“On what do you base your opinion?” he’d asked with deceptive openness.
“Upon our limited knowledge of her history, which indicates that this is her first hospitalization, and that, as an outpatient, she’s responded to talking treatment before.”
“Good points,” Whittenburg nodded, stuffing the bowl of his pipe with a pinch of tobacco. “But isn’t that all the more reason to get her out of here and back to work as quickly as possible?”
“Yes,” Matthews persisted, erroneously believing that Whittenburg had some respect for his view. “Except what’s to prevent another recurrence? I believe we’d help her more if we found out what precipitated this episode and treated the underlying causes rather than the symptoms.”
“I appreciate the depths of your convictions,” Whittenburg had replied, pausing as Matthews struggled to contain a flush of satisfaction, “… as well as the shallowness of your experience.”
Art swallowed hard, accepting this blow to his image as best he could. Whittenburg, savoring the moment, slowly reached for the packet of matches that lay before him, struck one, and decided that he could now afford to throw the young resident a bone.
“How long has the patient been here?” he’d asked Nancy Foster, the unit’s nursing supervisor.
“She was transferred from St. Vincent’s a week ago. On September second.”
“And,” Whittenburg summarized, “she’s been uncommunicative ever since.” He puffed lazily on his pipe. “Very well. Dr. Matthews, you may continue with your psychotherapy sessions for the remainder of the week. If there is no response, you will implement our treatment plan commencing Monday. Is that acceptable?”
Art could still recall the sting of humiliation as he nodded reluctant agreement, while his eyes roamed his shoe tops as he waited for that session to end.
At least he had the satisfaction of knowing he’d tried. And not just at Tuesday morning’s case conference, either. Arlene Lewis was one of the most intriguing patients he’d worked with. A beautiful and apparently successful career woman who unexplainably overdoses on Seconals and then exhibits catatonic behavior. Catatonia. A high-falootin’ medicalism which sounds quite complicated but actually describes intractable apathy, depression, and an unwillingness to talk to anyone. But why?
Was that persistent, angry little man telling the truth? Should he have believed Al Newfield’s story? That Jonas Lippman was personally involved with his patient? If he had shared those scandalous accusations at the conference would Whittenburg have agreed to a more humanistic treatment plan? Probably not. After all, Art had only completed his first year of psychiatric residency. At twenty-nine years of age, how much weight would his opinions carry? Besides which, if, as was most likely, Newfield’s story was unverifiable, he did not want to be part of the chain responsible for a whispering campaign against Jonas Lippman.
“You’re making serious charges,” he’d said when Newfield first came to visit Arlene. “Can you substantiate them?”
“Not yet,” Al had declared. “But I will.”
“Until you do,” Art concluded as he ended the interview, “I’d be particularly circumspect about repeating them.”
Why shouldn’t he feel a bit protective? Art knew Jonas as an instructor at the Analytical Institute on West Seventy-sixth Street, and had always enjoyed his open-minded and liberal approach to classical analysis. Jonas was not steeped in the rigid orthodoxy of some of the other faculty members, but he was certainly too respected and well-trained a man to have participated in anything resembling Al’s accounting. If he had informal, out-of-the-office meetings with Arlene—some variation of stereotypical procedure that a narrow-minded person might exaggerate beyond proportion—what of it? Wasn’t that what interpersonal psychiatry was about?
As far as Art was concerned, Jonas’ report, while not explaining things, seemed plausible: that he had treated Arlene for a period of about half a year, had helped her overcome a chronic depression and fear of men, and had terminated sessions in mid-July. Why did he think she fell apart? Jonas didn’t know. Did he plan to see her again? Conceivably, after discharge, but only if Arlene wished it. Meanwhile, Art could keep him apprised of developments.
So why even repeat Al’s story to Jonas? Why have one of his own teachers view him warily as some gossipmonger? Yes. His decision made both ethical and political sense.
Oh, he’d mentioned the story to Arlene, but all she did was stare straight ahead. Not even a blink. The same reaction she had to everything and everybody. Including both Newfield and Jonas Lippman. The one exception occurred last Thursday afternoon, as he sat with her, talking gently about the pain and hopelessness she must feel and wouldn’t she like to talk about it. Arlene had turned her head, looked directly at him, and her eyes filled with tears.
Art felt excited, moved, proud of having elicited some response. He mentioned it at the Friday morning staff conference, hopeful of postponing Whittenburg’s program. But the nursing staff failed to confirm any significant changes in her behavior and from the sly smiles on the faces of the other residents he saw that he was baying at the moon. No matter how much he howled, things would move, inexorably, at their own pace.
Accordingly, Monday rolled around. The fifteenth of September, clear and brilliant. One of those rare days when nature manages to intrude upon the soot. Pity to be indoors. If only he could take Arlene out for a walk. That would undoubtedly do more to clear her head than any fifth-floor treatment. If.…
Maybe he was overdoing it. Getting caught up in his own psychoanalytic bias. Being too critical of people like Whittenburg, who represented the faster (if, to his mind, less fundamental) somatic therapies. He would just have to suspend judgment; not let his orientation stand in the way of his objectivity. Perhaps Arlene would benefit, be able to communicate afterward, clear up the mysteries surrounding her case and confirm his intuitions.
And what were they? That Al Newfield was a sanctimonious pain in the ass who was unlikely to ever be Arlene’s, or anyone else’s, confidante. A man who, during his visits, hovered about her motionless presence like some prototypical Jewish mother, trying to cure stomach cancer by forcing chicken soup down the patient’s throat. If he were not an attorney—and the litigious type—Art would probably have banned him from the ward, for he was always pressuring and harassing the orderlies and nurses with questions about Arlene’s condition and requests for special treatment. A jealous suitor, that’s all he was, placing the blame for his rejection on Arlene’s former analyst.
Standing in the lobby of Bellevue’s old brick building, Art waited, impatiently, for the elevator. Elevators never seemed prompt enough to rescue you from last-minute latenesses. Today was no exception. Still, no catastrophe. As barren and inhospitable as the stone and marble lobby was—like some turn-of-the-century railroad terminal—it was downright cheerful when compared to the overcrowded, underscrubbed, poorly painted, ill lit patient areas. Even after a year, he was not comfortable with the place; with the locked rooms, locked wards, locked corridors. With the stench of sweating humans. Fortunately, he was now assigned to Female Admitting. At least he did not have to endure the stale pee smell that permeated the men’s units. Just like cats, he thought. One deep inhalation and a blind person could tell the sex of those about.
The elevator doors opened on the eighth floor. Art stepped into the corridor along with two technicians, took out his keys and opened the door to the ward. Pushing past two grotesques—one old and toothless mumbler whose stockings hung loosely below her knees; the other a younger woman, incoherently pleading to be let out while mucus ran from her nose—he again reached for his keys and unlocked the doctors’ lounge. There he went to the locker, put on his white jacket, looked in the mirror, and smoothed his lapel.
On the street, Art might have been taken for anybody: a writer, waiter, playboy, delivery man, civil rights lawyer, or welfare worker. Any nondescript fellow with longish hair and a full beard. But the jacket wrought a miraculous ch
ange. The beard now said “Sigmund Freud” as well as “maturity.” His casual clothing came to signify avant-garde “with it-ness.” A further look into his own eyes, his hand brushing back the tousled hair, out to the nurses’ station to confer, read charts, and then finally into the day room to check those under his care.
The physical set-up resembled a jail, but the atmosphere was far less cordial. Art had spent several weeks at the Riker’s Island Penitentiary, on a psychiatric elective while at medical school. The inmates there sat about, played cards, argued, clowned, fought, watched television, but always interacted. Bellevue afforded no such intimacy. It was as though every inhabitant was surrounded by an invisible wall, in a solitary confinement of their own making. Some would approach the staff from time to time, but never one another. Whether this was a result of their own preoccupations or their mutually intimidating eccentric behavior was a question beyond Art’s ability to answer. He only knew it existed.
It took him no more than twenty minutes to visit with most of his eighteen charges. Three were off the floor, two undergoing chest X-rays and another being seen in the dental clinic. Of the other fourteen, several would need adjustments in their medication. Florence Thomas required an additional six hundred milligrams of Thorazine after assaulting an orderly last night. Others were so tranquil they could barely keep their eyes open, much less sit up. Later he would meet privately with whomever seemed rational or interesting enough for psychotherapy.
It tended toward bedlam, with women being admitted, worked up, properly tranquilized, and then transferred or discharged, usually within three days to three weeks. Senile psychotics went to one hospital, adolescents in turmoil to another. The rich were sent, by relatives, to Gracie Square or South Oaks, the poor to Manhattan State. A few—those who stabilized quickly—were released. If they had no private therapist, Art followed them as outpatients. It was his hope that such might be the case with Arlene.
She was the last stop on his early morning circuit; leaning against the wall, blankly watching a tug pull a string of ore barges down the East River.
“Hello,” he said softly, as he approached, but aside from taking her hand from the pocket of the loose-fitting, rumpled, gray cotton hospital smock, she failed to acknowledge his presence.
“I take it there’s nothing you wish to say to me today.”
Another pause but not a scintilla of movement.
“Your treatment sessions begin today, you know.”
No change.
“I’ll be back in about ten minutes and go down to the fifth floor with you. Perhaps we can talk afterward.”
He went back to the nurses’ station, wrote progress notes, altered medications, answered a few questions, and returned to escort Arlene downstairs. Accompanying his patients, both before these treatments and during the recovery phase, was usually helpful. It allayed their anxieties, fostered rapport, and established trust. Coming alongside her, he took her arm gently and said, “It’s time.” She followed without resistance, through doors, to the elevator, into the cab, and down to floor five. Out again, through another locked door, until they finally settled upon a bench filled with other patients and orderlies. What a coup it would be to help Arlene. By significantly aiding a senior analyst’s patient, he’d undoubtedly score points at the Analytic Institute.
This idyll was interrupted by a male nurse telling him that the treatment area was now available. Again, placing his arm supportively under Arlene’s elbow, the two of them arose and accompanied him to the small examination room which, except for the narrow cushioned table and mechanical paraphernalia, was essentially bare. There was a resuscitation unit in case of an emergency and the Box. Arlene walked woodenly to the table and on command raised herself on it and lay on her back.
“I’m going to give you an injection,” Horst Becker, the attending psychiatrist said, “which will put you to sleep. It won’t hurt. There’s nothing to worry about.” He applied a tourniquet to her left forearm.
“Brevital,” he ordered, and the nurse handed him a syringe filled with the barbiturate. He injected it slowly; Arlene’s eyes closed in a matter of seconds and her breathing deepened. Next came another syringe, filled with succinylcholine, a muscle relaxant. Leaving the needle in place, Becker switched syringes with only a minimal leakage of blood.
Art stood there, aversion for the process and sympathy for Arlene tumbling about in his belly as the electrodes were applied to her temples and made fast with an elastic band. Moving closer to her side—the male nurse on the other—each placed one hand above her knee and another on her shoulder to help control any strong convulsion. Her body felt warm and firm, he thought, not unlike Ursula’s, and for a fleeting moment he thought of how nice it would be to touch her under other circumstances. But he banished the idea quickly as a manifestation of countertransference, a primitive emotion that only interfered with doctor-patient effectiveness.
Becker hit the switch and Arlene’s body grew rigid beneath his hands, went into a momentary spasm, followed by a series of mild convulsions.
The ECT was over and done with. Five more sessions to go, every other day, before the course was completed. Hopefully, in the confused and altered postshock state, she might begin to talk.
18
Jonas moved slowly as he mounted the staircase from his office to his home. Phoebe sensed what had occurred even before he supplied the details. His bowed head, drooping shoulders and shuffling gait spoke more eloquently than any words could.
Liza rushed over as he reached the living room landing.
“Guess what I got on my spelling test?” she bubbled. “A ninety-three.”
“Great.” He forced a smile and managed to stand erect. “I’m very proud of you.”
“And guess what I got in math?”
“I give up.”
“Come on,” she teased coquettishly, trying to stimulate his curiosity and rouse him to dialogue.
“Let your daddy be, Liza,” Phoebe interjected from her seat on the sofa. “He’s had a rough day, I think, and needs a few moments to relax.
“What happened?” Phoebe asked when Liza left the room.
“Arlene told Matthews the whole story.” Jonas slumped into an armchair facing her.
“Do you want to talk?” It was said with sincerity but also with aversion. Things had not changed very much. There was still the wish to comfort him—a desire based on the affection that grows out of familiarity—along with a longing to be free of his presence. Then, too, there was her firm belief in the absolute stupidity of his involvement with Arlene, an event that could readily jeopardize his professional career. Not to mention a substantial loss of income.
“What’s there to say?” he sighed.
“Jesus.” She looked up, shook her head, then stared directly at him. “The details! I’m involved in this too, you know. And I don’t like being left in the dark. I want to know just what’s happening.”
“Well,” he began, reaching for the cigarette tray that lay between them on the coffee table, “Art Matthews called about an hour ago.…”
“Yes?” It was like trying to pull straws away from a drowning man. Damn it, if he’d only hurry. Life with Jonas had become routine, at best. Lately, with his hangdog moods, it was really unbearable.
“He canceled our supervisory hour.” Jonas fumbled with the tray, removing its false bottom.
“Why? Did he say?” She knew it was difficult for him, but her voice could not hide her impatience.
“Arlene. After her second shock treatment today, she began to talk. Said something about me; about our being intimate. Living together for a week. Having sex therapy sessions before that.
“He realized, he said, that it was just a story, told in a confused way. But that he felt uncomfortable with it and that it would make him self-conscious during our hour. That if Arlene knew he were seeing me it would create ‘a sticky situation.’ Didn’t I agree.”
“And what did you say?”
“Nothing. ‘All right. As you say,’ I think.”
“Didn’t you deny it?” It was an astonished demand, not a question.
“Why should I have?” Taking a neatly rolled joint from the tray, he replaced it on the table. He stared back at Phoebe. “For one thing, I don’t feel up to an outright negation of truth. For another, if I were truly innocent, I doubt if I’d ever grace a remark like that with a denial.”
Phoebe broke off this pointed questioning, realizing that, under the circumstances, Jonas’ response was probably the best he could make. Okay. So the secret was out. What of it? During her years as an analyst’s wife she’d heard many gossipy stories about various and sundry therapists who slept about with patients. Including a few of the founding fathers at Jonas’ venerable Institute. In public, of course, it was universally damned. But in the confines of someone’s office? All it necessarily meant was that Jonas’ name would be bandied about, too. Until the next analyst provided food for salacious gossip.
“You’re right,” she said, attempting to reassure both of them, and reached for a cigarette herself. “And I’m sure that after the whispering dies down, that will be the end of it.”
“I hope so.” Jonas seemed unconvinced as he lit his weed, inhaled deeply, and held his breath so that the smoke might work its magic. But his resistance to her supportive comments aroused her worry and ire anew. Nor did she appreciate his increasing use of marijuana. Instead of his once- or twice-a-month smoke—the sophisticated thing that a few of their friends were into—he’d taken to dope quite frequently. Since their reunion, as a matter of fact. And almost daily for the past two weeks. When he was high, he was even less communicative. It dragged and worried her.
“Do you have to smoke tonight?”
“No. I don’t have to.” He inhaled again and let the smoke slowly out. “I want to.”
The Seducers Page 9
