by Tom Sullivan
“You’re always ready, aren’t you, boy?” Brenden grabbed hold of the harness. “I sure hope I am.” Man and dog headed to the fifth floor and their meeting with Antwone Carver.
As they moved down the hall to the elevator, Brenden mentally reviewed the patient’s intake notes. Antwone Carver had been injured when an IED blew up the personnel carrier he was riding in, killing the other three Marines and leaving Carver paralyzed. He noted that Carver was married and had grown up in Los Angeles. The profile also indicated that he was an African-American with a high-school education.
Not much to go on, Brenden thought. I really will be flying blind on this one.
Brenden had developed a technique that seemed to work well when he was introduced to a new patient in a hospital setting. He would allow the nurse to precede him into the room, putting Nelson on the follow command. This would bring them to the side of the bed—or in this case, to the patient’s wheelchair—allowing him to put out his hand for the initial awkward handshake. He knew that his blindness often made patients uncomfortable, so for a while he had considered not making Nelson part of the first meeting, but he had discovered that it was better for the patients to deal with his blindness up front than wonder about it as their clinical relationship developed.
One thing was for sure: when he came into the room accompanied by the big black dog with a harness on his back, their entrance was not missed by Corporal Antwone Carver.
“Corporal Carver,” the nurse said by way of introduction, “this is Dr. Brenden McCarthy. He’d like to speak with you for a few minutes, if you don’t mind.”
Brenden put his hand out and waited, with it suspended in air, for the usual clasp, but it didn’t come. McCarthy heard the Marine push himself backward in his wheelchair until it bumped the wall.
He tried to bridge the gap verbally.
“Hi, Antwone. I’m Dr. Brenden McCarthy,” he said. “Dr. Craig suggested I come and spend some time with you, see if there’s anything I might be able to do to be helpful.”
No response came from Carver, so Brenden went on.
“This is my friend Nelson. Would you like to meet him?”
That got a response.
“That’s a big dog,” the man said warily. “A real big dog.”
“Yes, he is,” Brenden said, “but he’s quite special, you know. He’s a guide dog.”
“Don’t matter,” Carver said. “He can bite you just like any other.”
“Not Nelson.” Brenden laughed easily. “He might lick you to death, but he’d never bite. Anyway, let me pull up a chair, and I’ll tie him to it so that he won’t be able to intrude on our conversation. Is that okay with you?”
“Okay,” he said, not really meaning it.
“Will that be all, Doctor?” the nurse put in.
“Yes, thank you, Amy. That’ll be all for now.”
Her shoes squeaked their way out of the room, and Brenden settled himself into the armchair she had pulled up for him, sitting directly across from Carver.
After tying Nelson to the chair, Dr. McCarthy leaned back, crossed his legs, and rested his arms on the chair, remembering that Kat had told him this position looked very conversational.
Immediately he noticed that Carver was fidgeting. He heard the man’s fingers drumming on the arms of his wheelchair. He heard the swishing sound of Carver’s head swiveling from side to side, as if he was searching for something. He kept making some kind of clicking sound in his mouth. And when he spoke, his words were almost unintelligible because the speech pattern was so quick. His autonomic nervous system was going wild.
Brenden noted all the signs of post-traumatic stress disorder—a postwar disorder that was shattering untold numbers of lives.
The doctor tried to create some form of simpatico.
“So, Antwone . . . May I call you Antwone? Corporal Carver sounds a little formal, don’t you think?”
Again no response, so the psychiatrist went on.
“Antwone, you’re from LA, huh?”
Still no response.
“Your intake says that you were raised in Compton. Pretty tough neighborhood, I’m thinking.”
Still nothing from Carver.
“Your Marine Corps bio says that this was your second tour. For hobbies, it lists music and basketball. Are you a Lakers fan?”
That at least got the man to nod his head. Brenden heard the movement and was encouraged.
“Me, too, although I’ve never understood how they could have traded Shaq.”
Still no direct engagement, so Brenden kept working.
“But you know what?” he said. “This kid, Andrew Bynum, really might be something, and they’re getting great backcourt play from Jordan Farmar, the kid out of UCLA. What do you think about their bringing Derek Fisher back? Do you think it was a good move?”
“The man can play.”
Ah, Brenden thought, a mini breakthrough.
“Yes, he can,” Brenden agreed. “He can really ball, but more than that, I think he’s an important psychological balance for Kobe because they played together in three championships. Did you play the game a lot growing up, Antwone?”
Brenden was surprised when he got an answer.
“All the time, man. I was king of the court. I had the sweetest jump shot you ever saw. Would’ve made it in the pros, too, even though I’m small. There’ve been a lot of small guys that have made it—Spud Webb, Tiny Archibald, Calvin Murphy, and now Steve Nash and Chris Paul. I was as good as any of them. I know it.”
“It’s good when you know something,” Brenden suggested. “We all need to know we’re good at something. Listen, if you don’t mind, I need to ask you some questions. I know they’ll seem a little boring, but you know how it is. There’s always paperwork to fill out; the military marches down the road of red tape.”
Back to no response.
Brenden had seen this kind of behavior with civilians before, but for some reason, in the case of veterans, the depression seemed to be extraordinarily complex and profound. He had learned from Dr. Williams that hospital rules required the chart to be filled out in a very specific way, but getting there could often be like pulling teeth. He decided it was time to tell Carver why he was here.
“Listen, Antwone, I probably should have told you I’m a psychiatrist, and Dr. Craig felt that it might be helpful for you and I to spend some time together.”
The man’s reaction was not untypical. “I don’t need to talk to any head doctor,” he said. “There’s nothing you can do for me.”
“Well, maybe that’s true,” Brenden said. “But just give me a couple of minutes, will you? First of all, can you tell me what happened? I mean, how you got hurt?”
“You already know that from the file,” the Marine said. “An IED blew up a personnel carrier I was riding in. Three dead, and I wish I was too.”
Too early to push that button, Brenden reminded himself. Just get the history. Try to create trust.
“Corporal, have you ever seen a psychologist or psychiatrist before?”
The Marine’s laugh was a single note of disgust. “In my neighborhood, man? We just had pimps and pushers, gangs, drug runners, and preachers.”
Brenden smiled. “What about the rest of your family? Any of them ever see a professional?”
“Not unless it was in juvie or on the inside.”
“You mean prison?” Brenden said. He heard the guy nod. “Okay, I got it. What about chemical dependency?”
The Marine laughed darkly. “You mean drugs? Oh yeah, we got a lot of that in the family. Booze and drugs—I’ve seen it all.”
“How about you, Antwone—any problems with drugs?”
“There would have been,” he said. “But the Corps saved me.” His voice took on a different sound. “The Corps was my family, man. The Corps was everything.”
“I’m sure they still care about you,” Brenden said sympathetically. “Semper fi. Once a Marine, always a Marine.”
“No
t when your legs are broke. Not when you can’t make it up the hill. Not when you pee through a catheter or have enemas twice a day. Not when you’re not a man.”
“I don’t believe that,” Brenden said. “I know I haven’t been around here for very long, but from everything I’ve heard, the Corps cares more than any other military service.”
Carver didn’t respond, so the doctor went on. “Did you have any illnesses growing up? Any serious stuff?”
“Not until now,” the man said. “Not until this.”
“What about family support?” Brenden asked. “Has your mother been here to see you? Or . . . let me see, from your records, I see that you’re married, right?”
“Yeah,” the Marine said, his voice taking on a timbre that sent an alarm through Brenden.
“So has your wife been here to see you?”
“Yeah, she was here,” the man said. “But she won’t be here for long. Listen,” he said, “I’ve had enough of these questions. You want to get out of my face?”
Brenden pressed just a little. “Antwone, it sounds like you’re worried about your relationship with your wife. Is that true?”
Now the man went stone quiet, and Brenden knew that this clearly was the end of the interview.
“Look, Antwone, you’re going to be here for a while, and, well, I’d love the chance to talk to you again when you feel more like it.”
More silence.
“Okay, I’ll see you sometime tomorrow,” Brenden told him, not giving the man a choice.
Standing, he forgot he had put the leash around the leg of the chair, and so when Nelson stood, the chair moved.
“Oh, sorry, pal,” he said, reaching down and untying the leash. “I forgot you were tied there.”
Brenden was always amazed when Nelson took it upon himself to get to know someone. The animal picked certain people to communicate with, and they weren’t necessarily the ones who seemed obvious. In this case, the dog moved forward to the end of his leash and sniffed the Marine’s hand before Carver could pull it back.
“Get that dog away from me!”
“I’m sorry,” Brenden said. “There are just some people he seems to like.”
“Get him out of here!” Carver said again. “Take your stupid dog and get out of here!”
Brenden smiled warmly. “Nelson’s pretty persistent,” he said easily. “He just knows when he likes someone, so I guess we’ll have to come back tomorrow.”
Turning, the two moved toward the door, and Brenden had the feeling that the Marine’s eyes were watching them work, taking it all in but saying nothing.
The doctor turned his head back as they moved outside. “See you tomorrow afternoon, Corporal.”
Moving down the hall headed for the elevator, Brenden understood that this was going to be a hard case, and it seemed to him that his first priority was to get the young man to agree to begin a drug protocol. The problem, as always, was that you couldn’t impose treatment on a patient; it had to be voluntary. And, as the doctor settled in behind his desk, instinct told him that bringing Antwone Carver to a place where he would accept treatment in any form was going to be difficult.
At the moment, Brenden believed, Carver was a guy who felt that he had nothing to live for.
I remember what that felt like, Brenden thought. That’s exactly what I was feeling when I went blind. Somehow I need to create a level of empathy, and from that maybe I can begin to build some elements of trust. God willing, I’ll be able to help.
Brenden took a cassette machine out of his desk and completed the patient history notes that he would dictate onto Carver’s chart. Then, sitting back a little deeper in the chair, he let himself free-associate with the machine still running, trying to clarify his own thinking.
“There are so many layers of life and loss I have to work my way through with Patient Carver, and to do that I need to find touchstones that bring us together. We’re men who come from completely different social structures, and if he follows the normal pattern, he probably has an inherent distrust of white people, even though he’s worked with many in the Marine Corps. It’s clear from our first conversation that the Marines have become his family and that prior to signing up, he did not have a particularly positive self-image. The question of sexuality is going to be the elephant in the room, and that conversation is never easy, especially when there’s a wife involved.
“I have the impression that right now it’s going to be extremely difficult to find building blocks to restore Carver’s mental health. I’ll need to get to know his wife, maybe his mother; and maybe there’s an aspect of faith in God somewhere in his background we can lean on. I’m going to have to begin very slowly and search carefully for common ground, or I’ll lose him. Maybe my own story will create connection. In the end I suppose that’s what therapy is really about. You create bonding and trust, and then maybe, as Frankl says, a course of treatment becomes a course of directive action.”
Brenden stretched and switched off the cassette.
“What do you think, Nelson?” he said to the big dog. “Do you think it all comes down to trust, with a little love thrown in?”
The dog’s tail thumped the floor in complete agreement with his master.
“Okay, pal,” Brenden said, “let’s take a walk and get some lunch. We’ve got to see the patients who pay our bills this afternoon. Maybe we can have some positive results back in our own stomping grounds.”
The big dog stood and shook himself, and Brenden had the feeling that he was saying, Don’t worry about it, Master. It’ll all work out. It always does.
chapter seven
Brenden always tried to take the five o’clock ferry home so that he would be on time for an early dinner with his family, but today two patients kept him in the office until six thirty. He decided to place a call to “Bad News” Barnes before he headed home. He sensed that the distance between himself and Antwone Carver not only was based on the trauma the Marine had experienced, but also carried an overtone of racial mistrust that would make it difficult to develop a relationship.
He wondered how his friend Barnes had overcome this in his own life, both personally and professionally. Had Barnes’s white patients questioned his capacity to treat them? Did he sometimes feel threatened or angry when he felt that whites were patronizing him, both because he was blind and because he was black? He was surprised to realize that he and Barnes had never really talked about any of these issues, and he found himself curious to discover what his friend would say.
The sonorous voice answered on the third ring.
“Hello,” he said, “this is Dr. Barnes. May I help you?”
“I don’t know,” Brenden said. “It’s after seven thirty back there. You may already be on your third drink and be no use to me at all.”
“My second, young man,” the voice said, “but at my size, I have an astounding capacity.”
His tone then changed to a step-and-fetch-it kind of attitude, parodying the 1930s musicals. No one could ever be more self-deprecating. “Oh, golly gee, Dr. McCarthy,” he said. “You mean, you really want the advice of a poor little ol’ psychologist like me about your patient? Mm, mm, mm. Land sakes, I can’t believe it.”
Brenden laughed and parodied a British accent of his own. “I know it’s quite remarkable,” he said, “but sometimes we in the medical profession find it necessary to reach down to those of you who are less fortunate in order to help us solve a problem with which you, of the lower class, are more familiar.”
Now Barnes laughed loudly, vibrating the crystal on Brenden’s desk.
“Listen, Marvin,” Brenden went on, “this is really serious. I’m calling about my pro bono case with Seattle Veterans Hospital. This guy, a Marine on his second tour in Iraq, was injured when an IED exploded on his Humvee. Now he’s a paraplegic, including the possible loss of sexual function, suffering from post-traumatic stress disorder, and he seems completely closed off, either to a drug protocol or to any form of i
nteractive therapy.”
“That’s interesting,” the big man said. “It sounds like a couple of guys at this table, doesn’t it? When we went blind, neither of us was reachable. I don’t find this Marine’s feelings to be unusual, do you?”
“It’s not just that, Marvin,” Brenden said. “I’ve only seen him once, but there seems to be a cultural divide, and even more, I have the feeling that it’s going to be difficult for me to establish the kind of trust necessary to make the therapy useful. Do you get where I’m coming from?”
The big man took a long pull on his drink and sighed.
“The racial divide,” he said. “A chasm wider than the Grand Canyon and getting wider. You know, Brenden,” he went on reflectively, “I really think it was a lot easier in this country when the polarization of the races was more clear-cut. Now, with the success of affirmative action and the Civil Rights Amendment, prejudice has gone underground, and it’s rooted deeply on both sides. I worry very much that we’re void of effective leadership to continue to bring the issues forward in the minds of the American people. Look, I’m not trying to get on a soapbox or anything, but I can tell you that when I grew up during the sixties, the African-American community had real leadership. Now we have rap and bling and attitude, and that garbage can’t do any of us any good. But I must say I’m encouraged by the election of Obama as president. There seems to be a change of attitude going on that’s affecting not only this country but countries around the world. It makes you believe that some thing profound and grand just might be happening. To tell you the truth, Brenden, I’m praying about it, and I haven’t done that for a long, long time. But back to your patient. Tell me about his family background.”
“From what I’ve learned so far,” Brenden said, “he never knew his father, so it’s a matriarchal family. Eight kids, abject poverty, drugs, and gang violence. His life could have gone either way, but the Marine Corps became his family, and then he fell in love with his wife. I haven’t met her, but I get the impression that she is a remarkable woman. He clearly has her on a pedestal.”
