by M. J. Cates
And moving on a little: Quiet or fussy baby? Easily disturbed by noise? Breast- or bottle-fed—feeding problem? Malnutrition? Illnesses—accidents—convulsions? Age of walking? Age of talking (words and sentence formation)? Response to habit training?
Millie’s father, Reggie Cobb, was a high school janitor, and could not fathom why on earth his daughter’s doctor was asking these things that were so very remote from his daughter’s jump into Baltimore harbour. And that was before Imogen had even broached childhood and adolescence, under which she was supposed to record serious illnesses, operations, domestic upheavals, deaths in the family, economic strains.
Sitting across from her in the interview room, Mr. Cobb sometimes glowered, sometimes wept, as he tried to recall the minutiae of Millie’s early years. Imogen pushed on to Sleep habits: Bed alone? Night terrors? Sleepwalking? and then to Food habits: Fussiness over food? Vomiting? Gagging? Dawdling over meals? At this Cobb cheered a little.
“Millie was one fussy little princess. Wouldn’t eat anything but bologna sandwiches for months on end.”
And then the less congenial subjects of Toilet habits, Bedwetting, Emotional control: Tantrums? Sulking? Whining? Tears?
Mr. Cobb looked upward as if to his deceased spouse for confirmation.
“Millie was a quiet little thing, mostly.” He puffed on his pipe, perhaps trying to convey an image of the responsible father. “Yes, she was a good girl.”
Do any circumstances surrounding the above facts stand out as having a possible influence on your daughter’s current habits and attitude toward life?
Mr. Cobb snatched the pipe from his teeth.
“What, you mean what she ate for breakfast back in 1903? I’m telling you there’s something wrong with the girl’s nerves. With her brain. Not with her table manners. Her brain’s all scrambled up.”
Imogen gripped her pencil and moved on to School background: Age on entering kindergarten or first grade—public or private—country or city. Repetition of grades? Special difficulties with subject matter? Friction with teacher? Age on leaving elementary school—grade reached? Age on entering high school—date of graduation? College? Business school? Special courses in music, arts, home economics? Give dates in chronological order.
Dear God, all this, and she hadn’t even got to sex. Residents were expected to glean not only the patient’s level of information about sex but at what age they learned what, who from, and what effect it had on them. Millie, upon admission, was in no shape to answer any questions that did not revolve around her belief that the staff of the Misses’ Shoes department on the fourth floor were closely allied with the elevator operators in a plot to bring her down. Still, Imogen did get her to agree to two hours of hydrotherapy, which would consist of a continuous bath strictly maintained at a temperature of 94 degrees Fahrenheit.
Dr. Ganz was well versed in the latest twists and turns in Freud’s psychoanalytic theory, but he was not one to throw out any therapeutic technique that had been shown to work. The hydrotherapy facilities in the Phipps’s basement were of the highest quality and so far Imogen had never heard of a patient refusing the continuous bath. During the blackest moods of her own adolescence, she had occasionally resorted to a hot bath herself.
It was amusing to see such a household remedy, albeit refined with the latest technology, at work in the country’s most prestigious hospital. Of course, it was not a matter of a twenty-minute soak. The minimum duration was forty-five minutes, and two hours was standard, applied daily, sometimes twice daily where needed, for weeks on end. And it did work. It could calm the panicked, quiet the manic, and even somewhat settle the inner chaos of the psychotic. The nerve clinics would credit the soothing effect of vasodilatation; Freud suggested that it was a return to that acme of comfort, the mother’s womb; Jonas Ganz liked it because it worked.
Millie emerged from the tub room after a couple of hours’ immersion on her first day, her cheeks flushed as if she had just engaged in a game of tennis. She was tucked into a bed on the admissions ward and was sipping a cup of tea when Imogen came to see her again.
“There’s no need for me to be in bed,” Millie said. “I would really prefer the garden.”
“I’m glad you’re feeling better,” Imogen said, “but all our patients spend the first twenty-four hours in bed. That way we get a sense of where you are emotionally, physically, mentally, in the absence of any kind of strain or excitement. Also, it creates a buffer between your convalescence and your experiences of the past few weeks.”
“Are you going to be my doctor?”
“One of them. Dr. Quinn is the ward psychiatrist, so she is ultimately responsible for your care. Now I hope you’re comfortable because I’m going to be asking you a lot of questions.”
“That’s all right.”
“Some of them you may find intrusive, but I assure you that all the information will be useful to us in working out how best to help you.”
“I may not answer all of them,” Millie warned her. “I may not answer any of them.”
As it turned out, Millie was voluble. She didn’t even balk at the questions regarding her discovery of sex. At the age of eleven, she had been playing on the neighbours’ porch with an older friend when they came across what Millie thought was a balloon. Her friend knew better and told her it was something you used when having sexual intercourse. Millie had never heard the expression before and wondered whatever could it mean? It’s when a man lies on top of a woman, her knowledgeable friend informed her—you know, so that they don’t have a baby. Imogen’s gentle but persistent questioning elicited the information that Millie had been confused on the matter for several subsequent years, believing it was not the sheath that prevented conception, but the man’s lying on top of the woman. Somehow that preposterous action prevented a woman from having a child.
“And did you come to a clearer understanding later?” Yes, she did, but only because she searched through the science section of the local library until she found a book on female health.
Imogen yearned to be asking her about her current situation, recent setbacks at work, in love, in family connections, but it was a history they were expected to construct, and that meant plowing on. Onset of menstruation and attendant circumstances and facts. Onset of curiosity about sex, how satisfied. Any secrecy or shame associated with it? Imogen doubted she would ever come across a patient who hadn’t felt stealthy and ashamed about sex, certainly not a female.
So far, so good. But Dr. Quinn was standing at the foot of the next bed, eyeing Imogen up and down. She was young to be a ward psychiatrist, not much over thirty, small in stature, with a fine-boned grace somewhat marred by a slight curvature to her back, perhaps a mild scoliosis or an old injury. Imogen was about to embark on some of the most sensitive questions—Sexual transactions after puberty? before puberty?—when Dr. Quinn spoke up. “Your chart for Miss Obermeyer is not up to date.”
“Yes, I’ll be getting to it before the end of shift.”
Imogen turned back to her patient.
“I note also that Mrs. Waldstein has not had a complete night’s sleep in three days and yet no chloral, no bromide, nothing has been administered. Do you have some personal objections to the treatment of insomnia?”
“Mrs. Waldstein felt she was becoming habituated to chloral, so she’s been having an extra bath in the evening.”
“All decisions on medication go through the ward psychiatrist.”
“Yes, well, you were not on duty, and—”
“I repeat: all decisions on medication go through the ward psychiatrist.”
“Perhaps you’re not aware, I do actually have an MD.”
“Oh. Different from the others, are you? More experienced? Wiser? Ready to run the place? Just perform your duties as expected, if you please, and don’t be so high and mighty.”
Dr. Quinn let the chart fall back against the foot of the bed with a loud clack, and headed off to torment some other resident.
> Imogen turned back to Millie, who had now screwed her eyes shut tight and gripped the edge of the sheet.
“Millie? Millie, it’s okay. She’s angry with me, not with you. May I ask you a few more questions?”
Millie pulled the sheet up over her head. Imogen watched it quiver for a few moments.
“I’ve got some very interesting questions for you now. They’re extremely personal, and you may not want to answer but I hope you will.”
The small voice came back from under the sheet. “Ask what you want, I don’t care.”
“All right. Tell me about infatuations with individuals of your own or the opposite sex. During your adolescence.”
No answer.
“You can keep the sheet up if you like. What did or do you do for relief of the sex impulse? How do you attempt to regulate this?” Until she came to the Phipps, Imogen had never met a female who admitted to having a “sex impulse.” What forms of sex arousal are you now subject to? What is your sex goal? Imogen was not even sure what was meant by “sex goal,” and to make it more comfortable reframed the question as “What part would you like sex to play in your life?”
Millie wouldn’t answer any of them. Eventually she lowered the sheet and said, “It’s still here.”
“What’s here?”
“It.”
“Do you mean me?”
“It.”
“You mean I’m a thing. Because of the questions I ask? Is that it? To ask you about sex in that way seems inhuman?”
“It.”
Later that night Imogen knocked on Donna’s door with the patient history protocol in hand. Donna was in her dressing gown, a tatty old thing held together with what looked like a schoolboy’s scarf.
“Can you explain Lila Quinn?”
“Oh, dear. A little frazzled, are we? Go fetch your cup. I’ll share my hot chocolate.”
Imogen came back with her cup and saucer.
“You take the chair.”
Donna poured some chocolate from her own cup into Imogen’s. She propped her pillow up against the desk and sat on the bed, her legs folded beneath her. She was such a fetching combination of curves and angles that Imogen had to suppress an impulse to curl up beside her as she recounted the afternoon’s events.
“Yes, that’s her favourite trick,” Donna said, “humiliating an intern in front of a patient.”
“I hadn’t even done anything wrong.”
“Even if you had, it’s obviously bad form to tear a strip off a colleague in public. Have you ever seen her interview a patient?”
“No.”
“It’s terrifying. So harsh. Impatient. She must imagine she’s a force for reality, but she just comes across as some kind of pull-your-socks-up sergeant-major.”
Imogen sipped her chocolate.
“You’re looking profound again,” Donna said. “It’s tiresome.”
“Well, it makes me wonder about Dr. Ganz, that’s all. Why would he keep such a person on staff? Why have her near patients?”
“Well, she’s addicted to her work, for one. That woman does not go home until long after shift ends. She takes endless trouble over her patients, keeping up contact with their families and so on. She writes hundreds of papers. She’s very involved in community mental hygiene—one of Ganz’s pet projects. She runs a tight ship.”
“And she’s thoroughly nasty.”
“And she’s nasty—which can’t be good for the patients, so you’re right: why does he keep her on?”
“Perhaps simple kindness? She has that unfortunate scoliosis. I suspect she’s in pain a good deal of the time and that’s what makes her irritable. And lonely, too, don’t you think?”
“I don’t know about that.”
“Well, she’s a spinster at thirty-five or so. Doesn’t seem to have anything but her work. I think she’s terribly lonely and Dr. Ganz feels protective toward her. That’s a good instinct, don’t you think?”
“Maybe. Unless you run a psychiatric clinic.”
“On another subject…” Imogen held up the protocol. “How do you get through this thing? How do you make yourself ask these questions? I’ll never be a psychiatrist if I can’t.”
“I don’t really see the problem, Imogen. You’re a physician—you wouldn’t have any trouble asking about polyps or diarrhea. Why should this be any different?”
“Because it is different. People don’t routinely talk to a physician about sex. And we certainly don’t ask about it. I mean I do it, but I’m blushing furiously the whole time.”
“I had the same trouble on my rotation here last year. Everybody does. That’s why half the women drop out. I nearly did, myself. Shall I tell you my secret?”
“Immediately.”
“I just pretend I’m an actress, on a stage. I have to play the part of a psychiatrist who is not timid about asking these sorts of questions.”
“And that works?”
“I don’t even think about it anymore. It just began to feel natural.”
“It sounds too simple.”
“Why does that matter?”
Imogen smiled.
“What’s funny?”
“You are.”
“I am never funny. Withdraw that remark at once.”
“You are, and it’s adorable.”
“Then tell me about your love life.”
“I can’t. I don’t have one.”
“You do. Tell me, you timid little mouse.”
“No.”
“All right. Let’s try a little free association. Close your eyes and tell me the first thing that comes to your mind. Come on—I’ll be Freud, you be the hysteric.”
“No.”
“Imogen, don’t be boring.”
“All right.” Imogen closed her eyes.
“Cigar.”
“Father.”
“Duck.”
“Quack.”
“Sock.”
“Mock.”
“Punt.”
“Runt.”
“Hunt.”
“Fox. And you are stacking the deck, missy.”
“I am not. Penis.”
“That’s it. I quit.”
They talked on into the night, talked as if they had been friends their whole lives. So delicious to open up to a lively, and beautiful, person like Donna. Donna told her about an ill-fated romance, a narrowly avoided wedding, her first sexual encounter, which took place on an extremely uncomfortable picnic table. Imogen told her about Quentin, and cried a little. “He could be lying in a trench somewhere, wounded and dying, and his last memories of me are me telling him to go away.”
“Not at all, darling. He’ll have seen the kindness underlying everything you said and did. He’ll know you were trying not to hurt him, to protect him.”
“Oh, I doubt that.”
“Well, I don’t, and I’m far more perceptive than you.”
Imogen wanted to say, “Do you know, I grew up with three sisters—four for a while—but I feel like you’re the first real sister I’ve ever had.” But she remembered having said something similar to Quentin and felt it might be bad luck.
* * *
—
Millie’s husband, Eustace, came in for an interview one night after work. He was employed in the packaging department of the Bromo-Seltzer factory, a pudgy little man with a rubbery face and thick round spectacles. He was only ten years older than Millie, but he looked and spoke like a much older man.
“My wife,” he said, when he was seated, “was the most light-hearted girl you could ever meet, before all this happened.”
Imogen asked him many of the questions from the family interview protocol. He answered them thoughtfully, as if he had long known doctors to ask such questions and it was only to be expected.
“I know she shouldn’t be home alone while she’s in this…condition,” he said. “She starts talking to streetcars and next thing you know she’s jumping in the harbour. I’m at work all day. Her father’s at
work all day. And her mother died years ago. But when do you think she might be coming home? It’s awful without her.”
“It may be quite some time yet.”
“This hearing streetcars talking—sending her messages—that’s not going to be forever, is it?”
“We don’t know yet if these delusions are a symptom of a long-term illness such as schizophrenia, or a more passing ailment brought on by temporary circumstances. Millie is showing a mixture of emotional symptoms—her deep unhappiness, for example—and also elements of paranoia. We’ll be able to tell more when she’s had some rest.”
“She definitely needs sleep. Last couple of months, she’s just been pacing all night, saying all sorts of nonsense to herself. I tell her to come back to bed but it’s like she doesn’t even hear me. I don’t even know this person she’s turned into—she’s not the woman I married, that’s for sure. She will be getting better, won’t she?”
“It’s too early to tell. A week or two of good sleep could make all the difference.”
“Because—” Mr. Nielsen removed his glasses, and pinched the bridge of his nose for a moment. When he had collected himself, he put his glasses back on and said, “Because—without Millie—my life isn’t worth a whole lot.”
* * *
—
After only a week, Millie’s talk of speaking streetcars and plotting salesgirls became intermittent, rather than constant, and the colour came back to her cheeks. She became more cheerful and, with a good deal of coaxing from Imogen, began to take part in occupational therapy, as well as in social events arranged for the patients.
After two weeks, she pronounced herself “shocked” at her former behaviour, and her husband declared that Millie looked ready to come home. Imogen asked them to wait, to give the apparent improvements time to solidify. Millie reluctantly agreed to stay another week but no longer.
“I can’t talk them out of it,” Imogen said at the next staff meeting. “Her behavioural changes seem far too sudden to be real. But her husband desperately wants her home, and she wants to go.”
“We are not police,” Dr. Ganz said. “She is not here on a warrant. If she demands to go home, and her husband wants her, there’s nothing we can do to stop it.”
