Lying on the Couch

by Irvin D. Yalom

  The salmon en croute arrived, but Peter ignored it while he pro-

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  ceeded to relate how Adriana, too, had been greatly dissatisfied with her previous therapists.

  "In fact, Marshal," he continued, "that's one of the two things I wanted to discuss with you today. Adriana would like very much to work with you for a few sessions: she's got to iron out some things in her relationship with her father, especially now that he may not have long to live."

  Marshal, a close observer of class differences, had long known that the upper class deliberately delayed taking the first mouthful of food; in fact, the older the wealth, the longer the delay before the first forkful. Marshal did his best to pause along with Peter. He, too, ignored the salmon, sipped his Calistoga, listened intently, nodded, and assured Peter that he would be glad to see Adriana in brief therapy.

  Finally, Marshal could stand it no longer. He dug in. He was glad he had followed Peter's recommendation of the salmon. It was delicious. The delicate buttered crust crackled and melted in his mouth; the salmon needed no chewing—with the slightest pressure of tongue on palate, the rosemary-laced flakes separated and, on a bed of warm, creamy butter, glided gently down his throat. The hell with cholesterol. Marshal thought, feeling positively wicked.

  Peter, for the first time, looked at his food, almost surprised to see it there. He took one hearty bite, then lay down his fork and resumed speaking.

  "Good. Adriana needs you. I'm very relieved. She'll phone this afternoon. Here's her card. If the two of you can't make phone contact, she'd appreciate your phoning her to leave an appointment time for next week. Any time you have free: she'll work her schedule around you. Also, Marshal—and I've cleared this with Adriana—I'd like to pay for Adriana's hours. This will cover five sessions." He handed Marshal an envelope containing ten hundred-dollar bills. "I can't tell you how grateful I am that you'll see Adriana. And of course this adds impetus to my desire to repay my debt to you."

  Marshal's interest was piqued. He had supposed that the endowed lecture series signaled that his window of opportunity had closed forever. Fate, it seemed, had decided to tempt him once again. But he knew his professionalism would prevail: "Earlier you spoke of two issues you wanted to discuss. One was my seeing Adriana in therapy. Is your continuing feeling of indebtedness the second issue.''"

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  Peter nodded.

  "Peter, you've got to let this go. Or else—and this is a major threat—I'm going to have to suggest you delay your trip for three or four years so we can resolve this in analysis. Let me repeat: there is no outstanding debt. You contracted for my services. I charged an appropriate fee. You paid that fee. You even paid more than my fee. Remember? And then you were gracious and generous enough to endow a lectureship in my name. There never was an outstanding debt. And, even if there were, your gift clearly settled it. More than settled it: 1 feel indebted to yow!"

  "Marshal, you taught me to be true to myself and to express my feelings openly. So I'm going to do just that. Humor me for a couple of minutes. Just hear me out. Five minutes. Okay?"

  "Five minutes. And then we bury it forever. Agreed?"

  Peter nodded. With a smile Marshal took off his watch and placed it between them.

  Peter picked up Marshal's watch, studied it intently for a moment, returned it to the table, and began.

  "First thing: let me clear the air about something. I'd feel like a fraud if I let you think that the university bequest was really a gift to you. The truth is I make a moderately sized gift to the university almost every year. Four years ago I endowed the very chair in economics that my father holds. So I would have made the gift anyway. All I did differently was earmark it for your lecture series.

  "Second thing: I understand entirely your feelings about gifts, and I respect them. However, I have a suggestion that you may find acceptable. How much time left?"

  "Three minutes and counting," Marshal grinned.

  "I haven't told you much about my business life, but what I do primarily is buy and sell companies. I'm an expert in pricing companies—I did it for Citicorp for several years before striking out on my own. I guess I've been involved in the purchase of over two hundred companies over the years.

  "I've recently identified a Dutch company that is so amazingly underpriced and with such powerful profit potential that I've purchased it for myself—perhaps I'm being selfish, but my new partnership is not yet complete. We're raising two hundred fifty million. The opportunity to purchase this company is brief and, I'll be honest, it's too good to share."

  Despite himself. Marshal was intrigued. "So?"

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  "Wait, let me finish. This company, Rucksen, is the world's second leading manufacturer of bicycle helmets, with fourteen percent of the market. Sales were good last year—twenty-three million—but I am certain I can quadruple that in two years. Here's why. The largest share of the market—twenty-six percent—is held by Solvag, a Finnish company, and it just so happens that my consortium owns controlling interest in Solvag! And I own controlling interest in the consortium. Now Solvag's main product is motorcycle helmets, and that division is far more profitable than the bicycle helmet division. My plans are to streamline Solvag by merging it with an Austrian motorcycle helmet company that I'm bidding on now. When that happens, I'll discontinue Solvag bicycle helmets and convert their plant into full motorcycle-helmet capacity. Meanwhile I'll have stepped up Rucksen production capacity and positioned it to move right into the gap left by Solvag. You see the beauty of this, Marshal?"

  Marshal nodded. Indeed he did. Insider beauty. And he also saw the futility of his pathetic attempts to time the stock market or to buy a stock with the worthless crumbs of information that made their way down to outsiders.

  "Here's what I propose." Peter glanced at the watch. "A couple more minutes. Hear me out." But Marshal had forgotten all about the five-minute limit.

  "I leveraged the purchase of Rucksen and need put up only nine million cash. I expect to go public with Rucksen in approximately twenty-two months and have very good reasons to expect more than five hundred percent return. Solvag's departure from the field will leave them with no powerful competitors—which of course no one knows but me, so you must keep this confidential. Also I have information—I can't reveal the source, even to you—of legislation making bicycle helmets mandatory for minors that will be introduced imminently in three European countries.

  "I propose you take a portion of the investment, say, one percent—no wait, Marshal, before you refuse: this is not a gift, and I am no longer a patient. This is a bona fide investment. You give me a check and you become part owner. With one proviso, however— and here's where I'm asking you to stretch yourself: I do not want to find myself in another Dr. Black scenario. You remember how much aggravation that caused me?

  "So," Peter continued, sensing Marshal's growing interest and

  speaking more confidently now, "here's my solution. For the sake of my mental health, I want this to be risk-free for you. If at any time you feel unhappy about the investment, I will buy back your shares at your cost. I propose to give you my personal promissory note— fully secured and payable upon demand in an amount equal to one hundred percent of your investment plus ten percent interest annually. But you must give me your promise that you will exercise this note in the event of some unforeseen incident—who knows what? . . . presidential assassination, my accidental death, or anything else that you feel puts you at risk. In other words, you are obligated to exercise this note."

  Peter sat back, lifted Marshal's watch, and handed it back to him. "Seven and a half minutes. Now I'm finished."

  All of Marshal's gears were spinning at once. And now, finally, the gears did not grind. Ninety thousand dollars, he thought. / make, say, seven hundred percent — that's over six hundred thousand dollars profit. In twenty-two months. How can I, how could anyone, turn that down
f Invest that at twelve percent and that's seventy-two thousand dollars a year for the rest of my life. Peter's right. He's no longer a patient. This is no transference gift — I put up money; it's an investment. So what if it's risk-free! It's a private note. There's no professional misconduct here. This is clean. Squeaky clean.

  Marshal stopped thinking. It was time to act. "Peter, I only saw part of you in my office. Now I know you better. Now I know why you've been so successful. You set a goal and you go after it—go after it with a tenaciousness and intelligence that I have rarely seen . . . and a graciousness, too." Marshal extended his hand. "I accept your offer. And with gratitude."

  The rest of the transaction was completed quickly. Peter offered to take Marshal in as a partner for any amount up to one percent of the company. Marshal decided, now that he had come this far, to grab the brass ring and invest the maximum: ninety thousand. He would raise the money from selling his Wells Fargo and his Fidelity select electronic stock and wire the money to Peter's Zurich bank within five days. Peter was going to close the purchase of Rucksen in eight days and was required by Dutch law to have all parties Usted. Meanwhile Peter would prepare a secured note and leave it off at Marshal's office before he left for Zurich.

  Later that afternoon, after Marshal had seen his last patient of the day, there was a knock on his door. A pimpled adolescent bicycle

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  messenger, in a denim jacket with magenta fluorescent armbands and the mandatory San Francisco Giants baseball hat worn backward, handed him a manila envelope containing a notarized letter specifying all the aspects of the transaction. A second note for Marshal's signature specified that he was obligated to request a full repayment of his investment should, for any reason, the value of Rucksen fall below its purchase price. A memo from Peter was also enclosed: "For your full peace of mind, a secured note from my attorney will reach you by Wednesday. Enjoy my celebratory token of our partnership signing."

  Marshal reached into the envelope and extracted a Shreve's Jewelry Store box. He opened it, gasped, and gleefully put on his first jewel-spangled Rolex watch.

  TEN

  ,ust before six o'clock on a Tuesday evening, Ernest received a phone call from the sister of Eva Galsworth, one of his patients. 'Eva told me to call you and just to say, 'It's time.'" Ernest wrote a message of apology to his 6:10 patient, taped it to his office door, and rushed to the home of Eva, a fifty-one-year-old woman with advanced ovarian cancer. Eva was a creative writing teacher, a graceful woman of great dignity. Ernest often imagined, with pleasure, living his life side by side with Eva, had she been younger and had they met under different circumstances. He thought her beautiful, admired her deeply, and marveled at her commitment to life. For the past year and a half, he had unstintingly devoted himself to easing the pain of her dying.

  With many of his patients, Ernest introduced the concept of regret into his therapy. He asked patients to examine regrets for their past conduct and urged them to avoid future regrets. "The goal," he'd

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  say, "is to live so that five years from now you won't look back on these five years filled with regret."

  Occasionally Ernest's "anticipatory regret" strategy fell flat. Generally it proved meaningful. But no patient ever took it more seriously than Eva, who dedicated herself to, as she put it, "sucking the marrow out of the bones of life." Eva packed a great deal into the two years following her diagnosis: she left a joyless marriage, had whirlwind affairs with two men she had long desired, took a wildlife safari in Kenya, finished two short stories, and traveled around the country visiting her three children and some of her favorite former students.

  Throughout all these changes, Ernest and she had worked closely and well. Eva regarded Ernest's office as a safe haven, a place to bring all her fears about dying, all the macabre feelings she dared not express to friends. Ernest promised to face everything directly with her, to flinch from nothing, to treat her not as a patient but as a fellow traveler and sufferer.

  And Ernest kept his word. He took to scheduling Eva for the last hour of the day because he often ended the hour flooded with anxiety about Eva's death, and his own as well. He reminded her over and over that she was not entirely alone in her dying, that he and she were both facing the terror of finitude, that he would go with her as far as he was humanly able. When Eva asked him to promise he would be with her when she died, Ernest gave his word. She had been too ill for the past two months to come to his office, but Ernest kept in touch by telephone and made occasional home visits, for which he chose not to bill.

  Ernest was greeted by Eva's sister and ushered into her bedroom. Eva, heavily jaundiced because her tumor had invaded her liver, was gasping for breath and perspiring so heavily that her soaked hair was plastered to her head. She nodded and in a whisper between breaths told her sister to leave. "I want one more private session with my doctor."

  Ernest sat down next to her. "Can you talk?"

  "Too late. No more words. Just hold me."

  Ernest took Eva's hand, but she shook her head. "No, please, just hold me," she whispered.

  Ernest sat on the bed and leaned over to hold her but could find no workable position. There was nothing to do but to get on the bed, lie next to her, and put his arms around her. He kept his suit

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  jacket and shoes on and nervously eyed the door, worried that some misunderstanding person would enter. He felt awkward at first and was grateful for the layers between them—sheet, comforter, coverlet, suit jacket. Eva pulled him to her. Gradually his tension dissipated. He loosened up, took off his jacket, pulled back the comforter, and clutched Eva closely. She clutched back. For an instant he felt an unwelcome warm purring inside, the foreshadowing of sexual arousal, but, furious at himself, managed to banish it and to devote himself to hugging Eva in a loving fashion. After a few minutes he asked: "Is this better, Eva?"

  No answer. Eva's breathing had become labored.

  Ernest jumped up from the bed, bent over her, and called out her name.

  Still no answer. Eva's sister, hearing his call, rushed into the room. Ernest reached for Eva's wrist but could feel no pulse. He put his hand on her chest, gently pressing her heavy breast aside, and felt for an apical pulse. Discovering her heartbeat to be thready and wildly irregular, he pronounced: "Ventricular fibrillation. It's very bad."

  The two of them sat vigil for a couple of hours, listening to Eva's heavy, erratic breathing. "Cheyne-Stokes" breathing, Ernest thought, surprised at how the term had floated up from the deep unconscious flotsam of third-year medical school. Eva's eyes trembled from time to time but never reopened. Dry spittle-foam formed continuously on her lips, and Ernest wiped it away with Kleenex every few minutes.

  "That's a sign of pulmonary edema," Ernest pronounced. "Because her heart is failing, fluid is accumulating in her lungs."

  Eva's sister nodded and looked relieved. Interesting, Ernest thought, how these scientific rituals—naming and explaining phenomena—ease terror. So I give a name to her breathing? So I explain how the weakening right ventricle causes fluid to back in the right auricle and then in the lungs, causing the foam? So what? I've offered nothing! All I've done is to name the beast. But I feel better, her sister feels better, and, if poor Eva were conscious, she'd probably feel better too.

  Ernest held Eva's hand as her breathing grew more shallow and irregular and, after about an hour, stopped entirely. Ernest could feel no pulse. "She's gone."

  He and Eva's sister sat silently for a few minutes and then began

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  making plans. They generated a list of phone calls to be made—to children, friends, the newspaper, the funeral parlor. After a while Ernest stood to leave, as her sister prepared to wash Eva's body. They briefly discussed how to dress her. She would be cremated, her sister said, and she thought the funeral parlor would supply some type of shroud. Ernest agreed, though
he knew nothing whatever about it.

  He knew very little about any of this, Ernest thought, on the way home. Despite his lengthy medical experience and cadaver dissection in medical school, he, like many physicians, had never before been present at the actual moment of death. He remained calm and clinical; though he would miss Eva, her death had been mercifully easy. He knew he had done all he could, but he continued to feel the pressure of her body against his chest through a very troubled night.

  He awoke just before five in the morning clutching at the remnants of a powerful dream. He did exactly what he always told his patients to do after a disturbing dream: he stayed in bed motionless and recollected the dream before even opening his eyes. Reaching for a pencil and notepad by his bed, Ernest wrote down the dream.

  / was walking with my parents and my brother in a mall, and we decided to go upstairs. I found myself on an elevator alone. It was a long, long ride. When I got off, I was by the seashore. But I couldn't find my family. I looked and looked for them. Though it was a lovely setting . . . seashore is paradise . . . I began to feel pervasive dread. Then I started to put on a nightshirt that had a cute, smiling face ofSmokey the Bear. That face became brighter, then brilliant . . . soon the face became the entire focus of the dream — as though all the energy of the dream was transferred onto that cute grinning little Smokey the Bear face.

  The more Ernest thought about it, the more important this dream appeared. Unable to return to sleep, he dressed and went to his office at six a.m. to enter it into the computer. It was perfect for the chapter on dreams in the new book he was writing. Death Anxiety and Psychotherapy. Or perhaps Psychotherapy, Death, and Anxiety. Ernest couldn't decide on the title.