by The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases
Ralph took his foot out of his mouth and said, “Anything’s possible, Larry.” I’m not sure Larry heard him—he was already halfway down the hall.
The ECT suite was a large converted conference room on the first floor of the medical center. It contained four gurneys separated by curtains at one end, while the other side of the room had a crash cart, two ECT machines with paddle electrodes, an electrocardiograph, medication bottles, and anesthesia equipment. The ECT attending physician, Tom Reynolds, was a stocky, muscle-bound psychiatrist who was rumored to use steroids to augment the effects of his weekend-warrior workouts at Gold’s Gym.
Real-life ECT is very different from the so-called shock treatments seen in the movies where helpless, screaming patients are strapped down, hooked up to electrodes, and thrown into frightening grand mal seizures. In fact, the curative element of ECT is not muscular spasms at all but instead the seizure that results from the electrical stimulation of the nerves that control those muscles. To avoid the potential dangers of a full muscular seizure, the unconscious, anesthetized patient is injected with succinyl choline, a drug that temporarily paralyzes the muscles.
Heather was being prepared for her treatment, and I was there to observe and assist as needed. After she was injected with a short-acting anesthetic, Tom pumped a blood-pressure cuff around her opposite arm to cut off the circulation to her forearm. In this way the succinyl choline would not reach her forearm, and we could observe it shaking, to ensure the rest of her body was experiencing a neural seizure.
He placed one electrode on Heather’s forehead and the other on her right temporal area. The nurse then set off the electrical impulse, which lasted only a second, and Tom pulled away the electrodes. We watched Heather’s left forearm and hand shake for about thirty seconds. Tom took off her blood-pressure cuff and we wheeled her gurney to the other side of the room. I pulled the curtain around her and stayed, waiting for the anesthesia to wear off. I was jotting down notes in Heather’s chart as Tom started to prepare the next patient.
As I finished my charting, I heard someone say, “What’s going on?”
I looked outside the curtain to see if somebody needed help.
“Where am I? Who are you?”
I quickly turned and saw Heather sitting up as if she had awakened from the dead. She was really looking at me for the first time.
“You’re in the hospital, Heather,” I said, “at UCLA.”
She lay back down, weakened by her ordeal. “I’m really thirsty.”
I was ecstatic. “Let me get you some ice chips.”
For the next half hour, while in the ECT recovery area, Heather remained relatively clearheaded and responsive. I was able to fill her in on some of what had happened to her over the previous month and how she had gotten here. She asked to see her sister but then drifted off to sleep. By the time she got back to her room, she was again in her unresponsive, catatonic state.
After each subsequent ECT treatment, Heather’s episodes of clarity lasted longer, and by the sixth treatment, the catatonia was gone. Her successful response to ECT confirmed that the cause of her altered mental state was acute mania, not encephalitis. She was transferred from her medical ward to a psychiatric inpatient unit. We started Heather on lithium to stabilize her mood and discontinued ECT after twelve treatments. I found an outpatient psychiatrist in Santa Monica who could see her for therapy and medication monitoring once she got home.
The morning of Heather’s discharge from the hospital, I took the stairway up to her ward to say good-bye. She was on 2 South, along with the other low-risk, high-functioning inpatients. As I walked down the hallway, I passed the ward’s dayroom, where a few patients were watching TV and playing cards. I continued on and saw Heather’s door open. Her sister, Andrea, was inside helping her pack. I knocked and said hello.
Andrea turned to me. “Dr. Small, you’re our hero. You brought my Heather back to me.” Before I could say anything, she threw her arms around me and gave me a bear hug.
Heather laughed. “Whoa guys, get a room.” I felt myself blushing, that reflex of mine I hate.
Andrea continued. “Really, if it wasn’t for you, they’d still be pushing antibiotics, waiting for Heather’s ‘brain infection’ to clear up.”
I felt like scuffing my shoe and saying, “Aw shucks,” but instead I said, “I’m just glad you’re feeling better. Anyway, there was a whole team of doctors that helped with your case.”
Andrea laughed. “Wow, Doc, you’re not so comfortable with compliments, are you? Maybe you should see someone about that.”
I grinned and said, “Yeah, maybe I should.”
As I walked back to my office, I thought about what Andrea had said. I had mixed feelings about the case and how I had handled it. A part of me felt like a hero for correctly diagnosing Heather. But I also knew that my diagnosis would not have been taken seriously without my mentor, Larry Klein, stepping in and supporting me. I harbored some guilt, too, that my anger at Porter was a big part of what motivated me to solve the case. What I didn’t grasp at the time was that even a seasoned clinician knows when it’s necessary to bring in a Larry Klein to do his bidding. At that point in my career, I was learning when to ask for help from others and who to go to. It just took me a while longer to get comfortable with accepting that help.
CHAPTER SEVEN
The Shrinking Penis
Spring 1985
I WAS BUYING GROCERIES AT THE corner market near my house in Sherman Oaks, a half-hour drive over the foothills from UCLA. In the four years since I’d returned to Los Angeles, I’d been so busy with my clinical practice and building my research program that I usually didn’t get to the market until eight or nine in the evening. I was in the fruit section, searching for a perfectly ripe, sweet-smelling cantaloupe, when I heard a familiar southern twang: “Well, Dr. Gary Small, what’re you doin’ shoppin’ over here in the Valley?”
I turned to see my friend and colleague Dr. Pete Carter. He pulled up next to me with a full shopping cart.
“Well, if it ain’t Pete Carter,” I said, mocking his accent.
Pete grinned broadly as he towered over me from his six-foot-four height. He was an internist from Tulane University who had moved his young family out West to take a position as an assistant professor at UCLA. “You need to work on that accent, Gary.” He reached out and grabbed any old cantaloupe and went on, “You know, it’s great timing running into you like this. It saves me a call. I’ve got a couple I want to refer to you.”
“Sure. What’s their story?” I asked as we strolled down the aisle with our shopping carts like a couple of gossiping housewives.
Pete lowered his voice. “The husband is my patient—he’s a lawyer at one of those large firms downtown. They’ve got three young kids, and he’s completely stressed out about making partner. His wife is fed up, and I think the marriage is in trouble.”
I noticed the diapers and Froot Loops in Pete’s cart and realized why he might be sensitive to this patient’s issues. “What are you treating him for?” I asked.
“Nothing exciting, just regular physicals. Our practice group does all the medical care for his firm.”
“I’ve got some times open. Have them call me,” I said as I started toward the checkout counter.
Pete looked down at his shopping list, “Oh, shit, I forgot the Tub O Peanut Butter.” He looked at my cart and laughed. “God, I miss those days when I could just buy a couple of bananas and some soda and be done with it.”
When I got home, the house was quiet and dark. I usually liked being alone, but that night I felt lonely. I was about the same age as Pete, and he was already married with a family. And though I had been dating my girlfriend, Linda, for a couple of months, it didn’t feel like a serious commitment for either of us. I wondered when I’d ever get around to settling down. The idea of diapers and Froot Loops didn’t really do it for me then, but having someone I cared about sounded good. I started putting away my groceries and r
ealized that Pete had distracted me from my quest for the perfect cantaloupe. The one I picked was not quite ripe, so I left it out on the counter.
Two days later I listened to the message from Pete’s patient. “Yeah, hi, this is Steve Ackerman. Dr. Carter suggested I call you.” He sounded brusque and businesslike. After exchanging a few messages, we finally arranged a time when Steve and his wife, Sharon, could come in for an appointment.
I’d been at UCLA long enough to start feeling more at home there. Including my time as a psychiatry resident, I had already chalked up half a dozen years of psychotherapy experience. I had moved into a slightly larger office with a view of the Jules Stein Eye Institute. Besides my desk and some file cabinets, I had three chairs, a small green sofa, and a coffee table in it.
I was catching up on some articles when the Ackermans knocked on my open door. “Are you Dr. Small?” Sharon asked.
She was around forty, thin and wiry with curly brown hair; she wore faded jeans and a tank top. Steve looked about the same age, dressed in a pin-striped suit. As he stood by the door, his body language told me he was in a hurry and wanted to get on with it. I guessed he had rushed over from his office and wasn’t pleased about it.
“You must be Sharon and Steve,” I said. “Please, come in and sit down.” I got up to shut the door as they sat at opposite ends of the sofa.
Before I could get back to my chair, Sharon started talking at a rapid clip. “We had a tough time finding your office, Dr. Small. This place is like a maze—you go down a hallway and it just keeps going, but when you turn a corner the office numbers change. We finally figured out that the C in front of the number stood for the floor, but it didn’t say that on the elevator, so we had to keep going back to the information desk in the lobby and—”
Steve cut her off. “None of that matters, Sharon. Let’s get to the point. The man bills by the hour, just like I do.” I was surprised that Sharon didn’t seem bothered by his patronizing tone.
They made me feel anxious, which was a clue that they felt anxious too. Sharon’s pressured speech had a manic flavor to it, but it was linear and logical. I suspected that this Chatty Cathy persona was how she expressed her anxiety. Steve appeared to be working hard to keep his anxiety in check, and his impatience also suggested an undercurrent of anger—he seemed to be seething inside and ready to explode at any moment.
“So, how can I help you two today?” I asked.
Sharon jumped in. “Well, I worked as a pharmacist before we had kids, and Steve is an attorney who graduated top of his class at USC. We have three kids—Lisa, our six-year-old, was planned, but our three-year-old twins, Jackson and Robby, were sort of a surprise. That’s why I’m not working anymore.” As Sharon continued at lightning speed, Steve looked both exasperated and bored. He stared out the window as she rambled on. “We live in Benedict Canyon. You know, the place where the Manson murders happened in the seventies?”
Steve snapped, “That’s enough, Sharon. It’s amazing how you can talk so much yet say so little.”
“I’m just giving him some background, honey. And I was about to tell him about the stress you’ve been under while you make partner at the firm. I mean, you hardly sleep at night, and you seem pissed off all the time, sweets.”
She remained composed despite Steve’s biting remarks. I could also understand his frustration with her nonstop chattering. I turned to him, “Tell me about this stress, Steve.”
“Everybody goes through it. I’m working around eighty hours a week, but it’s not that big of a deal. Sharon’s the one who can’t handle it.”
“That’s not true, hon. I can handle it. I’m just worried about you,” she said.
I intercepted. “Let me see if I’ve got this straight. Steve, you’re up for partner and working long hours. Sharon, you’re concerned that it’s affecting Steve’s mood and stressing him out. But Steve, you say you’re handling it. Sounds like you disagree whether there’s a problem here at all.”
“Oh, there’s a problem, all right,” Steve said. “I’m out trying to support my family, I’m working for our future, and she never shuts up about how I’m not doing enough at home.”
He had finally provoked Sharon—she tensed up and replied at a higher pitch, “I’m not asking for much, Steve. I just want you to be there for the kids sometimes. I do everything around the house while you’re either working or staring off into space. And I don’t ask for any help.”
Steve spoke slowly, in a controlled rage. “I’ve told you a million times, Sharon. We can afford a nanny. You could have some free time to yourself to do your yoga or Pilates or whatever you do.” He shook his head and turned to me. “She’s too controlling to hire anyone to help her with the kids or the house.”
Steve’s long hours at the office kept him away from the kids and the house, and he didn’t seem to mind that they also kept him away from Sharon. I figured he was no picnic to live with either. His constant criticisms must have been hard for Sharon to take. I could see what Pete Carter meant about things being rocky with the Ackermans.
Despite my attempts to mediate, they squabbled through most of the session. I was becoming impatient with Sharon’s nonstop commentary, yet Steve’s cruel quips made me want to protect her. They were definitely a provocative pair. Sometimes when Sharon spoke, Steve would just tune out, as if he was having a private conversation in his head. And the more silent and withdrawn he became, the faster she spoke.
I tried to keep her on topic so I could eke out more history about their relationship. “So you two dated in high school?”
Steve rolled his eyes as Sharon snapped at the bait. “Yes. Steve was a basketball jock and I was a cheerleader. In college we moved in together and got married in our senior year. I went on to pharmacy school and Steve got his law degree. But I stopped working when I was pregnant with the twins.”
I learned that there was no family history of psychiatric illness, and neither of them reported ever being depressed or seeing a mental health professional. They drank alcohol socially on weekends, and during college they had experimented with recreational drugs, mostly marijuana.
With about twenty minutes left in the session, I wanted to get beyond basic history; during a rare moment when Sharon stopped talking, I asked, “So how is your sex life?”
They answered at the same time.
“It’s fine,” he said.
“It could be better,” she said.
Steve glared at Sharon and she shrugged.
Steve suddenly stood up. “You know what? I’m late for a meeting. You two can talk about whatever you want.”
Before I could say anything, he was out the door. Apparently, sex was not a topic Steve wanted to discuss.
Sharon started to cry. I handed her a box of tissues. “Are you all right?”
She blew her nose and nodded.
“So you two disagree about what’s going on in the bedroom.”
“Nothing’s going on in the bedroom. That’s the problem. We haven’t had any real sex in almost a year.”
“What do you mean by real sex?” I asked.
“Intercourse,” she said. “For a while, we were still fooling around, but he wouldn’t let me touch him—down there. He said he had some kind of crotch rash that he got at the gym, and he didn’t want me to get it. But how long does that last? The rest of our lives? For all I know, he’s having an affair.”
“What do you think is going on?” I asked.
“I don’t know, but whenever I ask him about it, he changes the subject,” she said. “About a week ago, he got out of the shower and when I asked to see the rash, he flipped out and got all paranoid, like I was going to pull the towel off him. Then he disappeared into the other room to get dressed.”
“Before this rash thing started, how was your sex life?” I asked.
“Great,” she answered. “We couldn’t keep our hands off each other. Now he’s always got some lame excuse to avoid sex—he’s got too much work, or he’s
too tired or stressed out, or he just put his ointment on the rash. It’s always something.”
“Ointment?” I wondered aloud.
“Yeah, some cream he got from Dr. Carter when the rash first started.” She paused, then said, “I don’t know how long I can take this, Dr. Small.”
I made a mental note to follow up with Pete about Steve’s rash and ointment. “Sharon, I appreciate your candor. I think it will be helpful to talk more about this, but right now we’ve got to stop. I can meet with you and Steve next week at the same time.”
That Saturday night, Linda and I were driving back to my house after seeing a movie. She was staying over, and I had already stocked the house with snacks and breakfast food.
As we got into bed, I reached over to kiss her, and she announced that she had just gotten her period and didn’t feel like making love. I hid my disappointment and kissed her on the forehead. She rolled over to go to sleep. I picked up my Ken Follett novel and started reading.
My mind wandered from Eye of the Needle to Linda’s preemptive rebuff. Then I thought about Steve and Sharon’s sexless marriage. In their case, it was Steve putting on the brakes, and his crotch-rash alibi seemed pretty weak. Also, it didn’t explain why he got so paranoid when his wife wanted to see his rash. What was he hiding under that towel? How bad could his pubic irritation be, and why did he still have it after a year?
I had a sense that Steve might have deeper psychological issues that Sharon knew nothing about. The guy was wound tight as a watch and looked like he might bust his springs at any moment. He could be a closet obsessive-compulsive or an enraged depressive, or perhaps this towel episode was a clue to something even more serious. I wondered what was going on in his mind while he spaced out during our session. When we started talking about their sex life, he bolted from the office.
Sex is a big issue in therapy for many people. Freud viewed sex as our primary social activity and defined it as much more than merely intercourse. Sexuality can be a symbol of power, and powerful people—billionaires, politicians, celebrities—are often perceived as sexy, even though they might not be physically attractive. In loving, intimate relationships, sex can be an expression of that love, even though one or both partners might be having humiliation, bondage, or other fetish fantasies involving other people.
