by G. H. Ephron
Mr. Black showed Emily where he wanted the surgeon to cut, precisely two inches above the elbow. Then everything would be better. He could begin looking for a new job in earnest. Reconnect with his estranged daughter. Go out in public without feeling like a leper.
The session ended and Mr. Black got up to leave. He collected his notebook. Emily shook his hand and then held on, her other hand on his forearm. She didn’t seem to notice Mr. Black’s shudder.
“I’ll see you tomorrow evening at the lab?”
He nodded, his gaze riveted on the arm that Emily held. He cleared his throat.
“You gave me the address already.”
“Right. Park in the building. If anyone asks, tell them you have an appointment with Dr. Shands.”
When she let go, a look of relief washed over Mr. Black’s face. He stumbled as he left the room.
After the session Emily and I went to my office to talk. She stood, surveying my walls. Her eyes flicked over my Wines of Provence poster. She pointed to the crayon drawing of the brain and gave me a questioning look.
“I did that when I was eight. My mother had it framed when I got my doctorate in neuropsychology.”
Emily gave a wry smile and shook her head. “You’re amazing. You knew from the get-go that this is what you wanted to do.”
I laughed. “Who knows? She saved all my drawings. If I’d become an astronaut she’d have framed one of my moon rockets. A baseball pitcher? I drew a whole series of Yankee Stadium.”
“You played baseball?”
“Stoop ball. We didn’t have ballfields in Flatbush, we had front stoops. You throw a Spalding,” I said, pronouncing it Spaldeen. “You know, a pink rubber ball.”
“How fascinating. And?” Emily said, facing me now, her chin resting on her fist.
“You really want to hear this?” She nodded, her eyes wide. It had been ages since I’d thought about stoop ball, though I’d played it with Danny Ellentuck just about every day after school. “You throw it against the steps and the other guy tries to catch the ball on the rebound. After one bounce it’s a single, two a double. Catch it on a fly and you’re out. Three outs and you switch and the other person gets to throw the ball. The real object of the game is to hit the edge of the step on the stoop because then the ball goes flying and you get a home run.”
Emily smiled appreciatively. “Where I grew up there were no front stoops, or ballfields either.”
She picked up a matted photograph I had lying on my bookcase. It was a black-and-white picture of a woman in black with a mournful face and long flowing hair. She stood intertwined with the sinuous trunk and limbs of a tree. Undulating lines merged nature and woman into a single form.
“A patient gave that to me,” I told her. “She knew I liked Annie Brigman’s work.”
“It’s a pretty disturbing image.”
“I guess that’s why I haven’t put it up. Not something I want patients to have to confront while they’re in therapy.” I paused. “That’s the thing about therapy. It’s why that therapy room is so neutral. The point is for the patient to deal with what they bring into the room, not what we put in there or what we bring of ourselves.”
Emily sat down in a chair. She tilted her head to one side, alert to the nuance. “Are you saying that I’m bringing something into that room?”
I ducked under the ceiling overhang and sat at my desk, my back to the dormer window. “I noticed you trying to keep a therapeutic distance. That’s good. But shaking Mr. Black’s hand, holding on to his arm the way you did—it made it uncomfortable for him.”
“But I was just—” Emily started. She took a breath and started over. “Yalom says therapists should make a point to touch a patient during each session. Touch makes a patient feel valued.”
“I know there are therapists who make a point of shaking hands when the patient comes and when they leave. That’s not inappropriate. But perhaps touching a man with this particular disorder is pushing it. For him, it may be as intrusive as if your own therapist patted you on the behind.”
She swallowed. “Do you think I upset him?”
“He definitely reacted. It’s hard to gauge whether he took it as an aggressive intrusion, as a sexual overture, or just as a too-friendly gesture.” I rested my elbows on the blotter and folded my hands. “You want to be a neutral presence and deal with his mishigas, not yours.”
“Of course. You’re absolutely right. I guess I’m a toucher. And it’s not always the right thing to be doing.” Emily wrote in her notebook. “I’m so glad you called me on it. It’s something I need to watch.”
It was gratifying to work with a bright post-doc who didn’t go all defensive in the face of constructive feedback. Who actually wrote down suggestions. Who knew she hadn’t arrived at this rotation knowing all the answers.
As she leaned toward me, her buttoned suit jacket gaped. I caught a glimpse of skin and a transparent, flesh-colored camisole that Emily wasn’t wearing anything underneath.
“And, uh…” I tried to remember what I’d been saying. “Everything you do, what you wear…”
She tugged at the hem of her skirt.
I needed to say more. But how to do it without sounding like a lech or a prig? “You have to be careful about the signals you’re sending,” I said, raising my eyebrows and looking at her suit jacket as I touched my hand to my chest. “You might be encouraging the wrong kind of attention.”
It worked. Emily glanced down and then shrank back. “I didn’t realize—” she started.
“Any patient is going to notice. Someone like Mr. Black, with body dysmorphia, is going to be riveted. He’s already made a remark about your body. It’s like having a clanging bell in the room providing a constant source of interference.”
“Of course, you’re right.” Emily looked up at me. “How inconsiderate of me. Do you think that’s the reason I haven’t been getting anywhere with him? I keep trying to get him to examine other aspects of his life, his personality, when this first arose—and he always comes back to ‘I need to cut off my arm.’”
“That’s classic resistance,” I said. “You poke around where he’s sensitive and he becomes intractable. He redirects the dialogue.”
“Every time. I need to cut off my arm. It’s like a mantra that he keeps chanting at me.” Emily gave an anxious glance at her front. The suit jacket had stayed in place.
“I’m sure there’s more to his resistance than what you’re wearing,” I said. What a therapist wore was easily fixed, once he or she was aware. “I had an obsessive patient who drove me nuts. He’d go on and on about how miserable his life was. Nothing I could do could make him shift perspective. With people who are obsessed like that, it takes on such intensity that no matter how logically you argue, you lose.”
“That’s Mr. Black all right,” Emily said. “Remember, we talked about whether the roots of his obsession might be organic?”
It was an interesting idea which Emily had begun to investigate. At first I’d dismissed the notion that something in Mr. Black’s brain was telling him that he shouldn’t have an arm. Then I reconsidered. Why not? People with phantom limb syndrome continue to feel sensations in an arm or leg long after that limb has been amputated. We’d speculated about what a functional MRI might show. Maybe arm movement on one side elicited qualitatively different responses in the brain. One of the pleasures of working with a bright young psychologist, new to the field, was wrestling with fresh ideas.
“I was able to convince Dr. Shands to give me an hour on the new system.”
“New system?” I asked. In recent years, magnetic resonance imaging technology had taken huge strides. Scanners had become smaller and less intimidating, and at the same time more powerful. And unlike PET and CT systems, huge magnets didn’t give off radiation.
“It’s a four-point-five tesla machine.”
I whistled. That made it nine times as strong as the one we had at the Pearce. Must have cost a fortune. But then, the medica
l schools would be flocking to it with their research grants. It would pay for itself long before it became outdated. In the meantime Shands had his own his own high-tech playground—a researcher’s dream.
“I’ve never seen a system that powerful. I’ll be very interested to see what you find out.”
“You want to observe? It’s tomorrow night,” Emily said, her color rising. “There’s usually a no-observers policy, but I’m sure he’ll make an exception for you. You can sit in the control room with me. You’ll actually see the images as they come in. The computer synthesizes them to three-D. It’s like watching a movie of the brain in action.”
I glanced up at my crayon drawing of the brain, at the plastic model of the brain I kept on my shelf. I remembered the excitement I’d felt when I dissected my first brain. I couldn’t turn down a ringside seat, watching a brain in operation.
Tomorrow night? Shit. That was when I had a date with Annie. I heard myself saying “What time?” Immediately I felt a rush of guilt. I’d just stood Annie up and now I was about to do it again.
“Eight.” She turned to a new page in her notebook and wrote, tore off the sheet, and handed it to me. The note said “University Medical Imaging Center” with a Sidney Street address in Cambridge.
Surely the test wouldn’t take more than an hour. I’d call Annie and see if we could get together after. As I tucked the paper into my pocket I wondered what the hell was wrong with me anyway. Most men had the problem of letting the little head control their actions. I seemed to be letting my big one run amok.
“Thanks for the feedback.” Emily stood, reaching out to shake. I got up and grasped her hand. “I was also wondering what you thought about my questioning. Did I overstep?” she asked. Her hand was warm in mine. I felt a moment of discomfort as she held on, her eyes rapt.
“Not for the most part,” I said, jerking my hand away and reaching to straighten my bow tie. Okay, she’s pretty and you’re flattered by the attention, I told myself. You’re her supervisor. Where’s your clinical distance? “The only place I thought you skated the line was when you reminded him that he wouldn’t be able to change his mind. It wasn’t so much what you said as how you said it. It felt somewhat confrontational.” My voice sounded stiff and formal.
“I guess I don’t want him to make a terrible mistake.”
It was the kind of thing you typically heard from an inexperienced therapist. “Remember, you never know what’s best for your patient.” I opened the door for her.
“But what if he makes the wrong decision? I mean, amputation? It’s barbaric.”
“It’s his decision to make. His life to live. You can’t help him unless you truly believe that.”
She was halfway out the door when she stopped and turned back. “How do you think he knows I drive a Miata?”
I’d wondered the same thing. “You think it could be him?”
“I wouldn’t have thought so,” she said.
I agreed—Mr. Black seemed far too self-absorbed to have formed an obsessive attachment to Emily. On the other hand, I’d evaluated enough murderers to know that villains took surprising shapes. Ralston Bridges had fooled a jury.
“I wouldn’t rule anybody out unless you know for sure,” I said. “Please be careful.”
4
“I’M SURE you’ll be dazzled by it,” Annie said dryly after I told her I had an opportunity to see a functional MRI on this new machine, and could we postpone our date. “Actually, I was going to call you. Something has come up—”
“I could be there by nine-thirty. Ten, the latest,” I tried.
“No, really, it’s okay. I’m probably going to be tied up.”
“Another family emergency?”
“Something like that.”
“Is there anything I can do to help?”
“Maybe.” I heard some papers rustle on her end. “I’ll let you know.”
I hoped “family emergency” wasn’t just a convenient excuse. I was coming up with one bad scenario after another. I’d been crowding her and she needed some space. An old boyfriend was in town. She was doing round-the-clock surveillance on a particularly dangerous case and didn’t want to worry me.
“You could try calling me when you’re done,” Annie said. “I may be finished.”
“Sounds great. I can pick us up some takeout from Mary Chung’s, maybe a pint of French vanilla from Toscanini’s?” I get that from my mother, a belief in the power of good food.
“Mmm,” she said, but it sounded as if her mind was already somewhere else.
Her good-bye was distinctly distant and our conversation felt unfinished. It was still gnawing at me the next evening when I drove to the imaging center. My stomach rumbled, reminding me that I hadn’t eaten anything since a bowl of tepid minestrone soup and a packet of saltines at lunch. Some dun dun noodles from Mary Chung’s sure would hit the spot. I hoped Annie would be home when I was done.
I turned down Sidney Street. This area had been transformed over the last five years. Once the home of the Simplex Wire and Cable Company, the area was now the poster child for urban renewal, Cambridge style—a mixture of residential buildings, office space targeting before-the-bust dot-coms and biotech startups, with a hotel and giant supermarket thrown in for good measure. A historic brick-and-beam factory building, where myth has it they baked the first Fig Newton, was now artist lofts.
I drove past the modern glass-and-granite office building. The entrance to the basement parking garage was around the corner. I had to go two levels down to find a spot. Then I rode the elevator up to the main floor.
The lobby had a high ceiling with an old-fashioned crystal chandelier that would have felt right at home at the Met. The interior, with its warm wood and brass fittings, was designed for tenants who could afford to pay plenty of overhead.
A uniformed security guard behind a circular mahogany counter asked me to sign in. He pointed me to the two-story archway that led to the University Medical Imaging Center. A pair of potted trees, taller than I, flanked the double glass doorway.
In the waiting area, the large window in the wall was slid open. A young woman at a desk on the other side had her jacket on and was shutting down her computer. She was tall and blond, like she was fresh off Malibu Beach. I told her who I was and why I was there. She disappeared into the back.
While I waited I looked around the empty carpeted waiting room. Rows of straight-backed chairs were punctuated by low tables loaded with magazines. The photos on the wall were blow-ups of historic Boston. I was admiring a picture of the Old Howard—a burlesque house in Scollay Square, that mythic part of Boston long ago torn down to make way for a soulless Government Center—when the door to the inner area flew open. A tall, handsome man with a chiseled profile and a mane of silver curls came toward me, his hand outstretched. He wore wire-rimmed glasses and his teeth glowed.
“Dr. Zak?” he said. “Dr. Ryan has told me all about you. I’m Jim Shands.”
He had the firm handshake of a seasoned politician. He ushered me into an antiseptic-smelling area where harsh fluorescent lighting bounced off a white vinyl floor.
“Please, call me Peter. I’ve read your papers on Lewy body dementia. Very interesting.”
“And I’ve read yours on memory,” he said. “Impressive.”
His gaze fell to a FedEx box on the floor. “What the…?” he started. Labels on it read WET ICE and STORE AT 4 C. “How the hell long has this been here? They know I’ve been waiting for this.” He looked around and, seeing no one, raised his voice. “Why in God’s name didn’t someone tell me this was here?”
He picked up the box like someone might pick up a newborn baby and cradled it in his arms. “Amanda,” he barked. “Where is that girl?”
“I think she went home,” I said.
“Incompetence.” He muttered some more about how he’d told her a million times. Then to me, “Sorry. I need to take care of this. This won’t take a minute.”
He disappeared
down the corridor. When he returned a short time later he seemed fully recovered.
“I appreciate your allowing me to observe,” I said. “I don’t know nearly as much as I’d like to about MRI technology.”
“If you’re going to see it, this is the place. We’ve got the strongest whole-body magnet used for clinical imaging in the country.”
We started down the corridor.
“I understand you do some forensic work?” he said.
“I evaluate people who are accused of crimes.” I didn’t mention that I always work for the defense. I’d learned not to the hard way, having sat through more than my share of lectures that began with raised eyebrows and a knowing look, followed by Oh, so you’re one of those hired guns.
“Have you read about the recent Johns Hopkins work, examining brain scans of convicted criminals?” Shands asked. “They found abnormalities in the prefrontal cortex.”
I’d read the study. Their findings confirmed what had been hypothesized for years—that the prefrontal cortex plays a role in controlling emotions and behavior. It invited the question: Could we “fix” a criminal’s frontal lobes so he’d stop committing crimes? This kind of speculation had encouraged a flurry of work exploring drug therapies and brain surgery. Cingulotomies—operations to excise a portion of the brain’s limbic system—were in vogue. The operation seemed to help certain patients, especially extreme obsessives. Still, the thought of it made me shudder. I hoped we weren’t headed back to the good old days of frontal lobotomies àla One Flew Over the Cuckoo’s Nest.
We approached a pair of double doors. There was a sign on one of them, a bright yellow triangle with a picture of a horseshoe magnet on it with zaps of lightning coming from the ends. Below it were the words STRONG MAGNETIC FIELD, and below that NO METALLIC IMPLANTS.
Shands pointed to the sign and gave me a questioning look.
“No implants,” I said. “At least none that I know of.”
