by G. H. Ephron
There was a long pause.
“He’d be living a nightmare,” she said, her voice calm and quiet. “I’ll fax the consent forms over to the lab this afternoon. Though I have to tell you, I don’t like that place. Do all research labs treat patients like crash-test dummies?”
It was the perfect image. Maybe it was inevitable. After all, researchers had to be dispassionate observers, and that required a certain sangfroid in the face of human suffering. They worked at the macro level looking for patterns—the occasional patient who beat the odds only muddied the picture.
“I’m glad you’re not a researcher,” she added.
11
FOR TWO weeks Uncle Jack became my proverbial watched pot. I knew improvement, if any, would come in imperceptible increments. But even in this short time there did seem to be some. His gait was more stride than shuffle. He seemed a bit more coherent and the hallucinations less frequent. The nurses reported that he was doing better caring for himself, and was sleeping without nightmares.
I tried to curb my enthusiasm when I gave Annie progress reports. It could just be a bubble. I looked forward to those daily phone calls, even though all we talked about was Uncle Jack. Whenever I suggested that we get together, Annie put me off.
That morning Uncle Jack had gone to the imaging lab for a follow-up MRI. This time, he’d made the trip with a mental health worker. Philbrick had given me a curt “absolutely not” and cited safety concerns when I’d asked if I could observe.
I checked on Uncle Jack when he got back. He was in the common room watching TV. This time, the experience had left him somewhat subdued but otherwise unscathed.
I wondered if his test results would confirm the improvement, or if I was seeing what I wanted to see. It could be simply a result of the move to the Pearce, regular meals, combined with our trained staff and the meds we were giving him for the tremors and hallucinations. For all we knew, Uncle Jack could be getting the sugar pill.
“I finally got the analysis of Mr. Black’s test results,” Emily told me during our weekly supervisory one-on-one that afternoon. Her stalker had been dormant since the incident in the garage. “Usually it only takes about a week. Guess this wasn’t anybody’s top priority but mine.” She reached for a tissue, discreetly removed the gum from her mouth, and threw it away.
“And?”
“Very disappointing. Differences left to right are pretty much the same for him as for the average person we’ve tested. If I’d been reporting results just based on observation, I’d have said for sure there was something there. I guess that’s why research studies are always double-blind.”
“We see what we want to see,” I said. “Fortunately there’s all that sophisticated equipment and data analysis to keep you honest. How’s Mr. Black doing?”
“I’ve been thinking about what you said. That you never know what’s right for your patient. Intellectually, I know you’re right. I’ve heard it over and over—they drill it into you. But emotionally I can’t quite wrap my arms around it.” She gave me a hard look.
I didn’t say anything.
“I know, I know, as a therapist, I’m supposed to keep telling myself that I can only try to control what goes on within the confines of the therapy room. To believe otherwise is a sure recipe for disaster.”
I had to smile. “A sure recipe for disaster” had been one of the trademark phrases of Dr. Rofstein. That was how mentoring worked—hopefully we only bequeathed the good stuff.
“So how is this different from a patient who’s suicidal?” Emily continued. “I’m not supposed to just sit there and nod and say, ‘How interesting. Tell me more about how you’re going to kill yourself.’” Today she wore a white blouse under her suit jacket, and there were no flashes of bare skin as she leaned forward. “Don’t I have an obligation to act?”
“If you think a patient is serious about killing himself, then yes, you have an obligation to act. If he tells you he’s going to hurt someone else, then by law you have to warn that person.”
“So here’s a man who says he’s going to cut off his arm? What can I do to stop him?”
“If he’s psychotic or demented, you can commit him. Do you think he is?”
“He’s not.”
“Do you think he’s suicidal?”
“No. But he’s got this obsession—”
“You can’t hospitalize him unless what he’s doing is life-threatening. We’re talking self-mutilation. That’s not necessarily even about wanting to die. It can be just the opposite. Some people crave pain in order to feel connected to the real world. While we all might have opinions about what Mr. Black should or shouldn’t do, as his therapist you have to accept the fact that you can’t control his actions.”
“It’s so frustrating,” Emily said, her fists clenched. “So I just sit back and watch, engage in some intellectualized bullshit when a person is in desperate need of a kind of help that I’m not allowed to give?”
I admired her passion, her determination to help, but she was dead wrong. “It’s not intellectualized bullshit.”
Emily stared out the window. “Well, I can’t do nothing. Can’t I at least tell him that as an outside observer, I don’t think this is such a good idea?”
“Sure you can, but what would be the consequences? Suppose you say, ‘I don’t think you should cut your arm off,’ but that’s what he wants to do? Why would he come back to you? By offering your opinion you run the risk of ruining the therapeutic relationship.”
“So what do I do?”
“Think about it this way. It’s like penicillin. If a patient has an infection, then the key to treating him is to make sure he takes the penicillin.”
“So”—Emily paused, sitting up straighter—“you’re saying that the key is to keep Mr. Black working in therapy before he takes action. Make sure he keeps working at understanding where this need comes from.”
“Right,” I said. “Explore other ways of dealing with these urges.”
“So I was on the right track when I tried to help him understand the downside of doing this?” Now she didn’t need to look to me for approbation. It was one of those “aha” moments that make supervision so gratifying.
“You could go even further,” I said. “Encourage him to get the data he needs to make an informed decision.”
“Data…” Emily murmured. She frowned and thought for a few moments. “So I could suggest that he talk to people who are amputees.”
“Sure. That’s the kind of thing that would give him a chance to experience vicariously before he acts.”
Just then my phone rang.
“I wonder—” Emily said, her brows coming together over her eyes. The phone rang again. “Go ahead, take the call.” She stood. “I gotta run anyway. Mr. Black is probably waiting for me and I’ve just had a brainstorm.”
I picked up the phone. It was Gloria. “I thought you’d want to know,” she said as Emily shut the door. “Mr. O’Neill isn’t feeling well. Started vomiting after lunch. Now he’s wheezing and feverish. We called his niece and let her know.”
As if to underline Gloria’s concern, the red message light on my phone had begun to blink. I ignored it. Whoever it was would beep me if it was important.
“But I was down there just a couple of hours ago and he was fine.”
“Hey, I’m just the messenger. Could be a stomach bug. We’re keeping an eye on him.”
I checked my watch. My last patient of the day wasn’t due for fifteen minutes. I hurried down to the unit. Uncle Jack’s bed was cranked nearly vertical and an oxygen mask was strapped over his face. He looked pale but comfortable, his chest rising and falling with each breath. At the end of each exhale, I could hear a little whistle from his lungs. His eyelids fluttered when I touched his shoulder.
“How you feeling?” I asked, pulling up a chair and pushing the mask aside.
“Been better,” he said.
“Heard you had another MRI this morning,” I said.
He muttered something that sounded like “fool thing.” Then his eyes drifted and he was focusing on a space over my right shoulder, a faint smile on his lips. I wondered if Felicia’s ghost was back.
I turned around. Annie had come into the room. She must have had to testify in court today because she was wearing a dark suit and had her hair pinned up. She looked worried. I knew this wasn’t the time or the place to notice her legs, but I couldn’t help it. Uncle Jack blinked at her. She took his hand.
“Hey big guy, what’s this about you getting sick?”
Uncle Jack managed a chuckle.
Later, in the hall, Annie asked me, “You don’t think this has anything to do with that test he had today? I mean, both times he gets an MRI he ends up wheezing.”
“MRIs don’t cause breathing problems,” I said. I didn’t add that this time it was more than breathing problems. He couldn’t keep food down and his temperature had spiked to over a hundred.
“But he was in that tube. Maybe the person in there before him was sick. Coughed all over the place. They don’t bother to wipe it down—”
I didn’t bother to point out that in fact they did. “Most bugs that make you sick like this have an incubation period that’s more than a couple of hours.”
Annie was having no part of it. “People pick up all kinds of infections in hospitals that they wouldn’t if they just stayed home,” she said. “Didn’t I read about flesh-eating bacteria that some guy got after he was operated on for a hangnail?”
“Flesh-eating bacteria?”
“I’m not making this up.”
“Annie, your uncle’s probably got the flu, not a hangnail. It’s the kind of thing he could have picked up anywhere. At least he’s here, where can monitor him closely.”
Annie was pacing up and back now in short rapid strides.
“Maybe I should take him out of here. Right now. He was fine at home.”
“Annie!” I stopped her and put my hands on her shoulders. “You know as well as I do that he was not fine.”
“But he wasn’t sick like this.” A tear started at the corner of her eye.
“I know, I know,” I said gently, taking her in my arms. “But he is now.” I rested my cheek against her and inhaled her fruity scent. “And he needs to be monitored. It could be a virus of some kind.”
“Just flu?” She sounded hopeful.
With someone Uncle Jack’s age it was never “just flu.” Flu and pneumonia were among the leading causes of death in older people.
“We’ll watch him round the clock. If there’s any problem we’ll get him admitted to the medical hospital immediately.”
“Hospital?” Annie pulled back and gave me a horrified look.
It had been a long day. Administrative meetings had lasted until seven. After that I checked in again on Uncle Jack. The oxygen mask was on the table and he seemed to be breathing easily. He had the covers pulled up to his chin but seemed chilled. I got an extra blanket and tucked it around him.
I went up to my office, hauled my briefcase from under the desk and slid in some notes I’d taken. I was feeling tired and achy myself and wanted to get home. I reached for the phone, intending to give Annie a quick update before taking off. The red message light was still going.
I groaned, and considered leaving it until morning. I swallowed my impatience and dialed voicemail.
“You have four new messages….”
I sank into my chair and scrounged for a pencil and a scrap of paper.
“Dr. Zak? This is Leonard Philbrick calling.” I recognized his high-pitched voice. “I wanted to”—there was a pause, like he wasn’t sure why he’d called—“I wanted to check on how Mr. O’Neill was doing. The procedure went smoothly this time, but he did have some breathing difficulty. I was concerned about…” His voice trailed off. “I wonder if you could give me a call. I’m at the lab.” I made a note of the number and deleted the message.
The next one had come in at three. It began with a stretch of silence. At first I thought it was one of those automatic-dial phone solicitations. Then, “Damn.” Sounded like Philbrick again. The third message came in at 3:26. It was my mother, wondering if I wanted to join her and her friend Mr. Kuppel for a seven o’clock screening of The Collector at the Brattle. Too late for that. Too bad, too. I remembered the film—a dweebie bank clerk adds a girl he’s lusted after from afar to his meticulously catalogued collection of butterflies. It was a world-class creepy performance.
The last message. Six-twenty. I waited. The caller cleared his throat. “This is Dr. Philbrick again. Please give me a call this evening? I should be home after nine.” He left his number.
He hadn’t called all that long ago. Maybe he was still at the lab. I called. Their answering system picked up. I punched in Philbrick’s extension. Six rings, then his voicemail. I left a message that I’d call him at home.
There was no answer at home either. Later that night I tried again after the ten o’clock news. Still nothing.
I got in early the next morning. First thing I went to check on Uncle Jack. His empty bed had been stripped. Was he up and about, a miracle overnight cure? I didn’t want to think about the alternative. I wheeled around and ran smack into Kwan.
“We hospitalized him,” he said.
“How come no one called me?” My voice came out louder than I intended.
“Peter, he just went off a couple of hours ago. I knew you were coming in and—”
“What happened?”
“If you’ll stop interrupting me, I’ll tell you.”
A woman patient was hovering down the hall watching us. I pulled Kwan into Uncle Jack’s room with me.
“His fever was worse and he had shaking chills,” Kwan said. “Shortness of breath, chest pain. Not severe, but I didn’t want to take a chance. Better he’s in the hospital where they can treat him aggressively if it turns into pneumonia.”
Pneumonia. Some called it “friend of the aged” because it was a relatively benign death. Certainly it was quicker and neater than dying of Lewy body dementia.
“Has anyone told the family?”
“I was just about to do that,” Kwan said.
“I’ll take care of it.”
I rushed up two flights of stairs and down the corridor to my office. I barely noticed Mr. Black waiting outside Emily’s office. I unlocked my door and went for the phone. Annie might still be at home or she might be on her way to work. Either way, her cell phone was the better bet.
One ring. Two. Please pick up.
When she did, I exhaled.
Before she could ask what was wrong I said, “Kwan doesn’t think it’s life-threatening, but as a precaution your Uncle Jack has been admitted to Beth Israel.” I told her about the fever, the chills, chest pain.
She didn’t say anything for a moment. Then, “This was just what I was afraid was going to happen. I told you I didn’t like that place.”
“And I told you that MRIs can’t cause upper respiratory illnesses.”
“So why is he sick? That’s it. No more tests. No more magnets. No more little pink pills. I don’t care. That place is a death trap.”
“Annie, I’m really sorry,” I began, the words sounding lame and inadequate.
“It’s not your fault. It’s mine. I should have listened to my gut.”
Instead she’d listened to me. I gave her the information about where Uncle Jack was and when she could visit. Then I hung up the phone and massaged my temples. It was too early for a headache, but I was developing a doozy.
I opened my drawer and took out a bottle of aspirin and what I thought was an empty mug—turned out it had a coating of pungent scum on the bottom. I headed for the bathroom to get some water.
Mr. Black was still out in the hall, waiting. “Have you seen Dr. Ryan?” he asked. “Her car wasn’t in the parking lot when I got here.”
Hadn’t he just had an appointment with her the day before? She was his therapist, not his girlfriend.
What she drove and where she parked was no business of his, and I was about to tell him so when I noticed his right shirtsleeve was empty. It was too late to keep my jaw from dropping.
Mr. Black glanced at his missing arm. Then he examined my face. He suppressed a grin. Then I noticed that his upper body seemed thicker on the armless side, and his shirt twitched. He must have taped his arm to his chest. Emily had said she had a brainstorm. I had to admire it. Here was an intervention, allowing Mr. Black to try out what it was like to live without an arm before actually doing it.
“I thought I had an eight-fifteen appointment with her,” he said. It was past 8:30. “Do you think she’s all right?” He seemed genuinely concerned. “I’m sure I don’t have the date wrong. I just saw her yesterday afternoon and we made a special appointment for first thing today. She wanted me to come in and report on my, uh”—he paused, glancing at his arm—“progress.”
I went downstairs. Gloria was at the nurses’ station. She checked the notebook she keeps with all our schedules. “She’s supposed to be here.” She cocked her head and looked up at the ceiling, as if she were looking up at Emily’s empty office. “It’s not like her to keep a patient waiting.”
I picked up the desk phone and called Emily’s beeper. I punched in the number for the unit. While I waited for a call back, I washed out my cup, filled it with fresh coffee and knocked back a couple of aspirin. I sifted through the mail, and Gloria hovered over the phone.
After ten minutes, Emily hadn’t called. Gloria had already looked up her home number. She tried there. The answering machine picked up.
“Maybe she’s at the lab where she works,” I suggested. I looked up their number and called. The phone rang and kept on ringing.
That was odd. It was after nine. Where was Amanda, the receptionist? If the office wasn’t open, wouldn’t they have calls forwarded to an answering service? I was about to give up when someone picked up.
