by G. H. Ephron
Annie had an answer ready. “Look, you’re the shrink. But if you’re wearing blinders for some reason, the answer is simple. To get attention. Your attention.” Maybe she was right, and I had been blindsided. I was supposed to be able to call myself on that kind of thing. “Of course now she’s gotten herself in quite a pickle. She had motive, opportunity. And you’re sure as hell paying attention. So are the police. I suppose if there’s a lesson in all this it’s be careful what you wish for.”
I sat in the observation room the next day, watching Emily and Mr. Black. I was more than a little troubled. A person who’d allow herself to be photographed by Playboy, even ostensibly for the money, had to be something of an exhibitionist. Emily did seem to crave center spotlight. It was exactly what she was doing in her sessions with Mr. Black, subtly shifting the focus of the therapeutic relationship to herself. It was a personality style that probably had its roots in Emily’s childhood, when she’d sought and never managed to sustain the attentions of a father who abandoned the family but kept returning every few years just long enough to impregnate her mother. But would she go so far as to create her own stalker? That seemed a reach.
“It’s damned uncomfortable,” said Mr. Black. “The tape itches, and my arm gets numb. But when I’ve had the operation, I won’t have to deal with that. Beyond that, it’s just a lot of inconveniences. Minor, really.”
“Like what?” Emily asked. Today she had on a discreet, dark pantsuit with a pink turtleneck.
“Like it takes twice as many trips to the car to unload my groceries. And it’s a pain in the ass using my computer one-handed. Buttons are hard. Zippers are harder. Handling money—getting dollar bills into my wallet? It’s all stuff I can learn to deal with.”
“Anything else?”
“Yeah. People look at me.” He paused. “They really seem to connect with me now. It’s like I jump off the radar. That part I like.”
“How do they look at you?”
“Well, they look at the arm, of course. The one that’s not there. Then the other arm. Then they look at my face.”
“So it’s a way of connecting.”
“At least they’re not ignoring me.”
“What do you imagine they’re thinking?”
“Maybe they’re wondering if I was born this way. Or did I lose it in an accident? Did I fight in the military? Maybe it makes some of them uncomfortable. I’m sure some of them get off on it. There was this one guy who followed me. I’m in Walgreens and he’s half an aisle away from me the whole time.”
“Did that bother you?”
“Why should it? It’s his problem.”
Emily looked at him without saying anything.
“You mean like, do I get off on it?” he asked. “I guess I kind of do. Do you think that’s what this is about? Wanting to be looked at? Like a flasher?”
“Does it make you feel like a flasher?”
“You mean, do I get some sexual charge out of being an amputee? I do not.” The words came out like an oath. “I certainly don’t want to be made into a dirty joke. That’s not what this is about.”
“What is it about?”
“It’s about feeling normal.”
That was interesting—equating “normal” with being stared at as opposed to being ignored, dismissed as inconsequential. Self-esteem did seem to be at the root of his issues, and maybe Emily’s issues as well.
“But there are inconveniences. True?” Emily asked.
“Some. Like I said, it’s itchy.”
“If your phantom limb itches, you won’t be able to untape it and scratch yourself.”
Mr. Black put his hand over his mouth and looked away from her. “What else am I supposed to do?” I wondered if Emily saw the same yellow lights flashing that I did. Mr. Black was asking her to save him. Would she take the bait?
“We’ve discussed medication before—” Emily began.
He stiffened. “Would you want to take a pill that erased part of who you are?”
“Think about it. You’re afraid to take a pill to erase part of who you are, but you’re willing to have a piece of yourself cut off, erasing part of yourself surgically?”
It was painful to listen to her—being confrontational like that was only inviting a pissing contest.
He reared back. “You condemn me for being self-destructive. Take a look around before you pass judgment. People do all kinds of things that are self-destructive. Smoking. Drinking. Driving a motorcycle. Owning a pit bull. You don’t medicate those poor slobs. Though I don’t know why not. Seems like we’ve got pills for everything. You want to be thin? Here’s a pill. You want to be happy? Have another. More virile?”
He gave Emily a sideways look. He was attracted to her. But now his attentions didn’t cast a sinister shadow. He wasn’t the stalker and the attraction wasn’t obsessive—this was part of transference, one of the inevitables of therapy.
“What happened to an individual’s right to choose?” he asked.
“So what do you wish for, right now?”
“To be taken seriously,” he shot back at her.
“And I’ll take you more seriously if you cut off your arm?”
“No. That’s not what I mean. What I mean is that I want people like you to take me seriously when I say this arm doesn’t belong here. And that I’m not acting out some adolescent sexual fantasy. And that I don’t need medication to anesthetize myself and turn into another kind of zombie.”
“Mr. Black, I do take you seriously. I want to help you.”
The session continued to spiral downhill. What had began as an auspicious self-examination had disintegrated, first with Mr. Black feeling attacked and disapproved of, then rising to defend himself. Now it had detoured into whether or not Emily cared about him. It was the kind of thing you expected from a novice therapist, not an experienced post-doc.
I met Emily in the cafeteria a few hours later. It was nearly two, but the cavernous room was still about half-full of staff, visitors, and patients, all dressed in business or casual clothes. Emily was at a table writing in a notebook. She wore tight leggings, and her sleeveless top, molded to her body like a second skin, was cut low. Her hair had come loose. If she’d been leaning casually against the wall and added some eye makeup and red lipstick, she’d have looked like a hooker who’d set up a concession in the middle of the caf.
“Why don’t we sit over there,” I suggested, indicating a table in the corner where there weren’t a lot of others sitting nearby.
She finished writing and moved while I got myself some coffee. When I returned, she was drinking from a bottle of water.
She looked at me expectantly. “I hope it’s okay meeting you in these.” She indicated her outfit. “I’m trying to get my running in during daylight.”
“You’re still feeling anxious?”
She didn’t answer.
“Has something more happened?”
“I feel so foolish saying this, but I’m pretty sure someone’s been in my apartment. There’s nothing missing. But some things in my bathroom were definitely rearranged. And my bed. I usually don’t make it in the morning, I’m in such a rush. It was made when I got home yesterday. It’s got to be all in my head, right? Lenny’s dead, so this shouldn’t be happening.”
“Maybe you should stay with someone for a while,” I suggested.
“Maybe I will.”
“Did you call that attorney?”
She nodded.
I considered holding back the feedback I needed to give her about her interaction with Mr. Black. She was obviously vulnerable. But she was the one who’d insisted on continuing to work with patients. My first concern had to be their well-being, not hers.
“Do you think the stress is affecting your ability to do your job?”
Spots of pink appeared on her cheeks. “Do you?”
“Why don’t you tell me how you think it went today with Mr. Black,” I said, sidestepping the question.
At firs
t she seemed flustered. “I think it went fine. I—” Then her look hardened and she slammed the notebook shut. “But obviously you don’t. If you’re going to criticize me, why don’t you just come right out and say so instead playing games?” Her voice echoed in the large space. Emily looked around uneasily, noticing that people at tables halfway across the room were staring at her.
I waited. This wasn’t a game; it was a test. Self-control and self-reflection were essentials for a therapist.
She took a breath and steadied herself. “Mr. Black. It’s going okay.” She looked at me. “Wrong answer, I know. Okay, it’s not going okay. I was sure once he tried living without his arm he’d be convinced that amputation was a mistake. But a few minor inconveniences is all, according to him. Then he goes all defensive on me. Accuses me of not caring what happens to him. How can he even suggest that I don’t care?”
“Listen to yourself. He disappointed you. He goes all defensive on you. How could he suggest that you don’t care,” I said. Emily’s mouth dropped open. I’d never been confrontational with her before. Now I was deliberately pressing to see if she was going to break. “It sounds as if you think Mr. Black’s therapy is about you.”
“Of course that’s not what I think,” she snapped.
“Then you seem to have lost your clinical perspective.”
She took another drink of water, held it in her mouth, and then swallowed.
“And since you asked,” I added, scanning the remaining dozen or so people in the cafeteria, “no, I don’t think those clothes are appropriate here.”
“Then I guess I’d better go change.” Emily sat still, blinking back tears. “Why are you being such a shit?”
She stood, gathered up her things, and left.
16
“GOOD QUESTION,” I said to myself, crushing the Styrofoam cup and tossing it in the garbage.
I’d lost it. By attacking her personally, I’d only given her permission to write off the message. She could tell herself I was the one who was under stress, overreacting. And maybe she was right. For the first time in a very long time, I felt unsure of my internal compass.
Instead of heading back to my office, I found myself walking up the hill toward the administration building to Dr. Nelson Rofstein’s office. It had been more than a decade since he’d been my clinical supervisor, but even now he served as a touchstone whenever I needed one.
“Peter?” he said, his shaggy eyebrows lifting and his face lighting up when he saw me at his door.
“Got a minute?”
He was up, shaking my hand and patting my shoulder. “Of course, of course. It’s good to see you.” A robust man, his face was lined with character and his once brown hair was now fully gray. A sloping right shoulder and a squinty eye were the only evidence of the stroke he’d suffered a few years earlier.
“Sit, sit,” he said, indicating one of cushioned chairs that faced his desk. He sat, too, leaning back in his chair and lacing his fingers over his middle. “So, tell me. To what do I owe the pleasure?” He knew me well enough to know this wasn’t a social call.
“I’m afraid I’m losing my perspective,” I said, getting right down to it. I told him about my observations of Emily Ryan and our last interaction. “I lost it, and I’m not sure why.”
“Tell me about her.”
“She’s been with us for a few months,” I said. I gave him a synopsis of the work Emily had done on the unit. “She’s exceedingly bright but doesn’t seem to be particularly self-aware. Like how she looks. Wearing running tights and a skimpy top in the cafeteria—so completely inappropriate.”
“I seem to recall you were a bit clueless in that department once upon a time,” Dr. Rofstein said with a wry smile.
I was still embarrassed, remembering how I’d washed up on Dr. Rofstein’s doorstep, ready to save the world. I’d promptly found myself struggling with my first patient—a woman whose husband was dying of a brain tumor—and my increasing frustration because she’d only talk to me about how she was renovating the house and managing the night nurses. “She’s not taking you seriously,” Dr. Rofstein had said to me. And why the hell not, I’d wanted to know.
He’d shrugged and looked up at the sky, a mute prayer for patience. “You can cut your hair any way you want,” he’d said, eyeing my three-inch Afro, “and you can wear anything you like”—he gave a nod to my open-necked sport shirt—“but your patients come in with their own mishigas and they’re going to judge what they see. First impressions. It’s not enough to act professional, which you do,” he assured me. “If you want to be taken seriously, look the part.”
Now, a dozen years later, Dr. Rofstein was giving the same heavenward look as he unlaced and laced his fingers. “Yes, you were very green. But a fairly quick learner, as I recall.” He noted my shorn hair and suit and tie. “What else are you concerned about?”
I told him I thought Emily was showing questionable judgment in her work with patients. “I’m worried that she’s relying too much on her feelings and not enough on her intellect. I’m trying to keep my perspective. She has been under a lot of stress.” I went on, hitting the high spots—the stalker, the death in the MRI lab that might or might not have been her fault, the police surveillance. “It feels as if she’s been depending on me, clinging more than I’m comfortable with. I guess it’s understandable given what she’s going through.”
“And you’re sure it’s not projective identification—that you’re not doing something to provoke this dependency?”
I didn’t think I was. Though maybe he had a point. Following her home to tell her about a broken taillight. Rushing over to the MRI lab and sneaking in. Maybe whatever Shands had seen in my brain scan was already eroding my judgment.
“I do seem to be constantly trying to rescue her.”
“So you’re wondering if there’s something going on with you that you’re reciprocating this woman’s unconscious attentions.”
“I guess I am,” I admitted. Dr. Rofstein sat there, waiting for me to get to the point. “And now I find myself doubting her integrity, wondering if she’s made up being stalked. Wondering if she’s as innocent as she says she is in her colleague’s death.”
“You’re worried that these doubts, even though they’re unsubstantiated, are coloring your professional relationship with her. Making you doubt her competence.” He pondered for a few moments, peering at me from beneath his eyebrows. “Sounds as if for some reason your view of her has changed.”
I sat up. Hearing him restate my own words gave them a different meaning. Parallax, I reminded myself. If your position shifts, the position of the object you’re looking at appears to shift. It’s why when you’re riding along in your car, the moon seems to be moving along with you; when you stop, it appears to be stationary.
There’s a similar problem in psychology—what you expect to see colors how you interpret your observations. If you think someone is a jerk, actions seem stupid that you might have called inspired if you’d prejudged the person a genius.
So what had changed my perception of Emily?
“I found out that a few years ago she posed for Playboy,” I said, feeling a little sheepish.
“And that makes you see her differently. Is it just her judgment this has called into question, or maybe there’s something more?”
I’d been at this long enough to know what he was getting at. I’d been attracted to Emily. Flattered by her rapt attention. I’d responded intellectually while suppressing the sexual part. The Playboy photos felt like a betrayal. Not unlike someone who finds his lover has been cheating.
Rofstein continued, “Peter, you’ve got a number of things going on here and it’s not surprising that you’re feeling confused. You need to pay attention to your gut. It’s telling you something, though it may take you a while to figure out what. And from what you tell me, it sounds as if this young woman has got a few things going on as well. No doubt you’re right to be concerned.”
�
�I haven’t felt this unsure in a very long time,” I said.
Rofstein sat up and leaned across his desk. “Peter, as long as you remain self-reflective you’ll do fine.”
“I should have had better self-control,” I said.
“Yes, you should. So you’ll work on it?” He rose. “And in the meanwhile, wait and see.” He walked me to the door.
“So this young woman also works at University Medical Imaging,” he said. “That’s the one over on Sidney Street?”
“Right. You know Dr. Shands, don’t you? The guru in charge?”
“Guru,” Rofstein said with a soft chuckle. “Dr. Lewy body dementia. Thank heavens for the supervisor who discouraged that young man from going into clinical psychiatry. Some of us are healers and some of us are watchers.”
“Bedside manner is not his forte. Didn’t you know him from the Cambridge Brain Bank?”
“He was one of the lead researchers.”
“But no longer?”
“We should all have his drive,” he said.
My ears pricked up. This was an evasion, not an answer. “He and the brain bank parted company?”
“He needed to pursue his own path. The brain bank wasn’t founded to support special research.”
“And how was his research special?”
Dr. Rofstein had opened his office door. Now he closed it. “He developed a way of looking at cell membrane permeability, but it was a destructive process. Brains were being lost at an alarming rate. He assumed that the brains, not to mention the funding, were at his personal disposal. It was never made public, but it was pretty clear that a percentage of each grant was being skimmed off and funneled into his personal research.”
“How did he manage that?”
“Let’s just say that he and the executive director had a very close relationship. They both resigned.”
“Dr. Pullaski?”
He nodded. “But you didn’t hear that from me. When they left, part of the agreement was that the details would never be made public.”
