Because I Come from a Crazy Family

by Edward M. Hallowell

  The cuisine in New Orleans was as distinctive as the funeral processions, and just as much of a celebration. It has evolved since I was there in the late 1970s, influenced by the genius of chefs such as Paul Prudhomme, Emeril Lagasse, and “Miss Ella” Brennan, but even when I lived there it was unique in the world of food and truly to die—or pass on—for. The lowliest bar served a great red beans and rice, every restaurant served coffee with chicory so rich you could almost use it as a sauce, the baguettes were crunchy, warm, and chewy, and the service was always begging us busy, serious people, “Just sit back, relax, and ennn-joy. Don’t hurry none, y’hear?”

  I had my favorites. When I could afford them, the famous Galatoire’s with its perfect shrimp rémoulade; Commander’s Palace with its Cajun-spiced pan-seared redfish; the Caribbean Room at the Hotel Pontchartrain with its inimitable Mile High Pie; Pascal’s Manale with its luxurious barbecued shrimp drenched in a bath of olive oil, white wine, garlic, and Manale spice (black pepper, cayenne, paprika, salt, thyme, oregano, and basil); and all the fish shacks on stilts out on the lakeside—all destroyed in Hurricane Katrina but since rebuilt.

  And then there was a very special joint—it looked like a joint for sure, a ramshackle shack on the side of the road which you’d never know was one of the best restaurants in the USA—that you had to drive the twenty plus miles across the causeway to get to, Mosca’s, with its fabulous, nowhere-else-to-be-found Oysters Mosca as well as its simple crabmeat salad that is like no other crabmeat salad you will ever have and that you will never be able to replicate. (Believe me, I’ve tried dozens of times.)

  Like New Orleans’ cuisine, many members of the Tulane Medical School faculty were unique. Aside from my favorite, McCormick, there was Thorpe Ray, chief of Medicine, whom students called Yoda. He was a barrel-chested Texan who smoked cigarettes (you had to be one stubborn, addicted, independent-minded sumbitch to be chief of medicine at an academic medical center and smoke cigarettes in 1978) and could diagnose just about anything within minutes of hearing the history. He could gauge your degree of heart failure by looking at your neck veins from across the room, could tell your hematocrit within a point by looking at your nailbeds.

  He had no use for the abstract. One time I went with a few other students to talk about the moral questions raised by keeping people alive when they wanted to die. He listened to us, quietly smoking his Camel, then put it out in the ashtray on his desk. “You’re third-year students doing your Medicine rotation, am I right?”

  “Yes, sir,” we said.

  “Well, my friends, here’s my advice. I suggest you spend your days and burn the midnight oil learning how to keep people alive. When you master that, then you can come back and we can talk about how and when to let them die.”

  Senior to Thorpe Ray was Robert (Bob) Heath, a movie-star-handsome, tall, tanned, white-haired psychiatrist who became a psychoanalyst because that’s what you did in the 1940s but then became a neurophysiologist. He believed that mental illness had its roots in biology and could best be helped through biologically based therapies. At first, this made him a renegade. He headed to Louisiana, no doubt because he wanted to find the freedom to pursue his interests in ways that the more orthodox northeast medical community would not allow. A persuasive leader, he founded the Department of Psychiatry and Neurology at Tulane in 1949.

  Heath was a brilliant man, and, coupled with his striking good looks, he exuded charisma. He could get away with just about anything. But, like many charismatic, brilliant people, sometimes he went too far and did what today we would look upon as unethical and deplorable. For example, he once tried to convert a gay man to being heterosexual by surgically implanting electrodes in the pleasure center of his brain, then hiring a prostitute for him to have sex with. We now look with horror at what he did, but this was the era when homosexuality was still regarded as a mental illness. I say that in no way to excuse Heath—what he did was hideous—but to put his actions into historical perspective. The treatment of gay people back then was cruel and unforgivable, not just in the field of psychiatry but in ordinary life everywhere.

  When my cousin Jamie was a junior at Harvard in 1970, wrestling with the sexual feelings he’d had for boys and men since he was a small child, he went to the leading psychiatrist at the Harvard Health Services who after just a few minutes told him not to be silly, he was not homosexual at all, and to put those fears to rest. It’s that kind of advice that precipitated suicides. It would be decades before the field of mental health would de-pathologize homosexuality and see it as what it is, a normal and healthy variant, a trait some people are born with.

  Heath was trying to understand all of human behavior and emotion from a biological perspective, and in that regard he was ahead of his time. It’s just that his methods and his findings were objectionable. In the 1950s he isolated an antibody he named taraxein in the blood of some schizophrenics that produced schizophrenia-like symptoms when injected into monkeys. This led Heath to postulate that schizophrenia was an autoimmune disease.

  When he presented this idea to us med students in a lecture, my classmate, Tom Garland, one of the brightest guys in our class, asked, “If it is an autoimmune disease, wouldn’t you predict that steroids would help, seeing as how steroids help most autoimmune conditions?”

  Dr. Heath had to admit that that was a good point. There was, and is, no research to show that schizophrenics benefit from a course of steroids. Since then the role of taraxein in causing schizophrenia has been debunked, with many experts not believing that taraxein exists at all.

  Heath later teamed up with a neurosurgeon to implant electrodes in the limbic area of some schizophrenics’ brains. The limbic region controls emotion, and Heath’s hypothesis was that there is some lesion in the pleasure circuitry that impairs schizophrenics. After surgery, the patient could push a button on the external box he or she carried around and stimulate the limbic system when the patient was hallucinating or otherwise having symptoms. I actually had one of these patients under my care as a student during my third-year psychiatry rotation. The patient was proud of the little box he carried in his shirt pocket, but beyond that, he reaped no benefit from his electrical stimulator. As far as I could see, the research subjected the patient to considerable risk with no gain whatsoever.

  As a med student, I didn’t know what to make of Dr. Heath. On the one hand, he was chair of the department of the specialty I would likely enter. On the other hand, he was going off on wacky tangents supported mostly by his own grandiose vision of himself. Or so it seemed to me. I found myself wishing, once again, that I had a less crazy, wiser man in charge of the family I was planning to join.

  But Heath was the exception. Almost all of the teachers I had at Tulane were smart, ethical, and inspiring. They taught me doctoring, they taught it in a way that made me love doing it. I adored George Bailey, a professor of medicine who did his fellowship in nephrology at the Brigham in Boston before coming to Tulane. Along with three other fourth-year students, I did a clerkship with him senior year.

  George was larger than life, all three hundred pounds of him. He loved food and wine. He was a true Dionysian, and his enormous girth showed it. He was a life enthusiast, brimming with energy and loving to teach.

  Four of us seniors spent a week with him on the road. It began with his holding his two little daughters in his arms outside his home on St. Charles Avenue, where we met him, kissing them goodbye, and then piling us into his capacious BMW. He ran dialysis units in New Orleans and throughout the state and made tons of money, so lots of people were jealous of him, but as far as I could see he was a great doctor who happened to be a crackerjack businessman as well.

  And boy, did he love food. He’d find the one restaurant in the middle of bayou country that was a gem. He was the person who introduced me to Mosca’s and several more out in the swamps that I fear I’ll never get back to but hope I will.

  That week, as we drove those Louisiana back roads, he’d talk ab
out food and wine (he taught me about the great Sauternes from Château d’Yquem, which I had never heard of until then), or give us practical tips on medicine. “I’m gonna tell you what you need to know as a doc but they don’t teach you in your med school classes. Let’s start with constipation. You’ve gotta have plenty of remedies for constipation in your mental Rolodex. People, especially old people, especially old people in rural Looosiana, don’t like to be stopped up. And if you can give ’em some relief, they will love you forever. There’s softeners, there’s lubricants, there’s stimulants, there’s osmotic agents, there’s bulking agents, there’s enemas, and don’t forget, there is always your index finger. Never forget your index finger. You can make an old person practically have an orgasm if you disimpact them right there on the spot.”

  “Aw, c’mon, George, I don’t wanna be doin’ that!” one of us said.

  “I’m jus’ tellin’ you, you can bring a body a ton of relief, but you do what you want. And then we got headaches. You gotta have remedies for headaches. The two most common reasons a person goes to the doctor are cough and headache. So you wanna have good solutions for both of those.”

  I had more fun with George Bailey, and learned more that week about practical medicine, than during just about any other week of med school.

  But in remembering the Wild West style of Charity and Tulane, I have to end with Dr. Gallant. Raised in Brooklyn, Dr. Donald Gallant came from New York City to Tulane to practice psychiatry and teach. Another connoisseur of fine food, Dr. Gallant even had a dish at Mosca’s named after him.

  I had only one direct exposure to him, but it’s one I will never forget. I took the elective he offered in the treatment of addictions in general and alcoholism in particular.

  Gallant was an immensely popular instructor, winning the best teacher award many times. He gave his all to us medical students and to the residents. Innovative, irreverent, but also ethical and conscientious, Gallant was a brilliant teacher and hugely generous, good man.

  His theoretical basis in treating addiction was to start by breaking down the alcoholic’s denial in order to help him or her achieve and maintain sobriety. This is standard procedure in the field. How he did it, however, was anything but standard.

  It was theater. All of us—Gallant’s sessions usually had an audience of around twenty-five, including students from all disciplines, interns, residents, and an occasional faculty member—gathered in a conference room and sat in a semicircle. Gallant sat in front of us, at the center of the semicircle.

  At the start of the first session I attended, after Dr. Gallant took his place, a man entered the room along with his wife. The two of them looked to be in their early forties, maybe; both were attractive, in pretty good shape, and looked well off. The man was wearing a wrinkled suit and a nondescript tie, while his wife wore white pants and a pale blue blouse. Certainly not your stereotypical alcoholic and spouse. They did both look nervous, understandably, before this audience of strangers. Of course, they had been told what the setting would be, and they had agreed to it.

  After pleasantries, the session began. “Have you had anything to drink since our last meeting?” Dr. Gallant asked.

  “Well, I had one slip,” the man sheepishly admitted.

  Gallant then went off. “What do you mean, a slip? Did you slip on a banana peel? Or a cake of soap? Or did someone pry open your mouth and force alcohol down your throat? Or, just maybe, are you telling me you were so weak you just couldn’t stop yourself?” He spoke those last few words in a mocking, whining child’s voice. “And so you just had to take a drink? Aren’t you ashamed of yourself?”

  The man nodded.

  “Well, you should be!” Gallant went on.

  Then he turned to the wife. “Have you been giving him his Antabuse?” She nodded. “Did you give it to him that day?”

  “I thought I did,” she said. “I mean I thought I saw him swallow it.”

  Gallant went off again. “How many times do I have to tell you? When will you learn? Addicts are liars! They are born liars, they will do anything to deceive you.” Then, looking at the man, “Am I right? Aren’t you a liar? Won’t you do anything to get your precious drink? Well, c’mon, won’t you?”

  The man nodded, almost imperceptibly.

  “Well,” Gallant went on, “what are we supposed to do with you? Are you gonna string this lady along forever, just lying your way into a divorce and losing everything?”

  “No,” the man said. “I’m going to do better.”

  “That’s what you all say,” Gallant barked. “Why should anyone here believe you?”

  It was painful to watch this. I wanted to stand up and say “Stop it!” but restrained myself, knowing that I would only get into a ton of trouble and Don Gallant would only redouble his efforts to “break down the denial.” I had to remind myself that Dr. Gallant had developed his method over years, and that people came to see him because he got good results.

  I’ve thought of Don Gallant often in the years since I graduated. Was he right or wrong to use his confrontational style? I didn’t know then, and I don’t know now. I do know that I admired Dr. Gallant because he was doing his best to address the deeply difficult problem of alcoholism.

  I am sure he did not think he was being cruel. He thought he was doing what needed to be done. That I felt it might have been cruel, well, that’s just me. And Gallant had a whole lot more experience in treating alcoholism than I did, that’s for sure.

  But what he did teach me, and why I remain to this day grateful to him, is that the confrontational style with which he treated that patient, and all the others he ran through his regimen, lives within me just as much as it did within Dr. Gallant.

  Because whenever he was going off on a patient, attacking and even humiliating him in front of all of us, carrying on as he did, all I had to do was imagine Uncle Unger in the patient’s chair, and then, presto!—I’d be cheering Dr. Gallant on as if he were my knight in shining armor. “You tell ’im, Don, you sock it to him good, you bring him to his knees and make him beg for mercy. Don’t let him worm his way out. Make him confess!”

  Dr. Gallant showed me far more dramatically than any textbook or classroom lecture ever could have the rage that I felt toward Uncle Unger. Gallant got me out of my head and into my emotions. He made me see just how primitive a person I can be. Gallant was using his own aggression constructively, but I doubt I could have done that. I would have unleashed an unholy torrent of anger had I let myself go. Gallant was more disciplined than I could have been.

  I took from those sessions with Dr. Gallant not just that I have the capacity to be cruel, indeed the desire to be cruel, but that I had better watch out for it. I had better learn to control it so it does not control me.

  So while I cheered Dr. Gallant on, seeing Uncle Unger in the patient’s chair instead of the patient, I came to learn that what I was cheering for is a part of me I should get to know and work to control rather than give vent to in the name of delivering care.

  46.

  In the winter of 1978, my fourth year of medical school, I got a letter from my father telling me he had lung cancer. “It was only diagnosed a few weeks ago,” he wrote. “It started with a cough that wouldn’t go away. Then they found a tumor in the upper lobe of my left lung. They say it’s highly malignant. I go for chemotherapy twice a week. I stop the car, open the door, and puke every time on the way home. They say there’s no point in doing surgery.”

  So he was dying, I said to myself. I went off to the public library just a couple of blocks from the medical school, sat in a chair, and stared out the window. The library was all glass windows. It was one of my favorite haunts, and I wanted to be alone.

  He was always good to you. He saw you as much as he could. He took you to Red Sox games, he taught you to fish and to sail, he taught you to skate. If you’d had more time with him, he would have turned you into a good hockey player, maybe even as good as he was, not likely, but maybe. He p
layed miniature golf with you, he took you and Jamie to horror movies in Hyannis, he played croquet with you and let you win. He was as good a dad as he could have been.

  Then why did he let the whole thing with Unger happen? Why didn’t he beat the crap out of that son of a bitch? Why didn’t he come down to Charleston and take me out of there?

  Because your mother wouldn’t have let him. And because he had a major mental illness. It was pretty damn impressive he could even hold his job teaching school.

  Why didn’t he beat up Unger? He left defending yourself up to you. After Mom went off with Unger, Dad checked out. But he didn’t completely; he sent her a dozen pink roses on her birthday every year.

  It was all fucked up, Ned. You gotta see that. You were dealing with crazy people. Normal people try to get custody if their kid is in a bad situation, but these were not normal people. Gammy Hallowell had the money to send you to places where other people would look out for you, and you should thank God for that.

  There was no bad guy, the badness came from madness. Dad was crazy, Unger was crazy, Mom became crazy, the whole scene was just plain nuts.

  So now Dad’s dying. At that moment I remembered Dad standing on the periphery of the soccer field at Fessenden, a hundred yards away from me, in the mist, staring out at our practice, and then, after I looked away for an instant, disappearing. That’s the best he had. You should be glad he had that.