Mount Misery

by Samuel Shem

  Around the far end of the lake and up a last rise through the woods, I came to Emerson, where Ike White’s office was. The center stairwell had spectacular woodwork, enclosing the stairs in wooden banisters and railings that were meant to prevent suicidal jumps. The light from the skylight at the top was chopped up by hundreds of slats. On the second-floor landing was a sign, EMERSON 2: BORDERLINE WARD, and a small hand-written note, Split Risk. I searched the twenty keys on my ring for the right one and opened the door. As I was trying to pull my key back out, someone shot out past me screaming, ‘Freedom!’ He ran down the stairs and was gone.

  Next came two large men running full-tilt. Feeling I’d made a terrible mistake, I walked into the large, well-furnished living room.

  ‘Hey, dickhead!’

  I turned, just after I realized that to turn and answer was really stupid. I found myself facing a sandy-haired, baby-faced man my age dressed in jeans, suspenders, and a white shirt and bow tie.

  He smiled and said, ‘Dickheads Make Mistakes!’

  In the nursing station there was pandemonium. Two people were on the phone at once, talking about how Harrison, a dangerous paranoid man, had split again.

  ‘Nice work, Dr Basch,’ the ward secretary said. ‘Split Risk splits again! If he gets at his wife, we’ll all get sued to hell.’

  ‘Sorry. What time will Ike White be in?’

  ‘He’s been here like two hours already. Down in his office.’

  ‘Since five a.m.?’ I asked. ‘Why?’

  ‘Said he had some work to do.’

  I went down a flight to the first-floor ward, Emerson 1, Depression, and knocked on Ike’s office door.

  ‘C-c-come in,’ he said, with his characteristic stutter.

  Dr Ike White, Director of Residency Training, was a short, slight man of forty, with a slender face and light green eyes highlighted by delicate, long lashes. His dark hair was cut boyish, all the way to a cowlick he twirled with an index finger when deep in thought. Ike was the kind of person who always seemed glad to see you. His stutter made him sound vulnerable, and humble. He was my mentor, the reason I’d come to Mount Misery for my psychiatric training. I’d met him a year before, when he’d interviewed me for admission. It was difficult to get into Misery, ten applicants for every slot. Yet Ike had taken one look at my documents and said, ‘A t-t-terrific C.V.’

  ‘I look pretty good on paper.’

  He smiled. ‘How can we c-convince you to c-c-come?’

  ‘You’re accepting me?’ I said.

  ‘Yes. I don’t b-b-believe in p-p-putting pressure on. Let’s just t-t-talk.’

  I had been surprised. For years, applying to the best colleges and medical schools, I’d gone into these interviews on guard against deception, and intent on deceiving. Ike just seemed to want to make contact with me, hear about me, for no other reason than his curiosity. As if we were friends, we began to talk. And as we went on, I was even more blown away: Ike listened. I felt heard, responded to, suddenly more alive. We had a wide-ranging, leisurely talk – surprising in itself, for most other doctors who’d ever interviewed me for anything had been in a hurry, the goal of the interview being mainly to get it over with. When I asked Ike about himself and his work, he responded with clarity graced with humility. His expertise was depression and suicide. He treated patients, did research on the causes of depression, and was both a Freudian psychoanalyst and an expert in the use of drugs to treat depression. He loved to teach new residents. Ike was a rising star in the BMS sky.

  ‘Is there anything you’re not good at?’ I asked.

  He smiled. Gesturing to the floor-to-ceiling shelves on which books were haphazardly arranged, and to the piles of journals and notes on the floor, with a few paths threading through between desk and analytic couch and chair, and the desk buried under paper and heavy objects holding down other paper, he said, ‘I have a helluva t-t-t-time keeping my stuff in order.’

  I’d gone into the interview planning to do my psych training in a tough, competitive program at the inner-city hospital nicknamed ‘Man’s Best Hospital’ – ‘the MBH.’ My interview with Ike – set against the elegance of Misery, where not only the buildings and grounds but even the two tennis courts were immaculate, with bright white lines and crisp twiny nets – changed my mind.

  ‘OK,’ I’d said. ‘You convinced me. I’ll come here on one condition.’

  ‘N-name it.’

  ‘That you be my teacher.’

  He smiled shyly. ‘N-n-nothing would make me h-h-h-happier.’

  So Ike had become my main teacher, or supervisor. Learning to become a psychiatrist was an apprenticeship system – you learned by being apprenticed to senior psychiatrists on the Misery staff. You watched them treat patients and received their supervision on your treatment of patients. Usually you would have an hour of supervision for every hour you spent with a patient in therapy. The supervisory session would consist of your telling the supervisor what went on in the session, either from your memory or, as some supervisors required, from notes you took during the session. Like most first-year residents, I had never actually done psychotherapy with patients. In fact I hadn’t taken psychiatry as a medical student – it wasn’t a required course at the BMS, and I, at that time more focused on the body than the mind, had never gotten around to it. Unlike most of my fellow first-year residents, I myself had never even been in therapy – I’d never felt the need until the experience of my medical internship, but then there had been no time, or money. I was a latecomer to wanting to be a shrink. It had kind of surprised me, as a career choice, toward the end of my internship. Most of the other first-year residents had been focused on becoming shrinks for a long time, at least from medical school on. As a result, I felt more naïve about all this psychiatric stuff than the four others, and was always trying to catch up.

  Ike White had helped me, immensely. My first month I’d spent with him on Emerson 1, Depression. During that time I had been dazzled, not only by his brilliance and integrity, but by his modesty and just plain humanness. Watching him interact with his depressed patients on his daily rounds, I’d seen his skill at listening and responding to them, and had tried to model myself after him. In my month with Ike, he had fulfilled all of my expectations.

  Now, he nodded a welcome to me. He sat behind his large cluttered desk, papers piled to his head. His dark suit seemed too big, as if he’d lost weight. It was cold in the office, so I put my own suit jacket back on. I told him about the interview with Cherokee and asked what I should do.

  ‘T-t-tell me more about his d-delusion.’

  ‘Is it just that,’ I asked, ‘a delusion?’

  ‘So f-far it is.’

  ‘Should I talk to Schlomo?’

  ‘What are your thoughts about t-t—’

  ‘Talking to him? I think I should let him know—’

  The phone rang, twice, then the answering machine clicked on, and then at a high volume came a strong, assertive voice:

  ‘Dr White, this is Hilda in the Misery Benefits Office. I’m returning your call from this morning, enquiring about your benefit package—’

  Ike jumped up and turned off the volume. He sat down, smiling shyly, and with a strangely embarrassed look in his eye. It made me nervous, and to break the tension I joked:

  ‘Congratulations. Ladies and gentlemen, we got a cure! Hilda’s not depressed anymore, hell no!’

  We laughed. Ike, dealing with depressed people all day long, had developed what he called his ‘Answering Machine Strategy.’ He set the pickup level on the machine so low that when depressed people called and spoke at the low, hesitant level of their depression, the machine would cut them off. To avoid being cut off, they had to speak up. As time went on they would learn to be more assertive, which helped them recover. I didn’t know whether or not this Hilda from Misery Benefits had been depressed, but it had become a standing joke between us.

  ‘Of c-c-course you can talk to him,’ Ike said, returning to my ques
tion about Schlomo.

  ‘Do you know him well? I mean is this possible?’

  ‘He was my a-analyst. I saw him five t-times a week for six years. D-do I know him well? No. But your p-patient, Cherokee?’ He looked down at his hands. ‘B-being with sick people is sc-scary. You start to wonder, “Am I s-sick? Why is he the p-patient, and I the d-doctor?’” He smiled at me. ‘Roy, psychiatry is n-not only a science, b-but an art. More than in any other medical specialty, you learn by working with others. Day after t-tomorrow, August first, I start my vacation. I’ve arranged for a t-terrific third-year resident, Dr Leonard Malik, to t-take over and supervise you when you move to the b-b-borderline ward, and—’ The intercom buzzed: ‘Mary Megan Scorato is here.’ Mary was a patient on our depression ward. Ike shrugged. ‘Sorry. It’s urgent. She’s ac-acutely suicidal again. Have to see her. Will you be at the seminar t-tonight at my house?’

  ‘Sure will.’

  ‘Good. I’ll save our g-g-good-byes till then.’

  ‘But it’s impossible, isn’t it? Someone like Schlomo? Doing this?’

  ‘Our patients come in with seams,’ he said, ‘and they go out seamless.’

  ‘What does that mean?’ I asked, amazed at the seamless flow of words.

  But the buzzer buzzed again and I was history.

  As I finished lunch and was taking my tray to the garbage, I saw Schlomo eating. Head down, fork up, it was not a pretty sight. The hell with it. But then I realized that, being a Freudian, he would vanish the day after tomorrow, for the month of August. I approached him. There was an empty seat on either side of him, and across the table too.

  ‘Dr Dove?’

  He raised his head. Those tiny eyes popped out a little from under those slitty lids, and he said, ‘Call me Schlomo. Everybody else does. Including myself.’ He laughed. A trickle of red gravy from the Misery Lunch Special, a ‘Sloppy Joe,’ oozed from the corner of his mouth.

  ‘Schlomo, can I—’

  ‘Good. Schlomo likes being called Schlomo by cute young psychiatrists.’

  ‘Can I see you later today for supervision?’

  ‘Oy what a joy! Schlomo Dove will see you at two.’

  Later that afternoon I found myself wandering through the wet heat down the hill and around the lake to the swampy end, wending my way through the mosquitoes and cattails reaching high overhead and the muddy path sucking at my shoes, to the Misery Outpatient Clinic, where I asked to see Schlomo Dove. His office was filled with fragrant plants – narcissus and jasmine – and bananas of all degrees of ripeness, some green, some yellow, some black. Schlomo, with a huge yellow plastic watering can in his hand, was doing his plants. He smiled broadly – showing teeth with severe gaps from a childhood where orthodonture was not an option, clenching a fizzled fat half cigar. He gave me a big ‘Hello, Dr Roy Basch!’ urged me down into a leather chair beside the leather Freudian couch, and said, ‘Nu?’

  Schlomo was the kind of man who seemed happier to see you than you were to see him, and I was caught off guard. Given this reality of Schlomo, there seemed to be no way that Cherokee’s suspicion could be true. I half decided not to tell Schlomo anything. But he stood there so open-faced, seemingly so anxious to hear and so able to hear whatever I’d say, that I plunged in, telling him that Cherokee Putnam thought he was having an affair with Putnam’s wife Lily, Schlomo’s patient.

  For a second Schlomo just stood there, the oversized spout of the watering can arching at me like, yes, a big, thin yellow penis.

  ‘What a great case!’ he said. ‘Oedipal. Boy thinks momma is schtupping Poppa Schlomo, boy goes meshugge. Great case for you. Schlomo will supervise you on it.’

  ‘Wouldn’t that be a conflict of interest?’

  ‘Nu, so I won’t supervise.’ He laughed. ‘If you can get another supervisor with balls instead of one of the goyim around here who think their shit don’t stink, good luck.’

  ‘So there’s no truth to what he’s saying?’

  ‘You believe the patient?’ Schlomo said.

  ‘I shouldn’t believe the patient?’

  ‘Never.’

  ‘Not even what they say in therapy?’

  ‘Especially not in therapy. The patient is unbelievable. Someone like you is unbelievable too, because you haven’t been analyzed. When you decide to do it, does Schlomo have the guy for you.’

  ‘Ed Slapadek, I know, I know.’ Ed was the analyst Schlomo always recommended to new residents. ‘So I shouldn’t believe what my patients are telling me in therapy?’

  ‘No Slapadek for you, bubbie. Better. Patients spend their time in therapy lying, and thinking they’re telling the truth. Your job is to show them they’re lying. When they stop lying, you terminate. Therapy is simple: they fall in love with you, they get disappointed – sad and lonely – they work it through, they get better. It takes chutzpah to be a shrink. Does Schlomo have it?’

  ‘No question,’ I said, chutzpah reminding me of the rumor that Dershowitz the lawyer was a Schlomo patient, lying there lying and—

  ‘Call me Schlomo.’

  ‘No question, Schlomo.’

  ‘Do you?’

  ‘What are your thoughts about if I do?’

  Schlomo laughed heartily and then suddenly threw his watering can into my lap, soaking me. I leaped up. Schlomo cracked up.

  ‘Asshole!’

  ‘I know, I know, it kills me.’ He took a terrible-looking hankie out of his pocket and tried to get at my crotch, but I was heading for the door. ‘Royala, Royala,’ he said, wiping the tears of laughter away, ‘you might have chutzpah too. Don’t let ’em kill you here. In this Christian shithouse, somebody farts, they call the fire department. God’s Chosen People meets God’s Frozen People. You got a spark, a little outrage. Like Schlomo. Keep it. Schlomo can help.’

  This startled me. He was right. Already, after only a month in this buttoned-down place, I was feeling hemmed in. ‘Yeah. Thanks.’

  ‘Don’t mention. Good thinking, about not believing that patient. I know all about that joker from his wife.’

  ‘You believe her?’

  The slits of his eyes widened. Dark beads glittered in there. And then he recovered. ‘What a mensch! To fool Schlomo is not easy. See? You might have chutzpah too. Great case. Keep Schlomo posted. A cliffhanger. Bye-bye. Call Schlomo to make you a match, with that very special analyst, just for you. You got two choices: call Schlomo now, or call Schlomo later. When you’re halfway into all that sad and lonely, you’re halfway out too. Mmm – such a cutie. I’d like to sink my teeth into that tender little ego myself. Ciao!’

  I left feeling like a few convolutions of my brain had been unrolled, not knowing whether I’d just met with a moron or a genius or if it mattered. This clown, Ike White’s analyst? Sex with this? You’d have to be crazy.

  Exhausted, I floated around the grounds and found myself at the tennis courts. I sat on an iron bench in the shade of an immense copper beech tree, watching two patients play. One, a white-haired man dressed in the long white pants and long-sleeved white shirt of gentlemen’s tennis of Bill Tilden’s era, stood at the baseline and hit smooth perfect ground strokes. The other, a thin man, young, with jet-black hair and black-framed glasses tinted amber, was clearly self-taught. He seemed manic, gifted with jittery quickness and speed. The older man would hit a shot deep to the right side, and the younger would run it down and take a mad swipe at it, starting his stroke as if his elbow were attached to his hip and then lifting like a man loading something onto a truck – say a fresh-killed turkey. The return would be deep to the left side, seemingly out of reach, but with fanatical effort the young man would be there, and back it would go again, for long, thrilling rallies, on and on. The older man seemed imperturbable, calm and businesslike; the younger tireless, never failing to run a shot down, making incredible saves. Diagnosis? The younger, manic-depressive, manic phase; the older, normal. The spot was so peaceful, the lowering sun muted to cool through the coppery curtain of leaves so friendly
, the soft phwop phwop of the ball on the strings so soothing, I dozed off.

  Later that evening I got a lift out to the suburbs to Ike White’s Freud seminar with another first-year resident named Henry Solini. Misery kept us new residents so busy, so isolated from one another on our separate wards, that I’d never had a chance to talk with Solini. He was a crooked-smiled little guy with dark curly hair ending in a short neat ponytail, mischievous eyes, and a thin gold ring in one ear. He dressed down, shirts and slacks instead of suits and ties, and had already been dressed down for this by the powers that be in Misery. In late afternoon I’d run into Henry in the hallway of the attic of Toshiba, when both of us had rushed out of our tiny offices onto the iron fire escape to stare down at a tremendous commotion on the Cyclone-fenced tennis courts three floors below. Solini was so tiny, he barely came up to my shoulder.