Mount Misery

by Samuel Shem

  ‘And this is your first year as a psychiatrist?’ I said nothing. ‘You can tell me, it’s OK.’ Oh God. Is she a hyper-demanding borderline? I nodded. ‘And will you be talking to a supervisor about your work with me?’

  ‘No,’ I said, lying, and then, ‘wait a second – did you say “suicidal”?’

  She blinked, and sat back. Her face drooped in sorrow. She said that yes she was thinking of killing herself and had some pills stored up to do it. She didn’t see why she should go on living after all the losses in her life, the latest being her father who had died just a few months before. ‘I can’t stop crying. I cry for days on end! My heart is breaking!’ She sobbed horribly, her body all scrunched up. I wanted to do what anyone would have done – put my arm around her shoulder, comfort her – but a wall seemed to go up and I tried to keep cool and figure out what to do to keep her from committing suicide.

  ‘You got any Kleenex?’ she asked, all stuffy-nosed and puffy.

  ‘No.’

  ‘Well, why don’t you!’ she said angrily, and cried harder, the black mascara running down her cheeks, so she looked like a sad, lost clown. ‘How can you just sit there, so unfeeling?’ Her accusing me of being unfeeling made me feel so unfeeling that in dread I drew away. ‘Say something! I’m about to kill myself and all you can say is nothing?’

  Gimme a break! is what I wanted to say, but instead, sensing its lameness as it came out, I said, ‘You shouldn’t kill yourself.’

  She stared at me in disbelief. ‘You’re not doing anything for me.’ She picked up her handbag. ‘Because you’re a cold fish!’ She got up to leave.

  ‘See you next week.’

  ‘You wish!’ She grabbed the doorknob. ‘I am going to kill myself!’ She walked out, slamming the door, and the room echoed with angry black-on-blond.

  I sat there for a few seconds, and then I jumped up, opened the door, and found myself face-to-face with Arnie Bozer, another first-year resident, standing in his doorway across the hall, staring after my fleeing patient. I ran down three flights into the hot damp day, shouting, ‘Christine! Christine!’ and caught up to her at the tennis court. She stared at me with contempt. ‘Are you all right?’ She shook her head no. ‘I’ll call you tonight.’

  ‘You better not. I’d rather talk to a mortician.’ She walked away, slwish slwish, around the corner. My heart sank. What if she did kill herself?

  ‘Oy gevalt.’

  With a sinking feeling, I turned around. Schlomo Dove. Still in his crumpled suit, he was wearing aviator sunglasses, carrying a tennis racket, and peeling a banana.

  ‘She said she was going to kill herself. I followed her down here.’

  ‘You did what?’ he cried, as if I’d just told him I’d converted to Islam.

  ‘Followed her down to the tennis court. Because she—’

  ‘You shouldn’t even think that, much less do it! Get yourself an analyst, bubbula, fast.’ He finished peeling the banana. ‘Now Schlomo Dove will eat a banana, for Schlomo’s heart.’ Chewing, he danced off up the path.

  And Cherokee’s going through hell about this? Maybe the cure would be to introduce them. Get a little reality testing going, why not?

  Feeling bad about Christine, I headed back toward Emerson. What if she did kill herself? How bizarre. In any other setting I’d’ve been able to talk with her, easily, naturally, but in this setting, designed for talk, I was on an Alice in Wonderland trip where the smallest, most trivially natural things had become gigantic, laden with criticism, shadowed by the threat of death. ‘A cold fish,’ she’d said. Hey, she was right. She’d been the one able to feel things, and talk about them. Was she more normal than me?

  ‘So maybe she is more normal than you,’ Solini said, sitting in Emerson 2 with me and Malik at the end of the day. ‘So big shit.’

  ‘So I don’t know what I’m doing.’ I glanced at Malik, sitting there poking a wooden toothpick, a ‘Stim-U-Dent interdental cleaner,’ in and out of his teeth pensively. ‘I was trying to do what you said, Malik, act human, but—’

  ‘Be human. I said be human. You wanna act, try Hollywood. Here we do real. C’mon, c’mon. Tell me about it.’

  Malik talked me through my session with Christine. He was curious about what had happened, asking good questions, nodding, giving me feedback on what had gone on. He tuned in not only to Christine, but to me, seeming to sense what I’d been feeling. Behind those tinty lenses, those eyes got it. Attended to intently, I recalled just about everything, word for word. I felt understood – the same feeling I’d had in my first interview with Ike White.

  ‘Look,’ he said, ‘the thing that pissed her off was your not responding to her – not telling her where you went to school, that you’ll be supervised in your work. Why didn’t you?’

  ‘It seemed unprofessional. I can’t be totally open with her, can I?’

  ‘’Course not.’

  ‘So how do I know whether to tell her things about me or not?’

  ‘Use the “Asshole Criterion.” Key concept. When you’re with a patient, to decide whether to tell her something, you make the decision based on whether or not you’d be an asshole if you didn’t.’ We laughed.

  ‘But she said she was going to kill herself.’

  ‘Her “doorknob” comment? Nah, I don’t think so.’

  ‘How do you know?’

  ‘Same as you. Use the “Corner of Your Eye” and the “After-image.” What’d you see with Christine out of the corner of your eye? Quick.’

  ‘She was sizing me up, and was cool about it. Cool and calculating.’

  ‘And her afterimage? Quick.’

  ‘Intense. At the tennis court, really intense. Her eyes.’

  ‘See? That’s real. Authentic. Her intensity scared you, she felt your concern, she got it. Low risk, OK?’

  ‘And what about Ike White? Quick.’

  ‘Eyes off somewhere else. Not here. I never got to real with him, and boy did I try.’ He blinked. ‘I never realized that before, I mean that I never asked myself about his afterimage. That’s good, Basch, to ask me that, yeah. You did good. Why doncha go home?’

  ‘Yeah, in a little while,’ I said. ‘Henry, I want to ask you a favor. Will you tell your patient Thorny to stop calling me a dickhead?’

  ‘No problem. Let’s do it.’ We walked out into the living room.

  ‘Achtung! Putzkopf!’

  ‘Hey, man, stop calling my buddy Dr Basch a dickhead, OK?’

  ‘Fuck you, you faggoty midget.’

  Henry’s other patient, Split Risk, hearing this, limped off to his room. We walked after him. Solini and I entered the room. Harrison backed into a corner and crouched, shouting, ‘Are you guys gay? You crucify Ike White and now you wanna fuck me up the ass? Do you? Answer me!’

  I froze, then turned to Solini, figuring that, as the therapist, he should have first crack at answering this. He too had frozen.

  ‘Hey there, Harrison,’ I heard Malik say casually, and felt his hand on my shoulder, parting Solini and me. ‘Jill wants to talk to you, OK?’

  A tall woman with long light hair came in. Outside the door were three big guys. They and Jill were ‘mental health workers.’

  ‘These two fags are negotiating to fuck me up the ass.’

  ‘Harrison,’ Jill said, ‘can I talk to you?’

  ‘Only if you get these two fag doctors out of here.’

  We stepped out of the room. Jill, alone facing Harrison, said, ‘You’re a little out of control, and you’ve got to take these meds, OK?’

  ‘Who says?’

  ‘I say, and Dr Malik, who you know is a good straight guy, says. Here.’ She moved slowly to him and handed him the pills and water.

  He started to take them, but suddenly Solini started coughing, big bulletlike coughs. With a scream Harrison threw Jill aside and charged. Solini and I ran. The three big guys covered Harrison with their bodies, but as easily as a housewife snapping the dust from a blanket, he lifted and scattered th
em. Jill ran out, her face bleeding. Again the goons pounced. This time, while they held him down, Malik pulled down his pants and gave him a shot in the butt. They sat on him until the trank took effect, then carried him away to the Quiet Room.

  Malik led us back to the nursing station. Jill’s scalp had been cut, and I volunteered to sew it up.

  ‘Homosexual panic,’ Malik said. ‘People don’t get more enraged than that. If you’re male, you gotta stay away. Why didn’t you ask for help?’

  ‘He seemed friendly,’ Solini said.

  ‘“Friendly” don’t mean shit around here. Any doubts, ask for help. The problem ain’t not knowin’, it’s not askin’. Especially for us guys, like not askin’ directions even when we’re lost. Repeat after me: “Ask!”’ Henry and I looked at each other. ‘Go on, say it: “Ask!”’

  ‘Ask,’ Henry and I said, kind of embarrassed. ‘Ask.’

  ‘Louder!’ Malik yelled. ‘Ask!’

  ‘Ask!’ we yelled out. ‘Ask!’

  ‘LOUDER!’

  ‘ASK! ASSSSSSSK!’

  ‘AWRIGHT!’ Malik said, giving us high fives. He opened up the sports section of the Times, working his Stim-U-Dent.

  I did a slow, neat job on Jill’s scalp, the light blond hair falling silkily away from the gash. From my position above her I was looking down at the swoop of her breasts, a long cleft descending, widening, blossoming to a fullness, the tan summer skin arrested by shy white skin above the peach-colored lace of her bra. Even the wound itself, the inner lips of tissue flaring a pulpy red, was sensual, an O’Keeffe iris, closing gradually under my fingers as I placed the sutures, first the subcutaneous amber catgut, then the black silk, and pulled it up into a healing pucker.

  ‘Thanks,’ Jill said, her light eyes on mine, ‘I hardly felt a thing.’

  ‘It’s nice to be able to do something right around here.’

  ‘It’s a zoo,’ she said, ‘which is why Malik likes it, right, sport?’

  ‘Spent half my childhood in the elephant pavilion of the Lincoln Park Zoo, Chicago. Loved the smell of elephant shit. Always wanted to be a vet.’

  Jill left. Malik and Solini and I sat there. It felt cozy and safe.

  ‘You did good in medicine, did you, Basch?’ Malik asked intently.

  ‘Yeah, but it wasn’t enough, and—’

  ‘Yeah, that’s important, to do good in medicine, yeah.’

  Solini was on call, and got beeped out. Before I left I asked Malik, ‘Why don’t my patients cooperate with me?’

  ‘Because they’re uncooperative.’

  ‘So then why are they in here? Don’t they want to be?’

  ‘They wanna wanna, but they can’t.’

  ‘Why can’t they? All they do is hassle me.’

  ‘That’s why they’re here.’

  ‘To hassle me?’

  ‘What you call “hassle” is your job.’

  ‘Psychiatry is hassle?’

  ‘The hassle that drives their families and friends and lawyers and regular doctors bullshit. Nobody knows what to do with ’em. Somebody’s gotta, OK? We can’t just walk away. That’s what we get paid for.’

  ‘To deal with hassle?’

  ‘Human suffering, yop. These people are in pain.’

  ‘I didn’t go to school all these years to write orders for visits to department stores.’ Two borderlines had gone to Bloomingdale’s that day, Heiler BPOs with BCCs – Bloomingdale’s Charge Cards.

  ‘Visits to department stores are important. Lotta hassles, shopping.’

  ‘But they all hate me.’

  ‘You want ’em to not be who they are? Like Lloyal and the rest of the dickheads running Misery want Ike White’s suicide not to be a suicide?’

  ‘You’re not listening! I’ve got no idea what to do!’

  ‘Good.’

  ‘Good?’

  ‘Just don’t terrorize ’em, OK? They’re just human – more like you and me than not. Trust your gut, your kishkees. Don’t believe what anybody tells you.’

  ‘Not even that?’ I asked.

  ‘Sweetheart! You asked! There’s hope!’

  I took my suit coat and walked out onto the ward toward the door.

  ‘Dickheads Go Home to Momma!’

  Feeling a slow burn of fury, I ignored Thorny and left. But I was surprised to find that Malik had slipped out behind me. The heavy door clanked shut. He and I were alone on the wooded stairwell.

  ‘Look, I figured out why I’m preaching to you today. I’m fucked over by Ike’s bein’ gone. He was real important … y’know, to me?’ His eyes glittered behind the amber. ‘I got to show you what I know, OK?’

  ‘Sure.’

  ‘And bring your racket tomorrow? A sport a day, OK?’ I nodded. ‘By the way, have you ever done any psychiatry, I mean before now?’

  ‘Nope. It wasn’t required in med school when I was there.’

  ‘Ever been in therapy yourself?’

  ‘Never felt the need. I tend to just jump into things, and think later. So I just jumped in here, to try to understand people, as a shrink.’ His eyes widened. ‘Bad, eh?’

  ‘Hell no! Good – even great!’

  ‘That I don’t know anything about shrinking?’

  ‘It’s a gift!’ he said, and disappeared back onto the ward.

  Walking away, I felt a wave of exhaustion, an inner exhaustion, as if from a vague lack, say of oxygen to my brain. I’d been punched around above the neck, but from within, and not allowed to punch back. As I walked the shaded road up the hill, the oaks lining it, the oak leaves, the actuality of the leaves whether or not they were named ‘oak,’ even things you’d think of as vague such as the heat, the humidity, the exhausted sunshine itself – all were a starkly real and actual comfort, compared to the world of Misery. In the haze of the exquisite twilight, the leaves of the grand high oaks moving gently, light-greenly in the breeze, seemed rock solid.

  As relieved as I was to get out of the nuthouse, and as real as the outer world seemed, I found I was carrying with me a suspicion about the people in it. My fellow bus riders were subject to scrutiny. I studied their physical appearance – their body language, the barricades of their bus faces – and their overheard words for clues to their mental illness, realizing with alarm that I was making a running checklist of the Krotkey Factors for the diagnosis of Borderline Personality Organization, which Malik had said didn’t exist.

  At home, wiped out, I staggered to bed. As I started to fall out of exhaustion into sleep, I was horrified by the idea that I was killing myself to learn a profession that was supposed to keep people from killing themselves but that the world expert in how to do this had been shaking my hand at ten-thirty the night before and at eleven that same night that same hand was flipping enough pills into that world expert’s mouth to kill himself, all of which was being denied by other world experts teaching me psychiatry. Having seen so much death in the world all last year I could understand how it was a helluva lot simpler to close down to this disaster rather than open up to it and the one guy who’d admitted the truth and cried about it had no explanation for it and while he seemed on the ball he was a definite flako a jock shrink of all things always jolting my mind telling me these slashed-up, suicidal patients were more like me than not, like the first time a baby stares out into space jolted by a first idea of a word or of a self which are maybe one and the same all the breathless red spices of summer, all in all so far except for Jill and her definite peach lace it was all so fuzzy you’d have to call it kind of crazy – and what the hell did those initials on Malik’s tank top what was it what the hell was it oh yeah LAMBS what did they stand for anyway?

  Christine! Shit.

  I said I’d call tonight. Too tired. But what if she was sitting there waiting, what if my call might just make the difference in keeping her alive, like someone’s promise to Ike White, unkept, had tipped him over? Or had my telling him my suspicion about Schlomo, his analyst, tipped him over? God. Christine might be
sitting by the phone, pills in her hand. Was it too late? Midnight.

  I picked up the phone. Dialed. Four rings. Answering machine, and Carly Simon’s ‘You’re So Vain’ came on. And then, Beep.

  ‘This is Dr Basch. Hoping things are all right and feel free to call me in the morning. See you next week at the usual time and please call tomorrow to confirm.’

  Putting the receiver down, I found that my heart was pounding. My anxiety was bringing out in me my father’s gentle dental conjunctions. Was Malik wrong, could she too be lying there dead? Should I go over?

  I poured a knockout scotch and lay down, my mind reeling back and forth, back and forth, shuffling fears and hopes till it could no longer take credit or blame for anything living, and died.

  Three

  ‘WATCHIT, BASCH, YOU’RE jiggling the napoleons!’

  It was seven the next night. Malik and I were climbing up the manicured hill to the Farben Building. I was carrying by a loop of green satin ribbon a box of French pastries from Gourmet Misère, a shop in the nearby mall. The napoleons were, according to Malik, the key to an easy night on call.

  The day had sped by. While most of my Emerson 2 patients had deigned to speak with me, the sessions had had a surface-level, lacquered feel, which, compared to their hostility, was a relief. My main worry was still Christine, the Lady in Black. She hadn’t returned my call, my several calls. Despite Malik’s reassurance, I was scared for her. But what more could I do?

  That morning I’d seen Cherokee. He’d called and said he needed an appointment right away. He seemed worse, eyes red from another night without sleep, collar wrinkled, the part down the middle of his scalp ragged, his light hair falling to and fro like wheat missed in a harvest. Our first session, he said, had made everything worse, opening him up, setting his mind reeling in the terror of jealousy. But talking about it with me again seemed to calm him, and we did manage to move from Schlomo – whom he imagined to be ‘tall dark and handsome, like you, Basch’ – to his deep sense of being a failure in his life and his work.

  ‘I thought you did well at Disney?’ I said.

  ‘Disney is suspect, to my people. But the real killer, lately, is that I feel like a failure in my marriage.’