by Samuel Shem
‘Doctors never come back here, to Chronic. Except for one other young doctor, a few years ago, from Mount Misery.’
‘Malik?’
‘Yes! Wonderful person. He had us all doing sports!’ I laughed with her. ‘His wife Bronia works here, on Ironwood, the Children’s Unit. I’m Mrs Kondrath-Robb.’ We chatted. After a while she said, ‘Some of these women have been here forty years. No-one comes to see them anymore. They can’t survive anywhere else.’
I glanced at my watch. ‘I have to go.’
‘Come back whenever you want. These aren’t animals. These are people too.’ She walked with me through the clutch of insanity to the door. Once out of Chronic, I took deep breaths of the less fetid air of the corridor, and ran all the way back to Errol. I was utterly demoralized, not only by the sight of the patients but also by Mrs Kondrath-Robb’s reply to my ‘I’m a doctor’:
‘What are you doing here?’
Good question.
‘You gotta dog?’ Win asked me, at the end of the day in his office in the lower bowel of the Misery labs, in the basement of the Farben. A big, aged, Siberian husky lay amidst the piles of papers and journals, licking his hock repeatedly. He looked sick. An old mainframe computer filled one wall, its two fat tape spools like the eyes of a cartoon clown. A desktop computer was clacking under Win’s sculpted fingers.
‘No,’ I said, ‘why?’ I peered over his shoulder at the computer screen:
Dogs were sought with chronic ALD for an 11-week drug treatment study. Notices were placed in veterinary newsletters. Dog groomers were also alerted.
‘We need dogs for our study, on chronic ALD – Acral Lick Dermatitis. Where they lick themselves silly, causing lesions. See? Hey, Van Dusky!’ The husky raised his head. Where he had been licking was red and raw, ulcerative and oozing. ‘ALD happens mostly with big dogs, like Van Dusky here.’
‘Your dog?’
‘My nephew’s. We’re sure ALD in dogs has the same biological cause as OCD in humans. Got two grants to prove it. NIMH, National Institute of Mental Health, and Glücksspiel Apotheke Ltd, Düsseldorf.’
‘Why study dogs?’
‘Because they have no psychology. Prove it in dogs, you prove it’s biological. Prove a drug in dogs, you can use it in humans, especially kids.’
‘Kids?’
‘OCD is big in kids. Biological. Besides, you can get their brains.’
‘Kids?’
‘Dogs. Coupla weeks of Placedon and Zephyrill, Van Dusky here is better.’
‘That’s better? He looks awful.’
‘Better. My nephew says, quote, “He seems like a puppy again.” We count the licks.’ The clown eyes on the mainframe spun and numbers rolled out. ‘Win, you hot shit you!’ he cried, and sprinted out the door and down the hall. I followed. A sign on a door cried out: STEREOTACTIC BRAIN SURGERY, KEEP OUT. The room was tiled on all six surfaces. There was a big sucking drain in the floor. ‘Why all the tile?’
‘Used to be used for “hydrotherapy,”’ he said, his words echoing hollowly. ‘They used to throw lunatics in here and hose ’em down with water. Back then they knew nothing. They thought that the hosing helped. Fools.’
He sprinted out up the tunnel. I sprinted after.
Back on the West, as I tried to catch my breath, he ripped through charts as fast as possible, one after another, signing his name to new drug orders. As I watched I heard screams behind me, breaking the sepulchral stillness of the ward:
‘I’m a kernel of corn you’re chickens you want to eat me you killers ahh!’
A wild-eyed man was running toward the Dutch doors, which Deedee the nurse adroitly slammed in his face so he went splat against the Plexiglas wall, although he kept trying to rip at it with his fingernails as if it were chicken wire. Quicker than I would have thought possible a goon squad of four anabolic mental health workers – three men and a woman – pounced on him, stabbed him with a hypodermic, and carried him away to the Quiet Room.
Beside me a door opened and Gloria poked her head out to check on the commotion. She was half out of her nursing uniform, going offshift. A white bra, a tiny pink bow in the cleft. Covering herself, she said, ‘Oh hi, Roy. He’s a chicken farmer from Maine. Delusional. Thinks he’s a kernel of corn, and that we’re all chickens. Talk about crazy. We’re using drugs and behavior modification. He’ll stay in the Quiet Room till tomorrow.’
‘Good to know.’
‘See you around the campus, Roy.’
On the ward, the other patients stared after their lost member briefly, and then continued sleeping or pacing or twitching, as if what had happened was a slight petulation far out on a sea, nothing to do with them, and now that it was done, something that had not ever happened at all, really. Like a child in a night-terror, screaming lucidly at you, who will remember nothing you or she said, in the morning.
Win took no notice of any of this. As he worked, he sang the Scarecrow’s song from The Wizard of Oz, ending with the wistful line: ‘… if I only had a brain.’
Finished with his paperwork, he popped up to his feet and ran out. I followed.
It was raining softly, the kind of rain that reminds you of the optimism of tulips and the fearlessness of daffodils. In the parking lot Win clicked open a big, new, silver Porsche and got in.
‘Wait!’ I called out to him.
‘Don’t have time. I moonlight at a shockbox upstate. Ring the doorbell, get your first shock treatment. Ha ha. Due at the shockbox in an hour. I bury the needle at one fifty on the interstate.’
‘But it’s about OCD.’
‘Now you’re talkin’.’ He stopped dead still, all ears. ‘Fire away.’
‘What about love?’
‘Love?’
‘You think that being in love is biological?’
‘You bet. It’s an obsession and a compulsion.’
‘Love is OCD?’
‘And we’re about to prove it, thanks to Glücksspiel and NIMH.’
‘With dogs?’
‘Y’got one?’
‘No. Thank God you’re not working on monkeys.’
‘Yeah, I know. Monkeys cost the earth!’ He drove off.
I stood there, the rain drumming harder on my bare head, noticing that I’d been staring at a red Geo. Solini’s car. It had been vandalized, the tires taken, the eyes bashed in. Where was he? It was so sad!
I shivered. It was as if I’d been slipped a drug cocktail, mostly horror, but with a twist of delight. Horror at what I’d seen, but delight at how easy my rotation with the drug boys could be. As a doctor, I knew how to use drugs, how easy it was even to throw the right drug at a problem, let alone the wrong one. Using drugs in psychiatry was easier than using drugs in medicine, where you had real effects to measure – blood pressure, cancer cells in bone marrow, heartbeat. In psychiatry there was nothing much to measure with certainty, so you didn’t really know what you were treating, and couldn’t know if the treatment worked. All year long I’d prescribed drugs for my really depressed or psychotic or manic patients, often with good results. There were only about six kinds of drugs that helped psychiatry patients without hurting them. Drug therapy in psychiatry was mostly a no-brainer. The West would be a rest.
Despite all the death on my mind, just then the rain was a spring rain, soft and promising.
But then I heard the sorry wail of an ambulance approaching. It came in fast and stopped nearby, sliding off the gravel onto the grass.
The doors popped open. White-clad men got out, the last Dr Errol Cabot.
They started hustling a stretcher out, one man holding an IV bottle high like on a TV show. Unlike on TV, the IV tube snagged on something, and someone shouted ‘Stop, you asshole, stop!’ The stretcher stopped in its movement out, and the head slid off the edge, tipping down, jaw up like Oly Joe Olaf’s on that couch. Fearing the body would slide off and plunge onto the gravel, I ran to it and clutched it. I saw the ghost of a face I knew.
‘Lily Putnam?’
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br /> ‘You know her?’ Errol asked.
‘Her husband was my patient.’
‘Oh yeah, the suicide, OK.’
Lily seemed hardly to be breathing; her face looked like stone.
‘Hey, retards!’ Errol was screaming at the flustered meditechs. ‘Get the lead out! I’m late!’
‘She looks horrible!’ I said. ‘What happened?’
‘She’s suicidal. She’s an involuntary admission. I pink-papered her.’
‘Did she make a suicide attempt?’
‘Not yet. Dr Schlomo Dove said she was about to. He called us, and signed a ten-day paper, committing her to us.’
‘Schlomo, an analyst, signed her in for drug treatment?’
‘Which is what she needed all along. The gal’s endogenously depressed. Needs meds. Live better pharmaceutically.’
‘She looks terrible.’
‘Yeah and soon she’ll feel wonderful and be better. I’m running in drugs now. IV, Placedon and Zephyrill. Principle of synergism. Two drugs better than one, three better than two, and so forth. Magic bullets.’
‘But she’s totally zonked out.’
‘Better than being totally dead. OK, men, ready? Move ’er out.’
I watched them wrassle the stony body up the granite stairs into the West. My heart turned sharply on its spindle, fruit pecked at by crows.
My father’s dead.
His face in his coffin, compared to his face in his life, looked better. Calmer, yes. He looked more alive, dead. All these deaths. I had a hit of pain that took my breath away.
I hesitated to breathe in again, for it seemed that any real breath in would break my heart.
Fifteen
LILY, THE NEXT day, was still too drugged up to talk to me.
In her chart was a brief note written by Dr Schlomo Dove saying that ever since the suicide of her husband Cherokee, she herself had been threatening to commit suicide. Thus when she refused hospitalization, he had enlisted Dr Errol Cabot to go to her home with an ambulance and a ten-day paper to commit her involuntarily to Mount Misery.
Dr Errol Cabot had diagnosed her as ‘296.34, Major Depressive Disorder, Recurrent, with Psychotic Features which are Mood-incongruent.’ He noted that she met seven of the eight criteria, including depressed mood, insomnia and hypersomnia, decrease in sex drive, feelings of worthlessness or excessive or inappropriate guilt, psychomotor agitation and retardation, diminished ability to think and concentrate, and recurrent thoughts of death. The one she did not meet was weight loss when not dieting or weight gain, which I noted was the only symptom you could actually measure on a real scale.
To me, these symptoms were appropriate. The woman’s husband had just blasted his brains all over a bird sanctuary. She’d just learned that he’d been having an affair, and maybe killed himself because he thought she was. Who wouldn’t think of suicide, given all that? Yet she had never made a suicide gesture or attempt. Something didn’t fit.
Under ‘Treatment,’ Errol had inserted into the chart a Xerox copy of his standardized drug protocol, or ‘algorithm.’ I was to learn that he inserted the same protocol into every chart, since he used it on every patient. The protocol was a diagrammed drug flowchart decision tree, developed by NIMH and IPAP (International Psychopharm Algorithm Project), which looked, to my eyes, remarkably similar to the flowchart I had seen on Toshiba where the computer led you out onto thinner and thinner branches until you were out on a limb alone with the correct DSM diagnosis, or the flowchart for Misery itself, where the pathetic Nash and cute Jennifer were enboxed and dangling by a thread somewhere below Chief Lloyal von Nott, making the hospital seem like nothing so much as a Calder mobile made up of real live human beings in cages. And are there flowcharts of every institution, I wondered, and, in the Oval Office, a Flowchart for America?
Errol’s chart showed the flow of a total of thirty-four drugs to be used, alone or in cocktails, one after the other, flowing into each patient’s body until something worked, or didn’t.
I was soon to see just how simple this treatment was. In addition to Placedon and Zephyrill, Errol and Win would give each patient drugs that were either antipsychotic, antianxiety, antidepression, or anti-the-side-effects-of-the-other-drugs drugs. If one drug failed, they’d move on to another, or add another on. Almost every patient ended up on a six-drug cocktail. Since the six drugs had to be given on different schedules – from once a day to five a day – there was always a nurse in the Dutch door handing out drugs. She would check the mouth to make sure the pill hadn’t been tongued, and then say, ‘This’ll make you better.’
What if, by the end of the six-drug bingo up to a grand total of the thirty-four drugs the patient was not better? There, in the lower-left-hand corner of the protocol, in a small box in print you needed a magnifier to read, was:
Discharge to social worker, for Placebo Talk Therapy.
Taped to the cover of Lily Putnam’s chart was a handwritten sign: NARC.
‘Narcotics?’ I asked Errol as he raced out the door to shock people.
‘Not A Resident Case. Stay the fuck away, Frank.’
‘My name is Roy.’
‘Learn the name of one more resident,’ he said, ‘you forget the name of one more drug. Stay away.’
‘Why? Why can’t I see her?’
‘See? What the fuck is this, a residency in ophthalmology? Go away.’
‘What about the other patients? You mind if I go see them?’
‘Why?’
‘To listen to their stories, to try to understand them.’
‘Oh Jesus.’ He nodded at Win. ‘He wants to understand ’em. To listen.’
‘OH JESUS!’ Win shouted.
‘These are psychotics. These brains are neurochemical theme parks. But hey, you wanna sit there and listen to ’em talk bubble bath? Be my guest.’
I tried to talk with the patients. Someone had to. It wasn’t easy. Either they were too crazy-hot to talk, or, doused with drugs, too cool.
Lily Putnam had been hit hard by Prozac and Ritalin and Placedon and Zephyrill, and she lay in her bed in her private room, not exactly sleeping but not exactly awake. She rose from the horizontal only to go to the bathroom and to drink liquids and take drugs. When I introduced myself, while there was a flicker of recognition, it quickly slid away under a molecular coverlet, like an ember underneath ash. No chance of suicide in Lily on drugs, no way. Nor of anything much else.
My attempts to talk with other patients were pretty much as unsuccessful. People hallucinated every imaginable thing – Christ, Hitler, the Pope, Elvis, cockroaches, dildoes, apple pie – and had tried to kill themselves in every imaginable way. Some patients were known to me. The Woman Who Ate Metal Objects was back after her last abdominal surgery, and quickly asserted her omnivorous self by eating the prosthetic pinkie of a gay psychotic plumber admitted for ‘phantom limb pain’ who had the delusion that his real pinkie was poking up the rectum of Richard Milhous Nixon.
The patients, drugged at arm’s length by their doctors, seemed less people than objects. Drugs had thinned out the essence of being human and had left them both heavier and lighter than human beings ought to be, as if a human on drugs blocked the light and yet was way too insubstantial to hold any light, to be at all luminescent, even to cast a clear shadow. It was as if you could pass your hand through them, only your hand making the shadow. But you couldn’t pass your hand through them, they were so powerfully opaque. The vitality of the human had been diluted out all the way to the poverty of the translucent, leaving the steel shell of the opaque, all in the name of ‘better.’ It was appalling.
Even more appalling to me was that it was pretty much how I felt too.
What could I do? I felt so vulnerable and lost, so guilty about Cherokee and Lily, so isolated and alone, I felt myself sinking rapidly, trying my hardest merely to get out of bed in the morning and function, slipping into ‘full-catastrophe’ mode, that is, trying to keep myself alive, and not psychotic.
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One bedazzling mid-April morning I was sitting in the doorway of Lily Putnam’s room with a Pfizer cappuccino and a DuPont brioche. Lily was asleep. I was waiting until her next dose of drugs, which would be the lowest concentration of the six drugs in her system. It was at these times that she was slightly more alert. I felt I had to make contact with her. Cherokee’s delusion that she was being fucked by Schlomo was gnawing at me.
From time to time I would tune in to the Behavior Modification therapist, a short solid woman with a body like a van, a face like a hubcap, and a mind like a gearshift. Her name was Cynthia Krabkin, and she was pacing back and forth beside the psychotic chicken farmer, making him repeat over and over:
‘I am not a kernel of corn, I am not a kernel of corn, I am not…’
Cynthia Krabkin’s philosophy was that his repetition of this phrase a million times combined with the reward of her company might condition the chicken farmer to think he was not a kernel of corn. Sitting there on the quiet ward, I found this strangely comforting, a hymnal to the farmlands where men were men and women were women and animals were slaughtered and people ate red meat.
‘Lily Putnam?’ the nurse called out. I signaled I would bring her over.
‘Lily,’ I said, shaking her gently. ‘Wake up.’ Startled, she stared at me. ‘It’s me, Dr Basch? Do you ever think of killing yourself?’ She stared at me dully, and shook her head slowly, no. ‘Have you ever?’ Another shake of the head no. ‘Have you ever heard voices telling you to kill yourself?’ A shake of the head yes. She got up. Puzzling. Disturbing.
‘Hey, Dr Dickhead!’
I turned. Thorny? He was strapped to a stretcher being wheeled in. His clothes were in rags, his body was covered with fresh cuts and bruises, and he looked emaciated. His eyes were wild and his mouth was blaring, nonstop, a stream of consciousness sometimes making sense, mostly not:
‘This dickhead’s still clean Doc Zoe’s in deep shit my old man is turning the Gulf to shit my mind is solid toxic waste haste makes—’
He was in the throes of a manic episode, totally psychotic. Deedee the nurse was moving toward him with a syringe, and I jumped up and got my body between her and Thorny. ‘Hold it,’ I said. ‘What are you doing?’
