Mount Misery

by Samuel Shem

  ‘Maybe you are,’ he said, taking his hand away, ‘and maybe not.’

  He went on to talk about his pattern of drinking before I met him, and of his drinking during his residency. Two years before exactly, when his Heiler patient had hanged herself after a session with him, he’d gotten sober.

  ‘My second anniversary was hell,’ he said. ‘We drunks, deep down, have such a shitty opinion of ourselves, that all the good things that happen when we’re sober don’t seem to fit, so we sabotage ’em.’

  We finished the interview. I helped him strip for the physical exam. His dirt-dark head and hands and ankles contrasted with the white skin of the rest of him, like a blackface minstrel offstage. As I went over him, I saw the slippage in tone and tissue of his athlete’s body, and felt sad.

  ‘I refuse the rectal,’ he said. ‘Find anything? Like liver?’

  ‘Nope,’ I said, knowing he was wondering if I had palpated a hard liver edge, a sign that the cancer had metastasized already. ‘Except for some infected sores and dehydration, physical exam normal.’ Our eyes met again. He shook his head, at the irony of the ‘normal.’

  ‘Cancer, me?’ he said, shaking his head. ‘People always seem to get what they fear most.’

  ‘I’ll draw bloods and write the order for a Librium detox. We’ll get you cleaned up and to bed.’

  Getting the tubes and needles and putting on the tourniquet and drawing his blood was a relief. ‘You’re not so bad at straight medicine,’ Malik said sarcastically. ‘Y’ever think of becoming a real doctor?’ I smiled. ‘I know I need to go to groups here, see my sponsor, work the Program, but deep down all I feel is “fuck it.” I need you, Basch, to help me stay here, get my ass in gear.’

  ‘I’ll drop by as much as I can.’

  ‘Dickheads never learn. You don’t “drop by,” you make appointments with. I’m in hell. I need some order.’

  I got out my book and made appointments for each day. ‘OK, let’s go.’

  ‘I can’t go.’

  ‘Why not?’

  ‘Because I’m stark naked, schmucko, and I’ve got no clean clothes!’

  ‘Sorry. I’ll get you something to wear.’

  ‘Amazing,’ he said quietly. ‘You didn’t even ask.’

  ‘Ask what?’

  ‘Why I got cancer. We’ve gotten so used to everybody getting cancer, that when somebody gets it, we don’t even ask why. We see it as an act of God, which is the one thing it most certainly is not. Uh oh.’ He rolled his eyes.

  Bronia was in the doorway, carrying a suitcase. She marched past me straight to Malik, and from her stride I was afraid she would smack him for insubordination, but she put her hands on him gently and broke into sobs. I left them there together while I went to write his orders.

  The next morning Malik announced that he was leaving.

  ‘Nice try, Basch, but no thanks.’

  He made it out of his room into the foyer before he encountered Frankie, the mental health worker. Frankie, broad and solid, blocked his way. Geneva and Yoman were there. Seeing Malik, the dog whined and waggled expectantly.

  ‘Hello, Leonard,’ Geneva said. ‘Going to “Leisure Skills Group”?’

  Malik stood there for a few seconds, swaying. ‘I didn’t come in here of my own free will. I was carried in. It wasn’t my choice.’

  ‘Since when does a drunk have a choice?’ Frankie asked.

  ‘“Self-centered thought and action,”’ Geneva said, ‘is a killer.’

  ‘Screw you,’ Malik said bitterly, ‘screw you all. I’m going back to bed.’

  That was just the beginning. Malik attacked all of us, especially me, his alleged therapist. Anything I said or tried to suggest, or do, or not do – even the quality of my listening – he either trashed directly or mocked perfectly. He took everything I said and batted it back to me, using his uncanny feel for the inner workings of people on me, criticizing me mercilessly. I knew that he was in withdrawal and a little looped on Librium, but still, all his negativism about me and life was hard to take. I felt incompetent and naive, much like I’d felt on my first days on Emerson, faced with a hallful of ‘borderlines’ that Malik said didn’t exist. He was infuriating, baffling. Every day when I went to see him, I was called on to use all the skills he had taught me, and all the skills I had learned over the year – how to face someone’s rage, how to work the transference, how to keep exploring – trying to just be there with him despite his fatalism, bitterness, and rage.

  It wasn’t just his negativism that made things hard, it was the sheer force of his presence. For the first time I could see how I, and other psychiatrists, in the presence of someone full of energy, full of the fatal real stuff of living, could take the easy way out, retreat, protect, defend by calling in umpteen Heiler factors, or A.K.’s Freudian bullshit reducing vitality to bad childhoods, or Errol’s biology saying it’s all bad brain molecules and we can fix it fast because people are basically dogs. Like when the eye doctor clicks in those last few lenses and suddenly you not only see, but see that you have not been seeing, I saw the power of psychiatry to fashion hundreds of ways to deny the truth of human-to-human contact and label the other person as ‘sick.’ But if there was one thing I was sure of about Malik, it was that he was not ‘sick.’ Mentally, he was one of the healthiest people I’d ever met.

  I was not at all sure that I could meet him in his intensity. Often, being with him felt too hot to take. Or too cold, for sometimes he would withdraw under the covers, alone, all ice. I constantly felt like a failure, believing that after eight days he’d walk and start to drink, and it would be my fault. We extended our sessions to an hour and a half. The level of realness he demanded was extraordinary. Any wavering, any bullshit, any movement away from this ‘ruthless encounter’ in the present, and he picked it up and threw it back in my face. Sometimes there would come a point where it was like listening to fingernails screeching against a blackboard. Other times the silence was so intense I sensed it was the big one: a beloved person, dying.

  I was sitting with an expert who had handed over all expertise to me, while demanding that I not treat him ‘expertly,’ but merely as another suffering human being. How was I supposed to use my own experience of suffering to help him, anyhow? I felt lost. On rare occasions I would try to slip in one of the techniques he himself had taught me.

  ‘Don’t try that goody-two-shoes Malik bullshit on me,’ he’d say. ‘Let’s just forget it. The only thing that can help me is talking to another drunk.’

  ‘I may be a drunk too.’

  ‘You? You’re not a drunk.’

  ‘I’ve been drinking a lot.’ I told him about fleeing Misery for a drink or two before facing Zoe in therapy.

  ‘A drink or two?’

  ‘Yeah.’

  ‘A drunk would never stop at two. You ain’t one.’

  ‘So then how can I help you? You need to go to the AA groups, and talk.’

  ‘Yeah, but I can’t. The staff all know me. I’m too ashamed.’ I stared at him as if from a distance. ‘And stop looking at me like I’m already dead. I’m not an object, I’m a person. I’m still here. Jesus fuckin’ Christ!’

  Epidemic, unapologetic rain dimmed the days and pestered the nights. On day three, Malik refused to get out of bed. He was filled with gloom.

  ‘I’ve never been able to really love anyone, my whole fucking life.’

  ‘You?’ I said. He didn’t respond. ‘What do you mean?’

  ‘Aw c’mon!’ he said, and then, mockingly, ‘“What do you meeen?”’

  ‘People think you love them.’

  ‘Great, great. It’s nice to think that they think that, oh yeah.’

  ‘You draw people to you. It’s unbelievable how many people have come to visit you in here.’

  It was true. Malik was like a beloved patriarch on his deathbed in the autumn of his life. Not only was he visited by Bronia and her friends, but by great numbers of Misery workers, from Viv, who came in with
a florid dress and a perfume that whacked you hard and a lace hankie, and Primo, who blubbered like a baby, through various Misery social workers and nurses and mental health workers, to just about every member of Buildings and Grounds who chattered awkwardly with him in their particular dialects from Africa or the Caribbean and left a small token of their love, usually a single flower or a bead or, from one ebony-black woman whose neck seemed more constrained than adorned by gold bangles, a doll and pins and in a glassine bag a potion from the Brazilian rain forest containing a piece of skin from the giant anaconda that ate her brother which she said he should smoke to ‘kill dot Cancer Debil.’ Then there were those from the AA and NA community, the ‘Program’ people, people from all walks of life, ‘from Yale to jail,’ from all over New England, for it turned out that Malik had been active in going on ‘commitments,’ where one AA group went to talk to another.

  Soon Geneva and I, with his agreement, had to restrict his visitors. Word spread fast, and the torrent of visitors eased to a trickle and then to nothing at all, except one day when an older woman appeared who looked familiar. She turned out to be Mrs Kondrath-Robb, the nurse on Women’s Chronic 9 at Candlewood, the back ward that Malik and I had been the only doctors to venture into. Malik had kept going back weekly. I had not. Another failure.

  Now I said to him, ‘Everybody loves you, Malik.’

  ‘Yeah,’ he said, sinking lower into his pillow, ‘but I don’t love anybody the way I could. I look good, but I’m faking it. I lead a double life, a secret life. I can’t love anyone. Can’t really get to it with anyone.’ He paused, shot me a furtive, shy look. ‘Like I’m not gettin’ to it with you.’

  He turned his head and stared at me, waiting for my answer. I felt a pressure to respond, to try to help, to fix things. But I didn’t know what to say or do. Worse, I saw that he knew I didn’t. I felt flustered.

  ‘Can’t you say anything? For Chrissakes I just spill my guts to you, Basch, tell you the worst thing about me, and you just sit there? Fuck! Stop thinking about your fuckin’ self and start thinkin’ about me!’

  ‘I am thinking about you—’

  ‘The hell you are.’

  ‘You’re a lot better at this than me, Malik. I’m trying my best, but—’

  ‘I’m lost, I’m hurting, I need to feel you with me! You’re my best friend and I don’t know you!’

  ‘Me?’

  ‘What’s your pain? Your secret, the double life you’re leading? What’s your suffering, your obsession? What’s yours?’

  ‘I … I don’t know.’

  ‘Terrific. Basch, you’re history. I’m outta here.’ He got up and walked out into the hallway, heading for the unlocked door.

  Frankie the mental health worker stopped him. ‘Easy does it, Malik.’

  ‘I’m dying,’ he said bitterly, ‘I might as well die drunk.’

  ‘Malik, please,’ I said, ‘I’m sorry—’

  ‘Too late, Basch. When it came right down to it—’ He coughed, pitiably. ‘—you couldn’t even ask.’

  ‘Ask?’

  ‘Figure it out.’

  ‘Stop.’ I grabbed his arm. ‘You will not leave. No way.’

  ‘Oh that’s good,’ he said mockingly. ‘Use your authority. Use force. Get violent. That’s very good, that’s really going to work, on me.’

  I let go. He walked past us out the door. I walked out after him.

  He didn’t go far. He was standing on the bridge over the ravine between the Heidelbergs, stamping one foot, then the other, cursing. The wrought-iron imitation gas lamps lit him up like in a film. His breath made small clouds in the mist. I saw the smallness of the clouds as a diminished pulmonary vital capacity, from his cancer.

  I stood on the porch, staring at him across the stream of rain. I called to him. He waved me off. Then he took something out of his pocket that glinted in the fake gaslight. A knife? A gun? He bowed his head, struck a match. It went out. He cupped his hands more intently, struck another, and lit a cigar. He puffed, coughed, puffed again. Then he straightened up and stood there, facing me, smoking and coughing. The red tip of the cigar glowed and faded like a geriatric firefly. The shadow Malik cast seemed sharp and solid, as if a source of high wattage was blocked by something deathly opaque. Frankie came out onto the porch.

  ‘Ever been to a meetin’, Doc?’ Frankie asked as we watched Malik.

  ‘Nope.’

  ‘Shit. Biggest disease in medicine, and they don’t teach you young docs how to treat it. Only thing that’ll save our man Malik is gettin’ him to tell his story to another drunk, either his sponsor, or at a meetin’.’

  ‘He won’t.’

  ‘Yeah I know. All us guys, it’s like in our nature – when we get into trouble, we think we gotta “stand tall” and handle it ourself. All that ridiculous John Wayne bullshit. For a man like Malik to ask for help is the hardest thing in the world. But the fellas who make it, well, they go against their nature. Move in the e-zact opposite direction. Ask for help. You identify with this at all?’

  ‘Maybe. How do you get someone like Malik to ask for help?’

  ‘Didja get him to fill out his “Spiritual Inventory” in the chart?’

  ‘He refused.’

  ‘Yeah, well, I guess somebody’s gotta get down on his knees.’

  ‘Pray? Him?’

  ‘Him too.’

  ‘Who else?’ Frankie smiled. Horrified, I said, ‘Me?’

  ‘You’re the only one he’s talkin’ to anymore, Doc. He’s choosin’ you.’

  ‘Yeah, well, suppose I’m all out of God.’

  ‘Who said anythin’ about God? You don’t have to pray to God. You just gotta admit you ain’t God, I mean you yourself.’

  ‘Who ever said I was?’ My long kosher history of the Old Testament God who’d vaporize you if you dared eat a shrimp or soul-kiss a shiksa had scared me off, and I had mostly vaporized Him. ‘God? The face of Jesus in a plate of linguini?’

  ‘Aw, don’t do that, Doc.’

  ‘Hundreds saw Him, last week, in the linguini on a billboard in Tampa.’

  He laughed. From that bulky body came a girlish giggle. ‘Yeah, well I used to be the worst drunk in the world, Doc. One day I asked for help – not from God, from another drunk. It worked.’

  ‘You’re saying that it’ll help if I pray?’

  ‘Can’t hurt, can it? Malik’s just about gone now.’

  ‘Well how the hell is my praying gonna help him?’

  Malik, drenched, was coughing and shivering. ‘Dunno, Doc, but you got any better ideas?’

  I turned to go back inside.

  ‘Hey, dickhead!’ Malik called out.

  I turned back. ‘Yeah?’

  Malik was holding his cigar in the V of his index and middle finger, and pointing it at me accusingly. He looked like nothing so much as a failed, bitter impresario blaming me for his ruin. ‘What’s yours?’ he asked. ‘What the fuck is yours?’

  Nineteen

  THAT NIGHT I drove to the ocean, to moonlight as an emergency room doctor at Collins Community Hospital, which served a once-flourishing fishing port now decaying hopefully to a tourist trap. Solini had been moonlighting there. This was my first time. It was eighty bucks an hour for a twelve-hour shift, from seven at night to seven in the morning, and much of it, according to Henry, would be spent sleeping. I had dug up my battered black bag and instruments that I’d used on our trip around the world, serving as a doctor when needed. The last time had been just about a year before in Changsha, China, after the flooding of the Xiangjiang River.

  Now as I drove on through the dark rain – rain that I knew would assure me a busy night – Malik’s words echoed in my mind, much as, when a coin spinning on a tabletop falters, the ringing gets more and more insistent as it falls.

  ‘What’s yours? What’s your pain, your secret, your obsession?’

  He was saying that the only way I could be with him was to be with my own pain. Yet something was keeping me fro
m it, even from my telling anyone about my own despair, my having prepared to commit suicide. What had he meant when he’d said, ‘Too late to ask’? Ask what?

  Collins Hospital was a classic New England colonial complex overlooking the sea. I walked through the packed waiting room like a gunslinger hired to save the town. Greeting the nurses and orderlies, I eased into the familiar banter of those chosen to work the frayed edge between health and horror. I soon felt at home.

  Immediately I was bombed, starting with a kid with an earache and a temp of 105, a man my age dying from a heart attack, two ferocious nosebleeds, a garbageman who’d fallen down a manhole, a kid with a popcorn kernel in her ear which I couldn’t get out, a horrifically sick old man from a nursing home who thought I was ‘Lana Tuna,’ and several minor car accidents, one after a high-speed police chase that had half the local cops signing in with neck and back pain, going for the gold of workmen’s comp. Most I handled with ease, pleased that my body-doctoring skills were still intact.

  And there was also something new, for as I worked on these people I realized how much my vision had broadened. Instead of seeing just bodies, I was seeing people, reading people, sensing in people’s faces and postures and words and in the intangible stuff, some truth about the person, not only in terms of each life, but in each as part of any life, of life itself. I saw the sorrow behind the smile, the years of pain pulling out the lines from the corners of the mouth and eyes, the rage provoking the scar, the weight of nostalgia tugging down the lip, even the smile behind the sorrow. From my year of focusing on the something else besides what these people were showing me consciously, they had become more translucent yet more substantial, in the way that the translucency of a deep-sea creature reveals the bones, the guts, the feathery beat of the heart, that glassy-ribbed heart.

  My way of being with them as a doctor had changed. My instruments – my shiny chrome stethoscope, otoscope, ophthalmoscope, reflex hammer – were not so much instruments to probe the body as tools with which to make contact. Examining a feverish, scared infant making the classic bark of croup, I gave her the bell end of the stethoscope to play with, and let her put it on my own chest before putting it on hers, so that it became for her – and for me, through her laughter – a way of easing her fear. Once I had the feel with a person, he or she caught on, and seemed more interesting. For the first time in my medical career, something bizarre was happening: I, a doctor, was truly curious about them, the patients. How reassuring it was, after so many hands-off months of shrinking, to noodle around in bodies, palpating a belly, percussing a spleen, auscultating a heart, the sounds calling up the anatomy – that squeak a tight aortic valve, that train rumble a leaky mitral. And the beauty of the retina, the only place in the body where blood vessels can be seen directly, a bright red tangle of arterioles against the amber dome, the Sistine of sight.