by Samuel Shem
Not that it was easy. Medicine reflects society, and the society of this dying town was split between the few who owned everything, the Reagan-Bush-Clinton rich, and the anxious rest. The town was full of violence and greed and drugs and people losing jobs and losing hope, all under the mocking eye of the few who, in our tattered democracy because they could pay to control the tax code and the politicians, controlled the many, the few who holed up behind the alarmed granite walls and ironwork gates of their great estates, with private security and private schools and private jets and private clubs and private souls. I was the guy at the end of the ambulance ride, treating the rage and despair.
By eleven I hadn’t sat down, eaten, or gone to the bathroom, and that was just the start. A baby came in with a laceration on his forehead, needing two sutures. He was almost blue from screaming. The nurse asked the worried mother to leave, which wrenched me, as it had rarely wrenched me during my internship when I’d viewed mother or father or whoever else was there beside the patient as a mere bother, adding to my time awake, to be gotten rid of. Now, as I strapped the baby down on a papoose board, I saw in his desperate face that of an old man, bald, tormented at being strapped down into a nursing home bed, both faces at once. With a tiny hooked needle clasped in my forceps, I hovered above the baby’s face, sweating now, trying to place just two little sutures in that wound. The baby’s eyes suddenly became immense, as if the forehead were all eyes, eyes plump as ripe grapes, and his head moved back and forth with remarkable strength despite the nurse’s hands, and I thought, What if this needle hits his eye? The point snagged skin. I was amazed again at how tough skin is, even a baby’s. I curled it through, snagging the other edge, pulled, tied, cut. Drenched in sweat, I threw in a second suture. Done. I sighed with satisfaction. Undid the damp baby. Handed him back to his mom.
Much of what I saw was psychiatric: belly pain, anxiety, phobias, depression, suicide attempts, hallucinating crazies. Before, these had been ‘turkeys,’ unfathomable and untreatable, mocked by us real docs and turfed to the shrink or back out onto the street. Now they were familiar, and easy. In a few minutes I got the feel of where this person stood in the world. I had learned something in my year of psychiatry, something about how to listen to intense feeling without flinching, how to make sense of it.
At about midnight there was a lull. I went to see a woman complaining of shortness of breath. She had been to many specialists. No-one could find anything wrong except eosinophilia, a high number of allergic cells in her blood. She’d even been to MBH – Man’s Best Hospital – with no luck. She was a fine-featured, pleasant woman of fifty, sitting in her emergency room nightie, oxygen mask over her face, gasping for breath. I listened to her story. She was neither crazy nor hypochondriacal. I began asking her not about her breathing, but about her life. One thing led to another. It turned out that she rented out rooms of her house, and that one of her boarders was a magician who kept pigeons in her basement. Curious, I asked about this magician, these pigeons. It turned out that the pigeons were kept in cages near the washer-dryer. Whenever she did the wash, the pigeon shit got blasted up into clouds, which she inhaled.
‘That’s it,’ I said, ‘your lung disease.’
‘The pigeons?’
‘The pigeons’ shit. You’ve got “pigeon breeder’s lung disease.”’
‘But what’s the treatment?’
‘Move the pigeons!’
‘I will!’
You listen with curiosity, you hear it all.
I went to bed at two, but was awakened from deep sleep by a nurse, stat. I felt I had slept for ten hours, but it turned out to have been ten minutes. I had that horrible feeling of stumbling up out of a sweet dark dream into a fluorescence and having to face a terrible emergency, trying to remember where I was let alone what to do as a doctor. A two-car collision. Bodies mangled and cut and messed up in unmentionable ways. I was running to and fro and calling surgeons, who came cheerily in, happy to be doing nice civic things like sewing fingers back on hands and hands on wrists and lining up bones straight as five irons. Finally everybody was into operations or casts or cars home. I finished and stood there shivering in the spring cold, for I was wearing only a thin green operating room shirt, about to go back to bed again, but then the nurse said she had a case of child abuse where a father had broken a baby’s arm and then another car crash with two great drunken Americans going through the windshield so it was Laceration City and a woman giving birth, which brought back my days at the National Maternity Hospital in Dublin where at eleven-thirty at night we’d get kicked out of The Silent Woman – which so many of the docs and med students hung out at that we nicknamed it ‘the Office’ – and staggered up to Delivery and half-banjaxed on Guinness would pull out a baby or two before staggering back down to bed. And then a kid with a temp of 105 and seizures from it and an old man with a blood pressure of 60 and a temperature of 106 – in whose scared tight face I saw that of the baby I’d sewn up earlier – and then, before five, I got a call to do a favor for a local doctor who had been called at home to do it but didn’t want to come in, to go up onto the ward of the hospital to pronounce someone dead.
Sleepily, I took the silent elevator up to the top floor and walked the waxy corridor toward the light near the end, stethoscope tapping one side of my belly and then the other like an elephant’s trunk. I stopped at the nursing station, got the name, went down to the room.
There lay a man, his body emaciated. His eyes were open and dead and his mouth was open and dead and his color was more blue than white, which meant he was recently dead, the oxygen in his blood vanishing, but not vanished. His age was hard to guess, given his disease. Probably about sixty. A whole life, a whole family, a whole life of learning to creep and crawl and cruise and walk and talk and love and hate and beat out a single down the first base line and make money and woo and wed and have children and sicken and now die. My not knowing anything about him gave his death depth, for it was anyone’s death. My death, and Malik’s – for here was metastatic cancer.
I laid my stethoscope on his heart and heard nothing.
I went to the nursing station and signed him out as dead and walked down the still smooth corridor to the elevator alone and secure in my mortality. Secure, yes, for I felt comforted that sooner or later someone else would be viewing me this way, as anybody, once alive, now dead. I felt a sense of awe at that, at the brief human day, a blink in the eye of whatever lasts, a part of whatever is whole, the awe at all the faces and bodies I’d seen and treated that night.
Secure in my mortality, I went to bed.
I slept as if dead until seven, then dressed and walked out into the fluorescents. Caroline the night nurse thanked me and I her, for the good job we’d done. I followed the smell of freshly baked muffins to the cafeteria, where I sat watching the manly, insecure construction workers drink coffee and talk sports and ‘pussy’ and eat muffins and get ready to do death-defying ironwork in the name of making more hospital. Then I got into my car, but instead of heading back toward Misery, for some reason I drove down the main street of colonial mansions crowned with widow’s walks and through the slums of the seaport with its bars and yuppie shops and then along the sea to the neck of land leading out to the five-mile-long island, half of which was a bird sanctury, half public beach.
Berry and I had walked here once, a couple of years before, during my internship. She had suggested walking the whole beach in silence. I remembered how, that day, despite the bright sun and deserted beach and optimistic gulls and the hand of the woman I loved clasped in mine, my mind had been busily elsewhere, over and over running a tape of how, compared to others, I was a failure at … at … I couldn’t even recall at what now.
But it had spoiled our day. My obsession with comparing myself to others, and my feeling like a failure, had gotten in the way of my being with her. What insanity.
Now I looked around at the expanse of nipping, sharp sea, the gulls and sandpipers and husks of c
rabs and sand dollars, and then looked back to the twisted slats of dune fencing and willowy grasses taunting the wind, to the bird sanctuary.
Suddenly I felt cold. Somewhere in this sanctuary Cherokee Putnam had put a gun in his mouth and pulled the trigger.
Realizing then that that was why I had been drawn here, I stood chilled by the wind and warmed by the sun, trying to get my mind around these images. That was what had killed Cherokee: his relentless comparing himself to others and feeling he was not enough, a failure, trapped. A core ingrati, he’d called it, an ‘ungrateful heart.’
‘The hearts of ambitious people dry up,’ Malik had said. ‘The self is insatiable – it can never get enough. Once you get into your self, kid, you can’t help but compare yourself to others, and you’re doomed.’
Now I saw what he meant. Hadn’t I done a good job in the emergency room because nothing about me was riding on it? No-one knew me there, nothing I did would advance or retard my career. I was not into me, I was into caring for others. I had relaxed into just doing the job at hand, meeting each challenge without pride, doing things easily, with that relaxation into the truth in the corner of my eye. The meeting of the challenge had created the energy, increased the understanding. Not being focused on myself had opened up my vision, allowed me to read people. I knew all too well the destruction I caused when I went ruthlessly after things with tunnel vision, knocking others aside to get there. My focus on my failures on this beach on that dazzling day had kept me from being with the woman I loved. When I saw the world in terms of myself, I saw narrowly and perversely, I compared myself to others, felt I was never enough, and my obsession with all the others who were enough passed in front of my eyes like the electronic stock quote strip that runs around the front of that tower in Times Square.
But if I saw the world not in terms of me, but as a world of which I am a part, a temporary expression? What might I see?
Suddenly I understood how ‘self’ was at the center of psychiatry, a whole industry sprung up to use the self of the psychiatrist to solidify the self of the patient, using talk, using drugs – it was all the same. The various theories were an invention of complexity in the face of something that was incredibly simple: making connection. As if they had invented the complexity not only to protect themselves from that connection, but also to make their own ‘selves’ seem special, better than or smarter than – any comparative would do – their patients? All these suits of armor and regimented ties, these big black shoes, these laughable words. Make it so complex that you need advanced degrees to do it, and only they could do it, charging enormous prices for their monopoly on the perversion of ‘selfdom,’ the suicidal white underbelly of the American Dream, to fight tooth and nail not to be with others, or to be like others, but to be special, separated and individuated from others. What bullshit. And all the while it is connection, not self, that heals.
But how? How to get the self out of the way and just be there?
‘Ask.’
I stared directly into the sun as it eased aside the coverlets of mist, and saw what Malik had meant. In that moment with him, feeling pressured by him to respond, I thought I should be able to fix it, and not being able to think how to fix it, had said nothing. All I had to do was ask. My self-centeredness had kept me from asking. If I let go of the center, could the right questions be asked? Asked of him? Asked from him, for help? Are they the same?
‘What’s yours?’
Could it be just this, my obsession with comparison?
The way that I, from my earliest memories, had tried to be better than everyone, at grade school, at sports, with girls, in college – organic chemistry! – Oxford, med school, my trying to be better keeping me from connecting, keeping me from helping anyone else – great preparation for the ‘helping professions!’ – the tape of comparing myself to others running in my head, keeping me from having the clarity of heart to take the hand offered by the woman who loved me for myself and in spite of myself too, whom I could mostly hide the tape from, keeping me from being with her at the deepest levels, let alone nurturing others, except for my own success. Always comparing, and at the moments of my greatest success, feeling like I was a great failure. Now I saw how this whole year I’d been comparing myself to my teachers, how, when I was with my patients, I was focusing on trying to be as terrific a shrink as Heiler, or A.K., or Ike, or even Malik, rather than just forgetting myself and being there with them. A.K was the worst, the real point of her Freudianism being to focus on your own inner machinery, and this focus had first seduced, then isolated, and finally killed Cherokee. With disgust I saw how I had been intent on playing a boy’s game of ‘Follow the Leader,’ and all the while the people asking me for help were dropping alongside. I was walking along behind the alleged authorities, and all the while chanting under my breath the great American mantra, ‘not enough, not enough, I am not enough.’
And keeping it a secret, even from myself. Hiding it, yes. All the secrets we men keep, the double lives we men live. From the secret pain of Ike White smiling and shaking my hand an hour before he did it, to Cherokee, who never once mentioned his obsession with suicide to me, and all the patients I’d heard it from, like the man who for years seemed to be going out to work each morning but in fact went to shack up with a woman and drink and watch TV till the wife’s money ran out, and the cousin’s husband whose long affair with the fellow schoolteacher was discovered only when he left the pornographic photos of them on his workbench in the basement in a box filled with forms he’d been given to fill out by students for college recommendations, all of which were still blank. All these double lives, these secrets! All the ways we men stay unseen. My secrets. I’d never really opened up to Malik about my work with Cherokee. I still hadn’t told him about my seeing Schlomo fucking Zoe. And I’d yet to tell anyone about my plans to kill myself.
‘What the fuck is yours?’
‘I’m obsessed with comparing myself to others,’ I said to a nearby gull.
Is it possible? I wondered, staring at the gull and then past it to the sun, seeing it straggle up out of the week of rain and morning’s rain like a wet mirage, shaped through the layers of mist to look remarkably like a gilded version of my grandfather’s battered homburg hat. Is this ‘mine’?
‘Hey, it’s possible,’ I whispered to the sun, feeling embarrassed at this, such a thin, reedy voice at the billowing intersect of ocean and beach and windy sky, this magnificent edge of dawn’s bed. I felt really tired, tired of the old ways of seeing the world, and yet I felt like the sun, my heart rising through the mist, freed.
I wanted desperately to do something, to make some sign. I got down on my knees and put my palms to the sand and, that not being enough – there it is again, that ‘enough’ shit! – I lay flat on my belly, putting my face to the sand, it feeling rough, gritty, bathing my eyelids my nose my lips in a mist of grit. Wondering, Is this prayer I hope not, I rubbed my face back and forth in this grit, and then I gathered myself and sprang up into the air like one of the worst psychotics in the world and cried out, ‘It is possible!’ and continued to cry it out as I half ran half floated up the beach, back, feeling for the first time in my life that I was more like everyone than not.
The buffoonish gulls and meticulous sandpipers scattered, then re-formed like water in my wake. How could I have helped Cherokee? How can I help Malik?
By riding this sense of ‘like,’ by connecting. But how? Something is missing. Whom to ask now, for help?
Malik refused to see me.
At three that afternoon I drove to the nursery school. Berry would be out at three-fifteen. I hadn’t seen her for a long time, and although we’d talked on the phone maybe once every other week or so, we had stayed away from the pain, and the residual hope.
I stood on the civilian side of the Cyclone-fence swinging gate, looking into the driveway which, given how small the preschoolers were, was big enough, with a slash of grass on either side, to function as their playground
. To the left of the driveway were the jungle gym and swings and a tire suspended from three chains, which the kids could swing on and rotate around while other kids pushed. To the right, the sandbox and mud pile and a kids’ plastic kitchen set were next to the stairs of the old house that functioned as the school.
As I waited, the ‘threes’ and ‘fours’ were being picked up by their parents, thirty-two splashes of bright kid colors zipping here and there until each got linked up, each little hand finding a big one, attached to a grown-up more drably dressed. Seeing those little hands in those bigger ones, sensing the flutter of big people’s love even if clouded by irritation at little people’s dirt on pants or failure to wear a hat in the chill of the day, these hands and this flutter had a strangely deep effect on me, as if my heart, so dry as to be brittle, was drinking in some of it, and softening.
A lull. No more kids. I waited. Berry.
She looked older, more substantial, in a way, maybe because of all the small kids. She was dressed in jeans and a T-shirt with the nursery school logo on the front, a kid’s drawing of a sun, simple round black circle filled in with yellow, and with black sun rays streaming out. The yellow sun was a face, with a smile. She looked like she had gained weight.
