Man in the Empty Boat

by Mark Salzman

  The spells kept coming, every few hours, all through that weekend and the following week. I saw the cardiologist again, took the treadmill test, and passed it. He said that he’d done pretty much all that he could do and suggested that I see an internist. I scheduled an appointment with one for the following week and just held on as the spells came more and more frequently, although in no discernible pattern. Some woke me from a deep sleep, others came when I was sitting at my desk, others when I was reading aloud to my daughters, others when I was outdoors walking. They came most consistently, however, whenever I made any sort of conscious effort to relax my mind, so I stopped trying to do that.

  When the spells occurred, I couldn’t think at all. It was as if a blizzard were taking place in my head: whiteout conditions, zero visibility. I could carry out mechanical tasks, like cooking or driving or washing the dishes, but I couldn’t hold a conversation or dial a telephone number. My short-term memory was completely wiped out; anything that required holding sequences of words or numbers in mind became impossible. By the twelfth day of this ordeal, I felt exhausted and discouraged. It was all I could do just to get through each day, one hour at a time, sometimes one minute at a time, and the symptoms were changing. Now I was experiencing chills, fits of violent trembling, and hot flashes. On the morning of the thirteenth day, the attacks were occurring every five to seven minutes, and the feeling of confusion and discomfort got so intense that I called Srinath in desperation and asked what I should do. “Get to a hospital right away,” he said, and so once again, I drove myself to the emergency room, checked in, and then sat in the waiting room for two hours while a team of construction workers wielding jackhammers tore up the floor a few yards away. Just my luck—I was having the most frightening experience of my life during our hospital’s remodeling project.

  The sense of being crushed from all sides, of hanging on to consciousness by my fingernails, and of indescribable, imminent danger became overwhelming. I gripped the arms of the chair in the waiting room as tightly as I could, feeling that this was somehow all that was keeping me from blacking out. Convinced that I was about to lose either my mind or my life at any moment, I begged the triage nurse for a pen and a piece of paper and scrawled a farewell message to my wife and daughters. When, at last, my turn to be seen came, a new ER doctor looked me over, and after hearing the results of all my tests from the last two weeks, he said, “You’re having panic attacks. Very common these days, what with the recession and all.”

  “There must be some mistake,” I said. I explained that I wasn’t afraid of elevators or bridges or public speaking and that the spells were arriving unexpectedly, regardless of what I was doing or thinking about. They even happened when I was meditating. How can a person have a panic attack when he’s meditating?

  The doctor all but rolled his eyes. He wrote me a prescription for fifteen tablets of a tranquilizer and told me to “follow up,” meaning consult a shrink. I went to the pharmacy, bought the pills, and took one. Fifteen minutes later, my symptoms were gone. For the first time in nearly two weeks, I felt as if I could think clearly.

  I drove straight from the hospital to my local bookstore, bought the most scientific-looking book on panic disorders I could find, and then went home and read it. To my dismay, the book described my symptoms—and my perfectionist, self-flagellating personality—with eerie precision. To my relief, I learned that panic attacks are quite common, not “organ-threatening,” and highly treatable. While they can indeed be triggered by specific circumstances, such as having to drive over a bridge or get in an elevator or give a speech, they can also strike unexpectedly. You would think that learning to relax would be the key to overcoming the disorder, but for some of us, it isn’t that simple. Deliberate attempts to relax—by meditating, for example—can actually trigger the attacks or make the symptoms worse.

  For us, the way to manage the attacks is counterintuitive. If trying to relax doesn’t work, then we have to stop trying. A crucial step toward gaining control over the disorder is to become less afraid of the symptoms. The more willing we are to surrender to them, the more quickly they pass.

  Armed with this knowledge and my fourteen remaining tablets of lorazepam, I set out to cure myself of this affliction. Each time I felt the surge of adrenaline and the avalanche of unpleasant symptoms, I imagined I was a scientist conducting an experiment, and my only duty was to experience what happened and record the data. The experiences, I reassured myself, would be transient and of no lasting significance. Within a week of approaching the attacks in this way, I was down to only two or three a day, and after each spell, I was able to recover my sense of mental stability and clarity within minutes rather than hours. By the end of the second week, the crisis had passed; the attacks had been downgraded from hurricane status to mild showers. I felt shaky but stable.

  It may seem puzzling that someone who would go right out and buy a book about panic attacks written by a psychiatrist, and then follow its advice, wouldn’t simply make an appointment to see a psychiatrist. If the help is out there, why not make use of it? I live in Los Angeles, the therapy capital of the world—you can’t throw a rock in this town without hitting a Jungian or a Reichian or a transactional analyst—yet I never considered heeding the ER doctor’s advice that I “follow up.” I think this requires some explanation.

  I come with baggage. Part of it is temperamental: The kind of guy who can’t bring himself to wake up his wife when he thinks he’s having a heart attack and insists on driving himself to the hospital doesn’t feel comfortable asking for help. Another reason is that I was raised by a social worker—a professional counselor—who, over the course of his forty-year career, became deeply disillusioned with psychotherapy. “Breakthrough” theories and pop psychology fads came and went, along with their television-ready celebrity proponents, but the suffering continued. In the long run, he concluded, the people he knew who underwent therapy, himself included, didn’t seem to get any better than the ones who declined treatment or couldn’t afford it.

  Whether my father’s assessment was accurate or not, it is surely true that therapy only works if you trust your therapist. Having inherited my father’s skepticism, I have always felt the same resistance toward the idea of lying down on a therapist’s couch as I feel toward the thought of sitting down in a priest’s confessional. If the faith isn’t there, what’s the point?

  And finally, there is the fact that I am a writer. I don’t, under any circumstances, want to be told how my central conflicts ought to be resolved, whether fictional or real. I feel compelled to work them out on my own. The solution to the problems that define me must come from within rather than outside of me, otherwise the dissonance goes unresolved. Being a competent writer doesn’t make me a competent therapist, of course—but for better or worse, I am the only therapist I know how to trust. That’s my baggage.

  I made it through the month of April without any panic attacks, but I was still feeling shaky. One day I had to take Esme to the pediatrician’s office for a couple of vaccinations, and on the way she started crying.

  “I’m afraid!” she wailed. “Can you give me a grown-up pill so I won’t cry?”

  I wanted to say, “You and me both, honey.”

  I felt like a wounded animal that just wanted to curl up in a den and stay still for a while, but we ended up having a busy month instead. During Ava’s spring break from school, the four of us took a little trip north to visit Jessica’s parents. From there, we drove to Sonoma County to spend a few nights at a place called Safari West, where you sleep in semipermanent tents on the grounds of the park while exotic birds whoop and cheetahs bark and giraffes saunter by only a few yards away. On our first night there, Esme lost her first tooth, so we decided to have dinner at a nice restaurant in town to celebrate. Jessica was the second child in her family, and like a lot of later-borns, she wants to make sure that the younger sibling’s childhood accomplishments get equal attention, so she does her best to make sure tha
t little Esme gets her due. During this dinner, while showing her tooth for the umpteenth time to Ava, Esme lost her grip on it. It somehow fell into a crack between her upholstered, bench-style seat and the wall, and she started to cry. If this had happened in an Applebee’s, I probably wouldn’t have minded, but this was a boutique restaurant with only a dozen tables in it, so the sound of her crying seemed especially out of place. The waiter came by and valiantly offered to use a screwdriver to remove the back of the seat from the wall so that he could retrieve the tooth. As he went to fetch the screwdriver, Ava, who was distressed to see how upset Esme was, suddenly leapt from her seat to help look for the tooth, lost her balance, and fell across our table. The table had been cleared for dessert but still had two glasses filled with red wine on it, along with the half-empty wine bottle. The table lurched so violently that the two glasses and the bottle launched into the air, sent their contents flying in all directions, and then landed on the floor in an inverted rainbow of Merlot and broken glass. My anxiety level shot so high that I knew I could not survive another moment in that room without starting to panic. I took the two girls by the hand and led them as gently and steadily as I could out the door and to the car while Jessica helped the waiter clean up. When she came out, she said she’d given him a hundred-dollar tip.

  By the time we got home, I was exhausted after a full week of travel with two small children. Just getting through airports with kids and their equipment in this post-9/11 world requires patience, and that spring, I had no patience left.

  And we had a dog coming. The outfit in North Carolina sent word that our pet was nearly ready for delivery. Another two or three weeks at the most. Jessica and the girls were ecstatic, but every morning when I took my walk and the neighborhood gargoyles assaulted me with their infernal barking, I felt like a prison guard walking the tier and thought: In a few weeks, one of these things is going to be living in my house. What if I can’t handle the barking?

  I tried to imagine explaining to the girls that we would have to find another home for their dog because it made Daddy nervous. I pictured the awful scene: locking the bewildered animal in its travel crate while my daughters sobbed and my wife cursed me under her breath. I would be the goat, and it would be my fault for letting it go this far.

  This family adventure, I thought, is not going to end well. We’ve bitten off more than I can chew.

  Fourteen

  ON MAY 5, MY BROTHER, Erich, called before dawn. “I don’t want to scare you,” he said, but when he told me that Rachel was in the intensive care unit of a hospital in Connecticut with severe pneumonia, I got scared. “If there’s any way in the world you can get out here,” he said, “now would be the time.”

  I woke Jessica and told her what was going on, and all she said was, “You have to go there right now.” She emerged from the bedroom five minutes later with her laptop in her hands. She had booked a seat on a plane to New York for me already and was just confirming the reservation on a rental car.

  I made breakfast for Ava and Esme, dropped them off at school, and drove straight from there to the airport. I didn’t think I would have enough time to check in any luggage, so I brought only what I could pack in a carry-on suitcase. Good thing, too, because the flight attendants were about to shut the door to the plane when I made it to the gate.

  I called Erich just before we took off. He said that Rachel’s fever had gone down and she was able to speak again, but for some reason, the infection in her lungs was not responding to antibiotics. He explained to me that just four days earlier, he had invited Rachel and her family over for dinner. Before they started eating, Rachel said she felt tired and wanted to lie down. She stayed on the couch the whole evening. The next day, she had a fever of 105 and said she felt like she’d been run over by a truck. She was so weak that our father, who was at that time living in a small apartment over Rachel’s garage, had to drive her to the doctor’s office. The doctor examined her, detected fluid in both of her lungs, and recommended that she check herself in to the hospital right away. Once there, she was sent straight to the ICU, where she began receiving antibiotics, the standard treatment for pneumonia.

  She responded well, and after two days was able to move into a regular room. But that night, the infection suddenly got worse. Rachel was moved back to the ICU, and that was when Erich had called me. The doctors, he said, were beginning to suspect that Rachel had contracted an exotic virus on a recent trip she had taken to Costa Rica and Panama.

  On the flight east, I decided that I would offer to stay in Rachel’s house and help take care of her daughters, Isabela and Livia, until the crisis had passed. The girls were nine and six years old that year—exactly one year older than Ava and Esme. With me watching the girls, Rachel’s husband, Daniel, could spend as much time as he needed at the hospital. And who could be better qualified for the job than me? I could take over without missing a beat. As bad as the situation was, I drew some satisfaction from the thought that I could do something for my sister that not all brothers could do.

  I arrived late at night. My nieces had already gone to bed, and my father was in the living room waiting for me. He told me that Rachel’s condition was about the same and that Daniel was at the hospital with her. My father, whose seventy-ninth birthday was only a few weeks away, looked exhausted. He excused himself and headed back to his apartment for some sleep, and I went upstairs to check on the girls. I looked in their bedroom but saw that both of their beds were empty. Then I remembered that my sister and her husband practiced the “family bed” custom—the children had their own beds but rarely used them. They usually slept with their parents, all four in one bed.

  I went back downstairs and began poking through Rachel’s shelves for a book to read. It occurred to me, after glancing at a few dozen titles, that I was learning more about my sister by examining her library than I had in the thirty-two years since I had left home for college.

  Her interests, as reflected in her choice of reading material, turned out to be nearly identical to my own: psychology, philosophy, and cookbooks for busy parents. I pulled a yellowed paperback off the shelf: Meditations, by Marcus Aurelius. A few of the pages had been crimped, which made me curious, so I opened up to the first one and found that she’d marked the following passage:

  For a human soul, the greatest of self-inflicted wrongs is to make itself (so far as it is able to do so) a kind of tumor or abscess on the universe; for to quarrel with circumstances is always a rebellion against Nature—and Nature includes the nature of each individual part.

  And on the second marked page, this:

  Let it be clear to you that the peace of green fields can always be yours, in this, that, or any other spot; and that nothing is any different here from what it would be either up in the hills, or down by the sea, or wherever else you will.

  Wow, I thought. My poor sister. I didn’t know that she’d been circling around on the same weary path as me, consulting the Stoics, Alan Watts, Krishnamurti, D. T. Suzuki, and so on. You’d think that I would have enjoyed the sense of a shared interest with her, or of kinship, but I didn’t. I just felt sorry.

  I didn’t get much sleep that first night in Rachel’s house, but I got up before anyone else and started poking around the kitchen for breakfast ideas. Daniel’s car was parked outside; he must have come home very late. Livia, the younger of the two girls, was the first to make it down the stairs. When she appeared in the kitchen, I stepped forward to give her a hug, but she backed away and stuck out her tongue, and I remembered that she had reacted the exact same way the last time I’d seen her, a year earlier. Rachel had apologized for this and explained to me that Livia wasn’t the hugging type.

  Isabela came down next, and she is the hugging type. Once she had peeled herself off me, she explained that her mommy was in the hospital but would be home soon and then we could all go to the Danbury mall together to the Build-A-Bear store and build bears. While I started fixing breakfast, Isabela played her violin
and her recorder for me. Livia asked if she could stir the batter and flip the pancakes and announced that her big sister had memorized an entire Hannah Montana dance routine. “Show him!” Livia commanded, and her older sister ran to fetch a CD player, started the music, and launched into a performance in the kitchen.

  Daniel, who is the most hugging type of all, came downstairs while Isabela was dancing, and he nearly crushed me in his embrace. Everything about him is emphatic; his voice can be heard a mile away and his laugh from at least twice that distance. He thanked me profusely for coming and reported that Rachel’s condition was stable when he left the hospital at two o’clock and that he was sure the worst was over; she was going to be fine. I offered him a cup of coffee and he took it but apologized for having to run; he had to get to work as soon as possible and finish a job that week or—he told me this quietly so the girls wouldn’t overhear it—he and Rachel would not be able to make the mortgage payment on the tile shop building that month.

  The recession had been killing them. So even during this crisis, he was still tiling bathrooms all day before rushing over to the hospital to keep Rachel company at night. He poured the coffee into a thermos bottle, grabbed a banana from the counter, and in a roar of tires flying over loose gravel, he and his Tile Shop truck were down the driveway and gone.

  I got the girls to stop dancing and eat, fixed their lunches, and made sure they’d put their homework in their backpacks. We walked outside to wait for the bus, and when it came, they boarded it happily and waved to me as it pulled away. I went back inside and called Erich, who was keeping vigil at the hospital. He told me that Rachel was stable for the time being, and he encouraged me to drive over to see her.