by John Irving
There was no aura of discouragement about Dr. Berger; it was as if he expected to be proved wrong, but he was not one to be deterred by failure.
Jack refrained from jumping to the conclusion that the most interesting psychiatric ailments were not easily diagnosed or cured. After all, upon seeing his dad’s full-body tattoos, who wouldn’t have guessed that William Burns was obsessive-compulsive? And that it physically hurt him to play the organ, yet it drove him completely insane not to play—well, who wouldn’t have been depressed and subject to mood swings about that?
But Dr. Berger was “a fact man”; his role was ruling things out, not zeroing in. He was an essential member of the team, Jack’s sister said—if not the easiest of the doctors to like. Although a German, he had adopted the Swiss habit of shaking hands zealously for prolonged periods of time, which Dr. Berger did with what Heather called “a competitive vengeance.”
This guy confused Jack in advance; someone vaguely resembling Gene Hackman or Tommy Lee Jones came to mind. (As it would turn out, Jack couldn’t have been more wrong.)
The rest of the team members were women. In Heather’s view, they were the most formidable. Dr. Regula Huber, for example—she was head of internal medicine. She was a Swiss woman in her forties, blond and tireless. There were many elderly patients at the Sanatorium Kilchberg; an internist was kept busy there. Most of the older patients had been committed by family members; these patients were not free to leave.
Heather told Jack that she’d had many meetings with Professor Ritter and the team of doctors looking after William; on every occasion, Dr. Huber’s pager had gone off and she’d left to attend to an emergency. In the case of William Burns, who’d been committed to the psychiatric clinic by his daughter but had stayed of his own volition—happily, without protest—Dr. Huber, like Dr. Berger, first wanted to rule out a few things.
Did their father have an underfunctioning thyroid gland? (This could make you feel cold.) No, he did not. Did he have Curshman-Steinert disease? Thankfully, no! And why was William Burns so thin? Because he didn’t drink, and he thought that overeating was a sin; their dad kept to a strict diet, as if he were a fashion model or a jockey or an actor. (Like father, like son!)
It was Dr. Huber who treated, or attempted to treat, their dad’s arthritis. She’d recently tried a new class of nonsteroidal anti-inflammatory drugs that were supposed to be more stomach-friendly than the older anti-inflammatories, but they gave William so much gastric irritation that Dr. Huber instead applied a conventional drug topically.
And it was Dr. Huber who took the view that some so-called placebos worked—that is, if the patients thought they did. She raised no objection to William’s fondness for hot wax and ice water, or his taking glucosamine with the extract of shark cartilage. William Burns also wore copper bracelets, except when he was playing the piano or the organ.
Heather liked Dr. Huber, whom she called a pragmatist. (Jack thought inexplicably of Frances McDormand, one of his favorite actresses.)
The third German, Dr. Ruth von Rohr, had a curiously incomplete title—she was some sort of department head. Of what department was unclear, or perhaps deliberately not stated. She was a tall, striking woman with a wild mane of tawny hair that had a silver streak, which Heather said looked natural but couldn’t have been. Dr. von Rohr had a regal, head-of-department demeanor. She usually let others speak first, although her impatience was demonstrable and calculated. She knew when to sigh, and she had considerable dexterity in her long fingers—in which she frequently twirled a pencil, almost never dropping it. When she spoke—usually last, and often dismissively—she turned her prominent jaw and angular face in profile to her audience, as if her head were about to be embossed on a coin.
“On the other hand,” she liked to begin, as if she were head of the doubt department—as if the silver streak in her hair were a banner to that gray area of every argument. It was Dr. von Rohr’s job to make the others feel less sure of themselves; she liked opening the door to those things that could never be ruled out.
Everyone at the Sanatorium Kilchberg thought that William Burns was a model patient. He had to be happy there; after all, he’d not once attempted to run away. He rarely complained about the place, or his treatment. Yes, he occasionally gave in to his demons; he had his rages and irrational moments, but he had far fewer of these episodes in Kilchberg than he’d experienced in the outside world. Jack’s sister maintained that their father was where he belonged; remarkably, William seemed to accept this. (Hadn’t he positively embraced the idea? Dr. Horvath had enthusiastically asked.)
Yet it was Dr. von Rohr’s department to raise the unasked question. “Isn’t hospitalism a second disease for some of our patients?” she would inquire, just when everything seemed fine. “What if we’re too successful with William? In a sense, if he’s happy here, haven’t we made him dependent on us and this place? I’m just asking,” she was fond of saying, once a seed of doubt had been sown.
It was Dr. von Rohr who would not stop asking why William often felt cold. “But what triggers this?” she frequently inquired. (At the Sanatorium Kilchberg, Jack’s sister had told him, the word triggers was hugely popular.)
It was Dr. von Rohr who suggested that William Burns might have a narcissistic personality, or even a narcissistic personality disorder. He shampooed his gray-white, hippie-length hair daily; he was very particular about which conditioner and gel he used. (He’d had a fit—a running-naked-and-screaming episode—because his hair dryer had blown a fuse!) And then there was the meticulousness of his tattoos, not to mention how protective he was of them. For the most part, he concealed them. He wore long-sleeved shirts, buttoned at the throat, and long pants, and shoes with socks—even in the summer. (Yet when William Burns wanted you to see his tattoos, he showed you all of them.)
It was not uncommon among schizophrenics to wear long pants and long-sleeved shirts; they felt so unprotected. But Jack and Heather’s dad wasn’t diagnosed with schizophrenia. The issue Dr. von Rohr had raised was William’s fastidiousness, his vanity—the way he watched his weight, for example. “Isn’t William an impossible perfectionist?” Dr. von Rohr would say. “I’m just asking.”
The osteoarthritis was the reason William Burns could no longer play the organ professionally—hence his early retirement, which had precipitated his mental decline. But he could have kept teaching—even keyboard skills, albeit to a limited degree, Heather had said. William certainly could have continued to teach musical theory and musical history; yet he had retired totally, and perhaps unnecessarily.
“A failure to live up to previous standards or expectations, which can also lead to someone’s early retirement, is a signature feature of a narcissistic personality, isn’t it?” Dr. von Rohr had said to the team. (The “I’m-just-asking” part was always implied, if not stated.)
“A piece of work,” Jack’s sister had called her. “A head-of-department type, if I ever met one.”
Trying to envision Dr. Ruth von Rohr, Jack thought of Dr. García, who was a good listener, and who raised a lot of unasked questions. Boy, was Dr. García ever a head-of-department type!
Last, but not least, was the sixth member of the team—an attractive young woman, authoritative but self-contained—Dr. Anna-Elisabeth Krauer-Poppe. She always wore a long, starched, hospital-white lab coat—seemingly not to assert her medical credentials but to protect her fashionable clothes. (She was Swiss but her clothes weren’t, Heather had claimed.)
Like the two unambiguous hyphens in her name, Dr. Anna-Elisabeth Krauer-Poppe was as perfectly assembled as a Vogue model in Paris or Milan; she seemed too chic to be Swiss, although she’d been born in Zurich and her knowledge of the city was as irreproachable as her command of her field. Dr. Krauer-Poppe was head of medication at the Sanatorium Kilchberg, where it was everyone’s opinion that she knew her prescriptions as well as she knew her clothes.
It had frustrated her that William was not treatable with those new (a
nd so-called stomach-friendly) nonsteroidal anti-inflammatory drugs and that he could tolerate only the topical solution. His hot-wax routine made Dr. Krauer-Poppe cringe, not least for what a mess William made of what he was wearing when he picked the dried wax off. And to see him with his hands plunged in ice water must have made Dr. Krauer-Poppe want to change her entire ensemble. (As for the copper bracelets, she couldn’t even look at them; the glucosamine, particularly the extract of shark cartilage, she dismissed as “a folk remedy.”)
But when it came to William Burns’s obsessive-compulsive disorder, Dr. Krauer-Poppe had prescribed an antidepressant; the medication had had a calming effect. She’d tried two drugs, in fact, Zoloft and Seropram. Each one had its merits, both being selective serotonin reuptake inhibitors used to treat depression.
As for the side effects, Heather had said, their father had tolerated the dizziness, the dry mouth, the drowsiness, and the loss of appetite; the latter was the most persistent problem. (But William was so devoted to being thin that his loss of appetite probably thrilled him.) He’d complained about occasionally painful and prolonged erections, and there were certain “changes”—which Heather had not specified to Jack—in William’s sexual interest and ability. But over time, William Burns appeared to have tolerated—or at least accepted—these side effects, too.
The drugs did not impair William’s motor functions. His keyboard skills were unaffected by the antidepressants. The music he’d committed to memory remained intact, and he could sight-read music as quickly as ever.
Dr. Krauer-Poppe had worried that William’s ability to concentrate might suffer, and he admitted to being more easily distracted; it took him longer to memorize new pieces, and he occasionally complained of fatigue, which was unusual for him. He was used to having more energy, he said; on the other hand, he was sleeping better.
Dr. Krauer-Poppe had also watched William closely for signs that prolonged administration of the drugs might make him feel indifferent or less emotional; this was sometimes referred to as “the poop-out syndrome,” Dr. Krauer-Poppe said, but William had shown no such signs. According to Heather, their father was indifferent to nothing or no one—and he was, “regrettably,” as emotional as ever.
Dr. Krauer-Poppe thought that, in William’s case, the antidepressants had been successful. She noted that his sexual “changes” did not include impotence, another possible side effect; she called the drugs “an acceptable trade-off.” (Dr. Krauer-Poppe was a woman at ease with hyphens, apparently. No one like her came to Jack’s mind.)
Jack couldn’t wait to meet these people, and he was relieved that he was meeting them first—that is, before he would see his father.
William Burns had been twenty-five when he met Jack’s mom; he’d been twenty-six when Jack was born. At that age, how long would Jack have stayed married to anyone? And what if he’d fathered a child at twenty-six, when he and Emma were burning the candle at both ends in L.A.? What kind of dad would he have been?
Jack knew what Dr. García’s answer would be—her less-than-one-word response: “Hmm.”
Jack checked into the Hotel zum Storchen on the Weinplatz. His room overlooked the Limmat, where he watched a tour boat drifting past the hotel’s riverfront café. He was staying in the Old Town—cobblestoned streets, many of them for pedestrians only. The church bells seemed to ring every quarter hour, as if Zurich were obsessed with the passage of time. He shaved and dressed for dinner, although it was still only midafternoon.
In the taxi—at the airport, in Kloten—Jack had considered going directly to the Sanatorium Kilchberg, but his appointment with Professor Ritter and the others wasn’t until late afternoon. He didn’t want to risk running into his father before he’d met with the doctors. Although he wasn’t expecting Jack, William would surely have recognized him.
Jack had questioned the clinic’s decision not to tell his father that he was coming, but both Heather and the psychiatric team had thought it best if Jack’s dad didn’t know; if he knew, he would be too anxious.
Nor had Dr. Krauer-Poppe recommended upping William’s dosage of the Zoloft or the Seropram, whether they told him about Jack or not. Even Dr. von Rohr had refrained from making her usual, on-the-other-hand argument; in fact, she said that giving William more antidepressants might make him near-catatonic or completely out of it for his son’s first visit.
Dr. Horvath, the hearty Austrian and deputy medical director who often jogged with William, had told his patient to expect “a special visitor.” Since it was too soon for more visiting time with his daughter, William was probably expecting someone from the world of music—a musician from out of town, a fellow organist making a guest appearance at a concert or playing in a church in Zurich. (Such distinguished visitors occasionally came to Kilchberg to pay William Burns their respects.)
Jack had asked the concierge at the Storchen to recommend a restaurant within walking distance of the hotel. William would be allowed to have dinner with his son, although Professor Ritter or one (or more) of the doctors at the clinic would accompany him.
“Better make the reservation for three or four people,” Heather had told Jack. “They won’t want you to take him away from the sanatorium alone. And believe me, Jack, you wouldn’t want to do that—not the first time, anyway.”
The concierge—a laconic man with a hoe-shaped scar on his forehead, probably from hitting a car’s windshield with his head—had booked a table for four at the Kronenhalle. It was an excellent restaurant and a pleasant walk, the concierge had assured Jack. “And because you’re Jack Burns, I actually managed to get you a table—even on such short notice.”
Jack went outside the hotel and watched the swans and ducks swimming in the Limmat. He checked the time on his watch against the clock towers of the two most imposing churches he could see from the Weinplatz, where he could also see a taxi stand. It was only a ten- or fifteen-minute drive to Kilchberg from the Storchen, and he didn’t want to be early or late.
Jack felt guilty about how much he had blamed his mother for everything. If she’d been alive and Jack were waiting to meet her for the first time, he believed he would have felt as nervous and excited about that as he felt about meeting his dad. It suddenly seemed ridiculous that he couldn’t forgive her; in fact, Jack missed her. He wished he could call her, but what would he have said?
It was Miss Wurtz who was waiting to hear from him; it was Caroline Jack should have called. But all he could think about was talking to his mother.
“Hi, Mom—it’s me,” he wanted to tell her. “I’m not doing this to hurt you, but I’m on my way to meet my dad—after all these years! Got any advice?”
Jack took a taxi out of town, along the shore of Lake Zurich—a nice drive, the road passing close to the lake the whole way. A theater festival had set up tents along the waterfront. It was sunny and warm, but the air was dry—mountain air, not nearly as humid as it had been in Edinburgh. There were these sudden, dramatic moments when Jack could see the Alps beyond the lake. Everything was clean, almost sparkling. (Even the taxi.)
Kilchberg was a community of about seven thousand. Because of all the sailboats on the lake—and the stately homes, many with gardens—the town somewhat resembled a resort. Jack’s taxi driver told him that the right shore of the lake was slightly more prosperous. “Europeans prefer to face west,” he said. Kilchberg, on the left shore of Lake Zurich, faced east.
But Jack thought Kilchberg was charming. There was even a small vineyard, or at least what looked like a working farm, and the sanatorium was high on a hill overlooking the lake, with a spectacular view of Zurich to the north; to the south were the Alps.
“Most of the patients take the bus from the Bürkliplatz—there’s a sanatorium stop in Kilchberg,” his taxi driver told him. “I mean the patients who are free to come and go,” he added—looking warily at Jack in the rearview mirror, as if he were certain that Jack had escaped. “You might want to consider taking the bus next time—the number one-s
ixty-one bus, if you can remember that.”
The driver was Middle Eastern, or possibly Turkish. (He’d mentioned “Europeans” with evident distaste.) His English was much better than his German, which was as clumsy and halting as Jack’s. When they’d first tried to speak German together, Jack’s driver had quickly switched to English instead. Jack wondered why he’d been mistaken for a patient at the clinic; the taxi driver was not much of a moviegoer, maybe.
Not so the preternaturally thin young woman in running shoes and a jogging suit who greeted Jack in what he thought was the main entrance to the hospital part of the clinic. There was a waiting room and a reception desk, where the young woman was pacing back and forth when Jack came in. A fitness expert, he assumed—perhaps she was the nurse in charge of physical therapy, or a kind of personal trainer to the patients. She should put on a little weight, Jack was thinking; one can take the athletic-looking thing too far.
“Stop!” she said, in English—pointing to him. (There was no one else in the entranceway or the waiting room; there was no one behind the reception desk, either.) Jack stopped.
A nurse appeared, emerging hurriedly from a corridor. “Pamela, er ist harmlos,” the nurse said.
“Of course he’s harmless—he’s not real,” Pamela said. “The medication is working. You don’t have to worry about that. I know he’s harmless—I know he’s not real.”
She sounded American, yet the nurse had spoken to her in German and she’d understood the nurse. Maybe the thin young woman had been a patient in the clinic for a long time—long enough to learn German, Jack speculated.
“Es tut mir leid,” the nurse said to Jack, leading the young American woman away. (“I’m sorry,” she said.)
