Guest Blog: A Difficult Case (by Keith Martin-Smith)
July 31, 2007 16:04
(The following is being posted according to Ken's generous offer. The posting of a submission doesn't imply that Ken or the editors of this site necessarily agree with any or all of it. Thanks, -Eds)
A Difficult Case
Blankets are pulled up tight against the dampening chill, and eyes close as the body settles and grows quiet. Consciousness begins to dim, releasing its hold over the more unruly, primal parts of the mind. Memories blend with fantasies and, holding hands, they dance in ever-widening circles. Sleep draws closer, with dreams awakening just below the fading intellect and occasionally coming into view. The waking mind, now flickering like a candle buffeted by an ever-stronger wind, finally, suddenly, blows out.
In the darkness that follows there is only awareness, pure and undifferentiated. It is without division, without separation, without thoughts or concepts or form. Only stillness and perfection, a nothingness fuller than all the stars in the sky, and more empty than the deepest vacuum in space. In this stillness everything simply is, as it should be. Eons and seconds pass, days and centuries, decades and long afternoons, it makes no difference; time has no meaning here, no power, no purpose.
This suchness gives birth to form and substance, and a woman begins to take shape, gaining solidity as her world forms around her. She is standing on a rooftop, looking out over the dark streets of a city that still sleeps. She stands at the edge of the building, precariously, hesitating only for a moment before she steps off. Instead of falling the eighty feet to the ground she stands on the air as if it were a solid thing, defying gravity, defying reason, and begins to walk along from building to building, her bare feet touching nothing but the emptiness of the night sky itself.
The woman enters a familiar building through its rooftop door and descends a flight of stairs. She exits into a dingy apartment strewn with books and clothes and discarded food, mementos of another life, of another existence. Moving around the room, she picks up objects and examines them as if reliving memories from long ago. She moves through the room self-importantly, absorbed in her own existence, not noticing a gossamer light that begins shimmering in the distance like a great city seen on the horizon. She is surrounded by the gentle light but oblivious to it, and her world begins to fade away, taking first the city, then the building, then the very room in which she stands. Without protest she too is dismantled, yet even as she ceases to exist, she thinks she is as solid as that world around her already vanished.
Darkness now comes, taking the last of the woman with it. This darkness is active, alert, like the sky just before dawn when the stars, knowing they must soon hold their secrets through another long day, blaze thunderously across the sky
In that explosive darkness Tersa begins to take shape. There is awareness of a body, warm and comfortable under heavy blankets. Scattered thoughts appear, and begin to congeal like crystals forming in a laboratory, taking familiar shapes and following predictable pathways. Her eyes open and blink, and stretching her body she smiles. What a strange place to have ended up, after all that has happened to her!
This morning, she rises into a canopy of clouds outside the window, her diffuse rays lighting the old curtains drawn neatly shut. She is the sun, she is the curtains, she is the stained, Rorschach-like patterns worked into the fabric, she is the gray metal bars that cover her window like heavy branches.
Feet are surprised as they, naked, touch the coldness of the tile floor. The curtains are pulled back and the light flows into the room as if that stained fabric were holding back a waterfall; the light washes over everything, undulating in continual, ever-changing motions, as complex and beautiful and breathtaking as the very thoughts of God.
Tersa uses the bathroom, showers, brushes her teeth and hair, and then lays on the bed in a set of clean clothes, wondering what this day will bring forth.
I am Tersa, although much of the time I don’t really know what that even means; her life and her patterns of thought are often as foreign to me as a tree standing in the distance, blowing and bending in its own gentle breeze.
Barry Long takes a sip of coffee from a mug that proudly declares Clozaril. Someone walks in behind him.
“Dr. Long,” a self-assured voice announces, “And how are we this fine day?”
“Not too bad.” Barry takes another sip. “Getting a little sick of this weather.”
“It seems like old man winter doesn’t want to give up the fight this year. Snow, then warm weather, then more snow. It’s a wonder our patients aren’t getting pneumonia.” Dr. White is a tall, lean man with an impressive head of neatly ordered gray hair, who carries himself with the infallible air of someone not only in charge but also steeped in the confidence imparted by prestigious degrees; a man with an infallible understanding of this world and its inhabitants. He pours himself a cup of coffee and pulls out a chair, sitting down across the small table from Barry. They are in a functional kitchen with two windows, framed by heavy steel bars, which look out over a lawn. A single florescent bulb hangs above them, giving the kitchen a clean, antiseptic feel. Dr. White sniffs the air dramatically. “That doesn’t smell like our coffee. Still bringing your own?”
“Everyday. Susan used to do it, and I guess I just picked up the habit.”
Dr. White raises a groomed eyebrow at Barry. “Is that so?” He pauses significantly. “You haven’t mentioned Susan in a long time.”
Barry ignores the comment. “Care to know where it’s from?”
“Columbia?” Dr. White asks innocently. He examines Barry with a swift movement of the eye, taking in feet that are askew under the table, white socks whose elasticity has long departed, an ample stomach sagging over a belt, and a shirt bearing a half-dozen stains of various sizes and colors.
“Originally, I’m sure that’s true,” Barry says, smiling into his coffee. “It’s Ghirardelli. The beans are infused with raspberry and then dusted with Ghirardelli semi-sweet chocolate.”
“How decadent,” Dr. White says. “And you grind that everyday and tote it into work, and then boil water and pour it into a French press. Isn’t that a lot of work for a cup of coffee – I don’t recall you making it that way a few months ago,” Dr. White clears his throat. His face, as crisp and well kempt as his starched white shirt, folds carefully along the brow.
“You really should try it, Jon.” Barry begins to get up. “Come on, let me make you a cup.”
“Oh no,” Dr. White says, adding his pinched laugh, “Ha-ha. I like the day-old. It keeps things honest. Besides, if I like that, you’ll have to be grinding and making coffee for two everyday.”
Barry’s smile, never long on his face, fades as he sits back down. “So, what are you reading,” Dr. White asks disinterestedly.
“This?” Barry says, tapping a new, spiral-bound notebook with his index finger, “It’s the Tersa woman’s journal. She offered it to me,” he adds, sounding embarrassed. “You know how hard it’s been to get her to open up, right? I mean, she’s got no interest in talking to us – or to other patients for that matter. I’m not sure if she wants to be here or not – frankly, I don’t think she really gives a shit one way or the other. She just gives you those strange stares – you know what I’m talking about?”
Dr. White nods. “Like she’s the only one who got the joke.”
“Yeah – yeah, that’s it exactly. So I asked her to write down her dreams, thoughts, whatever she wanted, thought I might get a better picture of what’s happening in her head, told her I’d be reading them on occasion.” Barry looks up again, brushing his thinning hair, still solidly brown and parted forcefully to the side, further off to the right. He offers a quick smile, “I think it just might work. Gotta try something to reach her before we have to ship her upstate.”
“Anything helpful in there?”
Barry lets out a little chuckle. “I suppose, but it’s not like any journal I’ve ever read before. I’m not entirely sure what to make of it. Not sure if this falls into an axis one or axis two model or shades of both, quite frankly.”
Both men sip their coffee. “I’ve gotten her to talk,” Dr. White says with a slight movement of his head. “And I believe I’ve made a positive diagnosis.” He looks over his colleague. “Frankly, I’m surprised you don’t see it.”
Barry sits his coffee down. “You got her to talk? Really? How? I tried everything, and the only thing I could get her to give me was a brief history, but even that was with almost no affect at all – it was like she was reading dictation.”
“Of course. Because she’s totally dissociated from her past. And it’s quite a colorful past, wouldn’t you say?” The skin around Dr. White’s eyes wrinkles a little in the corners, and he unfolds a newspaper, scanning the headlines.
“So how did you get her to open up?”
“I told her if she didn’t speak to me, I’d have her thrown in jail.”
Barry frowns. “That’s not much of a way to win her trust, Jon.”
“And yet it’s within my discretion, so it’s certainly not a fabrication.”
Barry shakes his head, one of his hands rubbing his bald spot the way he sometimes did when uncomfortable.
“Barry,” Dr. White says, crossing his legs, “You have to remember psychiatry is a scientific process, not an intuitive exercise. I simply applied pressure in the logical place at the appropriate time to get the desired result. Tersa can learn to trust me later. For now, she only need respect me, and the power this institution has over her. I gave her a most colorful description of jail – no windows, four women per cell, rampant sexual indiscretion – I got her out of that shell, if only for a moment. I simply gave Tersa an alternative to think about.” He turns the newspaper to another page. “Naturally, she opened up, even if only enough to placate me. She is suffering from a personality disorder, certainly. She has some kind of post-traumatic stress symptoms, too. She is clinically depressed. But her most pressing issue, and the one that is fueling the others and preventing any lasting healing is her schizophrenia. She has a wonderfully self-sustaining fantasy backed by a very capable intellect. If we’re to believe her, she has a Ph.D. And she’s very clever – tries to turn the analytical tables around when you’re talking with her – it’s quite remarkable. I think she may be a little too clever for her own good –”
“So what’s your diagnosis,” Barry interrupts.
“Fortunately, I’m a pretty clever man myself,” Dr. White replies, smiling slightly at his understatement. “Textbook type-one schizophrenia, of course.”
“I’m not so sure.” Barry’s hand flutters across his bald spot again.
“I am sure,” Dr. White says, “Type-one schizophrenia is the most obvious diagnosis – look at how she’s presenting. I’ve already started her on Cisordinal, so she can expect some relief soon enough.”
“You –” Barry begins, “But –”.
“We still have to deal with her depression,” Dr. White cuts him off, “And the high likelihood of suicide given her history. We’ll also need to start her on an SSRI.”
Barry leans back in his chair. “She’s uninsured, Jon. I thought your policy was to shuffle the uninsured off to State. Why the interest?”
Dr. White turns the page of the newspaper. “The interest, Doctor Long, is in helping her. State can’t do much but crudely medicate this woman. But we both know she isn’t going to stay on meds because she doesn’t think anything is wrong with her. No, she’s perfect for the SRU right here, which means she falls under the grant’s coverage. We’re behind schedule for the year already, and need to get another four or five patients enrolled as soon as possible, or we could risk our grant. We, Doctor Long, can cure her, not simply medicate her.”
Barry shakes his head. “But I don’t think she’s shown signs of positive schizophrenia symptoms – I mean, don’t you think it’s pretty Goddamn hard to tell the difference between schizophrenia symptoms and bipolar disorder?” He rubs his neck, “Hell, I’m not sure of much of anything about her, and don’t think it’s wise to begin medicating her this early in the game, before we can both assess her condition. Or does my clinical opinion not matter?”
Dr. White folds the newspaper shut and sits it between them, then removes his reading glasses. He looks Barry over with a calculated eye. An expert in the use of silence as a subduing weapon, Dr. White says nothing for a long moment.
“Of course it matters, Dr. Long. No need for defensiveness,” he says at last. “But let’s look at the facts: This woman lived in a city park for 6 months, never once showering, brushing her teeth, barely eating, just frozen in her own mind. It’s a miracle she didn’t end up dead. She’s probably been raped, and even though her blood and urine were clean, I strongly suspect previous narcotics usage. Her extreme introversion, convoluted speech, psychopathic behavior, and hostility to therapy, along with three serious suicide attempts, tells me she isn’t differentiating her prerational structures and impulses. She’s in denial of her own former depression, her three suicide attempts, the causes of her homelessness, her estrangement from her family, work, and all social relationships. She believes she is a god, and that God is now speaking through her so strongly that she no longer has a need to actually exist. She sometimes speaks of her past in the third person. Suicide is the next logical step for her – although she might think it a self-sacrifice.” When Barry only rubs the top of his head in response, Dr. White places his reading glasses back on his nose and continues to silently read.
You and Dr. White are urgently trying to determine just what is wrong with me; normal people, after all, people who have jobs and raise families and commute from nine to five, who take their allotted vacation someplace warm, who show up at church once a week, and who spend quality time with old friends on the weekend – these people do not behave like this. Normal people, you reason, do not act as I act, they do not speak as I speak, do not think as I think. And maybe something is wrong with me -- it is hard for me to say, or even to know -- some days I understand, I know, that a life spent in this hospital is as perfect and beautiful as one spent in a park, or at a job, or in a monastery, or helping others. It makes no difference, not because I do not care or am cynical, but because I see the impermanence of each of those lives, each of those choices, how all manifest existence is equally empty, equally dream-like.
I don’t know what ‘me’ you’re trying to help, Barry; I feel disintegrated; that there is so little left of me that I might simply blow away in the breeze, like so much ash left on the sidewalk, and I become afraid I may indeed disappear. Afraid -- as if that single world could capture it. And I see and feel things -- strange things; colors around people, feel their emotions inside of my own soul. It’s like the barrier between my skin and the world has collapsed to the point that we have fused into a single whole, one that has no room at all for the smallness of Tersa. On those days I feel a darkness; a separation from the calm that is normally present; and its absence is like a violent wedge in my mind; a splinter in consciousness. It is enough to drive anyone mad, especially a 28-year old woman whose life never had much meaning to begin with.
You are a psychiatrist, and like all who work with the mind you are not so much interested in my present state as you are in what got me to it. Both you and Dr. White would like to know more about Tersa. I will share with you that you may help me. Perhaps I am indeed insane, although I’m not certain what that even means. I am certain that I’m not like the others here, that there is something that sets me apart. I am certain that you too see that, Barry -- and that you want to help me. I trust you.
Tersa’s life had only two possible endings. My present state, or death at my own hands. In Tersa’s life, depression was the only constant. I remember vividly the first day depression entered her mind, taking hold there like a dark creature that burrowed in, unwanted, and began to breed. I was coming out of my kindergarten class into a cool fall day – the kind, late in the season, when the sky is forlorn and gray, and the trees seem muted, almost saddened, their colorful and effusive leaves taken from them by the cold. I walked out of the school building, a little girl in a bright pink Winnie-the-Pooh jacket, feeling the coldness and sterility of the air that was such a contrast to the warm, fragrant air of the classroom. As I crossed the playground, surrounded by other children, I was overcome with a profound sense of sadness and fear. I looked at the trees that stood naked on either side of the playground, their arms crooking up into a sky that seemed too gray, too low. I stopped, overwhelmed, and looked to my classmates, but they continued to skip and play and laugh, not even noticing that I was staying behind.
The wind still blew, and the sky looked much the same it had been that morning, but everywhere everything was different. I stood there, a little girl brightly dressed, and began to cry. Eventually my mother found me and led me to her waiting car, telling me that everything would be okay. But my life was never the same.
In the years that followed, I was lost in myself, with an ever-present bleakness there to great me every morning and to send me off to sleep every night. My loneliness would sometimes lessen when others were touched by tragedy; a classmate’s parent would die, or a teacher would become ill, or a bus driver seem overwhelmed by the some blackness in his life, and I would, however briefly, feel connected with another, even if we never spoke a word. Grief knows no boundaries, no races, no distinctions of any kind. One of my classmates died slowly of a brain tumor in the sixth grade, returning to school every so often in a façade of normalcy. After he died, I wished more than anything that I could have switched places with him.
By my sixteenth birthday, my life had been lived largely without friends or boyfriends. A tall, pimply boy named Jim asked me to a dance unexpectantly, and within a week I had fallen hopelessly in love with him. When he broke up with me, three days after taking my virginity, I realized something had changed. My love for him had torn a small hole in the grayness of my world, affording a glimpse of what lay on the other side. I was crushed by Jim’s rejection, and that taste of another state of mind became toxic, making my depression so much more unbearable.
This poor girl only wanted to be happy, like we all do. As that scared, depressed, self-doubting girl, I just wanted to be able to live like everyone else, to laugh, to have friends, to feel normal. Just for a few days a year. One weeknight in mid-winter, I climbed into my bathtub fully clothed and slit both of my wrists. And then I lay back, breathing hard, bleeding faster than I expected, and waited. As I lay there, bleeding out into the whiteness of the tub, my mind grew quiet, so quiet that my thoughts no longer seemed my own. Lying there, dying, I felt not fear or terror or regret, but freedom, absolute freedom.
As I started to lose consciousness, I heard my mother come home and call my name, and then heard her scream as she found me – my mother, my poor mother, the woman who sacrificed so much of herself for me, who always put my needs ahead of her own, who was, and is, the most selfless person I have ever known. I never wanted to make her suffer; I just wanted her to help me make the clouds go away, even if only for a little while, so I could see the blue sky again.
When I got back from the hospital and went back to school, my stitches hidden under long-sleeved oxford shirts, I sunk back into my old habits, withdrawing once again from the world. That taste of freedom I had felt laying there in the tub remained only as a memory, but also as the only thing that nurtured me. It had been more real than anything else in my life, and I clung to it. In my last year of high school I moved through the school halls like an apparition, growing ever fainter to my peers, teachers, friends and, most of all, to myself.
Barry rests his chin on his left hand, his gaze falling onto his wristwatch. When he finally sees the position of the small hands, he jumps out of his chair, knocking over his waste can as he heads out the door. Moments later he’s back in his office, scrambling to find a pen and, once found, he hurries out the door.
Barry finds Dr. White looking in through the small glass window that opens up to Tersa’s room, standing next to one of their residents, a boyish-looking 26-year-old named Ryan. Dr. White, in his crisp white coat with casebook in hand, doesn’t turn or otherwise acknowledge Barry as he rushes up, struggling to catch his breath. Barry glances over Dr. White’s shoulder at the handwriting that curls across his notepad in dense, perfectly formed script, easily readable even from a distance.
“So you think the schizophrenia is the primary mechanism fueling the delusions, as opposed to an axis two disorder?” Dr. White is saying, “Excellent, Ryan. Observational and clinical evidence backs up that assessment completely. Now –” The young man gives Barry a sheepish nod of the head, smiling as he notices Barry’s tie is off-center, exposing a collar that strains against his neck, while the left side of his shirt hangs out like a crumpled piece of paper. Ryan finds himself looking over the two men several times before giving his full attention back to Dr. White.
“Now – are you listening to me Ryan?”
“Yes, Doctor White.”
“So what is your assessment, then?”
“In my opinion,” Ryan says confidently, “She’s clearly exhibiting negative schizophrenic symptoms – the high degree of social withdraw, the lack of interest in anything or anyone, the lack of emotional affect, and the utter lack of humor all point to undifferentiated schizophrenia. Her inability to identify with herself, and her strong dissociation from her past, combined with what I can only infer is her belief that she thinks she is God, form the matrix of a highly unstable and potentially dangerous cross-section of symptoms.”
“Excellent,” Dr. White affirms.
“She’s been put on clozapine, right?” Ryan’s voice gains confidence and sounds more clinically self-assured. “It has shown tremendous clinical promise in treating negative symptoms.”
“I’m concerned about her side effects,” Barry says as if he’d been standing there all along.
“Yes,” Dr. White replies, looking only at Ryan, “We’ve discussed it already.”
“Not with me.”
“No, Doctor Long. You were late. She is beginning to show signs of tardive dyskinesia. But the tremors are mild, and as you know will almost certainly go away once she’s off medication – but we have to get her into the SRU and into ECT therapy for that.”
“Jon, she can hardly write. They’re more than just tremors. And I’m also growing concerned about her blood work.”
“Her counts are within acceptable limits. The risk of bone marrow failure is still remote. I saw your notes from yesterday,” Dr. White turns the page in his casebook definitively. “I don’t share your concerns.”
“I believe Tersa is making progress, and think we should begin scaling back the meds and focusing more on her therapy. I don’t see any difference between your diagnosis of negative schizophrenia and a diagnosis of bipolar disorder, and yet we are jeopardizing her health –”
“Someone suffering from bipolar disorder does not exhibit the kind of delusions this patient has,” explained Dr. White with a sagacious tilt of his head.
“Look, her condition simply isn’t that cut and dry – there is something quite unique going on with this patient, something that I don’t think is as easily quantifiable as you’re making it out to be. Her journals, for instance –”
“Are a waste of time. I warned you she was clever, Dr. Long.” Dr. White still faces Ryan, who looks back wide-eyed at the two men arguing while both face his direction. “She’s using them to manipulate you. She’s avoiding talking about her problems, avoiding taking blame for her actions, in denial about her own mental illness, and suffering still from a highly delusional belief that she’s somehow no longer herself and that that is somehow a good thing.”
All three men peer in through the window in the silence that follows, although all they can see are Tersa’s feet poking up through the blankets. Dr. White summarily moves down the hall to the next window.
“I’ve been making progress with her,” Barry insists, “I think she’s coming around.”
“Patient 4562,” Dr. White responds flatly. “Thomas M., Esquire. Ryan, you’ve worked with this patient. What is your assessment?”
“Identity neurosis fueled by an NPD,” the young man says quickly, “The intrapsychic structure of Thomas’ personality disorder was preserving his infantile grandiosity and narcissistic beliefs, until his law firm fired him for unethical behavior. This created a split in his psyche, and has directly contributed to his breakdown. His treatment thus far –”
“Jon,” Barry interrupts, still standing by Tersa’s window, “Her meds need to be lowered, and her psychotherapy increased. A breakthrough is imminent, I’m sure.” He presses on, despite the color that can be seen coming into Dr. White’s normally evenly-toned cheeks. “Look, it’s obvious that she hasn’t developed a rapport with you, that she doesn’t trust you. Do you really believe you’re in the best position to assess her condition?”
Dr. White puts his pen into his jacket pocket, clicking the point first, then folds his casebook closed. Two almost perfectly circular red dots, an inch in diameter, have appeared on each cheek. “Ryan, we are nearly finished our rounds.” His nostrils twitch indignantly. “Continue to overlook your notes, and then we’ll discuss the rest of your patients over lunch. Barry, walk with me.”
Dr. White walks away at his brisk pace, silently, forcing Barry – who is several inches shorter – to occasionally double-step to keep up. “I would like to see you in my office in one hour, Doctor Long,” he says tightly, his back to Barry. “And be punctual.”
Barry slows to his natural, ambling pace, letting Dr. White continue to stiffly march down the hallway ahead of him. Turning, Barry heads back to his own office where, checking his watch, he sees he can finish Tersa’s journal and make some headway in analyzing it. He sits down at his desk and, without another thought of Dr. White, continues to read where he left off.
I got into Brown as a languages major and did well, despite my condition. In many ways, college was easier than high school, for I had no friends or teachers distantly concerned about me and constantly asking if I was okay, which made my contraction from the world that much stronger. No one noticed or cared what I did or thought, which was both liberating and frightening. I got through, like a recovering addict, stubbornly, one day at a time, each day hoping that the next would be a little better.
Not knowing what else to do with my life, and knowing little else, I decided to stay in school and enter the Master’s program at Brown. It was my second year of graduate school when I got the call that my mother was in critical condition and I needed to come immediately home. My mother and I had drifted apart while I was in college. She tried to hold us together, writing me once a week and calling twice a month, but I never wrote back and mostly just listened to her when she called. That’s what’s so horrible, so constricting and suffocating, about depression. It prevents your heart from opening to anything or anyone; you are consumed by it, your mind made toxic, and you have no room at all for the suffering of another. It is like the whole of your being collapses in on itself into such a tightly-bound ball that nothing and no one can penetrate it.
My mother was a beautiful woman; she had the straightest hair that, as a little girl, somehow reminded me of moving water. Her eyes were brown and open and a little sad, but they always reached out to you; they always told me how much they loved me, how much they wanted to comfort and soothe. I remember her hands being soft, like gloves, but with a man’s strength running through them from planting and digging in her yard all spring and summer. She kept her nails cut short to keep the dirt from getting under them. When I was in high school and would come home in my dazed way, she would sometimes just sit with me and hold my hands in hers, not saying a word. She knew – she knew there was nothing she could say, that words often are harsh, fumbling things even when wielded with great care. She expressed her love much more directly than that, and it was she that sustained me. In her letters, she would talk about little things, the weather, seeing a fox run through the yard, hiring a man to fix the roof. But those letters weren’t her anymore than the phone calls were. It was when I would go home to visit, and she would look at me, look into me, really, and we would sit together like we had years before, her holding my hands as if I was still a little girl. I just wish I had known then what I know now, so I could let her know how much she meant to me, how much I loved her, respected her, needed her. But I didn’t, I couldn’t, and I lived my life in that narrow sphere of my own creation, circling slowly in upon myself.
When I finally made it home and went to the hospital, I was told the truth. My mother was dead. She had drowned in a lake near our home despite the fact that she was a good swimmer and the day had been calm, if cold. Within a week, her body was in the ground and I was back at her home, going through her things and trying to make sense of it all. I was left without another soul on the planet to call my own, and guilt, at not knowing if she had killed herself, at not helping, consumed me.
I dropped out of school and took a series of meaningless jobs from which I was frequently fired. About a year after my mother’s death, I remember packing away some picture of her for storage when that act – packing away an image – led to an epiphany. I realized I was free, free of any socially constructed identity – I was no one’s friend, lover, daughter, mother, wife, sister, or anything else. I was free, and was at last able to bury her.
And then something unexpected happened. My depression, with me since childhood, lessened and then, over a period of three days, lifted entirely. In its place there was elation, determination, drive; I sold my mother’s home and belongings, moved to Philadelphia, and enrolled in an accelerated Ph.D. program to finish my education. I ended up with my first real boyfriend, a relationship built not on sex or need but on trust and sharing. I made friends, went to parties, and felt almost unbearably alive. I wanted so badly for my mom to see me, to see that I had made it through, that I was, finally, happy. I missed the feel of her hands on mine, of seeing her graying hair that still flowed like melting snow across her back, and those everyday letters and phone calls so different from her presence.
But three hundred and ninety-four days after my epiphany, it returned. On a cloudy afternoon I awoke from a long nap, and there it was, as powerful as ever before. At first I fought back with everything I had, starting SSRIs and seeing a new psychiatrist, who promised new drugs and new therapies to help me. But nothing worked, and my world grew smaller, darker, narrower. I lost interest in my boyfriend and in sex, in going to parties and in keeping up with my new friendships. Twenty pounds slipped from my body in a single semester. Somehow I finished my work at the University of Pennsylvania, I think because I could no more stand the thought of being out of school than staying in it.
Which brings us to this year, after I finished my dissertation and was graduated. I gave in to the darkness, admitting that it had won, and that I could fight back no more. I would try and kill myself one last time, except this time I succeeded. Perhaps I killed my sanity -- perhaps Doctor White is correct -- but it’s not just that -- it’s something different. I know I’m not well yet, but I also know I’m not crazy. Don’t you see? The perfection of my mind requires no trappings, no constraints, no brightly colored garments in which to clothe itself. It need only be.
Dr. White’s office is a large, comfortable room complete with wood-lined walls, packed bookshelves, a hardwood floor, and two unbarred windows that, along with the large inlaid desk (which has been in the hospital’s possession for over 150 years), face the door. Dr. White is sitting behind his antique desk, Barry in an overstuffed leather chair facing him. After clearing a few papers away, Dr. White straightens his penholder and stapler, and then folds his hands together in front of him.
“Dr. Long,” he announces solemnly, “Do you know why I called you here?”
Barry shakes his head.
“Earlier, in front of Ryan, I did not ask you about Tersa. I asked you about Thomas. What troubles me is your mind was not where it should have been or where I asked it to be – it was focused where it has been for quite some time. On Tersa.”
Barry leans back into his chair, looking out the window, at Dr. White’s elaborately framed degrees, at the floor, at his hands, and then finally at Dr. White, whose eyes have been following Barry’s with a mechanical precision.
“I am director of this facility, Dr. Long, and in front of our interns, I expect you to defer to my judgment. It is unprofessional to do otherwise. There is an order here, and young doctors like Ryan need to follow the rules, especially in the beginning. You know this – the same was expected of you, and you would not tolerate Ryan speaking out of turn to you. I expect you to be a professional.”
“A professional,” says Barry dismissively, “Are you serious? I don’t really give a shit about protocol, Jon. A woman’s life is at stake here – I think you’re being reckless with her. I do not believe she belongs in the SCU. Period. And I think you should at least consider the substance of my objections.”
Dr. White’s measured expression does not change. When he speaks, it is with a steady and commanding tone. “Reckless? Somehow I don’t think that’s a valid accusation. But you are free to disagree with me. Just not in front of Ryan, or any other subordinate. You have unfettered access to me, no? Use it wisely to make your points, in private, the way I expect a professional to do. Are we clear on this matter?”
Barry rubs his eyes before looking up.
“Are we clear?”
Barry sighs. “Yes, we’re clear.”
“I have been director here for eight years, and have worked with you for nearly four of those years. I would say that I know my job and that I know you as a professional and as a colleague. Agreed?”
“Yes.” Barry shifts slightly forward in his chair.
“Now, when your wife – ” Dr. White pauses, an uncharacteristic hesitancy passing over his face, “when your wife passed, so soon after your son, I was aware that a tragedy of that magnitude would require the proper amount of mourning, processing, recovery, therapy, and so on; and indeed, I believe I was supportive not only as the director of this hospital, but also as a colleague and, I believe, as a friend. Agreed?”
“Your card was very thoughtful,” Barry says, tugging on his ear and looking up to the corner of the room.
Dr. White’s face momentarily registers surprise before snapping back into place. “I was at a conference in San Diego, Barry, you know that. I couldn’t come back – it was on new ECT therapies for schizophrenia, and I was the keynote speaker, for God’s sake. And we did talk – extensively, when I got back. I offered you all the help I could.”
“You talked, Jon,” Barry says steadily, “I listened. Remember?”
“Because you wouldn’t say a Goddamn word,” Dr. White snaps. He pushes down on the lapels of his coat and takes a deep breath, tamping out the flare of emotion. When he speaks, his voice is calm and once again measured. “When Susan died, under such sudden circumstances, I obviously realized the strain of losing your son and your wife would be almost unbearable.” His calculating eyes attempt to digest Barry’s changing expressions. “Now, I arranged to provide you not only with adequate time off and reduced hours upon your return, but also to help you find the appropriate counseling with any number of qualified experts, all of which you refused, which I respected, despite my own rather strong feelings on the matter, which I made known to you. Agreed?”
Barry nods, just slightly, no longer looking at Dr. White but at his degrees. Cornell University. Harvard University.
Dr. White leans back in his chair. “Let us speak plainly. I’ve known you too long, and we are both too much professionals, to beat interminably around the bush.
“What happened in the past is no longer my concern. It is the past; it is through. My concern is with the present, and with the patients we have now, under our care, now. With how we treat them, now. With our ability to diagnose them, now. I have taken what was once a backwards-looking and ineffective hospital and turned it into one of the preeminent mental healthcare facilities on the East Coast, and intend to further make it the best in the nation. Our schizophrenia research unit has turned the tide on schizophrenia, and we are revolutionizing treatment of this disease. We have increased our state and federal funding ten-fold since I’ve been here, and stand poised to increase it substantially more as our clinical research continues to be published. This institution has become the model of schizophrenic cross-treatment therapy, and while our results are not yet statistically overwhelming, that is only because we haven’t had enough patients. But that will change this year.” Dr. White’s back had straightened into an exclamation point.
“In short, Dr. Long, this program has become bigger than you. It has become bigger than me. It will, with the funding and research methods I’ve put in place, outlast both of us.” Dr. White’s hands come together in front of him. “Which brings us to you. In the last few months,” he says in a stiffening tone, “I've watched a gifted researcher and psychiatrist go from an extroverted professional with impeccable judgment to an almost sullen, withdrawn, and introverted man whose judgment is increasingly suspect. I need you to take yourself out of Tersa’s care, Barry. For your own good.”
Barry crosses a leg while pushing his hand through his hair. “I will not,” he says evenly. “I believe I’m the only one really helping her.”
Dr. White sighs. “I need you to trust me on this, Barry. You’re nearly obsessed with her. And it’s at the expense of our other patients to whom you’ve hardly given any consideration.”
“The other patients are fine under your care, or Ryan’s, or Maureen’s, or Rick’s. I’m concerned with Tersa. I will not be removed from her care, Jon,” Barry says, groping for the right tone.
Dr. White momentarily breaks eye contact. “You don’t see it, do you?”
“Barry, doesn’t it strike you as odd that you’ve chosen to work with a depressed woman, prone to suicide? That you’re trying to prove she’s not schizophrenic? That you’re trying to help her so hard?”
“Look – I know the circumstances around Susan’s death. I know she was depressed. And I know that Tersa bears more than passing resemblance to Susan.”
“That’s preposterous,” Barry nearly shouts, trying to sound dismissive.
“Is it?” Dr. White’s eyes narrow. “Susan and Tersa look alike, they both suffer from depression, Tersa’s tried to take her own life – isn’t it obvious you’re trying to –” He swallows the end of the sentence, not having to add help her because you couldn’t help your own wife.
Barry sits immobile, his body rigid to the observation. But blood bursts into his cheeks and spreads across his forehead and jaw like fire, betraying his static expression and calculated posture. Dr. White notes the affect, then turns to look out his window.
“I’m sorry, Barry,” he says at last. “But you are jeopardizing Tersa’s health, and I am obligated to put her interests before ours. This isn’t your chance to get things right, things you couldn’t get right before.” The two men sit in silence, Barry red and sweating, eyes shifting around the room like an animal’s, Dr. White as static and immobile as a museum piece. Barry’s breath begins to slow as he takes control of it, and the color bleeds from of his face, leaving it as pale as it was crimson only moments before.
“My recommendation,” Dr. White says softly, turning back, “is take a few weeks off – do whatever you like. Leave Tersa in my care, and when you come back – refreshed, clear-headed – we can discuss her ongoing care, if there is still a need for it. I’ll have Dr. Mitchell take over your patients, and you will receive full pay, of course. This entire conversation will not be noted in any official record, nor will the reason for your absence.”
Barry nods, bringing a warm smile to Dr. White’s face. “I’d rather not,” Barry says, watching the smile wilt. “My place is here, with my patients.”
Dr. White says nothing for a long time. “You won’t reconsider?”
“You would have Tersa enrolled in the SRU and subjected to what – fifteen electroshock treatments a week for five weeks? Seventy-five treatments, possibly obliterating her memory and sense of self?”
“Yes, Barry, at least seventy-five treatments. But it isn’t her memory that will be obliterated, it’s her depression. And then we can bring her schizophrenia under control with medication. We can give Tersa her life back.”
“But what about patients like Dan Reynolds?”
“He lost his memory, true. But he is no longer depressed.”
“He’s no longer Dan, Jon. He doesn’t know who he is. What about Jason Kirk?”
“Look, I’m not going to go through this with you. You know as well as I do that ECT isn’t perfect. But for these patients at the extremes it’s their best hope. It’s Tersa’s last hope. Otherwise they’re lost, Barry.”
“It’s not about the funding, not about the publications?”
Those two bright patches of color reappear on Dr. White’s cheeks. “Careful, Dr. Long.”
“I’m just saying we all have our subconscious agendas, Jon. Dan wasn’t a good fit for the program – we all knew it, but pushed him through anyway. I don’t want to make that mistake again.”
“And if Tersa’s not introduced into the program, she goes up to State where they’ll turn her into a zombie and then release her back to the streets with a bus ticket and twenty bucks. Do you really want that?”
“Just give me more time to evaluate her. To make sure.” Barry looks down. “There’s nothing for me at home. You know that. What would I do without my work?”
Dr. White pulls down on the lapels of his coat again. “I do not have the luxury of warning you a second time on this matter, you understand? If you do not take the time off, I will have to note my reservations about your behavior into your official record. Do you understand what I mean by that? Do you understand that I will not warn you again?”
“It’s not personal, Barry. You know that too, right?”
Barry stands, not bothering to ask if there’s anything more. Dr. White watches him shuffle out the door. He sits silently behind his desk, fingers pressed together and resting under his nose, his eyes focused inward. After a few minutes he gets heavily to his feet and, opening a cabinet near his desk, pulls a file and returns with it to the desk. He begins writing in his careful and methodical way, his pen moving continuously and without pause until two pages are filled with the neat lines of his handwriting.
It was late on a Tuesday evening with the cold winter air still wrapped firmly around the city. My dissertation had been finished and submitted, and a job was offered to me at Brown, all of which would have made most people very happy. I had opened the letter from the university and left it on my desk, half-read.
I was lying on my back in my small apartment here in Philadelphia, looking at the ceiling, listening to the clock tick off seconds. It occurred to me that I had never wanted a PhD., had never wanted to teach, had never even wanted to have spent so much time on the East Coast.
I got out of my bed, looking at the wretched squalor of my apartment, with its filthy rugs, unwashed clothes, torn sheets, piles of papers and old food, and saw how they reflected exactly the disorganized state of my own mind, the true nature of my being – soiled, confused, purposeless. And I knew I could not live with myself for another night, for another moment; I realized it had to end, right there. I walked up the stairs to the top of my building and stepped out to the roof, shocked at the cold of the winter night. I wore only a T-shirt and shorts, and the cold sharpened my intent.
I stepped up on the edge of the roof, dangling one bare foot over the street. I spread my arms and closed my eyes – there would be no stopping me this time, no last-minute saves, no trips to the emergency room. I leaned out over Pine Street, and felt myself do a lazy half-flip so that I was going to land squarely on my back. I felt the ground rushing up beneath me, felt my body slam into the pavement, crushing my skull and spine, shattering my pelvis, and exploding both femurs. Tersa was instantly dead.
I opened my eyes and looked down at the street below, surprised to still be standing on the ledge. My arms were still spread, my one foot still raised off the ground. But my mind was as blank and as deep as death. I had no sense of time, or of temperature, or of place, or even of Tersa. It was as if I was looking out of my eyes for the first time.
I don’t know how long I was there, until a sudden, stabbing pain brought me back to my body, back to the world of time and place. Between my eyes it felt like a stray bullet had smashed into my skull. I placed my hand there and pulled it away, expecting blood but finding nothing. The pain became more intense, and it felt to me like the vastness of the universe was being forced into my head. I put my hands over my ears and fell backwards, almost blind with pain. I have no memory of what happened next.
I awoke lying on my back on the roof of the building. I opened my eyes, looking straight up into a sky that was astonishingly clear and blue and deep, as infinite as the heavens behind it. The sun shone not far off the horizon, its light infinitely more complex than I ever suspected was possible. It was, I realized, the very essence of life itself; it was love; it was God. Everything was crisp, distinct, as if the world was coming into existence every moment – even the grime on the roof, the discarded cigarette butts and the trash seemed unbearably alive.
I got dressed and wandered the streets of Philadelphia, wide-eyed and full of wonder. Instead of being separate from everything and everyone, I was everything and everyone; I was the source and the end; the sun and the darkness, life and death; beyond any duality or any sense of identity. I was a God, a gnat, a homeless man, a young pretty woman, the emptiness of the sky, the chaos of the morning rush hour, Tersa. I could turn my thoughts on or off, could summon the thought of Tersa and of her memories, her pain, her emotions, but wasn’t them anymore. It was like remembering a poignant biography of someone else. I went a minute without thought, five minutes, ten minutes. The wall of depression had been shattered, and I was part of a freedom more beautiful, more simple, than language can capture. I was no longer limited to the darkness of depression or the lightness of pleasure – I was both. I was none. I was everything.
And so I wandered the city, it is true, giving up my job and my apartment and any externally constructed identity. I simply existed, for 6 months, living on park benches and in shelters, sometimes unable to function and sometimes finding no need to do so. You see, on some days the self-contraction would return, and I would become Tersa again, overwhelmed by the vastness in me and around me. You have spoken to her and helped her with her contraction, and you have spoken to that which exists around her. Do you see the two-in-one, Barry? Do you see that I am realizing that only one of them is really real?
I do not understand why this has happened to me, Barry, but know I am not like the others here. I have seen the angels, and the devils, that reside within and around us. I’m beginning to see -- as these weeks have passed, I have been seeing more and more; I think I know now what has happened to me. I see it contrasted by you; you have been my foil, you have been my gift. You have cleared away the clutter that was in Tersa -- the pain of her life, felt so sharply, pain that even in my most clear moments swirled blackly around the feet of my freedom. As you have helped clear that away, I have begun to see, Barry, to see things as they really are.
You know -- you know I am not like the others here. These poor souls suffer from delusions so powerful many of them are in a hell far more real, and far worse, than any imagined by a theologian. You see their delusion, Barry, you see how their minds have tricked them into believing truths that you and Dr. White know to be false. But how different are your delusions, Barry, how different are Dr. White’s? Your prisons are much more finely constructed than those men and women you treat – your prisons are guarded by society and patrolled by theory and education. What happens on sleepless nights, when your mind will not be still and you must live with the tyranny of conscious thought, when theory and education and social status no longer provide an illusion of safety? What comes to you in the hours before dawn when the whole world sleeps? Don’t you wonder, Barry, what happens when everything falls away and there’s nothing left? What is it you see then? What words describe it? Can you tell me?
Barry takes out his notebook and makes careful, deliberate notes, then pulls two reference books from his briefcase, finds the pages for which he is looking, and makes the appropriate notations. After twenty minutes of work, he lets his gaze fall out the window of the train. It’s a mild morning for winter, overcast, but the eighteen inches of snow the city has received is still thick on the ground, and the warm air coaxes obscuring mists out of the moisture. Overhead, the sky is a thickening shade of gray, and the world seems more part of a dream world than a waking one.
The R7 travels on an elevated rail over some of the worst areas of Philadelphia, disgorging views of burned-out neighborhoods whose dilapidated factories still declare, in faded paint and broken signs, the dozens of industries that made the city one of the wealthiest places in the world a century before. The homes fair no better than the factories; one in four are partially boarded up and many sink into their foundations, their darkened faces providing no view of the difficult lives within. Barry rests his head against a rattling window, no longer interested in watching the stark images of poverty slide serenely past.
Tersa, Barry knows, is wrong about one thing: emotions are as permanent and fixed as anything in the human mind, and their reality and power can twist logic, unseat reason, and sabotage decades of education and experience. Emotions can even force an attractive and educated young woman to abandon her job and her career, and live as a homeless mendicant on the streets of Philadelphia, forsaking all human contact.
Barry takes his notebook back out of his bag, and makes a few additional notes in Tersa’s file before looking back out the window, nodding to himself and then even risking a smile. The gloom makes no acknowledgement of his breakthrough. He snaps his briefcase shut and exits the train at the next stop.
I see it now, Barry. I see where and why I was lost when I was first brought in here -- the patterns of energy, of thought, of archetype, of life that I so clearly could feel and see -- these too are just more phenomena, more expressions of the underlying Beauty of being. But I couldn’t understand that -- I knew that Tersa wasn’t real anymore, yet didn’t know what else was real, or was not…
All the way up and all the way down, it is Perfection; don’t you see it? The fire that burned upwards within me took me outside of myself, it is true, and landed me here, confused, conflicted, calm-but-on-fire, no? That fire burns upward still, but water now flows down at very same time, washing out of myself and into the world. I have been completed. The end and the beginning all at once, a glorious contradiction where the contradictions cease to have any meaning. When I first awakened on that rooftop, it shattered the habitual patterns of thought that made Tersa who she was. But Tersa was so damaged, so fragmented, that everything that came afterwards was built on unstable ground. You have put Tersa back together enough so that I can finally truly set her free. Tersa is beautiful and wonderful and worthy of love and respect, but she is as impermanent as anything else; she is, ultimately, not real, and she will indeed one day blow away like so much ash on the sidewalk. You can shatter yourself now, while you are still alive or, like most, you can wait to be dismantled in death, where you will indeed get a fleeting glimpse of your own true face, a taste of Perfection as your smallness is snuffed out of existence. I have indeed died, Barry, been set free into a deeper understanding.
Part of you understands me, part of you knows all too well that these words of mine are not the ramblings of an unsettled mind that has fallen asleep to sanity; you know it is the Truth of a mind that is Awake, that sees through the obscurations of our existence. You see, Barry, that it is time to set me free, to release me into the world. My place is no longer within these walls, of that I am absolutely certain. How can I prove this too you? Perhaps by sharing more of what I see and sense of you…
I see that you, Barry, believe that pain has substance, has life and power – you have given it hard edges and used it to prop up the whole of your life. You fight and claw to hold onto your world when, like Tersa, you are just about to break through into the infinite waiting behind every thought.
You have asked me so many questions, Barry, about my life, my loves, my family, my upbringing, my current understanding of the world. I wonder if you can answer some of my questions. Was there a time, perhaps not that long ago, when your theories, your sharp and methodical mind, divided the world into such digestible, easy-to-understand quanta that there was little wonder left? Magnificent sunsets reduced to low-frequency light diffracting in the atmosphere; fiery stars ablaze in a cold winter’s sky reduced to lumps of burning hydrogen gas; depression and anxiety and perhaps even love reduced to the simple interplay serotonin and dopamine within the brain itself. Life, after all, is much less frightening if everything is understood, if everything has its proper place, name, and purpose. Is that not so? Does that not make us all feel better? Isn’t it good to know that I am a Type 1 schizophrenic -- after all, that sounds solid, clinical, and definitive, no?
When I look at you, Barry, I can see in your eyes you have experienced great loss. I can tell you no longer quite believe yourself. Perhaps even your theories have been reduced to nothing more than empty concepts, no longer able to explain the world? I told you before grief knows no boundaries, not between races or sexes or cultural identities or even, Barry, between patients and their doctors. I see your grief, though you try to hide it from me. It’s in the way you hold your head, expressed in the slow movement of your eyes, heard in your deliberate and detached speech, shown in the curve of your shoulders, and seen with the dense movement of your body in every step.
I am free of the complex mass of mental, energetic, and physical habits held together by a few ruling ideas, desires, and associations that we call ‘Tersa’; the irony is that as my mind has become free, it is now my body that is trapped not in a metaphorical prison, but an actual one. I now see, in a way I could not before, how much the others around me suffer. Like Tersa, they think their suffering is real, is absolute, when in fact it is no more than the passing of a shadow across a wide, open field. I feel such intense joy, such profound peace, that transcends utterly ordinary, fleeting emotion. Sometimes, when other patients come near me, they too can feel it. Perhaps that is what I am to do with my life. I thought that it would be enough to just live, to exist, but know now that is selfish and incomplete. I can help others wake from their dreams, from their nightmares, and show them a world without division. But I cannot do it if you will not release me from this prison.
I can help those around me, Barry. I can help you.
Dr. White is peeling the skin off of a banana, pulling on the skin methodically to expose the flesh of the fruit beneath. Barry stands with his back to Dr. White, looking out over the hospital’s snow-covered grounds. Eddies of mists float up from the snow and are taken up by the air, twisting and turning in hypnotic patterns.
“I have confirmed,” Dr. White is saying, “My diagnosis with doctors Miller and Martin, and since Tersa’s already been involuntarily committed, the court order should arrive by week’s end. We will begin ECT therapy next week.”
“It’s a mistake, Jon,” Barry says, turning from the window. Dr. White equitably measures his colleague. He clears his throat, removing another piece of banana and taking the time to chew it. “We have been over this territory before. Have you found another reason to disagree with me?”
“The SRU,” Barry says, moving closer to Dr. Long, his eyebrows knotting together, “Is for low-functioning adults with long histories of mental illness, and long histories of ineffectual response to pharmaceuticals –”
“But under our strict guidelines, electroshock has resolved over a dozen cases of patient psychosis when their treatment is refractory to neuroleptic medication, improved their social withdraw, and lead to the simplification of their medication regiment. You are concerned about the side effects of Tersa’s medication. This is a great solution to that worry.”
“But the risk of personality disruption and memory loss is still very real –”
“Of course,” Dr. White interrupts disdainfully. “We want to disrupt the personality. That is entirely the point.” Dr. White walks towards the door. “Doctors Miller and Martin are going to review Tersa’s file and interview her before she is admitted to the SRU,” he states matter-of-factly, “I want their opinions. The four of us will meet in my office, after they’ve had time to review the files and talk to Tersa – Doreen will email you the time – and we’ll discuss the case.
“I would very much like Doctors Miller and Martin to hear what you have to say.” Dr. White steps into the hallway,
“And Dr. Long, may I suggest you do your homework, get some sleep, and get yourself cleaned up? This meeting is an important one for you.” Barry stands alone in the kitchen, listening as Dr. White’s measured footsteps fade down the hallway.
Barry finishes his rounds for the day and then, back in his office, carefully selects four reference books and a stack of papers, putting them neatly into his briefcase. He gathers his coat, gloves, and hat, placing them under his arm and, with his briefcase pulling heavily on the other hand, makes his way though the quiet hospital corridors. In his slow and methodical way Barry winds through the hallways until he is standing in front of room 51A. The room is dark, but through the window he sees a nightlight creating an inviting pool of ethereal light. He knocks gently and, receiving no answer, lets himself in.
Tersa is soundly asleep, her face the only part of her body exposed to the air. Her high cheekbones and oval face run into a strong chin, and her hair, as dark and vibrant as a living thing, spirals out in waves across her pillow. Dr. White, Barry reflects, was correct about one thing, at least. Tersa looks like Susan – the two could easily be sisters. After Dale died, he was so raw, so torn with pain that he hated Susan, hated her for reminding him, with every glace, of his son. When she touched him he would recoil as if struck, and they ended up not only in separate beds but on separate floors. Barry would sometimes see Susan send him a pleading look over their silent meals, or from across the room while he read. Sometimes she would linger by his study door as he worked, not entering or speaking, him knowing she was there only by the faint sound of her breath. He felt not pity, not compassion, not love, but hatred for her, for making his pain so unbearable. They lived this way for weeks and weeks, until that day when he got the call doctor long your wife’s been in a serious auto accident and airlifted to Temple University Hospital please come right away and he did, all of his hatred, his anger, evaporated in a flash, as suddenly foolish as a temper tantrum.
On that long drive, the longest fifteen minutes of his entire life, he felt only blinding love for his wife and prayed, bargained, and begged for her to be okay so he could tell her he still loved her, he had always loved her, and would love her always still. He wanted to whisper in her ear that they would get away, take a sabbatical from their lives and their sadness and find the time and the place to bury Dale and bring themselves together again. He wanted to take her hand in his and tell her he was sorry, that he never meant to push her away, and that he would forever hold her close. When he got to the hospital the chaplain was waiting for him at the entrance and he knew, of course, it was over, even before the surgeon told him Susan had driven into a telephone pole head-on at over fifty-five miles an hour. She was thrown from the car after going through the windshield, and had broken her back, arms, legs, and pelvis. She had four compound fractures, half a dozen broken ribs, and a fractured skull. She had, somehow, made it alive to the ER, where the doctors had worked to save her life for two hours before letting her shattered body grow still. The head surgeon was a handsome young man, much younger than he, who never made eye contact and who spoke in a dry monotone, like he was talking about something that had happened years before and had been retold so many times that the story no longer had any real emotion.
The nights afterwards had been full of such unspeakable darkness that each moment, each crawling second, had passed with an excruciating slowness. Alone, devastated with agony, he only thought again and again about the last time he had seen his wife alive. Susan had curled herself silently into the chair in his study without him even noticing, and when he turned and saw her sleeping body he had exploded in rage, shouting and screaming and ranting until she was driven away with tears streaming down her face. He had, somehow, managed to keep on all these months, even though he had killed the only woman he had ever loved.
Tersa stirs in her sleep and moans, and Barry looks around him as if unsure of even where he is. And then he remembers Tersa and her mother’s death, and how he had explained to her it had not been her fault. Yet he knows this is different, somehow. This is unforgivable. Children are supposed to hate their parents, after all, but not spouses, not Susan; not after she too had just lost her son. He turns to leave, but is surprised to see an envelop bearing his name propped under the nightlight. He opens it, straining to read in the half-light of the room.
Thank you for telling me that my fate is to be determined by an assessment this week with all those who have helped care for me. Thank you too for telling me you believe me, that you do not think I am in need of medication anymore. It is comforting knowing that you will be on my side, and help to convince Dr. White and the others that I am not delusional, not insane, not crippled by schizophrenia, not the product of my own delusions.
When I hear Tersa’s thoughts, when I reflect on who I was, I wonder if these medications, these treatments, these somber men in white coats, will erase this understanding I have gained, plunging me back into the dream, the nightmare, of my former existence. If that happens I will again be the clinically depressed girl who needs help. This perfection will be lost in the darkness, in the so limited understanding, of Tersa.
Regardless of what happens, thank you for all that you have done for me, and I hope that you may one day know the peace of an open sky.
With all of my heart,
Once home, Barry prints out his typed notes about Tersa that include the opinions he has been so strenuously voicing for so long. He reads over them, unsure of even his most basic conclusions. He walks down the short hallway to Dale’s room, peering in as if afraid of waking someone dozing inside. He remembers seeing television specials and news reports when a younger man that would show a family who never redecorated a lost child’s room, preserving it in what he thought then was a pathetic and desperate refusal to come to terms with a loss. And yet nearly a year has passed, and his son’s homework books are still on his desk the way he had left them before the accident, his bed still partially unmade, his backpack half-opened and spilling books in the corner of the room. A fine layer of dust is the only indication that an active and bustling young man hasn’t set foot in the room in too long a time. Barry goes back to his study, gathers the papers into order and places them in his briefcase, then carries the briefcase down the stairs and puts it by the front door.
Over the course of the night Barry watches, unable to sleep, as the shadows morph, gradually growing more distinct and defined. Light steals in around the blinds, filling the room with early morning twilight. Barry sits up, after seven hours laying awake, and places his feet on the coolness of the wooden floor, then showers, shaves, brushes his teeth, and dresses. He sits under the flickering glow of florescent lights on the train, surrounded by the long faces of the other commuters. Outside, the naked earth looks bruised and old, with even stubborn weeds long brown and dead. Tire tracks and rough footpaths have torn across yards and open fields, leaving streams of mud burst across matted grass. Banks of blackened snow stubbornly remain, clotted in dark corners and against unused fences.
Barry tells the stunned secretary to let the other doctors read over his notes and decide for themselves what to do.
“But Dr. Long,” she stammers, “They’re waiting for you –”
“Goodbye, Doreen,” Barry replies, handing her a stack of neatly ordered papers.
He walks through the cold morning mists and through the streets of the wakening city, passing people hustling to their jobs and street vendors detaching carts from beat-up cars. Everyone is dressed warmly, with faces reflecting thoughts of spring and of an end to the snow. Barry spends much of the morning walking, moving slowly, his hands in his pockets, letting people rush around him on either side. When he reaches Washington Park on 7th and Walnut, he wanders in, walking past the huge sycamores that, if they could speak, might tell of the days of cobblestone streets and horse-drawn carriages, or of the times when the Union army marched right past them a century and a half before. Barry sits on a hard bench brushed clean of snow, and lets his face fall into his hands. For a long time he doesn’t look up, but when he does, he sees the mists have cleared, and the sun is shining brightly.
# # #
© 2004, 2007 Keith Martin-Smith