Сэмуэль Шэм - Mount Misery

"Read," Malik said. "We'll listen." Mary read her poem, ending with:

"We all imagined his hesitant, stammering manner

Merely concealed his heart's strong core, But he had his misery, his hesitant stammering manner,

And nothing more."

Stillness. She'd gotten him exactly right. Errol and Win kept rocking in their chairs, but said nothing. Mary handed the piece of glass to Malik.

"Beautiful," Malik said, "and true. Can I ask you a few questions?"

"Yes. If you can be kind, like Dr. White."

"I'll try," Malik said. He talked with her for a while, and then the strangest thing happened. Later I couldn't recall how it came about, but after just a few minutes of their talking, talking as if they were old friends meeting after a long time, talking about her Down syndrome son and the parka crucified on the truck, Malik asked her something that seemed completely bizarre: 'Tell me about your other son."

Mary Megan sat up in shock, her eyes wide. "My other…?"

"Yes. The one you lost." I had no idea what he meant. Mary Megan had said nothing about another son. I felt a kind of "click." I waited.

"Oh God!" she said, and began to weep softly, and on her tears rode a story none of us had ever heard from her. Thirty-one years ago, when she was seventeen, she'd been forced into sex with a neighbor and gotten pregnant. She'd told no one but her mother, who demanded that she give the baby up for adoption. Finally Mary agreed, on one condition: that the

Clarissan nuns taking the baby let her see it just once. The Mother Superior agreed. She gave birth to a boy. The nuns never let her see it. Every year, every single year on his birthday, she would think of that baby boy and wonder where he was, and what his life had become. "A year and a month ago," she said now, "on his thirtieth birthday, the phone rang. I picked it up. A man's voice asked, 'Is this Mary Megan O'Toole?' I knew at once. My heart seemed to tear loose inside me. I said, 'Yes it 'tis.' 'Well… I am your baby boy.' " She wept frantically, searching for tissues. Malik handed her a box. Calming down, she went on, "We met a few days later, and… he said he wanted to meet just the once, no more. I told no one, no one knows this, no one a'tall, not even my dear husband Joey. I never even told poor Dr. White. I was okay for a year, but then, this year, without him, when that day came 'round… I could not go on… I couldn't even eat."

"Anniversaries are killers," Malik said. "You had an 'anniversary reaction'-it's totally normal. And why didn't you tell Dr. White?"

"He seemed too… vulnerable? And he didn't ask, like you did."

"You feel okay about telling us?"

"I do. You have a kind face. Thank you."

"Now that it's out, we can help you to heal the wound."

She wept again, quietly. I felt moved, awed even, by Malik's way: so simple, so there with her. She sniffled. "That would be fine. Thanks."

Mary Megan left, shutting the door quietly behind her.

"Okay good great," Errol said loudly. "Now let's do some real workl"

He and Win then discussed the "case," fitting it brilliantly to Borderline Theory, concluding that the diagnosis was BPO with A and B-Anorexia and Bulimia-even though Mary had explicitly denied previous anorexia or bulimic vomiting. And wouldn't you know it but BPO with A and B was a particular diagnosis Errol just happened to be the world expert in! Not only that, but by sheer coincidence he was also the world expert in the drug to treat it! "The treatment of choice," he said, "is my experimental drug amyoxetine-brand name Placedon. Brought it back from Bangkok-in my backpack. Placedon makes Prozac look like popcorn. We may need to

add my other experimental drug, Zephyrill." While these names were enticing, as if, if you did these drugs you'd be partaking in an encounter with two of Babar's lost children, I was appalled at this, a diagnosis and treatment totally at odds with her obvious and what seemed to me normal grief.

"The woman is going through a normal grief reaction," Malik said. "If we can keep her off drugs, she'll pull together just fine."

"This is for the benefit of the new residents," Errol said, glancing at me and Win. "There's never once been a controlled experiment that showed that talking to patients does any good at all. Any effect is placebo effect. You residents shouldn't waste your time learning how to do this mumbo-jumbo, 'cause there's no 'it' to do. So Malik got her to tell a story, so what? Won't help. Like pissing in the ocean. There are no 'psychosocial' factors in mental illness. If it's mental illness, it's biochemical, and vice versa. Save her a lot of grief-give her Placedon."

"Thanks for sharing, Errol," Malik said, "and now go fuck yourself."

"So," Errol went on, as if Malik hadn't said what he had said, "to get these experimental medications, she has to be in our new research study." He took out a lavender form and got up. "I'll get her informed consent."

"She refuses all drugs," Malik said, rising. "Thanks for stopping by."

"Don't worry, we'll get her to sign."

"She won't talk to you, guaranteed."

"We'll get husband Joey to sign."

"Not without her permission."

"She's not competent to give permission. She's a bottierlinel"

"And," said Win Winthrop, "bulimic. She deserves a trial of Placedon."

"After she's on it, we'll get some of her blood," Errol said. "When her level's in the therapeutic window, she will be competent, and then she can decide rationally about going off Placedon no problem thanks."

Malik picked up Mary Megan's chart and read aloud as he wrote, " 'Patient is mentally competent. Patient refuses all drugs.'"

Red-faced, Errol rose and said, "Know what your problem is, Malik?"

"Maybe that I think you're a neo-Nazi?"

"Your problem is you're nuts and you should be on medication!" They hurried out.

"Wait!" Malik shouted. "When are you gonna study drug compliance!" He turned to me. "Know what they don't do?" I asked what. "Sports! C'mon."

In the nursing station, as he changed into shorts for his morning run, Malik said, "Don't get me wrong, I'm not against using medication. I use it, if it's right to use. But all the studies of compliance show that patients don't take their drugs fifty percent of the time, and that the only reason they do is if they have a good relationship with their doctor. And guys like Errol are terrible at relationship. Which is one of the two reasons they specialize in drugs. Walk me out." I followed him outside.

"What's the other?" I asked, squinting at him in the bright sun.

"Money. Drug-therapy guys like Errol see six patients an hour, at seventy dollars a pop: four hundred and twenty dollars an hour. Talk-therapy guys see one an hour, at a hundred bucks." He stretched his quads, pulling a bent leg up behind his back so that, with those amber lenses astraddle his beak nose, he looked like a wise, hip stork. 'Talk therapy is dying. The drug cowboys are taking over. They use drugs to stay away from being with people. It's easier than being human with that kind of suffering. Other than drugs, the only way to make a living as a shrink is to write some bullshit self-help book. I'm thinking of writing one called 'Anorexia Digest.' "

"But how did you know, I mean about the other son?"

"Dunno. When she talked about that parka, crucified, I picked up somethin', like 'lost son.' So I took a shot, got lucky. Sometimes people don't know that on anniversaries they crash. Just to name it helps a lot."

"It's so sad! Every year, for thirty years, on that day, she's wondering where he is? It blows me away."

"Yeah. Ike's suicide for her, for all of us, is a big 'Fuck you!'" He sighed. "So now you see all the bullshitology around 'diagnosis.'"

"Isn't diagnosis important?"

"In psychiatry, diagnosis comes last."