Сэмуэль Шэм - Mount Misery

Around the far end of the lake and up a last rise through the woods, I came to Emerson, where Ike White's office was. The center stairwell had spectacular woodwork, enclosing the stairs in wooden banisters and railings that were meant to prevent suicidal jumps. The light from the skylight at the top was chopped up by hundreds of slats. On the second-floor landing was a sign, EMERSON 2: BORDERLINE WARD, and a small handwritten note, Split Risk. I searched the twenty keys on my ring for the right one and opened the door. As I was trying to pull my key back out, someone shot out past me screaming, "Freedom!" He ran down the stairs and was gone.

Next came two large men running full-tilt. Feeling I'd made a terrible mistake, I walked into the large, well-furnished living room.

"Hey, dickhead!"

I turned, just after I realized that to turn and answer was really stupid. I found myself facing a sandy-haired, baby-faced man my age dressed in jeans, suspenders, and a white shirt and bow tie.

He smiled and said, "Dickheads Make Mistakes!"

In the nursing station there was pandemonium. Two people were on the phone at once, talking about how Harrison, a dangerous paranoid man, had split again.

"Nice work, Dr. Basch," the ward secretary said. "Split Risk splits again! If he gets at his wife, we'll all get sued to hell."

"Sorry. What time will Ike White be in?"

"He's been here like two hours already. Down in his office."

"Since five A.M.?" I asked. "Why?"

"Said he had some work to do."

I went down a flight to the first-floor ward, Emerson 1, Depression, and knocked on Ike's office door.

"C-c-come in," he said, with his characteristic stutter.

Dr. Ike White, Director of Residency Training, was a short, slight man of forty, with a slender face and light green eyes highlighted by delicate, long lashes. His dark hair was cut boyish, all the way to a cowlick he twirled with an index finger when deep in thought. Ike was the kind of person who always seemed glad to see you. His stutter made him sound vulnerable, and humble. He was my mentor, the reason I'd come to Mount Misery for my psychiatric training. I'd met him a year before, when he'd interviewed me for admission. It was difficult to get into Misery, ten applicants for every slot. Yet Dee had taken one look at my documents and said, "A t-t-terrific C.V."

"I look pretty good on paper."

He smiled. "How can we c-convince you to c-c-come?"

"You're accepting me?" I said.

"Yes. I don't b-b-believe in p-p-putting pressure on. Let's just t-t-talk."

I had been surprised. For years, applying to the best colleges and medical schools, I'd gone into these interviews on guard against deception, and intent on deceiving. Ike just seemed to want to make contact with me, hear about me, for no other reason than his curiosity. As if we were friends, we began to talk. And as we went on, I was even more blown away: Ike listened. I felt heard, responded to, suddenly more alive. We had a wide-ranging, leisurely talk-surprising in itself, for most other doctors who'd ever interviewed me for anything had been in a hurry, the goal of the interview being mainly to get it over with. When I asked Ike about himself and

his work, he responded with clarity graced with humility. His expertise was depression and suicide. He treated patients, did research on the causes of depression, and was both a Freudian psychoanalyst and an expert in the use of drugs to treat depression. He loved to teach new residents. Ike was a rising star in the BMS sky.

"Is there anything you're not good at?" I asked. He smiled. Gesturing to the floor-to-ceiling shelves on which books were haphazardly arranged, and to the piles of journals and notes on the floor, with a few paths threading through between desk and analytic couch and chair, and the desk buried under paper and heavy objects holding down other paper, he said, "I have a helluva t-t-t-time keeping my stuff in order."

I'd gone into the interview planning to do my psych training in a tough, competitive program at the inner-city hospital nicknamed "Man's Best Hospital"-"the MBH." My interview with Dee-set against the elegance of Misery, where not only the buildings and grounds but even the two tennis courts were immaculate, with bright white lines and crisp twiny nets-changed my mind.

"Okay," I'd said. "You convinced me. I'll come here on one condition." "N-name it."

"That you be my teacher."

He smiled shyly. "N-n-nothing would make me h-h-h-happier."

So Ike had become my main teacher, or supervisor. Learning to become a psychiatrist was an apprenticeship system-you learned by being apprenticed to senior psychiatrists on the Misery staff. You watched them treat patients and received their supervision on your treatment of patients. Usually you would have an hour of supervision for every hour you spent with a patient in therapy. The supervisory session would consist of your telling the supervisor what went on in the session, either from your memory or, as some supervisors required, from notes you took during the session. Like most first-year residents, I had never actually done psychotherapy with patients. In fact I hadn't taken psychiatry as a medical student-it wasn't a required course at the BMS, and I, at that time more focused on the body than the mind, had never

gotten around to it Unlike most of my fellow first-year residents, I myself had never even been in therapy-I'd never felt the need until the experience of my medical internship, but then there had been no time, or money. I was a latecomer to wanting to be a shrink. It had kind of surprised me, as a career choice, toward the end of my internship. Most of the other first-year residents had been focused on becoming shrinks for a long time, at least from medical school on. As a result, I felt more naive about all this psychiatric stuff than the four others, and was always trying to catch up.

Dee White had helped me, immensely. My first month I'd spent with him on Emerson 1, Depression. During that time I had been dazzled, not only by his brilliance and integrity, but by his modesty and just plain humanness. Watching him interact with his depressed patients on his daily rounds, I'd seen his skill at listening and responding to them, and had tried to model myself after him. In my month with Die, he had fulfilled all of my expectations.

Now, he nodded a welcome to me. He sat behind his large cluttered desk, papers piled to his head. His dark suit seemed too big, as if he'd lost weight. It was cold in the office, so I put my own suit jacket back on. I told nun about the interview with Cherokee and asked what I should do.

T-t-tell me more about his d-delusion."

"Is it just that," I asked, "a delusion?"

"So f-far it is."

"Should I talk to Schlomo?"

"What are your thoughts about t-t-"

'Talking to him? I think I should let him know-"

The phone rang, twice, then the answering machine clicked on, and then at a high volume came a strong, assertive voice:

"Dr. White, this is Hilda in the Misery Benefits Office. I'm returning your call from this morning, inquiring about your benefit package-"

Dee jumped up and turned off the volume. He sat down, smiling shyly, and with a strangely embarrassed look in his eye. It made me nervous, and to break the tension I joked:

"Congratulations. Ladies and gentlemen, we got a cure! Hilda's not depressed anymore, hell no!"

We laughed. Ike, dealing with depressed people all day long, had developed what he called his "Answering Machine

Strategy." He set the pickup level on the machine so low that when depressed people called and spoke at the low, hesitant level of their depression, the machine would cut them off. To avoid being cut off, they had to speak up. As time went on they would learn to be more assertive, which helped them recover. I didn't know whether or not this Hilda from Misery Benefits had been depressed, but it had become a standing joke between us.