Сэмуэль Шэм - Mount Misery

"From what?"

"This." He spread his arms. "All this. The more I see, the more I think that if all the shrinks in the world were to die of heart attacks at once, all the patients in the world would be a helluva lot better off."

"Including you?"

"If and when I act like a shrink, yeah."

"But you are a shrink."

"You gotta know it to let go of it. You tell me if and when, okay?" I nodded. "And when I'm gone in a month, protect him from Blair Heiler and you."

"Me?" I asked, stunned. "You don't know what you're talking ab-"

"Kid, you're gonna go for Heiler like America goes for stars! C'mon, we got Case Conference. Heiler set it up before he went on vacation."

Malik left, but I couldn't, yet. A cloud darkened the quiet porch. I turned back to Mr. K. hi silence, he was weeping. Two glints of tears were running sadly down his old man's old damaged man's cheeks. I felt really bad. "I'm sorry, Mr. K.," I said. "Are you sad, hearing all that?"

"Hahaa!" he said, his laugh crackling and high-pitched, like a child finding a favorite toy, say a stuffed zebra. "Doctor, I've got some advice for you: always keep a low center of gravity sometimes."

"Deal," I said, relieved.

Laughing, he gave me a thumbs-down and a high five.

Case Conference was designed to try to get a fresh look at a problem patient by bringing in a world expert to talk things over. Waiting in the conference room was Dr. Errol Cabot, the world expert of the day, his world expertise being the drug treatment of mental illness. Errol was a chunky thirty-five-year-old man with a square-jawed flat face and eyes that seemed to bulge out of a sea of thyroid. This drug doctor was so restless and hyper he always struck me as being on drugs. His dark red hair was cut back like the helmet of Winged Victory, and he wore a long white lab coat.

With him was his proteg6, a new first-year resident named Win Winthrop. I knew Win from medical school. Though fat, he was energetic and optimistic, with the keen intelligence I had always associated with people with his fiery red hair and freckled, alabaster skin. In med school he had been doing special projects on the uses of computers in surgery, and using the internet and medical telecommunication to bring surgical supervision to distant parts of the globe, even, once, to a needy hospital in Tierra del Fuego. Early in medical school he had discovered, for the first time, a sex life, stimulated by a hot web-site e-mail with a surgical nurse several years his senior, who turned out to be just as hotly optimistic as Win, especially in bed, where Win had had little experience. She was soon pregnant. They married and had a baby boy. Now she was pregnant again. Given his surgical bent, I'd been surprised

when Win declared for psychiatry. He had explained that he would be combining fields, hoping to use computer-driven, stereotactic surgical techniques on the human brain, and, in his words, "using drugs with surgical precision, making surgical strikes against our common enemy, mental illness. You see, Roy, Mother has been bipolar for years, unbeatable, much to Father's chagrin. I'm working on a cure." Win's father was a Boston Brahmin, a well-known lawyer at Hale and Dorr, and he had been disappointed in Win's choice of psychiatry, for he had been hoping against hope for the only honorable medical specialty, surgery.

After only a month, Win, like a dog with its master, had become much like Errol: both were hyper and manic with eyes wide as boys eyeing an electric train set; both had their red hair cut like Prince Valiant; and both were bulky under their long white lab coats. They were rocking in their chairs as we entered the room. I was to find that Errol-and Win too-had two traits that would prove remarkably useful as they threw drugs into people: unawareness of self, and unawareness of others.

That day the patient was Mary Megan Scorato, admitted several weeks before to Emerson 1. For those weeks, Ike had been her therapist. I remembered that she was the "acutely suicidal patient" Ike had needed to see the day before as I'd left his office. Mary Megan was one of those "salt of the earth" people whom everyone loved, a kindhearted woman of Irish descent married to an Italian who, in her weeks on Depression, had taken to "mothering" all of us, patients and doctors alike. Hannah had formed a special bond with Mary Megan. "I love that woman!" Hannah always said, rolling her eyes way up. "She's a great mother-prefeminist and unconnected-and boy is it nice. Like eating whatever you want and not gaining weight. My mother, on the other hand, had a sign on the refrigerator: 'A Moment on the Lips, Forever on the Hips.' " Mary Megan baked cookies for us all, listened to other depressed patients' problems, cleaned countertops, and did laundry. Everybody loved her. How could you not?

Yet she herself remained hidden. A woman from a poor Irish family, she'd worked her way through secretarial school and had become an assistant to the director of admissions at Harvard, over an hour's commute away. Institutions like

Harvard always have a warmhearted type on the front lines, protecting the hard-hearted higher-ups, and Mary Megan was it in Admissions. She had had her share of suffering: married at forty, she gave birth to a baby with Down syndrome. Now a six-year-old, the boy was severely disabled. Mary Megan was a hefty woman, but she had lost her appetite, begun eating very little, and lost a great deal of weight. People said, mistakenly, that she "looked good." Two weeks before, she had completely snapped. She was picked up by the state police on the side of the interstate, weeping hysterically, threatening to throw herself into the traffic. As they were coming home from vacation, the family's luggage had blown off the roof rack and her six-year-old's new parka had flown away and reappeared crucified on the front grille of a trailing ten-wheeler. Since then she'd been actively suicidal. But something didn't make sense. Why should luggage falling off a car and a parka on the front of a truck plunge a fine, by-all-accounts cheerful woman with lots of friends at work and home into suicidal despair? No one, not even Ike White, had been able to find out.

"Okay!" Errol said as we sat down, before Mary Megan was brought in. "Let's go. Win and I have read the chart, so we all know the case. First, diagnosis. It's absolutely clear this gal is a BPO with Ano-"

"First," Malik said, "we talk with her."

Errol's jaw dropped, as if this were incredible, for a doctor to actually talk with a patient.

Mary Megan Scorato came in. Her freckled milky complexion was marred by dark bags under her eyes and slack skin around her mouth. The edges of her lips turned down, as if she were on the verge of tears. Her auburn hair was unwashed and halfheartedly in a bun, ends escaping out and hanging despondently down, ends she didn't brush out of her eyes. Her clothes, usually neat and clean and perky in the way that an old-fashioned good mother's kitchen clothes are perky, were rumpled and too big for her thinning body. She nodded to Errol, Win, Malik, and me and sat down. Malik explained that we would talk.

"This morning I wrote a little poem for this conference," she said.

"What meds are you on, sweetheart?" Errol asked.

"Dr. White was so kind and good, I wrote a poem."

"What meds worked best in the past, gal?" Errol asked.

It went on like that, Errol talking drugs and Mary Megan talking poetry. Mary Megan got more and more subdued. I felt for her. Finally Malik said, "You okay, Mary?"

"No I am not! I came here to read my poem for Doctor-"

"What about anticonvulsants, honey?" Errol asked.

Mary Megan stared at him and then took a green piece of glass out of her sleeve and held it to her wrist. "Let me read my poem or I'll cut myself!" Her thin cheeks made her eyes seem huge.