David Wallace - Infinite jest

The attempt had been serious, a real attempt. This girl had not been futzing around. A bona fide clinical admit right out of Yevtuschenko or Dretske. Over half the admits to psych wards are things like cheerleaders who swallow two bottles of Mydol over a high-school breakup or gray lonely asexual depressing people rendered inconsolable by the death of a pet. The cathartic trauma of actually going in somewhere officially Psych-, some understanding nods, some bare indication somebody gives half a damn — they rally, back out they go. Three determined attempts and a course of shock spelled no such case here. The doctor’s interior state was somewhere between trepidation and excitement, which manifested outwardly as a sort of blandly deep puzzled concern.

The doctor said Hi and that he wanted to ascertain for sure that she was Katherine Gompert, as they hadn’t met before up till now.

‘That’s me,’ in a bit of a bitter singsong. Her voice was oddly lit-up for one who lay fetal, dead-eyed, w/o facial affect.

The doctor said could she tell him a little bit about why she’s here with them right now? Can she remember back to what happened?

She took an even deeper breath. She was attempting to communicate boredom or irritation. ‘I took a hundred-ten Parnate, about thirty Lithonate capsules, some old Zoloft. I took everything I had in the world.’

‘You really must have wanted to hurt yourself, then, it seems.’

‘They said downstairs the Parnate made me black out. It did a blood pressure thing. My mother heard noises upstairs and found me she said down on my side chewing the rug in my room. My room’s shag-carpeted. She said I was on the floor flushed red and all wet like when I was a newborn; she said she thought at first she hallucinated me as a newborn again. On my side all red and wet.’

‘A hypertensive crisis will do that. It means your blood pressure was high enough to have killed you. Sertraline in combination with an MAOI [28]will kill you, in enough quantities. And with the toxicity of that much lithium besides, I’d say you’re pretty lucky to be here right now.’

‘My mother sometimes thinks she’s hallucinating.’

‘Sertraline, by the way, is the Zoloft you kept instead of discarding as instructed when changing medications.’

‘She says I chewed a big hole out of the carpet. But who can say.’

The doctor chose his second-finest pen from the array in his white coat’s breast pocket and made some sort of note on Kate Gompert’s new chart for this particular psych ward. Crowded in among his pocket’s pens was the rubber head of a diagnostic plexor. He asked Kate if she could tell him why she had wanted to hurt herself. Had she been angry at herself. At someone else. Had she ceased to feel as though her life had meaning to it. Had she heard anything like voices suggesting that she hurt herself.

There was no audible response. The girl’s breathing had slowed to just rapid. The doctor took an early clinical gamble and asked Kate whether it might not be easier if she rolled over and sat up so that they could speak with each other more normally, face to face.

‘I am sitting up.’

The doctor’s pen was poised. His slow nod was studious, blandly puzzled-seeming. ‘You mean to say you feel right now as if your body is already in a sitting-up position?’

She rolled an eye up at him for a long moment, sighed meaningfully, and rolled and rose. Katherine Ann Gompert probably felt that here was yet another psych-ward M.D. with zero sense of humor. This was probably because she did not understand the strict methodological limits that dictated how literal he, a doctor, had to be with the admits on the psych ward. Nor that jokes and sarcasm were here usually too pregnant and fertile with clinical significance not to be taken seriously: sarcasm and jokes were often the bottle in which clinical depressives sent out their most plangent screams for someone to care and help them. The doctor — who by the way wasn’t an M.D. yet but a resident, here on a twelve-week psych rotation — indulged this clinical reverie while the patient made an elaborate show of getting the thin pillow out from under her and leaning it up the tall way against the bare wall behind the bed and slumping back against it, her arms crossed over her breasts. The doctor decided that her open display of irritation with him could signify either a positive thing or nothing at all.

Kate Gompert stared at a point over the man’s left shoulder. ‘I wasn’t trying to hurt myself. I was trying to kill myself. There’s a difference.’

The doctor asked whether she could try to explain what she felt the difference was between those two things.

The delay that preceded her reply was only marginally longer than the pause in a regular civilian conversation. The doctor had no ideas about what this observation might indicate.

‘Do you guys see different kinds of suicides?’

The resident made no attempt to ask Kate Gompert what she meant. She used one finger to remove some material from the corner of her mouth.

‘I think there must be probably different types of suicides. I’m not one of the self-hating ones. The type of like “I’m shit and the world’d be better off without poor me” type that says that but also imagines what everybody’ll say at their funeral. I’ve met types like that on wards. Poor-me-I-hate-me-punish-me-come-to-my-funeral. Then they show you a 20 X 25 glossy of their dead cat. It’s all self-pity bullshit. It’s bullshit. I didn’t have any special grudges. I didn’t fail an exam or get dumped by anybody. All these types. Hurt themselves.’ Still that intriguing, unsettling combination of blank facial masking and conventionally animated vocal tone. The doctor’s small nods were designed to appear not as responses but as invitations to continue, what Dretske called Momentumizers.

‘I didn’t want to especially hurt myself. Or like punish. I don’t hate myself. I just wanted out. I didn’t want to play anymore is all.’

‘Play,’ nodding in confirmation, making small quick notes.

‘I wanted to just stop being conscious. I’m a whole different type. I wanted to stop feeling this way. If I could have just put myself in a really long coma I would have done that. Or given myself shock I would have done that. Instead.’

The doctor was writing with great industry.

‘The last thing more I’d want is hurt. I just didn’t want to feel this way anymore. I don’t… I didn’t believe this feeling would ever go away. I don’t. I still don’t. I’d rather feel nothing than this.’

The doctor’s eyes appeared keenly interested in an abstract way. They looked severely magnified behind his attractive but thick glasses, the frames of which were steel. Patients on other floors during other rotations had sometimes complained that they sometimes felt like something in a jar he was studying intently through all that thick glass. He was saying ‘This feeling of wanting to stop feeling by dying, then, is —’

The way she suddenly shook her head was vehement, exasperated. ‘The feeling is why I want to. The feeling is the reason I want to die. I’m here because I want to die. That’s why I’m in a room without windows and with cages over the lightbulbs and no lock on the toilet door. Why they took my shoelaces and my belt. But I notice they don’t take away the feeling do they.’

‘Is the feeling you’re explaining something you’ve experienced in your other depressions, then, Katherine?’

The patient didn’t respond right away. She slid her foot out of her shoes and touched one bare foot with the toes of the other foot. Her eyes tracked this activity. The conversation seemed to have helped her focus. Like most clinically depressed patients, she appeared to function better in focused activity than in stasis. Their normal paralyzed stasis allowed these patients’ own minds to chew them apart. But it was always a titanic struggle to get them to do anything to help them focus. Most residents found the fifth floor a depressing place to do a rotation.