David Wallace - Infinite jest

‘What I’m trying to ask, I think, is whether this feeling you’re communicating is the feeling you associate with your depression.’

Her gaze moved off. ‘That’s what you guys want to call it, I guess.’

The doctor clicked his pen slowly a few times and explained that he’s more interested here in what she would choose to call the feeling, since it was her feeling.

The resumed study of the movement of her feet. ‘When people call it that I always get pissed off because I always think depression sounds like you just get like really sad, you get quiet and melancholy and just like sit quietly by the window sighing or just lying around. A state of not caring about anything. A kind of blue kind of peaceful state.’ She seemed to the doctor decidedly more animated now, even as she seemed unable to meet his eyes. Her respiration had sped back up. The doctor recalled classic hyperventila-tory episodes being characterized by carpopedal spasms, and reminded himself to monitor the patient’s hands and feet carefully during the interview for any signs of tetanic contraction, in which case the prescribed therapy would be I.V. calcium in a saline percentage he would need quickly to look up.

‘Well this’ — she gestured at herself— ‘isn’t a state. This is a feeling. I feel it all over. In my arms and legs.’

‘That would include your carp — your hands and feet?’

‘All over. My head, throat, butt. In my stomach. It’s all over everywhere. I don’t know what I could call it. It’s like I can’t get enough outside it to call it anything. It’s like horror more than sadness. It’s more like horror. It’s like something horrible is about to happen, the most horrible thing you can imagine — no, worse than you can imagine because there’s the feeling that there’s something you have to do right away to stop it but you don’t know what it is you have to do, and then it’s happening, too, the whole horrible time, it’s about to happen and also it’s happening, all at the same time.’

‘So you’d say anxiety is a big part of your depressions.’

It was now not clear whether she was responding to the doctor or not. ‘Everything gets horrible. Everything you see gets ugly. Lurid is the word. Doctor Carton said lurid, one time. That’s the right word for it. And everything sounds harsh, spiny and harsh-sounding, like every sound you hear all of a sudden has teeth. And smelling like I smell bad even after I just got out of the shower. It’s like what’s the point of washing if everything smells like I need another shower.’

The doctor looked intrigued rather than concerned for a moment as he wrote all this down. He preferred handwritten notes to a laptop because he felt M.D.s who typed into their laps during clinical interviews gave a cold impression.

Kate Gompert’s face writhed for a moment while the doctor was writing. ‘I fear this feeling more than I fear anything, man. More than pain, or my mom dying, or environmental toxicity. Anything.’

‘Fear is a major part of anxiety,’ the doctor confirmed.

Katherine Gompert seemed to come out of her dark reverie for a moment. She stared full-frontal at the doctor for several seconds, and the doctor, who’d had all discomfort at being stared at by patients trained right out of him when he’d rotated through the paralysis/-plegia wards upstairs, was able to look directly back at her with a kind of bland compassion, the expression of someone who was compassionate but was not, of course, feeling what she was feeling, and who honored her subjective feelings by not even trying to pretend that he was. Sharing them. The young woman’s expression, in turn, revealed that she had decided to take what amounted for her to her own gamble, this early in a therapeutic relationship. The abstract resolve on her face now duplicated what had been on the doctor’s face when he’d taken the gamble of asking her to sit up straight.

‘Listen,’ she said. ‘Have you ever felt sick? I mean nauseous, like you knew you were going to throw up?’

The doctor made a gesture like Well sure.

‘But that’s just in your stomach,’ Kate Gompert said. ‘It’s a horrible feeling but it’s just in your stomach. That’s why the term is “sick to your stomach.” ‘ She was back to looking intently at her lower carpopedals. ‘What I told Dr. Garton is OK but imagine if you felt that way all over, inside. All through you. Like every cell and every atom or brain-cell or whatever was so nauseous it wanted to throw up, but it couldn’t, and you felt that way all the time, and you’re sure, you’re positive the feeling will never go away, you’re going to spend the rest of your natural life feeling like this.’

The doctor wrote down something much too brief to correspond directly to what she’d said. He was nodding both while he wrote and when he looked up. ‘And yet this nauseated feeling has come and gone for you in the past, it’s passed eventually during prior depressions, Katherine, has it not?’

‘But when you’re in the feeling you forget. The feeling feels like it’s always been there and will always be there, and you forget. It’s like this whole filter drops down over the whole way you think about everything, a couple weeks after —’

They sat and looked at each other. The doctor felt some combination of intense clinical excitement and anxiety about perhaps saying the wrong thing at such a crucial juncture and fouling up. His last name was needle-pointed in yellow braid on the left breast of the white coat he was required to wear. ‘I’m sorry? A couple weeks after—?’

He waited for seven breaths.

‘I want shock,’ she said finally. ‘Isn’t part of this whole concerned kindness deal that you’re supposed to ask me how I think you can be of help? Cause I’ve been through this before. You haven’t asked what I want. Isn’t it? Well how about either give me ECT [29]again, or give me my belt back. Because I can’t stand feeling like this another second, and the seconds keep coming on and on.’

‘Well,’ the doctor said slowly, nodding to indicate he had heard the feelings the young woman was expressing, ‘Well, I’m happy to discuss treatment options with you, Katherine. But I have to say right now I’m curious about what you started it sounded like to me to maybe start to indicate what might have occurred, something, two weeks ago to make you feel these feelings now. Would you be comfortable talking to me about it?’

‘Either ECT or you could just sedate me for a month. You could do that. All I’d need is I think a month at the outside. Like a controlled coma. You could do that, if you guys want to help.’

The doctor gazed at her with a patience she was meant to see.

And she gave him back a frightening smile, a smile empty of all affect, as if someone had contracted her circumorals with a thigmotactic electrode. The teeth of the smile evidenced a clinical depressive’s classic inattention to oral hygiene.

She said ‘I was thinking I was about to say you’ll think I’m crazy if I tell you. But then I remembered where I am.’ She made a small sound that was supposed to be laughter; it did sound jagged, dentate.

‘I was going to say I’ve thought sometimes before like the feeling maybe had to do with Hope.’

‘Hope.’

Her arms had been crossed over her breasts the whole time, and though the room was overheated the patient rubbed each palm continually over her upper arms, behavior one associates with chill. The position and movement shielded her inner arms from view. The doctor’s eyebrows had gone synclinal from puzzlement without his awareness.

‘Bob.’

‘Bob.’ The doctor was anxious that his failure to have any idea what the girl was referring to would betray itself and accentuate her feelings of loneliness and psychic pain. Classic unipolars were usually tormented by the conviction that no one else could hear or understand them when they tried to communicate. Hence jokes, sarcasm, the psychopathology of unconscious arm-rubbing.