The advantages of fiction
(I have followed my usual practice in this post of disguising the patient)
There was a time a number of years ago when I had the occasion to treat just the sort of patient therapists like to work with, that is, she was intelligent, attractive and young—and full of life. She felt passionately about many things. She argued at work—she was a designer—and fought with her friends. She fell in love repeatedly. She was always being swept away on one enthusiasm or another. I never knew whether she would return from a weekend despairing or full of new plans. She seemed to be more alive than most other people. I liked her very much. I will call her Amy.
Amy was phobic, and she had panic attacks. She was leery in particular of walking a distance from her home. So, I practiced with her in that setting. Not uncommonly, I make home visits—which sometimes gives the patient pause, particularly if she is a woman. Actually, more commonly, it is her friends who are uneasy. Still, these misgivings last only for a very short while; and it is much easier for the phobic person to confront those situations that trouble him—or, in this case, her—when somebody she trusts accompanies her. The strategy for the treatment of phobias is simple: to confront the frightening situation; but the tactics—just how far to go on a particular occasion—requires some clinical judgment. In any case, I went with Amy to all those difficult places that usually trouble phobic persons; and she improved.
The fact that Amy was phobic did not define her. Like every person, there was more to her life than fit comfortably into a psychiatric diagnostic category. She had particular skills and a particular style. Her friends called her bubbly. She had complicated relationships, particularly with her family. I came to understand that she had a large trust fund which was being administered by her brother and which was the source of some family discord. The family wanted her to return to Oklahoma, where they all lived. According to Amy, they still treated her as a child and wanted to protect her.
And Amy suffered from S.L.E. (Lupus.) At the time when I saw her, the treatment of that condition had advanced so that the illness was no more serious usually than that of any other arthritic condition—although potentially the disease could affect the kidneys and, indeed, any other organ in the body. She was troubled only intermittently. But there came a time when she became seriously ill. She developed a widespread rash, accompanied by a high fever. She spent a few days in the hospital before she began to improve. I visited her there. She was angry about something or other that was going on with her family; and she was looking forward to spending a holiday with her friends.
The next day, when I came to visit her, the nurse told me that she had had a convulsion in the middle of the night and was brought to the operating room but had died en route. I was stunned. I asked the nurse exactly what had happened, but she did not know. Possibly Amy had had a stroke, she thought.
I left the hospital grounds thinking, as a doctor does, about what complication of her condition could have killed her; but mostly I thought about her. Some people fade away when they die. If they are old enough and infirm, their death seems unremarkable and natural. But when a young person who is full of life dies– someone who did everything passionately and who cared about others–it seems anything but natural. It is unbelievable. And everyone is bereft.
Still, I had many other patients to care for; and I had a growing family that occupied my attention—and I was distracted by all those other aspects of life that continue to intrude into our thoughts no matter what else has happened. So, after a time, I grieved less for Amy—and in time I stopped thinking about her.
Two years later Amy called me on the telephone. She did not remember me, she said, but she found my number in her telephone book and wondered who I was. She went on to say that she had been ill and recuperating at home for a long time. Something had happened to her brain, she said, in unemotional tones, and that was why she did not know who I was. She apologized.
When I caught my breath, I asked her if I could visit her. She agreed. The address she gave me was her old address.
Her apartment was as I remembered it, except the walls were bare, absent of those drawings she had made and then hung. Perhaps other things were missing. The place seemed cold and had an emptiness about it. When Amy got up to get me a cup of tea, she had a slight limp. But in many other ways, she was different. Her appearance had changed. Her face was unmarked, but her expression was dull. She did not laugh, she smiled only a little and then only randomly. She was disabled, she told me, because of what had happened to her; and I could see that she was impaired mentally. Her thinking was slowed. Her personality had become vapid. And she had forgotten all her friends. And she had forgotten me. Now, instead of Amy dying, it was as if I had died a little. I was cancelled out from her memory and deprived of her appreciation of what I had been to her. I was nobody to her. After a time I left.
I have often complained that as a psychiatrist I come into someone’s life in the middle, and after some time, I leave it—still in the middle. It is rare that I know how a patient’s life turns out finally, unless I happen to be around when that person dies. So, I became a novelist. That way, I can choose what happens to my characters; and I can make them arrive at a proper ending—if not the ending I want for them, exactly, it is an ending that makes sense. Things happen because they ought to happen. Because I make them happen that way.
But Amy’s story, being real, was inexplicable. And unbearable. It had the wrong ending. And I could not understand what had happened. What in the world was the nurse thinking of when she told me Amy was dead? I suppose she was just repeating something that somebody had told her—or possibly she had mixed Amy up with someone else. What exactly, had happened to Amy to require two years of recuperation, and not a complete recuperation at that? Why had no one called me? What happened between her and her family? And, most of all, what would happen to her now?
I found myself turning Amy’s story into a murder mystery. Her family, intent on getting their hands on her inheritance, came surreptitiously to the hospital and, somehow, poisoned, her—or just abducted her—and removed her in the middle of the night to Oklahoma, a great empty space with a few oil derricks. Her brother bribed the nurse to head me off so that I, or the man she loved at that time—I forget his name—would not pursue them. And it worked. The young man mourned for her, as I did, but never forgot her. He had a number of desultory love affairs—I’m good at making up unsatisfactory love affairs since I’ve seen so many of them—but they came to no end; and he lived to no purpose. Then Amy suddenly reappears! She escaped from the wilds of Oklahoma with the aid of a young Indian, whom she taught to draw. They flew away at night from the barbed-wire enclosure in which she had been kept prisoner and snuck away surreptitiously over the dunes. Eventually, having many adventures, she returned to Larchmont. Whatever had affected her mentally wore off, and she was back to her old self! She ran into her old boyfriend, who had moved away to New Rochelle, and they married. The boy Indian was in attendance; and so was I. She had defeated the remnants of her phobia climbing through the wilds of Oklahoma and she was free now to be the creative person she was always destined to be. And she lived happily forever after. That is the advantage of fiction.
In real life I never heard from Amy again. (c) Fredric Neuman 2013