Dr. Neruda's Cure for Evil (40 page)

“It’s not really my decision to make unilaterally. I have to discuss it with Dr. Bracken.”

Carol’s hand was up again. “Enough said,” she said. “I’m sure it will work out.” She leaned so far forward she seemed almost to be on my desk. “One other thing,” she lowered her voice, although not enough for Gene to be excluded. “We haven’t told Gene’s father about this and I don’t think it’s a good idea to tell him about Gene coming three times a week. Not for a while. I only bring it up because if you send any mail or need to phone about Gene I’d like you to send it to my office or call me there, okay?” She put on her mask of a regretful smile again. Her hands went up and out to show her helplessness, her embarrassing, but inescapable need.

I smiled. A woman asking me to keep a secret. How was that for a change of pace? “In that case, I’m afraid Gene won’t be able to come here.” I felt as if I were mimicking her phony smile of regret, so I cleared my throat and tried to look solemn.

Her eyebrows were way up, her mouth was open. “Really?” she said with so much feeling and emphasis that it was comic.

“If Gene were an adult, it would be different. But he’s a minor and it’s the law that we must have parental consent to treat him. Of course no one outside of his father or you has to be told. And everything he says to me is confidential, including from you and his father. The only way I can make an exception is if there’s a compelling reason to keep it from his father.”

“There is.” She was very earnest now, jaw set, eyebrows in a line, her voice grave. She didn’t seem to have any neutral expressions; they were all violent. “He really really wouldn’t approve. He doesn’t believe in psychiatry.”

“That’s not enough for the law. There would have to be, at least from you, a statement that his father is abusing Gene or threatening him in some way. Is that the case?”

She shook her head vigorously. “No, no, but he wouldn’t allow it. So Gene couldn’t come anyway. So there’s no point in telling him. Anyway, I’m his mother. You have my consent.”

“I’m sorry. If you look at the form you were given—do you have it?”

“What?” She looked down at her purse. “Oh. Yes.”

“Both parents have to sign. It’s the law, as I said before, unless you’re alleging abuse. You’re not, correct?”

She had gone blank. She did have an expressionless expression. She didn’t move or speak.

“If Mr. Kenny,” I continued, “wishes to discuss Gene’s treatment with Dr. Bracken, I’m sure she can allay his anxieties. Gene is unhappy and needs some help. It won’t last forever, there’s no charge, and there’s no social stigma. Besides, outside of his immediate family, no one needs to know.”

“Okay,” she said abruptly. “I’ll tell him and he’ll sign the form. I’ll take care of it.” She was stern and displeased with me, her former pliancy and eagerness now as foreign to her facial terrain as water in a desert. “When should Gene come?”

“Well, how about Monday at four-thirty?”

“And you’ll be his doctor?” Her question was almost a reprimand.

“As I said, I’ll have to consult—”

“I’ll call Dr. Bracken. She’s the one to bother about all this. I shouldn’t bother you.” She stood and said, “Let’s get out of Dr. Neruda’s hair, Gene.”

Gene got to his feet immediately. Carol moved back to him, put her hand on his shoulder and pushed him at me. “Goodbye and thank you, Dr. Neruda,” she said to me in a loud slow beat, obviously prompting Gene to repeat the phrase.

“Thanks,” Gene mumbled.

“Shake Dr. Neruda’s hand,” she prompted.

Head down, Gene offered a limp hand.

“Do you want to shake my hand?” I said. What was I doing?

Carol goggled at me. Gene looked up, directly into my eyes. That was a first. His were shining. He smiled with his version of his mother’s wide mouth; broadly, but not a cartoon. “No,” he said.

“Then let’s skip it,” I said. “See you on Monday.”

Carol’s shoulders went way up. “Okay,” she said, and the shoulders dropped. “Thank you very very very much,” she added in a breathless whoosh.

I bought a sandwich from an all-night deli on Sixth Avenue, came back to our stoop, and ate half while waiting for Susan to finish with her last patient before tossing it. I didn’t have much of an appetite; anyway, the pastrami was dry and fatty. She came out a little after ten and glanced at me, surprised. “I thought you’d gone.”

“I fucked up,” I said.

She locked the door behind her and studied the dark building lovingly, the way a mother might regard her sleeping child. This look was the only pride I ever saw her take in her creation. (It
was
quite an achievement. People who normally wouldn’t, received first-rate therapy for little or nothing; and she had raised the money to open another clinic in Brooklyn just that month.) When she turned back to me, she hurried down the steps, taking my arm. “I don’t believe it,” she said.

“I had my worst session ever.”

“Tell me.” I reported my reaction to Gene and his mother while we walked north on Fifth to Susan’s loft on Sixteenth Street. I wasn’t anywhere near done by the time we reached her place. She invited me up. I declined, worried I’d disturb her husband, Harry. “He’ll be asleep,” she said. She was right. We sat at the butcher block table near the wall of windows at the front of her loft so our voices wouldn’t disturb Harry—there was only a half wall to seal off the bedroom at the rear.

Susan listened patiently, making no comment during my account of the session. She surprised me with her first question. “Do you usually ask patients to move to the couch so fast?”

I thought about it. “No. Sometimes not for several sessions.”

She nodded as if she had assumed that. “So?”

“I don’t know. He was upset and uncomfortable physically. He really didn’t want to look at me. I thought we’d never get going. He was so preoccupied about avoiding …” I trailed off. I knew she was asking for a deeper meaning, not this surface explanation.

“You were uncomfortable,” she said at last.

“Yes. I was, right from the start.”

“Why?”

I began to describe again those first moments, Gene’s obedient manner and appearance, his oval face, the off-center nose, my musings, about his being Eastern European.

Susan cut me off. “Kenny? You said his name was Kenny?”

“Yeah.”

“That sounds Irish. What’s his mother’s maiden name?”

I opened my briefcase and removed the preliminary interview taken by the NYU intern. “Shoen,” I said with a laugh.

“Sure doesn’t sound Eastern European,” Susan said. “Who did he remind you of? Who do you know who’s Eastern European?”

“Lots of people. My mother’s family, all my friends from Washington Heights. You. Harry.”

“And you,” Susan said. “You’re half—Eastern European.”

Harry appeared at the opening in the half-wall. His hair stood up in the air. He was in underpants and a T-shirt torn at the left armpit.

“Hello, darling,” Susan said.

Harry came over and kissed her sleepily. She slipped a finger into the tear to tickle him. He pulled away. “Not in front of the help,” he said. He studied me and then put a hand on my shoulder. “What’s wrong?” he said.

“Rafe had a session that worries him,” Susan said.

“Oh yeah?” Harry was a psychiatric social worker who worked with prisoners and their families, fighting a desperate battle against recidivism and the legacy of criminal behavior to their children. He tried to smooth down his hair. “I hope you really fucked up,” Harry said. “Sent the patient screaming to Bellevue.”

“Doesn’t sound serious at all,” Susan said. “In fact I think the patient likes him.”

Harry groaned. “Shit. I knew it. Want some coffee, Mr. Perfectionist?”

“Sure,” I said. The kitchen was open to the breakfast area so he could talk with us while measuring the coffee and filling a kettle.

“I saw him as me,” I said. “The pathetic me. The suicidal me.”

“Maybe,” Susan said. “Okay, so let’s go over it. You think he doesn’t want to move to the couch but he does it like a sullen little boy and you feel what?”

“I hated him.”

Harry laughed. Susan was skeptical. “Hated him?”

“It revolted me. There was something about the way he reacted, as if I were going to do something bad to him and he just resigned himself to it.”

“A perfect description of psychotherapy,” Harry said.

“Do something bad?” Susan asked wonderingly.

“I remember thinking at one point that he was worried I would hit him.”

“Possible abuse came up, didn’t it?” Susan asked. “About the father. When the mother made that—”

“That came from me. I said the law wouldn’t allow her to skip getting the father’s permission unless she was alleging abuse.”

“What?” Harry said. “Where did you get that gobbledy-gook?”

“The mother was trying to get Rafe to agree to keep the therapy secret from the boy’s father,” Susan explained.

“I needed to invoke the law or she would have kept after me forever.”

“We do require the parents’ permission,” Susan said. “That was appropriate.”

“A little hyperbolic,” Harry said.

“I can’t become part of whatever neurotic dynamic the mother has going with the father. And, besides, treating him in secret could easily become a legal issue,” I said. “You can’t treat minors without the knowledge of parents and I assume that means both parents.”

“Absolutely,” Harry said. “But it’s medical ethics. Why drag in the law?”

“You didn’t assert yourself,” Susan said.

Harry turned off the whistling kettle and shook his fist at me with mock outrage. “Be more phallic. You’re a goddamn M.D. You can sic the AMA on her.”

I covered my face. Despair, fatigue, disappointment in myself, the feeling that everything I had learned and worked for had been wasted overwhelmed me—and the knowledge that these reactions were excessive only made them worse.

“Rafe.” Susan said my name quietly, but it was a prompt. “Come on. Keep using your brain. Don’t indulge.”

These were key phrases from my therapy with her, Pavlovian in their effect. I uncovered, looked into her eyes and listed the reasons aloud. “I was angry at her, convinced I couldn’t stand up to her, so I grabbed for you first as a defense.”

“Help, Mommy,” Harry said.

“Shh,” Susan said.

“He’s right. Then I reached for the law—”

“Help, Daddy,” Harry said.

“And I was scared that if I was her only obstacle, she would talk me out of it
and,
typically irrational, I was scared if I stood my ground, she would use that as an excuse not to bring Gene in for therapy.”

“But that’s what you wanted, not to have him as a patient.”

“Me.
I
didn’t want to treat him. But I didn’t want to give her a way out of giving him treatment.”

“Sure is irrational,” Harry said. He put a cup of coffee in front of me. “She brought him in. She wanted him to be treated—”

Susan cut him off. “You didn’t believe her?”

“The school forced her to bring him in. No, I believe she wants her son to think of himself as sick. I don’t believe she wants him well.”

“Huh?” Harry said. “That’s quite a leap.”

“I know. I said I was out of control. Anyway, he needs treatment. I wasn’t confident that refusing to keep the therapy secret from his father was correct.”

“You were worried it was something you reached for to get out of being his doctor,” Susan said.

“Right,” I said. “So I wanted to leave the decision to you.”

“Bullshit,” Harry said mildly. “You were just being chicken.”

“No,” Susan said, equally mildly. “You let Felicia see you without telling her parents.”

I nodded.

“Felicia?” Harry asked.

Susan explained to Harry while he brought her a cup of coffee. “Felicia came in eight months ago. All by herself. She’s twelve. Her mother was a prostitute—”

“I remember,” Harry interrupted. “Your miracle cure. Twelve-year-old heroin addict turned into a ballerina. My wife, unfortunately, is right. You could have gotten into a shitload of trouble for seeing Felicia on the sly.”

“That’s the point. Why wasn’t I willing to take a very modest chance for Gene? It was a disgusting impulse.”

“No!” Susan slapped my hand, lightly, but it was still a slap. “Use your head. You were using it in the session. You’re not now.”

“I had a reason? A good reason?”

“Yes!”

I recalled the provocation:
Carol lowered her voice, but not enough for Gene to be excluded
…

“She was driving a wedge between Gene and his father,” I announced brightly, like an obnoxious A student in class. “The loss of the father-object is his central issue. I want the father to know his son is sick and I don’t want to strengthen the mother’s grip of guilt and shame about his need.”

Susan clapped. “And what’s more—you’re right. Don’t you think, Harry?”

“Yeah, yeah. He was right in theory, but in practice he was a chicken.”

“I was,” I admitted happily. “But it wasn’t just coming from my gook, I was still making a therapeutic choice.”

“You should have taken the responsibility yourself,” Harry said. “And not laid it on Susan or the fucking law.”

“You’re right. I had to be his father.”

Susan nodded. “His loss is acute.”

“Too acute given the slight provocation. That’s why I suspected abuse. It wasn’t just projection.”

“How could it be projection?” Harry said. “Your father didn’t abuse you.”

Susan shook him off. “Shut up for a second, Harry.”

“Be happy to,” he said, sitting down.

“You have to be Gene’s doctor. It’s important for you and Gene.”

“I can’t do it,” I said.

“What do you feel?”

“Scared.”

“Of what?”

“Failing.”

“Oh, heaven forbid,” Harry said.

“You have a right to fail. Your mistakes were minor. The transference, especially for one session, was excellent. And you have real empathy for him. Your intense dislike is an inversion of empathy.”

“He’s a boring case,” I said.

“What?” Harry said. “What the fuck does that mean?”

“I’m not even sure we should be treating him. He’s having some anxiety attacks, fucking up in school a little, okay, but we’ve got much more serious cases waiting for help.”