Lying on the Couch (28 page)

"I propose you take a portion of the investment, say, one percent—no wait, Marshal, before you refuse: this is not a gift, and I am no longer a patient. This is a bona fide investment. You give me a check and you become part owner. With one proviso, however— and here's where I'm asking you to stretch yourself: I do not want to find myself in another Dr. Black scenario. You remember how much aggravation that caused me?

"So," Peter continued, sensing Marshal's growing interest and

speaking more confidently now, "here's my solution. For the sake of my mental health, I want this to be risk-free for you. If at any time you feel unhappy about the investment, I will buy back your shares at your cost. I propose to give you my personal promissory note— fully secured and payable upon demand in an amount equal to one hundred percent of your investment plus ten percent interest annually. But you must give me your promise that you will exercise this note in the event of some unforeseen incident—who knows what? . . . presidential assassination, my accidental death, or anything else that you feel puts you at risk. In other words, you are obligated to exercise this note."

Peter sat back, lifted Marshal's watch, and handed it back to him. "Seven and a half minutes. Now I'm finished."

All of Marshal's gears were spinning at once. And now, finally, the gears did not grind. Ninety thousand dollars, he thought. / make, say, seven hundred percent — that's over six hundred thousand dollars profit. In twenty-two months. How can I, how could anyone, turn that downf Invest that at twelve percent and that's seventy-two thousand dollars a year for the rest of my life. Peter's right. He's no longer a patient. This is no transference gift — I put up money; it's an investment. So what if it's risk-free! It's a private note. There's no professional misconduct here. This is clean. Squeaky clean.

Marshal stopped thinking. It was time to act. "Peter, I only saw part of you in my office. Now I know you better. Now I know why you've been so successful. You set a goal and you go after it—go after it with a tenaciousness and intelligence that I have rarely seen . . . and a graciousness, too." Marshal extended his hand. "I accept your offer. And with gratitude."

The rest of the transaction was completed quickly. Peter offered to take Marshal in as a partner for any amount up to one percent of the company. Marshal decided, now that he had come this far, to grab the brass ring and invest the maximum: ninety thousand. He would raise the money from selling his Wells Fargo and his Fidelity select electronic stock and wire the money to Peter's Zurich bank within five days. Peter was going to close the purchase of Rucksen in eight days and was required by Dutch law to have all parties Usted. Meanwhile Peter would prepare a secured note and leave it off at Marshal's office before he left for Zurich.

Later that afternoon, after Marshal had seen his last patient of the day, there was a knock on his door. A pimpled adolescent bicycle

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messenger, in a denim jacket with magenta fluorescent armbands and the mandatory San Francisco Giants baseball hat worn backward, handed him a manila envelope containing a notarized letter specifying all the aspects of the transaction. A second note for Marshal's signature specified that he was obligated to request a full repayment of his investment should, for any reason, the value of Rucksen fall below its purchase price. A memo from Peter was also enclosed: "For your full peace of mind, a secured note from my attorney will reach you by Wednesday. Enjoy my celebratory token of our partnership signing."

Marshal reached into the envelope and extracted a Shreve's Jewelry Store box. He opened it, gasped, and gleefully put on his first jewel-spangled Rolex watch.

TEN

,ust before six o'clock on a Tuesday evening, Ernest received a phone call from the sister of Eva Galsworth, one of his patients. 'Eva told me to call you and just to say, 'It's time.'" Ernest wrote a message of apology to his 6:10 patient, taped it to his office door, and rushed to the home of Eva, a fifty-one-year-old woman with advanced ovarian cancer. Eva was a creative writing teacher, a graceful woman of great dignity. Ernest often imagined, with pleasure, living his life side by side with Eva, had she been younger and had they met under different circumstances. He thought her beautiful, admired her deeply, and marveled at her commitment to life. For the past year and a half, he had unstintingly devoted himself to easing the pain of her dying.

With many of his patients, Ernest introduced the concept of regret into his therapy. He asked patients to examine regrets for their past conduct and urged them to avoid future regrets. "The goal," he'd

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say, "is to live so that five years from now you won't look back on these five years filled with regret."

Occasionally Ernest's "anticipatory regret" strategy fell flat. Generally it proved meaningful. But no patient ever took it more seriously than Eva, who dedicated herself to, as she put it, "sucking the marrow out of the bones of life." Eva packed a great deal into the two years following her diagnosis: she left a joyless marriage, had whirlwind affairs with two men she had long desired, took a wildlife safari in Kenya, finished two short stories, and traveled around the country visiting her three children and some of her favorite former students.

Throughout all these changes, Ernest and she had worked closely and well. Eva regarded Ernest's office as a safe haven, a place to bring all her fears about dying, all the macabre feelings she dared not express to friends. Ernest promised to face everything directly with her, to flinch from nothing, to treat her not as a patient but as a fellow traveler and sufferer.

And Ernest kept his word. He took to scheduling Eva for the last hour of the day because he often ended the hour flooded with anxiety about Eva's death, and his own as well. He reminded her over and over that she was not entirely alone in her dying, that he and she were both facing the terror of finitude, that he would go with her as far as he was humanly able. When Eva asked him to promise he would be with her when she died, Ernest gave his word. She had been too ill for the past two months to come to his office, but Ernest kept in touch by telephone and made occasional home visits, for which he chose not to bill.

Ernest was greeted by Eva's sister and ushered into her bedroom. Eva, heavily jaundiced because her tumor had invaded her liver, was gasping for breath and perspiring so heavily that her soaked hair was plastered to her head. She nodded and in a whisper between breaths told her sister to leave. "I want one more private session with my doctor."

Ernest sat down next to her. "Can you talk?"

"Too late. No more words. Just hold me."

Ernest took Eva's hand, but she shook her head. "No, please, just hold me," she whispered.

Ernest sat on the bed and leaned over to hold her but could find no workable position. There was nothing to do but to get on the bed, lie next to her, and put his arms around her. He kept his suit

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jacket and shoes on and nervously eyed the door, worried that some misunderstanding person would enter. He felt awkward at first and was grateful for the layers between them—sheet, comforter, coverlet, suit jacket. Eva pulled him to her. Gradually his tension dissipated. He loosened up, took off his jacket, pulled back the comforter, and clutched Eva closely. She clutched back. For an instant he felt an unwelcome warm purring inside, the foreshadowing of sexual arousal, but, furious at himself, managed to banish it and to devote himself to hugging Eva in a loving fashion. After a few minutes he asked: "Is this better, Eva?"

No answer. Eva's breathing had become labored.

Ernest jumped up from the bed, bent over her, and called out her name.

Still no answer. Eva's sister, hearing his call, rushed into the room. Ernest reached for Eva's wrist but could feel no pulse. He put his hand on her chest, gently pressing her heavy breast aside, and felt for an apical pulse. Discovering her heartbeat to be thready and wildly irregular, he pronounced: "Ventricular fibrillation. It's very bad."

The two of them sat vigil for a couple of hours, listening to Eva's heavy, erratic breathing. "Cheyne-Stokes" breathing, Ernest thought, surprised at how the term had floated up from the deep unconscious flotsam of third-year medical school. Eva's eyes trembled from time to time but never reopened. Dry spittle-foam formed continuously on her lips, and Ernest wiped it away with Kleenex every few minutes.

"That's a sign of pulmonary edema," Ernest pronounced. "Because her heart is failing, fluid is accumulating in her lungs."

Eva's sister nodded and looked relieved. Interesting, Ernest thought, how these scientific rituals—naming and explaining phenomena—ease terror. So I give a name to her breathing? So I explain how the weakening right ventricle causes fluid to back in the right auricle and then in the lungs, causing the foam? So what? I've offered nothing! All I've done is to name the beast. But I feel better, her sister feels better, and, if poor Eva were conscious, she'd probably feel better too.

Ernest held Eva's hand as her breathing grew more shallow and irregular and, after about an hour, stopped entirely. Ernest could feel no pulse. "She's gone."

He and Eva's sister sat silently for a few minutes and then began

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making plans. They generated a list of phone calls to be made—to children, friends, the newspaper, the funeral parlor. After a while Ernest stood to leave, as her sister prepared to wash Eva's body. They briefly discussed how to dress her. She would be cremated, her sister said, and she thought the funeral parlor would supply some type of shroud. Ernest agreed, though he knew nothing whatever about it.

He knew very little about any of this, Ernest thought, on the way home. Despite his lengthy medical experience and cadaver dissection in medical school, he, like many physicians, had never before been present at the actual moment of death. He remained calm and clinical; though he would miss Eva, her death had been mercifully easy. He knew he had done all he could, but he continued to feel the pressure of her body against his chest through a very troubled night.

He awoke just before five in the morning clutching at the remnants of a powerful dream. He did exactly what he always told his patients to do after a disturbing dream: he stayed in bed motionless and recollected the dream before even opening his eyes. Reaching for a pencil and notepad by his bed, Ernest wrote down the dream.

/ was walking with my parents and my brother in a mall, and we decided to go upstairs. I found myself on an elevator alone. It was a long, long ride. When I got off, I was by the seashore. But I couldn't find my family. I looked and looked for them. Though it was a lovely setting . . . seashore is paradise . . . I began to feel pervasive dread. Then I started to put on a nightshirt that had a cute, smiling face ofSmokey the Bear. That face became brighter, then brilliant . . . soon the face became the entire focus of the dream — as though all the energy of the dream was transferred onto that cute grinning little Smokey the Bear face.

The more Ernest thought about it, the more important this dream appeared. Unable to return to sleep, he dressed and went to his office at six a.m. to enter it into the computer. It was perfect for the chapter on dreams in the new book he was writing. Death Anxiety and Psychotherapy. Or perhaps Psychotherapy, Death, and Anxiety. Ernest couldn't decide on the title.

There was no mystery about the dream. The events of the previous night made the meaning crystal-clear. Eva's death had hurled

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him into a confrontation with his own death (represented in the dream by the pervasive dread, by his separation from his family, and by his long elevator ascent to a heavenly seashore). How annoying, Ernest thought, that his own dream-maker had bought into the fairy tale of an ascent to paradise! But what could he do? The dream-maker was its own master, formed in the dawn of consciousness, and obviously shaped more by popular culture than by volition.

The power of the dream resided in the nightshirt with the bright Smokey the Bear emblem. Ernest knew that symbol was prompted by the discussion of how to dress Eva in preparation for cremation— Smokey the Bear representing cremation! Eerie, but instructive.

The more Ernest thought about it, the more useful this dream might be in teaching psychotherapists. For one thing it illustrated a point of Freud's that a primary function of dreams was to preserve sleep. In this instance, a frightening thought—cremation—is transformed into something more benign and pleasing: the adorable, cunning figure of Smokey the Bear. But the dream was only partially successful: though it enabled him to continue sleeping, enough death anxiety seeped out to soak his entire dream in dread.

Ernest wrote for two hours, until Justin arrived for his appointment. He loved writing in the early morning hours, even though it meant he'd be exhausted by early evening.

"Sorry about Monday," said Justin, walking straight to his chair and avoiding eye contact with Ernest. "I can't believe I did that. About ten o'clock, I was on my way to the office, whistling, feeling in a pretty good mood, when suddenly it hit me like a ton of bricks: I'd forgotten my hour with you. What can I say? I have no excuses. None at all. Just flat-out forgot. It's never happened before. Do I get charged?"