The Forgetting Place (2 page)

Y
ou've got a visitor,” Marjorie said, smiling over at me from the nurses' station.

I glanced toward the intake room. Through the rectangular glass pane in the door I could see Paul, one of the orderlies, ushering in a new patient.
A visitor,
I thought. One of Marjorie's euphemisms.

“Is this going to be one of mine?” I asked, checking the roster board. I hadn't been advised of any new admissions.

Marjorie nodded. “I think you should see this one.”

“Did he come with any paperwork?”

“Not that I know of.” Marjorie's eyes were back on the chart in front of her, her attention elsewhere.

I sighed. The protocol was that we were to be advised ahead of time regarding any new transfers to the facility, and that those transfers should arrive with the appropriate paperwork, including a patient history and medical clearance assessment. Patients weren't supposed to just show up unannounced, and it irritated me when that happened. Still, one had to keep in mind that we
were dealing with a state bureaucracy here. Nothing really surprised me anymore. I decided not to be a hardnose and to let the administrative screwup ride for the moment, although I certainly intended to bring it up with Dr. Wagner later.

Paul had stepped through the door and closed it gently behind him. He motioned me over, and I walked across the room to join him.

“What have we got, Paul?”

“Young man to see you,” he said, and we both peered through the glass at the patient seated in the room beyond.

“What's his story?” I wanted to know, but Paul shook his head.

“You'll have to ask him.” Apparently, Paul had no more information than Marjorie did.

I pushed through the door. The patient looked up as I entered, smiled tentatively at me. His handsome appearance was the first thing that struck me about him: the eyes pale blue, the face lean but not gaunt. He had the body of a dancer, slight and lithe, and there was a certain gracefulness to his movements that seemed out of place within these walls. A lock of dark black hair fell casually across his face like a shadow. He was, in fact, beautiful in a way that men rarely are, and I felt my breath catch a little as I sat down across from him. I gauged him to be about thirty, although he could've been five years in either direction. Mental illness has a way of altering the normal tempo of aging. I've seen twenty-two-year-olds who look forty, and sixty-year-olds who appear as if they're still trapped in adolescence. Medications have something to do with it, of course, although I think there's more to it than that. In many cases, time simply does not move on for these people, like a skipping record playing the same stanza over
and over again. Each year is the same year, and before you know it six decades have gone by.

“I'm Dr. Shields,” I said, smiling warmly, my body bent slightly toward him in what I hoped would be perceived as an empathic posture.

“Hello.” He returned my smile, although it seemed that even my opening introduction pained him in some way.

“What's your name?” I asked, and again there was that nearly imperceptible flinch in his expression.

“Jason . . . Jason Edwards.”

“Okay, Jason.” I folded my hands across my lap. “Do you know why you're here?”

He nodded. “I'm here to see you.”

“Well . . . me and the rest of your treatment team, yes. But can you tell me a little bit about the events that brought you here?”

His face fell a little at this, as if it were either too taxing or too painful to recount. “I was hoping you'd already know.”

“Your records haven't arrived yet,” I explained. “But we'll have time to talk about all this later. For right now, I just wanted to introduce myself. Once again, my name is Dr. Shields and I'll be your treating psychiatrist. We'll meet once a day for a session, except on weekends. I'll review your chart and medication list once they arrive. Paul will show you around the unit and will take you to your room. Meanwhile, if there's anything you need or if you have any other questions, you can ask Paul or one of the other orderlies. Or let one of the nurses know. They can all get in touch with me if necessary.”

I stood up, but hesitated a moment before leaving. He watched me with an expectant gaze, and despite my better professional
judgment, I leaned forward and placed a hand on his shoulder. “It's going to be okay,” I told him. “You're in a safe place now.”

He seemed to take my words at face value, trusting without question, and in the weeks and months to come I would often look back upon that statement with deep regret, realizing that nothing could have been further from the truth.

I
had to ask him for his name, Charles. I don't know the first thing about him.” I was in Dr. Wagner's office, trying not to let my irritation get the best of me. It was two days later and the paperwork for the Edwards patient still hadn't arrived.

“Don't worry about the paperwork,” he was telling me. “It's not important.”

“I don't see how you can say that,” I responded. I'd declined to take a seat, and now I shifted my weight to the other foot, struggling to maintain my composure.
Don't worry about the paperwork,
I thought.
He
was the administrator, not me. He should be worried enough for the both of us.

Dr. Wagner had been the chief medical officer at Menaker for as long as I'd been here. He'd hired me right out of residency, although he'd actually suggested during my interview that I consider working elsewhere for my first few years of practice. The conversation we'd had didn't seem that long ago, and standing here today I could picture that younger version of myself sitting in my black skirt and double button jacket—my
interview attire,
as I'd come to see it.

“The job's yours if you want it,” he'd told me, “but you should give it some extra thought.”

“Why is that?” I'd asked.

He reached forward and slid an index finger along the top of the nameplate near the front edge of his desk, scowled at the dust gathered on the pad of his finger during that single pass. Then he looked at me. “Right now, you want to go out there and make a difference. You're ambitious, enthusiastic, full of energy. You want to use the medical knowledge and skills you've obtained to change people's lives.”

“I feel I can do that here,” I replied.

He nodded. “Yes, yes. In small, subtle ways, I'm sure you could. But
big
changes, the kind you wrote about in your application to medical school, for example—”

“You read that?” I hadn't included it in my application for this position.

He chuckled and shook his head. “They're all the same,” he said, throwing up his hands. “Tell me something.” He cocked his right eyebrow and extended his index finger in my direction. The layer of dust still clung to it, displaced from its previous resting place after who knew how many months or even years. “You didn't use the word ‘journey' in your essay, did you?”

“Excuse me?”

“Seventy-six percent of medical school application essays have the word ‘journey' embedded somewhere in their text. Did you know that?”

“I didn't,” I admitted, although I wasn't sure what this had to do with—

“I used to be on the admissions committee at Georgetown,”
he said, “so I should know. I've seen enough essays come across my desk.”

“Seventy-six percent, you say?”

“It's a mathematical certainty.” He brought the palm of his right hand down on the table with a light smack. “Granted, there's some slight fluctuation from year to year, but on average it's seventy-six percent. The word ‘difference' is in
ninety-seven
percent of medical school application essays.
Ninety-seven percent
,” he reiterated. “Can you
believe that
?” He chuckled again. “We did a study, tracking the most common word usage in application essays over a ten-year period.”

I returned his gaze, not knowing how to respond. The man was eccentric, I had to admit.

“Which means,” he continued, “that almost all prospective physicians want to go on a
journey
and to make a
difference
. That's the prevailing dream.”

“And?” I prodded, still not clear where he was going with this.

“And you
won't do that
here at Menaker. There is no journey. Patients are here for the long haul and, for the most part, they're not going anywhere. And although you might make a small difference in the lives of some of these patients, that difference will be played out slowly over the course of ten or twenty years. It's not something you'll notice from month to month, or even from year to year. Young doctors come here because the place has a reputation of housing the sickest of the sick. I get that. I can understand the allure. But within a short time, most of them move on—because this is not what they wanted. Not really.”

“Some of them must want it,” I countered.

He only sighed. “A few, yes. But most don't. I've read enough essays to know.”

I'd gone home that night and managed to unearth my own medical school application essay from eight years before, and goddammit if he wasn't right. I'd used the word
difference
twice, and the essay's last sentence read,
I look forward to the journey on which I am about to embark. Pathetic,
I thought, standing there in my kitchen. But at the time I'd written it I'd meant every word. The next morning I called him up to accept the position. Maybe my expectations had changed since applying to medical school. Maybe I just wanted to prove Wagner wrong.

“Did you look?” he asked, and we both knew what he was referring to.

“Yes,” I admitted.

“And?”

“And I must be in the minority,” I lied. “When would you like me to start?”

That was five years ago, and despite his predictions at the time, I've been relatively happy here. The nursing and support staff at Menaker are dedicated, and the faces of those I work with seldom change. There is a sense of family, and for someone like myself whose real family has been splintered in numerous ways, there is a certain nurturing reassurance in that stability. Wagner had also been right about the patients, who are clearly in it for the long haul. Practicing psychiatry in a place like this is like standing on a glacier and trying to influence the direction it will travel. It's difficult, to say the least. But sometimes, despite all the forces working against us, we are able to effect a change—subtle, but real—and the victory can be more gratifying than one can possibly imagine. But all jobs entail occasional days when you feel
like banging your head against the wall, and for me today seemed to be one of them.

“Am I
missing
something here, Charles?” I asked. The volume of my voice had ratcheted up a notch. I made myself take a breath and exhale slowly before continuing. “We cannot admit a patient involuntarily to this institution with no court order and no patient records. It's false imprisonment, tantamount to kidnapping.”

If Wagner was concerned, he didn't show it. “I think you should leave the legalities to me,” he advised. “Focus on the individual before you, not his paper trail.
Talk
to him.”

“I've
been
talking to him. For two days now. He doesn't say much—doesn't seem to know
what
to say.”

“It can be difficult.”

“It's frustrating. I have no patient history or prior assessments to help me here. I don't even have a list of his current medications.”

Wagner smiled through his goatee. It was a look, I suppose, that was meant to be disarming. “I think you have everything that you need right now. Talking to him is the most important thing. Everything else is secondary.”

I turned and left the office without a retort, deciding that whatever response I might muster wasn't worth the price of my job.

W
hy don't you tell me a little bit about your childhood,” I suggested. We were walking across the hospital grounds, an environment I felt was more conducive to psychotherapy than sitting in a small office as my patient and I stared at each other. Something about the outdoors opens people up—frees them, in a way.

He gave me a pitying, incredulous look—one I'd already become accustomed to receiving from him. I never would figure out where that look came from, but I began to recognize it as his default expression. It was the look I imagined parents of teenagers received with regular frequency.
I'm embarrassed for you because of how clueless you really are,
it seemed to say, except with teenagers there was usually an added dose of resentment, and I never got that from him. Rather, Jason's expressions were touched with empathy—something about the depth of those eyes, perhaps—almost as if he were here to help me, instead of the other way around.

“On the surface, I was part of what you might call a traditional family. We lived in a middle-class suburban neighborhood in Columbia.”

“Columbia, Maryland,” I clarified, and he nodded. It was located in Howard County, about a thirty-minute drive to the west of us.

“Dad was a police officer,” he continued. “Mom used to be a teacher, but when the kids were born, she took several years off to run a part-time day care out of our house. It allowed her to stay home with us during those first couple of years.”

“You say ‘us.' You had siblings?”

“A sister.”

“Where is she now?”

He sighed, as if he'd explained this all a thousand times before. I wondered how many psychiatrists he'd been through before me.

“Your sister,” I prodded, waiting for him to answer my question, but he was silent, looking down at the Severn River below us.

“Is she older or younger?”

“She was three years older,” he said, and his use of the past tense was not lost on me.

“Is she still alive?”

He shook his head. “I don't know. I haven't spoken with her in a long time.”

“You had a disagreement? A falling-out?”

“No,” he said. His face struggled for a moment. Beyond the iron pickets, a seagull spread its wings and left the cliff, gliding out into the vacant space some eighty feet above the water.

I put a hand on his shoulder. I wasn't supposed to do that, I knew. There are rules of engagement to psychiatry, and maintaining appropriate boundaries—physical and otherwise—is one of them. What may seem like a compassionate gesture can be misconstrued. Extending a casual touch, or revealing too much personal information, for example, puts the psychiatrist at risk of
being perceived by the patient as someone other than his doctor. The relationship of doctor and patient becomes less clear, and the patient's sense of safety within that relationship can suffer. And yet, here I was with my hand resting on my patient's shoulder for the second time this week. I found it unsettling, for I was doing it without thinking, almost as a reflex, and I didn't understand where it was coming from.
Was I attracted to him?
I must admit I did feel something personal in his presence, a certain . . .
pull
. But it was hard to define, difficult to categorize. But
dangerous,
yes . . . I recognized that it had the potential to be dangerous for us both.

“What happened to your sister?” I asked, withdrawing my hand and clasping both behind my back.

“Gone,” he said, following the flight of the gull before it disappeared around the bend. He turned his eyes toward mine, and the hopelessness I saw there nearly broke my heart. “She's been gone for five years now, and alive or dead, I don't think she's ever coming back.”