A History of the Present Illness (29 page)

¹⁹
The newspaper listed “a car” among the objects I gave Mike during his two months at the SMCHC. The “car” to which they refer was the Civic, which, as I've already explained, had been gutted and so had no apparent value and didn't run. Mike wanted it anyway; I have no idea why.

²⁰
For a while, when the story broke, I set my alarm for four-thirty each morning and drove the thirty-two miles to my parents' house in the Los Altos Hills to wait for the paper boy, then removed the Bay Area section from their
San Francisco Chronicle
, that section being the one detailing the so-called abuses at the SMCHC, including an unnamed (but otherwise obviously identifiable) psychiatrist's on-site liaisons with a visiting “student.”

²¹
I decided to apply to the Master of Public Administration Program with emphasis on health services administration at USF after my temporary suspension and before my self-prescribed Prozac kicked in, on a day when I stopped by the SMCHC just to say hi and came upon Zbigniew (a.k.a. “Big Z”), whom one of the internists wanted to commit because Big Z had claimed in his peculiarly accented English (he's from Minnesota, not Poland) that he'd not only seen but talked to Jesus that very morning and that Jesus had told him he'd find cigarettes behind the register and not in aisle 5. I had to explain to my well-meaning but medically myopic colleague that it wasn't Jesus but
Jésus
who had spoken to Big Z—
Jésus
, whom I also sometimes asked for help, who pronounced his first name
Hay-zeus
and worked as an assistant manager at the pharmacy down the street—and that Big Z therefore was not hallucinating and so would not require a costly inpatient stay. Right then I realized that if a person designed a universally applicable language-and culture-sensitive medical personnel training program for docs like my internist colleague, that person would be making an important, ultimately cost-saving, and consequently bipartisanly popular contribution to the future of our tragically dysfunctional American health-care system and that a very smart first step toward such a contribution would be enrollment in an M.P.A./H.S.A. program.

²²
!!

²³
I have two much-younger brothers (my mother had a string of miscarriages until diagnosed with and treated for her “incompetent” cervix).

²⁴
I must strenuously protest the comments in the press by certain well-known lights of the psychiatric establishment (including you, Dr. Saperstein) suggesting the high incidence of hero complexes in people willing or even eager to work under socioeconomically challenging conditions. While I did not use the best judgment in allowing Mike to seduce me, it seems to me even now, in retrospect, that I behaved as I did, not because I had found someone to fulfill an insatiable need for worship, but because occasionally a person needs a brief interlude of semiprivate vasculo-muscular and neuro-chemical bliss, an opportunity, if you will, for the evanescent release of the otherwise rigorously repressed but still wildly vital animal within in order to punctuate the daily horrors of her job and the uniformly dismal realities of her patients' lives. It wasn't, after all, as if I planned my encounters with Mike. They just came over me in that way cravings might justifiably overtake even the most disciplined among us after hearing from a person (who, no matter how derelict and odoriferous, is a fellow human being) about how a group of perfect strangers, well dressed and out for a night on the town, kicked him and urinated on him and set fire to his bedroll, his only possession, and how, as a result, he might have frozen to death were it not for the actions of a buddy of his, another person who, by all standards of conventional society, is a nobody. Fortunately, this nobody had earned only enough change from passersby that afternoon (while napping, hat in lap, outside the McDonald's on Van Ness Avenue) to score a single pint and so was in the optimally functional zone between withdrawal and falling down drunk, and consequently not only spotted his beat-up, half-frozen friend but was cogitating sufficiently well to fetch the local cops, who got the friend to the emergency department at San Francisco General just in time. Imagine, if you will, hearing that story and then walking down a gray-carpeted, fluorescently lit hallway and seeing Mike's lean, rectangular torso or his tightly sculpted runner's thighs and wanting them for yourself, if only for a few minutes (which, I'll be honest, was about all I ever got because, his later denials, protestations, confabulations, and retractions before the Review Board notwithstanding, Mike certainly seemed the eager little beaver in the heat of that and other similar moments, grunting and panting like those funny small dogs with the smashed-in faces), and then perhaps you can understand how, in the twilight zone of the SMCHC, I decided that maybe a quick fuck wasn't such a bad idea.

²⁵
Perhaps this should read “medical
and/or personal
”?

²⁶
I know what you're thinking: How did she, a well-trained professional—a
psychiatrist
, for God's sake—not see that Mike was Borderline? The answer is simple: the usual way; I was charmed.

²⁷
In conclusion, I cannot resist pointing out what you as my fellow psychiatric professionals no doubt already know, namely that although personality disorders carry an ethically indefensible if sometimes well-earned historic burden of negative associations even in our own small psychiatric community, there are those among us who would benefit from receiving the sort of diagnosis that might be employed to explain our thoughts and behaviors not only to ourselves but to others, a diagnosis we might metaphorically hoist before us when we disappoint our families or lose a job or are subject to humiliating pseudo-public professional scrutiny, using it as protection in much the same way a soldier girds himself for combat with a bulletproof vest and helmet and grenade. Because, let's face it, the tragic truth is that even now, in the twenty-first century, too many people fail to understand and appreciate the huge and significant difference between differentness (i.e., me) and true insanity (i.e., Freddy Ramboteau, Tina Ball, Big Z), how the former can make a person needy and might even periodically impair her decision-making capacity but may also be responsible for precisely those traits that make her a unique, even special human being, a person striving to make daily contributions, large and small, to the faltering social experiment we call life on behalf of those too ill to do so for themselves. In fact, it might behoove the committee to pause long enough to consider whether, in fact, the selfsame constellation of traits might account for not only the BBD “disordered” person's character weaknesses and psychological vulnerabilities but also for those “gifted” and “good girl” aptitudes and interests that enable her both to excel in academic pursuits such as earning graduate degrees and developing new diagnostic categories and to feel a profound and sincere sympathy for those among her fellow humans who are too often ignored, written off, insulted, and abused by the sorts of people (including, I'm sorry to have to mention, certain media-hound-type members of the “Cluster B” revision subcommittee) who can look at the downtrodden and desperate and feel no sympathy or empathy, no bathos or pathos, and whose behavior leads some of us so-called crazies to wonder who among us really deserves the label of deeply and irredeemably psychologically deficient. Which brings me back to my relationship with Mike. I admit he was a manipulative, self-serving cutter, quick on the manly trigger and prone to dramatic exits both actual (he left a rainbow-colored trail of pills on the gray carpet the day the SMCHC fired him) and threatened (in addition to the fax, he twice left suicide notes on the handlebar of the bicycle I've used for transportation since the Civic's demise, though last I heard he was alive and well and collecting disability while awaiting a trial date for his wrongful dismissal lawsuit). But unlike most of the other people in my life, Mike also seemed able to see the parts of me that are so often misunderstood, and he not only loved those parts but valued and treasured them, and as a result, for a time, so did I.

Louise Aronson has an M.F.A. in fiction from the Warren Wilson Program for Writers and an M.D. from Harvard Medical School. She won the
Sonora Review
prize and the
New Millennium Writings
short fiction award, and she has received three Pushcart Prize nominations. Her fiction has appeared in
Bellevue Literary Review
,
Northwest Review
,
Sonora Review
,
Seattle Review
,
Fourteen Hills,
and
The Literary Review
, among other publications. She is the recipient of Ucross, Ragdale, and Hedgebrook residencies. She is an associate professor of medicine at the University of California, San Francisco, where she cares for diverse, frail older patients and directs the Northern California Geriatrics Education Center, UCSF Medical Humanities, and the UCSF Pathways to Discovery program. She is an associate editor of the JAMA Care of the Aging Patient series and director of public medical communication for the UCSF Program for the Aging Century.

Copyright © 2013 by Louise Aronson

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Published by Bloomsbury USA, New York

Library of Congress Cataloging-in-Publication Data

Aronson, Louise.
A history of the present illness : stories / Louise Aronson. — 1st U.S. ed.
p. cm.
eISBN: 978-1-62040-008-1
1. Medical fiction, American. 2. Physician and patient — Fiction
3. San Francisco (Calif.)—Fiction. I. Title.

PS3601.R67H57 2013
813'.6—dc23
2012018354

First U.S. edition 2013
Electronic edition published in January 2013

www.bloomsbury.com