Just After Sunset

Those summers seem like a long time ago--you and Johnny inseparable, me tagging along whenever you'd let me. Which was probably more often than I deserved! Yet your note of condolence brought it all back to me, and how I cried. Not just for Johnny, but for all three of us. And, I suppose, for how simple and uncomplicated life seemed. How golden we were!

You saw his obituary, of course. "Accidental death" can cover such a multitude of sins, can't it? In the news story, Johnny's death was reported as the result of a fall, and of course he did fall--at a spot we all knew well, one he had asked me about only last Christmas--but it was no accident. There was a good deal of sedative in his bloodstream. Not nearly enough to kill him, but according to the coroner it could have been enough to disorient him, especially if he was looking over the railing. Hence, "accidental death."

But I know it was suicide.

There was no note at home or on his body, but that might have been Johnny's idea of a kindness. And you, as a doctor yourself, will know that psychiatrists have an extremely high rate of suicide. It's as if the patients' woes are a kind of acid, eating away at the psychic defenses of their therapists. In the majority of cases, those defenses are thick enough to remain intact. In Johnny's? I think not...thanks to one unusual patient. And he wasn't sleeping much during the last two or three months of his life; such terrible dark circles under his eyes! Also, he was canceling appointments right & left. Going on long drives. He would not say where, but I think I may know.

That brings me to the enclosure, which I hope you will look at when you finish this letter. I know you are busy, but--if it will help!--think of me as the love-struck girl I was, with my hair tied back in a ponytail that was always coming loose, forever tagging along!

Although Johnny was on his own, he had formed a loose affiliation with two other "shrinks" in the last four years of his life. His current case files (not many, due to his cutting back) went to one of these Drs. following his death. Those files were in his office. But when I was cleaning out his study at home, I came upon the little manuscript I have enclosed. They are case notes for a patient he calls "N.," but I have seen his more formal case notes on a few occasions (not to snoop, but only because a folder happened to be open on his desk), and I know this is not like those. For one thing, they weren't done in his office, because there is no heading, as on the other case notes I have seen, and there is no red CONFIDENTIAL stamp at the bottom. Also, you will notice a faint vertical line on the pages. His home printer does this.

But there was something else, which you will see when you unwrap the box. He has printed two words on the cover in thick black strokes: BURN THIS. I almost did, without looking inside. I thought, God help me, it might be his private stash of drugs or print-outs of some weird strain of Internet pornography. In the end, daughter of Pandora that I am, my curiosity got the best of me. I wish it hadn't.

Charlie, I have an idea my brother may have been planning a book, something popular in the style of Oliver Sacks. Judging by this piece of manuscript, it was obsessive-compulsive behavior he was initially focused on, and when I add in his suicide (if it was suicide!), I wonder if his interest didn't spring from that old adage "Physician, Heal Thyself!"

In any case, I found the account of N., and my brother's increasingly fragmentary notes, disturbing. How disturbing? Enough so I'm forwarding the manuscript--which I have not copied, by the way, this is the only one--to a friend he hadn't seen in ten years and I haven't seen in fourteen. Originally I thought, "Perhaps this could be published. It could serve as a kind of living memorial to my brother."

But I no longer think that. The thing is, the manuscript seems alive, and not in a good way. I know the places that are mentioned, you see (I'll bet you know some of them, too--the field N. speaks of, as Johnny notes, must have been close to where we went to school as children), and since reading the pages, I feel a strong desire to see if I can find it. Not in spite of the manuscript's disturbing nature but because of it--and if that isn't obsessional, what is?!?

I don't think finding it would be a good idea.

But Johnny's death haunts me, and not just because he was my brother. So does the enclosed manuscript. Would you read it? Read it and tell me what you think? Thank you, Charlie. I hope this isn't too much of an intrusion. And...if you should decide to honor Johnny's request and burn it, you would never hear a murmur of protest from me.

Fondly,

From Johnny Bonsaint's "little sis,"

Sheila Bonsaint LeClaire

964 Lisbon Street

Lewiston, Maine 04240

PS--Oy, such a crush I had on you!

2. The Case Notes

June 1, 2007

N. is 48 years old, a partner in a large Portland accounting firm, divorced, the father of two daughters. One is doing postgraduate work in California, the other is a junior at a college here in Maine. He describes his current relationship with his ex-wife as "distant but amicable."

He says, "I know I look older than 48. It's because I haven't been sleeping. I've tried Ambien and the other one, the green moth one, but they only make me feel groggy."

When I ask how long he's been suffering from insomnia, he needs no time to think it over.

"Ten months."

I ask him if it's the insomnia that brought him to me. He smiles up at the ceiling. Most patients choose the chair, at least on their first visit--one woman told me that lying on the couch would make her feel like "a joke neurotic in a New Yorker cartoon"--but N. has gone directly to the couch. He lies there with his hands laced tightly together on his chest.

"I think we both know better than that, Dr. Bonsaint," he says.

I ask him what he means.

"If I only wanted to get rid of the bags under my eyes, I'd either see a plastic surgeon or go to my family doctor--who recommended you, by the way, he says you're very good--and ask for something stronger than Ambien or the green moth pills. There must be stronger stuff, right?"

I say nothing to this.

"As I understand it, insomnia's always a symptom of something else."

I tell him that isn't always so, but in most cases it is. And, I add, if there is another problem, insomnia is rarely the only symptom.

"Oh, I have others," he says. "Tons. For instance, look at my shoes."

I look at his shoes. They are lace-up brogans. The left one is tied at the top, but the right has been tied at the bottom. I tell him that's very interesting.

"Yes," he says. "When I was in high school, it was the fashion of girls to tie their sneakers at the bottom if they were going steady. Or if there was a boy they liked and they wanted to go steady."

I ask him if he's going steady, thinking this may break the tension I see in his posture--the knuckles of his laced-together hands are white, as if he fears they might fly away unless he exerts a certain amount of pressure to keep them where they are--but he doesn't laugh. He doesn't even smile.

"I'm a little past the going-steady stage of life," he says, "but there is something I want."

He considers.

"I tried tying both of my shoes at the bottom. It didn't help. But one up and one down--that actually seems to do some good." He frees his right hand from the deathgrip his left has on it and holds it up with the thumb and forefinger almost touching. "About this much."

I ask him what he wants.

"For my mind to be right again. But trying to cure one's mind by tying one's shoelaces according to some high school code of communication...slightly adjusted to fit the current situation...that's crazy, wouldn't you say? And crazy people should seek help. If they have any sanity left at all--which I flatter myself I do--they know that. So here I am."

He slides his hands together again and looks at me with defiance and fright. Also, I think, with some relief. He's lain awake trying to imagine what it will be like to tell a psychiatrist that he fears for his sanity, and when he did it, I neither ran shrieking from the room nor called for the men in the white coats. Some patien

ts imagine I have a posse of such white-coated men in the very next room, equipped with butterfly nets and straitjackets.

I ask him to give me some instances of his current mental wrongness, and he shrugs.

"The usual OCD shit. You've heard it all a hundred times before. It's the underlying cause I came here to deal with. What happened in August of last year. I thought maybe you could hypnotize me and make me forget it." He looks at me hopefully.

I tell him that, while nothing is impossible, hypnotism works better when it's employed as an aid to memory rather than as a block.

"Ah," he says. "I didn't know that. Shit." He looks up at the ceiling again. The muscles in the side of his face are working, and I think he has something more to say. "It could be dangerous, you know." He stops, but this is only a pause; the muscles along his jaw are still flexing and relaxing. "What's wrong with me could be very dangerous." Another pause. "To me." Another pause. "Possibly to others."

Every therapy session is a series of choices; branching roads with no signposts. Here I could ask him what it is--the dangerous thing--but I elect not to. Instead I ask him what sort of OCD shit he's talking about. Other than the one-up, one-down tying thing, which is a pretty damn good example. (I do not say this.)

"You know it all," he says, and gives me a sly look that makes me a bit uncomfortable. I don't show it; he isn't the first patient who has made me uncomfortable. Psychiatrists are spelunkers, really, and any spelunker will tell you that caves are full of bats and bugs. Not nice, but most are essentially harmless.

I ask him to humor me. And to remember that we are still just getting to know each other.

"Not going steady just yet, eh?"

No, I tell him, not quite yet.

"Well, we better be soon," he says, "because I'm at Condition Orange here, Dr. Bonsaint. Edging into Condition Red."

I ask him if he counts things.

"Of course I do," he says. "The number of clues in the New York Times crossword puzzles...and on Sundays I count twice, because those puzzles are bigger and double-checking seems in order. Necessary, in fact. My own footsteps. Number of telephone rings when I call someone. I eat at the Colonial Diner on most workdays, it's three blocks from the office, and on my way there I'll count black shoes. On my way back, I'll count brown ones. I tried red once, but that was ridiculous. Only women wear red shoes, and not many, at that. Not in the daytime. I only counted three pair, so I went back to the Colonial and started again, only the second time I counted brown shoes."

I ask him if he has to count a certain number of shoes in order to achieve satisfaction.

"Thirty's good," he says. "Fifteen pair. Most days, that's no problem."

And why is it necessary to reach a certain number?

He considers, then looks at me. "If I say 'you know,' will you just ask me to explain what it is you're supposed to know? I mean, you've dealt with OCD before and I've researched it--exhaustively--both in my own head and on the Internet, so can't we just cut to the chase?"

I say that most counters feel that reaching a certain total, known as "the goal number," is necessary to maintain order. To keep the world spinning on its axis, so to speak.

He nods, satisfied, and the floodgates break.

"One day, when I was counting my way back to the office, I passed a man with one leg cut off at the knee. He was on crutches, with a sock on his stump. If he'd been wearing a black shoe, it would have been no problem. Because I was on my way back, you see. But it was brown. That threw me off for the whole day, and that night I couldn't sleep at all. Because odd numbers are bad." He taps the side of his head. "At least up here they are. There's a rational part of my mind that knows it's all bullshit, but there's another part that knows it absolutely isn't, and that part rules. You'd think that when nothing bad happened--in fact something good happened that day, an IRS audit we were worried about was canceled for absolutely no reason--the spell would break, but it didn't. I'd counted thirty-seven brown shoes instead of thirty-eight, and when the world didn't end, that irrational part of my mind said it was because I not only got above thirty, I got well above thirty.

"When I load the dishwasher, I count plates. If there's an even number above ten in there, all is well. If not, I add the correct number of clean ones to make it right. Same with forks and spoons. There has to be at least twelve pieces in the little plastic caddy at the front of the dishwasher. Which, since I live alone now, usually means adding clean ones."

What about knives, I ask, and he shakes his head at once.

"Never knives. Not in the dishwasher."

When I ask why not, he says he doesn't know. Then, after a pause, he gives me a guilty sideways look. "I always wash the knives by hand, in the sink."

Knives in the silverware caddy would disturb the order of the world, I suggest.

"No!" he exclaims. "You understand, Dr. Bonsaint, but you don't understand completely."

Then you have to help me, I say.

"The order of the world is already disturbed. I disturbed it last summer, when I went to Ackerman's Field. Only I didn't understand. Not then."

But you do now? I ask.

"Yes. Not everything, but enough."

I ask him if he is trying to fix things or only trying to keep the situation from getting worse.

A look of unutterable relief fills his face, relaxing all the muscles there. Something that has been crying out for articulation has finally been spoken aloud. These are the moments I live for. It's not a cure, far from it, but for the time being N. has gotten some relief. I doubt if he expected it. Most patients do not.

"I can't fix it," he whispers. "But I can keep things from getting worse. Yes. I have been."

Again I have come to one of those branching points. I could ask him what happened last summer--last August, I presume--in Ackerman's Field, but it is probably still too early. Better to loosen the roots of this infected tooth a little more first. And I really doubt that the source of the infection can be so recent. More likely, whatever happened to him last summer was only a kind of firing pin.

I ask him to tell me about his other symptoms.

He laughs. "That would take all day, and we only have..." He glances at his wrist. "...twenty-two minutes left. Twenty-two is a good number, by the way."

Because it's even? I ask.

His nod suggests I am wasting time with the obvious.

"My...my symptoms, as you call them...come in clusters." Now he's looking up at the ceiling. "There are three of these clusters. They poke out of me...the sane part of me...like rocks...rocks, you know...oh God, dear God...like the fucking rocks in that fucking field..."

Tears are coursing down his cheeks. At first he doesn't seem to notice, only lies on the couch with his fingers laced together, looking up at the ceiling. But then he reaches for the table beside him, where sits what Sandy, my receptionist, calls The Eternal Box of Kleenex. He takes two, wipes his cheeks, then crumples the tissue. It disappears into the lace of his fingers.

"There are three clusters," he resumes, speaking in a voice that isn't quite steady. "Counting is the first. It's important, but not so important as touching. There are certain things I need to touch. Stove-burners, for instance. Before leaving the house in the morning or going to bed at night. I might be able to see they're off--all the dials pointing straight up, all the burners dark--but I still have to touch them to be absolutely sure. And the front of the oven door, of course. Then I started touching the light switches before leaving the house or the office. Just a quick double-tap. Before I get into my car, I have to tap four times on the roof. And six times when I get to where I'm going. Four's a good number, and six is an okay number, but ten...ten is like..." I can see one tear-track he's missed, running a zigzag course from the corner of his right eye to the lobe of his ear.

Like going steady with the girl of your dreams? I suggest.

He smiles. He has a lovely, weary smile--a smile that's finding it increasingly hard to get up in the morning.

"That's right," he says. "And she's got her sneaker laces tied at the bottom so everyone knows it."

You touch other things? I ask, knowing the answer to this. I have seen many cases like N. during the five years I've been in practice. I sometimes picture these unfortunates as men and women being pecked to death by predatory birds. The birds are invisible--at least until a psychiatrist who is good, or lucky, or both, sprays them with his version of Luminol and shines the right light on them--but they are nevertheless very real. The wonder is that so many OCDs manage to live productive lives, just the same. They work, they eat (often not enough or too much, it's true), they go to movies, they make love to their girlfriends and boyfriends, their wives and husbands...and all the time those birds are there, clinging to them and pecking away little bits of flesh.

"I touch many things," he says, and again favors the ceiling with his weary, charming smile. "You name it, I touch it."

So counting is important, I say, but touching is more important. What is above touching?

"Placing," he says, and suddenly begins to shiver all over, like a dog that's been left out in a cold rain. "Oh God."

He suddenly sits up and swings his legs over the edge of the couch. On the table beside him there is a vase of flowers in addition to The Eternal Box of Kleenex. Moving very quickly, he shifts the box and the vase so they are diagonal to each other. Then he takes two of the tulips from the vase and lays them stem to stem so that one blossom touches the Kleenex box and the other the vase.

"That makes it safe," he says. He hesitates, then nods as if he's confirmed in his mind that what he's thinking is the right thing. "It preserves the world." He hesitates again. "For now."

I glance down at my watch. Time is up, and we've done quite enough for one day.

"Next week," I say. "Same bat-time, same bat-station." Sometimes I turn this little joke into a question, but not with N. He needs to come back, and knows it.

"No magical cure, huh?" he asks. This time the smile is almost too sad to look at.

I tell him that he may feel better. (This sort of positive suggestion never hurts, as all psychiatrists know.) Then I tell him to throw away his Ambien and "the green moth pills"--Lunesta, I assume. If they don't work at night, all they can do is cause trouble for him during his waking hours. Falling asleep on the 295 Connector won't solve any of his problems.