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.
Why 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,
