By Julie Webb Kelley
Doctors doctoring on the seventh-floor psych ward progress in their profession toward a type of bent notion about human beings that cannot be taught in medical schools because it requires their lives to be touched by actual mental patients. A tender M.D. will start out believing that people can be helped, they can be saved, they can be made whole. Somewhere in the midst of this unoriginal ideal, they begin to take stock in the presumption, under no doing of their own, that people are sick and sad and often cannot be helped. When the young ones jump off the psychiatrist boat into an ocean of cerebral misfits it doesn’t take long for them to perfect the beginnings of their professional manner: a watery handshake followed by a flavorless hello. And by the time the psychiatrist approaches his own psych patients day after day, he has developed all the sincerity necessary to mirror his facial features into the grim terror resonant on the face of any given patient thus placing these two persons in juxtaposition between the patient’s buckling illness trimmed with discomfort and the legion of DSM tags available to the doctor.
The worm-looking doctor who tucked his bland head between the wooden door and the metal door frame of her room and tapped a bit too tenderly on the door but just enough to move it open several inches producing an insipid squeak that bothered no one but himself found his new patient, Katelyn Irma, sitting on the edge of her bed, unmoved, unnoticing, staring at the gray tile floor, wearing a blue hospital gown, tennis shoes with white socks but no laces, and a blanket wrapped around her legs. As he neared her, he noticed the goose pimpled flesh on her arms and the double ring of a distant telephone. The room was dingy with lightlessness even though it was after 2 o’clock in the afternoon. The towering building right outside the narrow, locked window blocked the idea of sunlight, allowing only grayness to touch the seventh floor room.
Katelyn Irma’s hair hung in dark, wet ringlets down her back, making her gown wet at the shoulders. She had to have a female aide accompany her in the shower and even with this stranger watching her wash her naked body the girl had refused to let her shave her legs. You can’t have a razor, honey, the aide was at least ten years her junior and had no business calling her honey. With or without makeup, Katelyn Irma had one of those faces that didn’t seem able to make up its mind. The eyes were neither green nor blue. The lips neither smiled nor frowned. The brow could neither furrow nor rest.
The doctor leaned in front of Katelyn Irma’s face and said Hi startling her out of her fixation with the grey tile floor. He straightened in response to her startle asking if she was indeed Katelyn Irma since this was their first meeting. Katelyn Irma nodded, staring at his shiny black shoelaces. He wondered if they could go out to one of the conference rooms to talk, then stepped back, giving her room to get up from the bed since it really wasn’t something he was wondering at all, it was actually a direct request in disguise.
Once seated across from each other in the game room, the doctor pushed a puzzle in progress toward the opposite end of the table, pulling his pen out of the left breast pocket of his white lab coat then rubbed his hand across the legal size pad of paper several times, studying Katelyn Irma.
“Will this room be okay for you?” He asked. “I’m sorry none of the conference rooms are available right now.”
“This is fine.” She said.
The doctor sighed; waiting several swollen seconds before assaulting her with more words then said did she feel like telling him how she came to be here today, in the hospital. She pressed her hands into fists and thrust them across the table toward him, her inner arms upward, revealing the bandages wrapping her forearms from elbows to wrists. Katelyn Irma looked him in the eye, waiting for the psyche ward doctor’s response.
“You hurt yourself. Can I take a look under the bandages?”
“Which one hurts less?”
He reached for her left arm and began unwrapping the white gauze and piling it on the table leaving the wounded arm exposed.
“You used a knife.” He commented, holding the underside of her left wrist as if it would snap off if he weren’t careful.
She nodded again, letting her eyes follow the puffy lurid lines running up and down her arm. Some of the slices near her wrists were deeper and had small white gauze patches taped over the stitches she had received in the emergency room.
“These here,” the doctor pointed at the cuts further up her arms where large portions of flesh were missing between some of the cuts leaving several inches of raw, crimson epidermis exposed. It occurred to him that she had literally skinned certain areas. “The shape here . . . the skinning of these areas, would you mind telling me what you used to make these cuts?”
“A hollow ground blade.”
He looked up from her arm into her face, as if he could find the answer there. “A serrated knife?”
“Will you wrap it back now? It’s stinging.” Katelyn Irma said.
The doctor began distally near her wrist and wrapped the gauze in the proximal direction toward her elbow, thanking her for letting him take a look. As he finished he said she must have felt really awful to hurt herself like this.
Katelyn Irma lowered her arms back into her lap then sighed trying to convey the extent of her patience with him. “You think I did this to hurt myself? The more skin I can peel off my arms, the faster I can bleed to death. I had no intention of hurting myself; I was trying to kill myself. Big difference."
The doctor asked if she would be willing to tell him about that difference.
“You’re a doctor and you don’t know the difference between someone hurting themselves and someone trying to kill themselves?”
The doctor jotted on his legal pad then looked up at Katelyn Irma again guessing that the irritation in her voice could mean that she was finally beginning to feel comfortable with him. This possibility produced another thought and he scribbled again on his legal pad.
“Can you share with me why you wanted to kill yourself?”
“I want out. Away from this pain. I need it to stop. For good. Merely hurting myself can’t accomplish that. Can’t make the pain go away.”
While writing furiously, the doctor had grunted a few affirmations, which were meant to prod her along more than agree with anything she said.
“The only way I can figure out how to make it stop is to die. It hasn’t gone away, it won’t go away. It’s been months and it won’t go away. I would rather be dead than feel this way. I wasn’t trying to hurt myself for feeling this way. I just got tired of toying around with it.”
“Toying,” he nodded, not lifting his gaze or his pen from the legal pad.
Silence sunk around them after his pen came to the end of a sheet of paper and he flipped over to the next page. He tilted his head in interest, hoping to make eye contact with her but her fingers had begun playing with the frayed edge of the blanket that was still wrapped around her, that she had carried with her into the game room and now she was watching her fingers in earnest.
“Do you have to keep looking at me?” She snapped.
“This feeling you’re talking about, is it anger at yourself or someone else? Is it related to your life not having meaning? Did voices talk to you, suggesting that you kill yourself?”
Her head went side to side in an ardent manner that seemed to him to be provoked. He was confused.
“You don’t understand, do you? The feeling is what’s wrong. The feeling isn’t something toward myself or life or brought on by hallucinations. The feeling is the reason I would be better off dead.” Katelyn Irma lifted herself slightly off the chair and pulled the blanket tight around her shoulders, shaking her hair free from the blanket’s pressure on her back. He noticed then that her hair was drying and that she ignored the ringlets that were falling into her face, hiding her left eye.
“The feeling you’re describing, is it the same feeling you have when you’re feeling depressed?”
Katelyn Irma laughed, without the aid of smiling lips. “Depression. Is that what you to call it? That’s what my counselor called it too. Depression. Okay. Sure. It’s depression that’s tormenting and killing me. It’s me being tormented and killed by depression. It’s my soul being eaten, my will defeated, my life blistered and stained. It’s me, myself disappearing.” She drug out the syllables of disappearing, then halted, waiting for his pen to stop moving, waiting for him to look up so she could look at him to see if he understood.
He stared right back at her, feeling unsure about the directness Katelyn Irma was showing. Unsure if she was feeling threatened by his questions or if it was merely another form of irritation for her.
“Are you feeling threatened?” He asked, his expression communicating a banal sympathy that seemed as if he had been practicing it in the mirror for decades.
Katelyn Irma hung her head in her hands. For several minutes she sat like this, sure the doctor was watching her since she didn’t hear the pressing of the pen on his paper. She took a deep breath before looking up at him. She noticed his crooked mouth and the slight droop of his right eyelid. She was right, he had been watching her.
“It hurts, this feeling. It is pain and painful all at the same time.”
“Where does it hurt?”
“Everywhere. I feel it in my face, my gut, my legs, my hands, my stomach, everywhere.”
He was writing again while silently urging her to continue. He felt she was opening up.
The doctor heard her take another deep breath. He looked up from his legal pad to find her staring at a spot just over his left shoulder.
“It can be terrifying to look in the mirror and not recognize the face that is looking at you.” She began. “Some part of yourself is familiar. The features, the shapes maybe but on a deeper level you are certain this is not the face of who you used to be. There is something hollow in the eyes, a depth of emptiness that has no bottom. The lifeless expression intimidates you, convincing you that you’ll be like this forever. And as every fear and weakness spills over your eyelids and down your cheeks you wonder just how much more pain a body can possibly hold. You lean in close to the mirror, you study the details of this stranger and you whisper, you don’t look like anyone I know.”
Her face writhed, as if all of her senses had suddenly been over-indulged by her words. “It’s the most savage pain. To me it is more than depression. It is more than sadness or feeling blue. It is more than the fact that every tangible evidence of life, eating, sleeping, time, tasks, smells, tastes, other people,”--she let her head roll backwards with these last two words--“is overwhelming and difficult and confusing. It’s so much more than just depression.”
Katelyn Irma rubbed her eyes with her left hand, then, lowering her hand back to her lap, she kept her eyes closed. The doctor was wondering where her thoughts would go next. It was her feeling; he didn’t want to lead with more questions unless he was sure she needed the nudge. He waited, continuing his writing, hoping not to disturb her. But she didn’t continue. When he looked up, she was still with her eyes closed, as if there were no words left inside of her.
“Katelyn.” He spoke her name as no one had ever said before, in a manner both kind and frail. She remained still, eyelids and all. He paused inside himself then, taking this time to center himself, to take a walk around this feeling she spoke of but keeping it at a safe distance, allowing himself to imagine her agony while honoring her feelings. But not sharing, no, never sharing them.
“I was wondering something.” His words fell out of his mouth one at a time, his way of meeting her where she was at, knowing that these initial conversations are always difficult for clients. “I was wondering if you could answer just one more question for me.”
Katelyn Irma’s chin had drifted toward her chest, yet she offered a dawdling nod in response to the doctor’s request.
“Katelyn, tell me . . .”
“Turn the page first.” She said.
“What?” The doctor seemed flustered momentarily as her interruption was followed by her eyes opening and her right finger pointing at his legal pad.
“It will make you feel better if I turn the page?” He asked, flipping to a fresh page on his legal pad then looking at her for several seconds.
“Katelyn, will you tell me about your sister.”
“How do you know about my sister?”
“Everyone knows Kimberly Irma by now. I’m wondering if her death has anything to do with the intense pain you talk about.”
Katelyn Irma moved around in her chair and ran both hands over her ringlets, her eyes darting for a secure place to settle. The doctor thought Katelyn Irma seemed the most distracted she had been during their entire discourse. He sat, looking at her. He noticed a strange combination of feelings within himself: an intense clinical interest in her responses wrapped in an unusual sense of something he could only place as concern, although this last feeling was rather vague to him. As her head rolled back and forth, he doubted himself, something he didn’t often do after 13 years of practicing psychiatric medicine. Maybe he shouldn’t have allowed his questioning to proceed in this direction. He knew of her sister and perhaps for Katelyn Irma it had become a place within her that was sacred. Perhaps he had asked too much.
“Katelyn. I’m willing to listen. All I want to do is understand. I’ll make no comments, I promise.” And he meant it.
Katelyn Irma let her gaze settle on the blue monogrammed name of the doctor stitched across the top of the left breast pocket on his lab coat. When the doctor noticed her eyes fixed and her fingers clutching the edges of the blanket, he understood that sometimes it was easier for clients to recede into a mental cubbyhole in order to feel safe enough to share certain things. He remained silent.
“Kimberly died two years ago yesterday. It shouldn’t have played out the way it did. We were diagnosed only five months apart and . . .”
“Diagnosed. Both of you?” He laid his pen on the legal pad.
“Yes, both of us. Breast cancer.” Two silent tears moved down her face, one at a time. “She was Stage 4 with 17 lymph nodes involved. They removed the tumors, she had three, all of them over five centimeters. By the time she was recovering from surgery, I got diagnosed. And that same week . . .” Her voice strayed; her eyes remained frozen.
The doctor waited.
“That same week the big announcement swept across America. No it swept around the world . . . the cure for breast cancer had finally been found. We didn’t believe it at first. But eventually Kimberly and I couldn’t help ourselves, we were ecstatic. Kimberly’s oncologist was hopeful for her; he said the new treatment might help her, but said she wasn’t at the top of the treatment list. Something about she had a few more hoops to jump through than I did because she was a Stage 4, because of her history. Something like that. But he didn’t waste any time getting me started on the treatment.
“Dr. Bronwyn. We had the same oncologist. I was a Stage 2 and was cured within two months of my diagnosis, but Kimberly . . . it spread so fast. The cancer was in her ovaries and lungs before she had a chance to try the treatment. Before she had the chance to jump through their hoops.”
“What happened?” The doctor asked.
“It was almost a year after her funeral, that’s when it got crazy . . . the press, the newspapers calling, television and anchor people wanting interviews with me, wanting my comments on Kimberly’s historic death.” She stopped, her mind numb, her body aching again with the unbearable pain that she knew she had failed to make the doctor understand, the pain she had failed to end with her hollow ground blade.
“My sister suddenly famous. I mean, she was dead. How could they be like that, so . . . insensitive? They’d leave messages on my answering machine, Please Ms. Irma, we’d like a comment from you about your sister being honored as the last America woman to die of breast cancer?”
As he watched her, the doctor could see the struggle ripple across her face.
“That’s when the disastrous pain began for you.” The doctor offered in a comprehending tone, allowing nothing more than his perception as understanding.
“You said you wouldn’t comment,” Katelyn Irma reminded him, finally looking up from the blue monogrammed name on his lab coat and meeting his eye. She placed her bandaged arms on the table and leaned into them. “If you could feel the horror of this pain, if you could experience it for even five minutes, you would know how unbearable, how disastrous it truly is. It’s like being destroyed and feeling destroyed all at the same time and there’s nothing you can do to make it stop.”
Katelyn Irma sat back in her chair, “Any sane person with half a brain would rather die than live feeling this way.”
The doctor watched her mouth say the words; Katelyn Irma watched his face take in the words.
He picked up his pen one last time and wrote on his legal pad, Any sane person with half a brain would rather die than live feeling this way. Then he added quotations on both ends.