Thursday, January 26, 2012

Patient O

Here's a short story I wrote several years ago (2004) - I re-read it recently, and it still resonates. Thought I'd get it out there.


“Doctor Reinhardt, I really think I have a problem.”
The doctor pulled out his chair, looking calmly at the patient he’d always thought of as Patient O, who was twittering on the modern and slightly awkward sofa.
“A problem you’d like to talk about?” the doctor asked antiseptically.
Patient O refrained from speaking, though words were obviously straining to be loosed – her lips jerked and contorted against each other like, yes, like mating snakes, thought the doctor. He didn’t bother wondering what words were causing such a stir in his patient; he knew he’d hear them eventually. It was only a matter of time and careful prying.
“Would you like me to unplug the phone?” he asked gently, slipping into his Patient O spiel. He had a spiel for every one of his cases. The doctor prided himself on his many faces, and on his ability to use each one as the situation demanded.
Patient O nodded.
The doctor did so, as he had done many times before for Patient O, though not before phoning his receptionist to inform her that he was not to be disturbed until further notice. He knew what the receptionist thought he was doing, isolated with Patient O, but he had it on his calendar to explain the situation to her once Patient O was no longer a patient.
Once the phone line was impotent on the carpet, the doctor seated himself in the chair he had pulled out earlier and gazed with what he was certain was an open, non-judgmental expression at Patient O. “Would you like to talk now?” He was a picture of honest intentions and attentiveness, legs crossed casually but with a hint of tension, not really able to relax until he had learned what was bothering his patient.
Fingers drumming a fast tattoo on the sides of her thighs, Patient O looked at the doctor, her chin down, her eyes wide. “Yeah.”
Doctor Reinhardt waited patiently, nodded just slightly, sniffing someone’s coffee, the scent of it leaking under the door with the light. He allowed his mind to wander briefly, and wondered if he should buy more coffee before he made his way home tonight.
“I’ve been thinking,” said Patient O.
The doctor segued into active listening mode, his face falling into empathetic quietude.
“Actually I haven’t,” Patient O corrected herself.
“Haven’t been… thinking?”
“No. The thoughts just come. I don’t think them, they’re just there, without having been thought.”
“What kind of thoughts?”
Patient O flashed a nervous grin which disappeared like mist in the sun. “Fantasies.”
Inside, the doctor chortled. Outwardly, he said, “You’re willing to share them?”
After a pause, Patient O pressed her hands together and said “Yeah. I’m pretty sure they might be a problem.”
The doctor nodded a complicated nod, which consisted of a strong backwards movement of the top of the head, accompanied by a slight forward thrust of the chin, and followed by a gentle bouncing of the entire skull. The meaning of the nod – the doctor had worked on this for a considerable time in the mirror – was: feel free to continue, you will not be judged, you will be respected no matter what you say. It really was a brilliant nod, and skillfully executed.
Patient O took a deep breath, as she had been taught to do, and inched a little closer to the edge of the sofa cushion. “Well,” she began with a sigh, the way everyone begins a story, “when it starts I’m in an office, a little like this, and the doctor is there.”
Active Listening Mode On.
“We’re discussing something, I never know what, but it doesn’t matter, I think. So here I am talking, and there the doctor is, listening, only he’s not listening, he’s just switched on this feature he has, with his Listening Face and his comments like ‘Please go on’ and ‘Mmm.’ In his head he’s laughing at just about everything I say.”
The doctor blinks, once, with care, and begins to listen, but not too closely. Occasionally a patient will come up with this, and it never pays to panic.
“So I sit there talking and all the while I’m feeling something build up inside.”
Indigestion? wondered the doctor.
“It builds and it builds and it causes me pain in my heart. I have no idea what it is, I’m thinking, is it frustration? Is it rage? Loathing? It could be any of those things. It could be all of them. At first I think it matters, but then I realize it doesn’t – it doesn’t make one bit of difference what that pain is. What matters is that I know why it is.”
Her face is so blank, the doctor observed. This isn’t her usual emotional outpouring.
Patient O slid a tiny bit closer to the edge of her seat. The movement was sudden and it caused the doctor’s eyes to jump up and down from Patient O’s face to the sofa and back again. Damn.
Patient O continues, her voice never rising above conversational level, her open face revealing nothing more than an earnest desire to share a problem. “Yeah, I know exactly why. Because, you see, I have some problems, maybe more than other people, but when you look at me, I’m not so bad. There are people out there who are much crazier than me.” Patient O smiled again, briefly. “This is all in the fantasy, you understand. … When I’m sitting there in the office talking to the doctor, I can feel my problems inside me. They live there. But I can also feel my sanity and my… normalcy. It lives there too. So I’m talking and at the same time I’m realizing… I’m whole… and I’m pretty damn well off, considering. There is nothing inherently wrong with me. Only there is, because the doctor has told me so.”
The doctor refused to allow himself a nervous shift of the legs, focusing instead on his expression: he was trying for attentive and calm yet concerned, which was one he hadn’t really perfected.
He found his eyes repeatedly drawn to Patient O’s hands, lying folded in her lap, the nervous drumming gone. The fingers were shortish and slender, with small knuckles; the nails were moderately well kept, and were painted bright red, the red of forties movie stars and the fire trucks young boys see in dreams. The hands themselves were deadly still.
“I’m off because I was told I was off. I feel off because I was told I should feel off, because the things that go on in my head are not the things that go on in normal heads” Patient O looked down at her lap suddenly, her eyebrows knitting.
“I can’t tell you how much that hurts me,” she said softly. “That’s where the pain comes from. That, and seeing the doctor who is listening to me for what he really is.”
Patient O looked up, sadness in her eyes.
“He’s a monster.”
The doctor stared, his expressions running on automatic.
“He feeds off of us, those of us who are crazy but not so crazy that we piss in the corners or can’t pay or be controlled by words and ideas, not so crazy that we won’t take the pills he feeds us by the shovelful. Here is the man who listens, but doesn’t feel. He’s doing nothing but eating my words and spitting out garbage. He pollutes me. To him, people like me are nothing more than… things. We are nothing more than numbers and diagnoses to him. And this causes me pain.”
The room was not quiet – it was rimmed with ambient noise from the hallway, voices, footsteps, shuffling clattering – but to the doctor it suddenly seemed as though the rest of the world was a thousand miles away. He was on a deserted island with Patient O and her red-nailed hands, sitting so still in her lap; but he put a stop to his imaginings, reminding himself of his need to maintain control of the situation. A doctor is nothing if he is not in control.
Patient O took another deep breath. “But I know what to do.”
And she stood up. Moving towards the doctor, she said with a dreamy confidence, “In my fantasy, I know what to do.”
The doctor’s legs uncrossed themselves in a hurry and he said loudly, “Please sit down!” This will not do, his brain said. Do not lose control! But his arms twanged with tension from his hands gripping the arms of his chair.
Patient O did not sit down. He screamed her name. “Sit down!” he barked, pleased with the force and authority in his tone.
“I know what to do,” Patient O said again, and leapt.
Sprawled across his desk, just as his fingers closed on the receiver, and just as hers closed around his neck, the doctor remembered he had unplugged the phone.
It was no use to scream. She’d found his trachea almost immediately, her short fingers like steel bands. His limbs flailed uselessly in the air, against the pressed wood of the desk; he felt his bladder evacuate, hot urine streaming down the inside of his thigh.  
“… And in my fantasy, the doctor can’t make a noise, he can only listen to the sounds he makes as he dies, and to the blood pumping in his ears. I wonder if he knows it’ll take minutes – minutes – for him to die, and that no one will come running because they all think he’s fucking me. And I wonder if he knows these are the last words he’ll ever have to listen to, and if he’s laughing anymore.”

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