nomads.
I dismissed the patient and he returned to his ward. I had been so astonished by his utter denial of everything human that I forgot to call the orderlies to go with him.
After he had gone I returned to my adjacent office and went through his entire file again. I had never experienced a case like this, one for which I couldn't seem to find any kind of handle. Only one other in thirty years was even close, and it also involved an amnesiac. A student of mine was eventually able to trace the man's roots through an analysis of his reawakened interest in sports-but it took a couple of years.
I jotted down what I had on prot so far:
1. P hates his parents-had he been abused?
2. P hates his job, the government, perhaps society as a whole-had there been a legal problem resulting in a perceived injustice?
3. Did something happen 4-5 yrs ago that underlay all these apparent hatreds?
4. On top of everything else, the patient has a severe sex hangup.
As I looked over these notes I remembered something that my colleague Klaus Villers has professed on more than one occasion: Extraordinary cases require extraordinary measures. I was thinking of the rare instances in which a delusional of exceptional intelligence has been convinced that his identity was false. The most famous example of this treatment is the one in which a well-known comedian graciously consented to confront a delusional look-alike, and a miraculous cure was quickly effected (but not before they both put on quite a show, evidently). If I could prove to prot that he was, in fact, an ordinary human being and not some alien from another planet ...
I decided to do a more thorough physical and mental workup on him. I was particularly interested in learning whether he was, in fact, abnormally sensitive to light, as he claimed to be. I also wanted to have the results of an aptitude test and to determine the extent of his general knowledge, particularly in the areas of physics and astronomy. The more we knew about his background, the easier it would be to find out who he really was.
WHEN I was a senior in high school our career counselor advised me to take the one course in physics our school offered. I quickly' learned that I had no aptitude for the subject, though the experience did serve to increase my respect for anyone who could master that esoteric material, among them my wife-to-be.
We were next-door neighbors from the day she was born, Karen and I, and we played together all the time. Every morning I would go outside and find her in the yard, smiling and ready for anything. One of the fondest memories I have is of our first day in school, of sitting behind her where I could smell her hair, of walking home with her and leaves burning. Of course we weren't really sweethearts at that age-not until we were twelve, the year my father died.
It happened in the middle of the night. My mother came and got me up because she hoped, vainly as it turned out, that I might be able to do something. When I ran into their bedroom I found him lying on his back, naked, sweating, his pajamas on the floor beside the bed. He was still breathing, but his face was ashen. I had spent enough time in his office and on hospital rounds to suspect what had happened and to recognize the seriousness of the situation. If he had taught me something about closed-chest massage I might have been able to help him, but this was before CPR was generally known and there was nothing I could do except watch him gasp his last breath and expire. Of course I yelled at my mother to call an ambulance, but it was far too late by the time it got there. In the meantime I studied his body with horrible fascination, his graying hands and feet, his knobby knees, his large, dark genitalia. Mother came running back just as I was covering him with the sheet. There was no need to tell her. She knew. Oh, she knew.
Afterwards, I found myself in a state of profound shock and confusion. Not because I loved him, but because I didn't-had almost wished him dead, in fact, so I wouldn't have to become a doctor like him. Ironically, because of the tremendous sense of guilt I felt, I vowed to go into medicine anyway.
At the funeral, Karen, without anyone saying anything, sat beside me and held my hand. It was as though she understood perfectly what I was going through. I squeezed hers too, hard. It was unbelievably soft and warm. I didn't feel any less guilty, but with her hand in mine it seemed as though I might be able to get through life somehow. And I've been holding it ever since.
ON Friday of that week we received a visitor from the State Board of Health. His job is to check our facilities periodically, see that the patients are clean and properly fed, that the plumbing works, etc. Although he had been here many times before, we gave him the usual grand tour: the kitchen, the dining and laundry and furnace rooms, the shop, the grounds, the recreation/exercise room, the quiet room, the medical facilities and, finally, the wards.
It was in the rec room that we found prot sitting at a card table with two of my other patients. I thought that a bit odd inasmuch as one of them, whom I shall call Ernie, almost always keeps to himself, or talks quietly with Russell, our unofficial chaplain. The other, Howie, is usually too busy to talk to anyone (the white rabbit syndrome). Both Ernie and Howie have been here for years, sharing the same room, and both are very difficult cases.
Ernie, like, most people, is afraid of death. Unlike most of us, however, he is unable to think about anything else. He checks his pulse and temperature regularly. He insists on wearing a surgical mask and rubber gloves at all times. He is never without his stethoscope and thermometer and he showers several times a day, demanding fresh clothing after each one, rejecting anything that shows the slightest spot or stain. We humor him in this because otherwise he would wear nothing.
Eating is a serious problem for Ernie, for several . reasons. First, because of his fear of food poisoning he will not consume anything that isn't thoroughly cooked and comes to him piping hot. Second, he will only eat food that is broken or cut into tiny pieces so he won't choke to death on something too large to swallow. Finally, there is the problem of preservatives and additives. He will not eat meat or poultry, and is suspicious even of fresh fruits and vegetables.
None of this is unusual, of course, and every psychiatric hospital has an Ernie or two. What makes our Ernie different is that he raises his defenses a notch or two higher than most necrophobes. He cannot be induced to venture outside the building, for example, fearing bombardment by meteorites, cosmic rays and the like, poisoning by chemicals in the air, attack by insects and birds, infection by dustborne organisms, and so on.
But that's not all. Afraid he will unconsciously strangle himself at night he sleeps with his hands tied to his feet, and bites down on a wooden dowel so he won't swallow his tongue. For similar reasons he will not lie under sheets or blankets-he fears they might wrap themselves around his throat-and he sleeps on the floor so as not to fall out of bed and break his neck. As a sort of compensation, perhaps, he sleeps quite soundly once his ritual is complete, though he awakens early to fitfully- check his parameters and accouterments, and by the time he has breakfast is his usual nervous wreck.
How could a person get so screwed up? When Ernie was a boy of nine he watched his mother choke to death on a piece of meat. Unable to help, he was condemned to witness her last agonizing moments while his older sister ran around the kitchen, screaming. Before he could get over that horrible experience, his father dug a bomb shelter in the back yard and practiced using it. Here's how it worked: At any moment of the day or night Ernie's father would suddenly leap at him or emit a blood-curdling screech or douse him with something. That would be the signal to run for the bomb shelter. By the time he was eleven Ernie was unable to speak or to stop shaking. When he was brought to MPI it took months just to get him not to jump and run whenever a door opened or someone sneezed. That was nearly twenty years ago, and he has been here ever since. His father, incidentally, is a patient at another institution; his sister committed suicide in 1980.
Fortunately, debilitating phobias like Ernie's are rare. Those who are afraid of snakes, for example, need only stay away from forest and field. Agoraphobics and claustrophobics can usually avoid crowds and elevators and, in any case, are treatable with drugs or by slow acclimation to the offending situation. But how does one acclimate the necrophobic? How to avoid the Grim Reaper?
Howie is forty-three, though he looks to be sixty. Born into a poor Brooklyn family, his musical abilities became evident early on. His father gave him his unused violin when he was four years old and, in his early teens, he played that instrument with a number of well-respected regional orchestras. As time went on, however, he performed less and less frequently, preferring instead to study scores, other instruments, the history of music. His father, a bookseller, was not particularly concerned with this turn of events and went about his tiny shop bragging that Howie was going to become a famous conductor, another Stokowski. But by the time Howie got to college his interests seemed to cover the entire spectrum of human endeavor. He tried to master everything from algebra to Zen. He studied night and day until he finally broke down and ended up with us.
As soon as his physical health was restored, however, he was off and running again, and no tranquilizing drug
