“Michael.”
“Can I call you ‘Michael’?”
“ ‘Dr. Crichton’ would be better.”
She pouted. “Why? Why are you so formal?”
“We’re here to work together, Karen, and I think we should keep that relationship in mind.”
“What does that have to do with what I call you? ‘Dr. Crichton.’ Ugh. I hate ‘Dr. Crichton.’ ”
“I just think it’s better, is all.”
I found myself nervous, standing next to her this way. Her physical presence was very strong. It left me a little shaky. As part of the workup, I had to begin by drawing bloods for routine chemistries, so I took her into the little examining room. We were alone.
“Aren’t you going to close the door?”
“No.”
“Why not?”
“It’s fine the way it is.”
“Afraid to be alone with me?”
“What makes you say that?” I asked. I felt very clever and psychiatric, saying that. Giving her a question back.
“Do I have to take off my clothes?”
“That won’t be necessary.”
“Really? But don’t you have to examine me? My body and everything?”
“Just draw some blood.”
She ran her fingers across the examining couch. “Mind if I lie down on this bed?”
“Go ahead.”
Having finished my neurology rotation, I was more relaxed about drawing bloods. But right now my hands were shaking. She was sure to notice.
She lay back on the examining table and stretched like a cat. “You want me on my stomach or my back?”
“On your back is fine.”
“This couch is too short; I have to put my legs up.” Her miniskirt slid around her hips.
“Whatever’s comfortable,” I said.
“Is it going to hurt?” she asked, wide-eyed.
“No, not at all.”
“Why are you shaking, Dr. Crichton?”
“I’m not.”
“Yes, you are. Do I make you nervous?”
“No.”
“Not even a little?” She was smiling, laughing at me.
“You’re a beautiful girl, Karen; you’d make anybody nervous.”
She smiled with pleasure. “You think so?”
“Of course.”
She seemed reassured by this, and I felt calmer as well. It didn’t hurt anything, I thought, to tell her she was attractive.
I started drawing the bloods. She watched the needle, watched the tubes fill. She had a calm gaze, a steady way of looking at things.
“Are you single?”
“No, I’m married.”
“You tell your wife everything you do?”
“No.”
“Men never do,” she said, laughing. It was a sarcastic, knowing laugh.
“My wife is in graduate school,” I said. “I sometimes don’t see her for days at a time.”
“Are you going to tell her about me?”
“What goes on between you and me is confidential,” I said.
“So you won’t tell her?”
“No.”
“Good.” She licked her lips.
I lived in an apartment on Maple Avenue in Cambridge. I had known my wife since high school. She was studying child psychology at Brandeis. One block away, my wife’s college roommate lived with her husband; they were both graduate students at Harvard. A block beyond that lived another friend and her husband, with whom I used to play basketball in high school. The six of us, all stable, all married, all in school, all connected in the past, spent a lot of time together. The relationships went way back. It was a small, complete world.
My wife liked to cook. She was cooking while we talked. “Is this girl in school?”
“Yes. Junior at BU. Says she wants to be a lawyer.”
“Smart?”
“Seems to be.”
“And she’s your patient?”
“Yes.”
“What’s her problem?”
“She has trouble relating to men.”
“And what are you supposed to do?”
“Interview her. Find out what’s wrong. Write a paper at the end.”
“Long paper?”
“Five pages.”
“That’s not too bad,” my wife said.
The resident told me I could meet with my patient twice a week, or three times a week, if I felt that was necessary. I felt three times a week would be required. There was an interview room that you booked.
I asked Karen how she had come to be admitted to the hospital. She told me she had had a bad trip on LSD in her school dorm; the campus police had brought her in. “But I don’t know why they made me stay here. I mean, it was no big deal, just a bad trip.”
I made a mental note to check with the BU campus authorities, and then asked her about her background, before college.
Karen spoke freely. She had grown up in a small coastal town in Maine. Her father was a salesman; he fooled around with a lot of women; he had always ignored her. Her father didn’t like it when she took up with Ed, just because he was a Hell’s Angel. Her father was very angry when she became pregnant by Ed at fourteen. He made her have the baby. She gave the baby up for adoption. Her father never liked her other boyfriends, either. For example, he didn’t like Tod, the rich kid who made her pregnant when she was sixteen. He wanted her to have that baby, too, but instead she had a miscarriage. She laughed. “In Puerto Rico,” she said.
“You had an abortion?”
“Tod’s rich. And he didn’t want his father to find out.” She laughed. “You probably think I’m crazy.”
“Not at all.”
“You smoke so much when we’re together.”
“Do I?”
“Yes. You’re chain-smoking. Am I making you nervous?”
“Not that I’m aware.”
“That’s good. I don’t want to make you nervous. I appreciate your helping me.”
She wore miniskirts all the time. She liked to curl herself in chairs. She would wait for just the right moment, then curl her body and show me her pink underwear. I had to quickly look away, but when my eyes met hers again, I saw that she was laughing at me.
“So? Did you make her pregnant yet?”
“No,” I said to Dr. Geller.
“Tell me how it’s going.”
I told him what I knew so far. Her story sounded terrible. I interpreted it as a cry from a young girl for the attention of her father, a man who obviously wasn’t capable of giving her the love and care she required. Instead he was harsh and punitive. Two pregnancies, then dismissed, sent off to various foster homes … It was amazing, I felt, that Karen had done as well as she had—had gotten into college and so forth.
“Why are you so protective of her?”
“I’m not.”
“Dad’s a bastard and she’s a victim?”
“Well. Isn’t she?”
“How does Karen relate to you?”
“She seems very open.”
“Ask about her mother.”
Karen didn’t have much to say about her mother. Her mother was a retired schoolteacher, crippled in one leg from an automobile accident. Her mother was a weak person who let her father walk all over her, abuse her. And her mother didn’t stand up for Karen, even when she knew—
She fell silent and stared out the window.
“Knew what?” I said.
She shook her head, continued to stare out the window.
“Knew what?” I said.
She sighed. “About my father.”
“What about your father?”
“My father used to fool around with me.”
“How do you mean?”
“He used to, you know, fool around with me. He told me not to tell my mother.”
“You mean your father had intercourse with you?”
She smiled. “You’re so formal.”
We had been talking about her father for a week
. “Why didn’t you tell me this before?”
“I don’t know. I thought you would be mad at me.”
She curled in the chair again, in her kittenish way. This time beneath the miniskirt she wore no underwear at all.
“How does she relate to you?” Dr. Geller said.
“I would say, seductive.”
“How?”
“Well, she usually doesn’t wear underwear under her miniskirts. And one day she wanted to come to our session in her nightgown.”
“What did you do?”
“I made her go back to her room and change.”
“Why?”
“I thought it was better.”
“Why?”
“I’m trying to control her flirtatiousness.”
“Why?”
“Well, I still have a lot to find out about her.”
“What don’t you know?”
After the second pregnancy, her mother found out that Karen had been having sex with her father. Her father then decided that Karen must go to a foster home. Karen lasted only six weeks at the first one.
“Why?”
The guy had a problem. He couldn’t keep his hands off her.
“And then?”
Another foster home. This time the woman threw her out, because she saw what was developing between Karen and the husband.
“And then?”
A minister and his family. She lived with them for almost a year. He was a very strict man, a very pure man, and he told her that she should stop it, that he would never be tempted by her.
“And?”
“He lied.” She shrugged. “One day his wife came home early and caught us. But by then it was time for me to go to college anyway.”
She found college boring, she said. It was so stuffy. She got good grades even though she cut most of her classes. She liked to take trips, to go skiing, or to go to New York. Anywhere, just to get away. School was so boring.
“Did you talk to those people at school?” she said. “The administration people?”
“No, why?”
“Just wondered.”
“Should I?”
“I don’t care. They don’t know anything about me, anyway.”
* * *
I interviewed the mother, a bland, worn woman of fifty. She had swollen ankles, she kept crossing and uncrossing them. Helen was upset to learn that Karen was in the hospital for a mental problem. She had worried about Karen for a long time. Karen had been such a difficult child to bring up. Helen had hoped that once she was in college she would be all right, but obviously she wasn’t.
I asked about Karen’s pregnancies. Helen was vague. She couldn’t really remember much about them. I asked about trouble between Karen and her father. Helen said they had never gotten along. I asked about improprieties. Helen said, Like what? I asked about sexual activities of any kind.
“Did Karen tell you that?” Helen said. “She is such a little liar.”
“It isn’t true?”
“I don’t know how she could say that.”
“It isn’t true?”
“Of course it isn’t true. Dear God, what kind of people do you think we are?”
“Then why did you send her to foster homes?”
“Because she was still seeing those boys, that’s why. We had to get her away from those boys. So she told you that about Henry? And I’ll bet you believed her. Men always believe whatever she says.”
“Well, what did you expect my mother to say?” Karen said. “You think she’ll admit that?”
Then she said she wanted a pass to leave the hospital for the following weekend, to go back to school for Saturday and Sunday. There was a party she wanted to attend.
I said no.
“Why shouldn’t she get a pass?” Dr. Geller said.
“I just don’t think it’s a good idea.”
“What’s wrong? Think she’s dangerous? She’ll commit suicide?”
“No.”
“You think she’ll get laid?”
“Probably.”
“What’s wrong with that?”
“Nothing,” I said. “She can do whatever she wants. I don’t care.”
“So let her leave.”
“I’m just concerned about my responsibility.”
“Your responsibility is to make a diagnosis, not to run her life.”
“I’m not trying to run her life.”
“Good. Because you can’t, you know.”
“I know.”
I gave her a pass. All weekend I thought about her. Wondered where she was, wondered what she was doing. I spent some time at my apartment, but my thoughts were elsewhere. Karen’s life seemed dangerous; she lived on the edge, in a way that was unfamiliar to me. I had always been so safe, so cautious in my own life. Here was somebody who just did what she wanted to do, said whatever she felt like saying, acted the way she wanted to act.
I was beginning to have dreams about her. Her eyes. Her legs.
“I think I’m a little attracted to her, if you want to know the truth.”
“Really?” Dr. Geller said.
“Yeah. I’m a little preoccupied with her and so on.”
“Dreams?”
“Sometimes.”
“Sexual dreams?”
“Sometimes.”
“I imagine I would, too. She must be pretty damn attractive. And she’s bright, you say. You like her intelligence.”
“Yes, she’s bright.”
“Nice body, nice young girl, nice legs, and so on.”
“Yes.”
“So it’s natural to be attracted. The thing is, what are you going to do about it?”
“Nothing.”
“Perhaps you want to talk to her about your feelings?”
“Why would I do that? She’s the patient.”
“That’s true,” Dr. Geller said.
There was a long silence. He waited. I knew from past experience he could wait a long time.
“But what?” I said.
“But if she’s behaving seductively toward you, perhaps you could discuss her behavior and how it is making you feel. If you brought it to her awareness, she would have a chance to change it.”
“Maybe she wouldn’t.”
“How do you know?”
I felt suddenly confused. “I don’t think that’s a good idea. Discussing my feelings.”
“Merely a suggestion,” he said.
Karen was cheerful and evasive after her weekend off. She had seen some friends. She had gone to some parties. I felt irritable.
“Why?” she said. “Does it matter?”
“To what?”
“To your research paper about me, or whatever you’re doing.”
“Who said I’m doing a research paper?”
“Ellen told Margie that all the students are doing research papers.” Margie was the depressed woman who had been seduced by her doctor. “What are you going to write about me?” Karen said.
At home, I had dinner with my wife, our friends. The topic of divorce came up. Somebody Marvin knew was getting a divorce, another couple in graduate school. A little chill passed around the table, a flicker of the candles.
I started to think. What if I got divorced? I would be a working doctor. What women would I meet? I would meet my patients, mostly. I would be busy; I wouldn’t have much time for a social life outside my work. So the women I met would be my patients.
But even if I was divorced, I couldn’t go out with patients. I certainly couldn’t have sex with patients. So how would I handle it, exactly? How would I find women to go out with?
And, for that matter, how would I handle my practice, where women might come in whom I found exciting? What was I going to do? The priestly dedication to medicine was fine in the abstract. But when it came to actual limbs, sexy limbs, and beautiful bodies on the examining table, and breasts and necks and girls who didn’t wear underwear—
She probably has a disease, I consoled myself. But it was
n’t much consolation.
“Yes,” I told Dr. Geller. “I am having trouble with my feelings.”
“You want her, huh?”
“Sometimes.”
“Only sometimes?”
“Listen, I have this thing under control.”
“I’m not saying you don’t. What about your marriage?”
“My marriage isn’t always that great.”
“Nobody’s is. But sexually?”
“Not that great. Not all the time.”
“So you think about Karen?”
“Yeah.”
“Listen,” Dr. Geller said. “That’s fine. In fact, it’s normal.”
“It is?”
“Sure. Think about her all you want. Just don’t fuck her.”
“I’m not going to fuck her.”
“Great. Glad to hear it.”
I diligently assembled facts, dates, information of all sorts. I wrote a twenty-page report, four times as long as required. I presented it to the entire psychiatric staff. My basic picture was of a seriously abused child who had grown up without proper supports and encouragement but who was valiantly struggling to keep her head above water, and who was probably going to make it. Karen had intelligence and strength, and while her obstacles were formidable, I believed she would pull through in the end.
The staff complimented me on my fine and unusually detailed report. But they viewed Karen’s case much more seriously. This girl had a prior suicide attempt a year before, while at college. This attempt, unknown to me, had required dialysis at another Boston hospital for barbiturate overdose. Karen had severe problems of self-worth. She had taken a great many psychedelic drugs. She was possibly even borderline schizophrenic. Her intelligence was a hindrance to contacting her true feelings. Her manipulative exterior kept her from feeling her pain. Her prognosis was not good. The chances were better than fifty-fifty that she would commit suicide within the next five years.
I was shocked. I wanted to tell them that they were wrong, that their detachment and their statistics were wrong. I wanted to shake them from their complacency. We were talking about a human life here, a human life. If they really thought Karen was going to die, they should help her. They should prevent her senseless death.
As calmly as I could, I said something to that effect.
The chief of service puffed on his pipe. “The truth is, there’s not much we can do for her.” He paused. “You’ve seen how she is.”
I nodded.
“You’ve seen how she relates.”