The Schopenhauer Cure
A Novel
Irvin D. Yalom
To my community of older buddies who grace me with their friendship, share life's inexorable diminishments and losses, and continue to sustain me with their wisdom and dedication to the life of the mind: Robert Berger, Murray Bilmes, Martel Bryant, Dagfinn Follesdahl, Joseph Frank, Van Harvey, Julius Kaplan, Herbert Kotz, Morton Lieberman, Walter Sokel, Saul Spiro, and Larry Zaroff.
Contents
1Julius knew the life-and-death homilies as well as...
2"Hello, is this Philip Slate?"
3Union Street was sunny and festive. The clatter of silverware...
41787--The Genius: Stormy Beginning and False Start
5Leaving Philip's office, Julius felt stunned. He gripped the banister...
6Mom and Pop Schopenhauer--Zu Hause
7At five minutes to seven Julius knocked out the ashes...
8Halcyon Days of Early Childhood
9Julius's spacious Pacific Heights home was far grander than any...
10The Happiest Years of Arthur's life
11Philip's First Meeting
121799--Arthur Learns about Choice and Other Worldly Horrors
13Jerking his head to dislodge the annoying couplet from his...
141807--How Arthur Schopenhauer Almost Became a Merchant
15Pam in India
16Schopenhauer's Main Woman
17At the start of the next meeting all eyes were...
18Pam in India (2)
19Bonnie opened the next meeting with an apology. "Sorry to...
20Foreshadowings of Pessimism
21At the onset of the following meeting, just as Bonnie...
22Women, Passion, Sex
23Bonnie's concern about the group proved unfounded: at the next...
24Philip walked for hours after the meeting, past the Palace...
25Porcupines, Genius, and the Misanthropist's Guide to Human Relationships 26At the next meeting Gill plunked himself down, his huge...
27After the session the group gathered for about forty-fiveeir...
28Pessimism as a Way of Life
29"I'd like to continue where we left off," said Julius,...
30When the group left, Julius watched them walk down his...
31How Arthur Lived
32Julius entered the group room the following week to an...
33Suffering, Rage, Perseverance
34As time raced by, Julius looked forward with increasing anticipation...
35Self-Therapy
36Pam opened the next meeting. "I've got something to announce...
37Leaving the group room did not clear the muck from...
38In the following meeting Philip shared neither his frightening experiences...
39Fame, at Last
40Members filed in for the penultimate meeting with contrasting feelings:...
41Death Comes to Arthur Schopenhauer
42Three Years Later
NOTES
ACKNOWLEDGMENTS
ABOUT THE AUTHOR
ALSO BY IRVIN D. YALOM
CREDITS
COPYRIGHT
ABOUT THE PUBLISHER
1
_________________________
Every breath we draw wards off
the
death
that
constantly
impinges on us.... Ultimately
death must triumph, for by
birth it has already become
our lot and it plays with its
prey only for a short while
before
swallowing
it
up.
However, we continue our life
with great interest and much
solicitude
as
long
as
possible, just as we blow out
a soap-bubble as long and as
large as possible, although
with
the
perfect
certainty
that it will burst.
_________________________
Julius knew the life-and-death homilies as well as anyone. He agreed with the Stoics, who said, "As soon as we are born we begin to die," and with Epicurus, who reasoned, "Where I am, death is not and where death is, I am not. Hence why fear death?" As a physician and a psychiatrist, he had murmured these very consolations into the ears of the dying.
Though he believed these somber reflections to be useful to his patients, he never considered that they might have anything to do with him. That is, until a terrible moment four weeks earlier which forever changed his life.
The moment occurred during his annual routine physical examination. His internist, Herb Katz--an old friend and medical school classmate--had just completed his examination and, as always, told Julius to dress and come to his office for a debriefing.
Herb sat at his desk, rifling through Julius's chart. "On the whole, you look pretty good for an ugly sixty-five-year-old man. Prostate is getting a little swollen, but so is mine. Blood chemistries, cholesterol, and lipid levels are well-behaved--the meds and your diet are doing their job. Here's the prescription for your Lipitor, which, along with your jogging, has lowered your cholesterol enough. So you can give yourself a break: eat an egg once in a while. I eat two for breakfast every Sunday. And here's the prescription for your synthyroid. I'm raising the dose a bit. Your thyroid gland is slowly closing down--the good thyroid cells are dying and being replaced by fibrotic material. Perfectly benign condition, as you know. Happens to us all; I'm on thyroid meds myself.
"Yes, Julius, no part of us escapes the destiny of aging. Along with your thyroid, your knee cartilage is wearing out, your hair follicles are dying, and your upper lumbar disks are not what they used to be. What's more, your skin integrity is obviously deteriorating: your epithelial cells are just plain wearing out--look at all those senile keratoses on your cheeks, those brown flat lesions." He held up a small mirror for Julius to inspect himself. "Must be a dozen more on you since I last saw you. How much time you spending in the sun? Are you wearing a broad-brimmed hat like I suggested? I want you to see a dermatologist about them. Bob King's good. He's just in the next building.
Here's his number. Know him?"
Julius nodded.
"He can burn off the unseemly ones with a drop of liquid nitrogen. I had him remove several of mine last month. No big deal--takes five, ten, minutes. A lot of internists are doing it themselves now. Also there's one I want him to look at on your back: you can't see it; it's just under the lateral part of your right scapula. It looks different from the others--pigmented unevenly and the borders aren't sharp. Probably nothing, but let's have him check it. Okay, buddy?"
"Probably nothing, but let's have him check it." Julius heard the strain and forced casualness in Herb's voice. But, let there be no mistake, the phrase "pigmented differently and borders aren't sharp," spoken by one doc to another, was a cause for alarm. It was code for potential melanoma, and now, in retrospect, Julius identified that phrase, that singular moment, as the point when carefree life ended and death, his heretofore invisible enemy, materialized in all its awful reality. Death had come to stay, it never again left his side, and all the horrors that followed were predictable postscripts.
Bob King had been a patient of Julius's years ago, as had a significant number of San Francisco physicians. Julius had reigned over the psychiatric community for thirty years. In his position as professor of psychiatry at the University of California he had trained scores of students and, five years before, had been president of the American Psychiatric Association.
His reputation? The no-bullshit doctor
's doctor. A therapist of last resort, a canny wizard willing to do anything he had to do to help his patient. And that was the reason why, ten years earlier, Bob King had consulted Julius for treatment of his long-standing addiction to Vicodan (the physician-addict's drug of choice because it is so easily accessible). At that time King was in serious trouble. His Vicodan needs had dramatically increased: his marriage was in jeopardy, his practice was suffering, and he had to drug himself to sleep every night.
Bob tried to enter therapy, but all doors were closed for him. Every therapist he consulted insisted that he enter an impaired physician recovery program, a plan which Bob resisted because he was loath to compromise his privacy by attending therapy groups with other physician-addicts. The therapists wouldn't budge. If they treated a practicing addicted physician without using the official recovery program, they would place themselves at risk of punitive action by the medical board or of personal litigation (if, for example, the patient made an error of judgment in clinical work).
As a last resort before quitting his practice and taking a leave of absence to be treated anonymously in another city, he appealed to Julius, who accepted the risk and trusted Bob King to withdraw on his own from Vicodan. And, though therapy was difficult, as it always is with addicts, Julius treated Bob for the next three years without the help of a recovery program. And it was one of those secrets that every psychiatrist had--a therapeutic success that could in no way be discussed or published.
Julius sat in his car after leaving his internist's office. His heart pounded so hard the car seemed to shake. Taking a deep breath to quell his mounting terror, then another and another, he opened his cell phone and, with trembling hands, called Bob King for an urgent appointment.
"I don't like it," said Bob the next morning, as he studied Julius's back with a large round magnifying glass. "Here, I want you to look at it; we can do it with two mirrors."
Bob stationed him by the wall mirror and held a large hand mirror next to the mole.
Julius glanced at the dermatologist through the mirror: blond, ruddy faced, thick spectacles resting on his long imposing nose--he remembered Bob telling him how the other kids taunted him with cries of "cucumber nose." He hadn't changed much in ten years. He looked harried, much as when he had been Julius's patient, huffing and puffing, arriving always a few minutes late. The Mad Hatter's refrain, "Late, late for a very important date," often had come to mind when Bob rushed into his office. He had gained weight but was as short as ever. He looked like a dermatologist. Whoever saw a tall dermatologist? Then Julius glanced at his eyes--oh oh, they seemed apprehensive--the pupils were large.
"Here's the critter." Julius looked through the mirror as Bob pointed with an eraser-tipped stylus. "This flat nevus below your right shoulder under your scapula. See it?"
Julius nodded.
Holding a small ruler to it, he continued, "It's a shade less than one centimeter. I'm sure you remember the ABCD rule of thumb from your med school dermatology--"
Julius interrupted, "I don't remember squat from medical school dermatology.
Treat me like a dummy."
"Okay. ABCD. A for asymmetry--look here." He moved the stylus to parts of the lesion. "It's not perfectly round like all these others on your back--see this one and this one." He pointed to two nearby small moles.
Julius tried to break his tension by taking a deep breath.
"B for borders--now, look here, I know it's hard to see." Bob pointed again to the subscapular lesion. "See in this upper area how sharp the border is, but all around here on the medial side it's indistinct, just fades into the surrounding skin. C for coloration. Here, on this side, see how it's light brown. If I magnify it, I see a tad of red, some black, maybe even some gray. D for diameter; as I say, perhaps seven-eighths of a centimeter.
That's good-sized, but we can't be sure how old it is, I mean how fast it's growing. Herb Katz says it wasn't there at last year's physical. Lastly, under magnification, there is no doubt that the center is ulcerated."
Putting down the mirror, he said, "Put your shirt back on, Julius." After his patient finished buttoning up, King sat down on the small stool in the examining room and began, "Now, Julius, you know the literature on this. The concerns are obvious."
"Look, Bob," replied Julius, "I know our previous relationship makes this hard for you, but please don't ask me to do your work. Don't assume I know anything about this.
Keep in mind that right now my state of mind is terror veering toward panic. I want you to take charge, to be entirely honest with me, and take care of me. Just as I did for you.
And, Bob, look at me! When you avoid my gaze like that, it scares the shit out of me."
"Right. Sorry." He looked him straight in the eyes. "You took damn good care of me. I'll do the same for you." He cleared his throat, "Okay, my strong clinical impression is that it's a melanoma."
Noting Julius's wince, he added, "Even so, the diagnosis itself tells you little.
Most--remember that-- most melanomas are easily treated, though some are bitches. We need to know some things from the pathologist: Is it melanoma for certain? If so, how deep is it? Has it spread? So, first step is biopsy and getting a specimen to the pathologist.
"Soon as we finish I'll call a general surgeon to excise the lesion. I'll be by his side throughout. Next, an examination of a frozen section by the pathologist, and if it's negative, then great: we're finished. If it's positive, if it is a melanoma, we'll remove the most suspicious node or, if necessary, do a multiple node resection. No hospitalization required--the whole procedure will be done in the surgery center. I'm pretty sure no skin graft will be needed, and, at most, you miss only a day of work. But you'll feel some discomfort at the surgical site for a few days. Nothing else to say now until we learn more from the biopsy. As you asked, I'll take care of you. Trust my judgment on this; I've been involved with hundreds of these cases. Okay? My nurse will call you later today with all the details about time and place and prep instruction. Okay?"
Julius nodded. They both rose.
"I'm sorry," Bob said, "I wish I could spare you all, this but I can't." He held out a folder of reading material. "I know you may not want this stuff, but I always distribute it to patients in your situation. Depends on the person: some are comforted by information, others would rather not know and just toss it on the way out of the office. Hope after the surgery to tell you something brighter."
But there was never to be anything brighter--the later news was darker yet. Three days after the biopsy procedure, they met again. "Do you want to read this? said Bob, holding out the final pathologist's report. Seeing Julius shake his head, Bob scanned the report again and began: "Okay let's go over it. I gotta tell you: it's not good. Bottom line is that it is a melanoma and it has several...uh...notable characteristics: it's deep, over four millimeters, ulcerated, and there are five positive nodes."
"Meaning? Come on, Bob, don't talk around this. 'Notable,' four millimeters, ulcerated, five nodes? Be straight. Talk to me as if I were a layman."
"Meaning bad news. It's a sizable melanoma, and it has spread to the nodes. The real danger here is more distant spread, but we won't know that till the CT scan which I've arranged for tomorrow at eight."
Two days later they continued their discussion. Bob reported that the CT scan was negative--no evidence of spread elsewhere in the body. That was the first good news.
"But even so, Julius, this adds up to a dangerous melanoma."
"How dangerous?" Julius's voice cracked. "What are we talking about? What kind of survival rate?"
"You know we can only address that question in terms of statistics. Everyone is different. But for an ulcerated melanoma, four millimeters deep, with five nodes, the statistical charts show a five-year survival of less than twenty-five percent."
Julius sat for several moments with head bowed, heart pounding, tears in his eyes, before asking, "Keep going. You're being straight. I need to know what to tell my patients.
What will my course be like? What's going to happen?"
"It's impossible to be precise because nothing more will happen to you until the melanoma recurs somewhere in the body. When it does, especially if it metastasizes, then the course might be quick, perhaps weeks or months. As for your patients, hard to say, but it would not be unreasonable to hope for at least a year of good health ahead of you."
Julius nodded slowly, head down.
"Where's your family, Julius? Shouldn't you have brought someone in with you?"
"I think you know about my wife's death ten years ago. My son is on the East Coast and my daughter in Santa Barbara. I've said nothing to them yet; I didn't see any sense in disrupting their lives unnecessarily. I generally do better licking my wounds in private anyway, but I'm pretty sure that my daughter will come up immediately."
"Julius, I'm so sorry to have to tell you all this. Let me end with a little good news.
There's a lot of energetic research going on now--perhaps a dozen very active labs in this country and abroad. For unknown reasons the incidence of melanoma has risen, almost doubled in the last ten years, and it's a hot research area. It's possible that breakthroughs are close at hand."
For the next week Julius lived in a daze. Evelyn, his daughter, a classics professor, canceled her classes and drove up immediately to spend several days with him. He spoke at length to her, his son, his sister and brother, and to intimate friends. He often woke in terror at 3A.M. , crying out, and gasping for air. He canceled his hours with his individual patients and with his therapy group for two weeks and spent hours pondering what and how to tell them.
The mirror told him he didn't look like a man who had reached the end of his life.
His three-mile daily jog had kept his body young and wiry, without an ounce of fat.
Around his eyes and mouth, a few wrinkles. Not many--his father had died with none at all. He had green eyes; Julius had always been proud of that. Strong and sincere eyes.
Eyes that could be trusted, eyes that could hold anyone's gaze. Young eyes, the eyes of the sixteen-year-old Julius. The dying man and the sixteen-year-old gazed at each other across the decades.