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An Open Letter to Doctor X


ISSUE:  Spring 2006

Dear Doctor X, if I may call you that:

Perhaps I should introduce myself. I am an attorney, currently employed by the Manhattan District Attorney’s Office. Relax, Doctor. Let me assure you. This is not that kind of letter. I mention my work only preemptively, anticipating what you might say: For just as it is your business to diagnose the physical and psychic pain of your patients, so my job requires me to be a bit of a student of human nature. To be good at what I do, I have had to learn to read the minds of criminals and innocent men, witnesses and jurors.

So, at times, my work requires me to leave my own skin and enter the skins of others. Yours, for example, Doctor. I should be able to take one look at a man like yourself and know what you are thinking and feeling, perhaps even begin to figure out why you do what you do. That is how we win cases, Doctor.

Which is why I am writing this. Sometimes we hit a wall. We cannot imagine what is going through someone else’s mind. Which is what happened with us, Doctor X—that is, you and me—just before noon this past Wednesday on the Fifth Avenue bus. And so I am writing this open letter in the hope that you will recognize yourself and come forward and give me a hint.

I notice that I have written: take one look at a man like yourself. Maybe that is my problem. I never saw your face. I only overheard you talking on your cell phone, from which I gathered that you are a highly respected family doctor with a subspeciality in adolescent eating disorders and that you have many friends who are also doctors, to one of whom you were speaking. I realize that men like myself—middle-class, married, reasonably healthy specimens with all the expectable anxieties but, believe me, nothing abnormal—are probably not what get you out of bed in the morning, raring to get to the office.

So excuse me if you feel that I am sounding like one of your patients: that is to say, confessing. Like most people, I’m a little scared of doctors. Especially shrinks. Maybe I am worried they will recognize some symptom, unsuspected by me, that means I am crazy, or fatally ill. So, when I’m around a doctor, say, at a dinner party, or even my own internist, Doctor Mike Mulvaney, an exemplary human being, I often find myself saying things that I might not normally say, preemptively confessing before they find out on their own.

So I confess. I’d been having a difficult morning, before you got on the bus.

I’d like to think it began in the museum. But it must have started earlier, as witnessed by the fact that I was in the museum, instead of at work. I’ve been calling in sick lately, taking mornings off. Playing hooky. Depression, you’re thinking, Doctor. But it was hardly as if I were shuffling around in my pajamas. I was doing interesting things. I’d spent the morning at a museum show of masterpieces of photojournalism.

The museum was nearly empty. I glided across the polished floor from one disaster to another. Hiroshima, the Spanish Civil War. Ethiopia. Sarajevo. I moved from image to image. The diamond mines, Iraq. The Sudan. I was distracted, wondering, How am I supposed to feel? I was glad that someone was doing something, that people were taking those pictures. Then I thought: that’s how bad things are, if those photos are cheering me up.

If I had seen you, Doctor, perhaps I could picture you leaning across your desk and telling me that’s how adults live: with disturbing thoughts, confusions, with an uncertain future. I can hear your voice, saying, “Bill, that defines an adult.” I know that, Doctor, trust me. A man in my profession understands that the world we have is not the world we would like.

But lately it has occurred to me that every human being, even the ones who seem to have no trouble putting one foot after another, many of these people are actually gyroscopes, Doctor, spinning on nothing, on air. And one little push, one breath, can knock them off course forever. I don’t mean gyroscope literally. You understand that, I hope. Does this sound crazy, Doctor? I don’t think so, really.

I’m not saying it was the museum’s fault. But something sent me into a tailspin. I felt as if I were watching myself on a security camera, stuck there, like a tethered ox, in the middle of the last gallery. I was actually standing in place, taking little steps forward, then back, like a very sick caribou I’d seen once when I’d made the mistake of looking behind a partition at the Central Park Zoo. Thank God there was no one there to see me and call one of your colleagues.

I recovered, eventually. I don’t know how much time passed. People use the expression snap out of it, and it actually felt like a snap that rubber-banded me onto the street, where I made it as far as a bench along the edge of the park.

I sat on the bench with my head in my hands awaiting another snap. I know it must try your patience, Doctor, to hear your patients talk about their symptoms in the unscientific, maddening language ordinary people use. All I can tell you, Doctor, is that every cell in my body felt soggy, as if my soul had been used as a paper towel to mop everything up. Mop what up, Bill? you must be asking. But if I knew that, Doctor X, clearly I wouldn’t have been there.

Possibly, you’re thinking, I’d had a series of small strokes. You might order the appropriate tests, whipping pages off your prescription pad, one for each procedure.

But wouldn’t a stroke have dulled me? It wasn’t like that, Doctor X. It was more like diving. An underwater descent and then the bob into the brilliant light. I was very clear by the time the Limited came, and I stood and got on the bus. The bus seemed like a great idea. Instead of taking the subway, I would take the bus down to Forty-Second Street and get off and have a delicious steamy roast pork wonton noodle soup at the noodle shop off Madison, and then take the train the rest of the way to the office. By then I’d be feeling fine.

I dipped my Metrocard the right way, on the first try, and found my favorite spot, a single seat, halfway back. Better yet, on the park side. It was a sunny day in late April, the yellow-green grass glowed beneath the pastel flowering trees, an Impressionist painting or a landscape from a picture book I used to read my daughter. Perhaps you know it, Doctor. It’s a story about a little-girl pig who outfoxes a wolf.

I concentrated on the landscape, ignoring the passengers who filed past me. That was when you must have gotten on. Or perhaps you were already seated in back when I got on the bus, and I didn’t notice you until I heard your voice. By then, we were still on upper Fifth Avenue, sailing down the channel between the luxury buildings, the museums, the limestone mansions, the park.

Even then, when the whole bus could hear, it took me a while to focus. I’ve lived in Manhattan all of my life, during which time I have learned to screen out anything short of a taxi speeding in my direction. As loud as your conversation was, there was nothing in it for me, since, as far as I could tell, it concerned some fine points of medical billing seen from the physician’s point of view. Complaints about the insurance companies, the hoops they made you jump. Matters of that sort. Many people on the bus could have told the same story, at least from the patient’s side, and we were the lucky ones, the insured, though perhaps not as lucky as you. So we listened with part of our brains, just enough to find out which side you were on: the patient’s or Big Money’s. And Doctor X, you sounded fine. Your heart was in the right place, though that may be another expression that you find annoying. In any case, the whole bus was on your side. We were right there with you. Though maybe I am imagining this, maybe no one else was listening. But how could they not have heard you? Your voice carried through the quarter-full bus: the perfect audience size.

I think it was the word menses that finally caught my attention.

You said, “With the girls, it’s easier. Three menses, and you’re in. Bingo. Check the box. Let the bastards go through your charts.”

Doctor X, I hope you’re not thinking that I have taken the long way round to one of those anti–cell phone rants. The rudeness, the banality! Oh, the quiet cars on Amtrak! Everyone on the bus probably had his own cell phone story. One evening, at a Japanese restaurant, Doctor, my wife and daughter and I sat beside a young couple, obviously on their first date. When the girl went to the bathroom, the boy called whoever had set them up and said, “I’d rate her six, maybe seven, on a scale of ten.” I found it especially painful to have him say this within earshot of our daughter. A young attorney I work with claims to have heard a mafioso ordering a hit, loudly, from the next table in a restaurant. 
I know my colleague exaggerates, but the reason I think it could be true is how often the rest of the world disappears for the cell phone user.

Doctor, you were one of those. There is no way not to say it. If any one of us had been real to you, could you have announced, so loud, over the noise of the traffic and the occasional siren: “With the boys it’s trickier. The kid was five-eight, Jerry. He weighed a hundred and ten. This was serious borderline shit. And he had a girls’ disease! Jerry, you can’t imagine what a tightrope I was walking. But I handled it, I handled it. I don’t mean to boast, but Jerry, dude… .”

The fact that you called your colleague dude was not lost on us, Doctor. But we couldn’t linger on that, because of the speed with which you went on to tell Doctor Jerry, or dude, about the consummate sensitivity and expertise with which you had faced this professional challenge.

You said, “Two minutes, I knew I had to break up their little trio and talk to the kid separately from the parents. Together they were strangling, no one knew how to begin, except that there was this skinny kid, slumped, not looking at any of us. Alienated affect, Jerry, does not begin to describe it. It was clear I had to isolate them, I had to start with the kid.”

It’s a funny thing, Doctor, that I have often observed. You might think that overhearing the inappropriate cell phone conversation would cause the overhearers to roll their eyes, exchange glances, looks, whatever. But you know, that rarely happens, perhaps because each listener is trying so hard not to be there. We were models of politeness. A perfectly orderly, well-behaved bus. We didn’t turn to look, or glare at you, we didn’t look at each other, so I have no way of knowing how many of my fellow passengers were leaning forward, as I was, to hear what happened when you got the skinny kid alone.

“I got nowhere with him, either. I couldn’t get him to make even minimal eye contact. We could have been in different rooms! The only thing he said was that his parents had no sense of humor. Which was true, so we could have bonded on that, it could have made me like him. Another kid, I would have laughed. It would have been a risk I’d have taken. But I’ll tell you something, Jerry. It’s not supposed to happen, but you and I know, it happens, sometimes you meet a kid, and who knows what it is, something chemical, something physical, who knows what, maybe he reminds you of some kid you knew at school, but you want to haul off and smack the little creep, you can see why the parents have a problem. It doesn’t happen often, thank God, but there it was. It wasn’t the kid’s fault, it was me, but it was better for both of us if I admitted it to myself. Everything got a lot harder. I just wanted to be out of there. I asked the kid if he would mind if I talked to his parents without him.”

If everyone on the bus had a different cell phone horror story, perhaps they all would have featured that moment when the listener cannot believe what he is hearing. That was it for us, Doctor, or anyway for me. Maybe everyone else had music streaming into their earplugs. My daughter is never without her iPod from the minute she gets up to the time she goes to bed. My wife says it is her fault, because when Nina was a baby, she’d put one of those early baby monitors in her cradle. My wife says Nina fixed on that like a baby duckling. I think, but don’t say, that whatever problems Nina has have more to do with my wife’s worry, the reason for the monitor, than with the little plastic box transmitting the baby’s even breaths.

So Doctor, let me speak for myself. I was amazed that you would say this so loudly to an audience, and a captive one, at that. Weren’t you worried that one of us—me, for example, Doctor—might sensibly wonder how much you had charged this family whose little creep you would have hauled off and smacked, if not for your professional training? It was hardly the sort of remark guaranteed to revive our declining confidence in the medical profession. Did you know that we were there? But that is the question underneath every cell phone horror story.

So let me add another element to the question I am asking. To sum up: You were having a conversation about a troubled teenager. And my daughter, Nina, has had some problems. Not an eating disorder, as it happens. But to employ the shorthand you would probably use, she has been, at times, “a cutter.” It disturbs me to use the word. Just saying it seems complicitous in some trendy diagnosis shorthand for the oily slick that surfaced out of nowhere into our golden family life.

What had we not noticed? The long sleeves? There was that. But it was a point of pride with us to let Nina wear what she wanted, dye her hair in spikes. They grew out. Mostly she looked like any scruffy jeans-wearing New York kid who did reasonably well in school and who had friends whose parents we knew. We were relaxed, Nina liked us, she felt she could talk to us, we mostly let her be.

That was why, we flattered ourselves, Nina never got pierced or tattooed, so when the long sleeves started, it did cross my mind that maybe she had a tattoo and was hiding it. On that morning, when my wife found the blood all over the bathroom, I had been trying to come up with some joke that would make it clear to Nina that her mother and father were cool, we would forgive that little rosebud or dragonfly on her arm. What I wouldn’t have given, Doctor, for it to have been a tattoo.

After something like that happens, you see things differently. Or perhaps you realize how little you see. Which is why it may make no difference, Doctor, that I never actually saw you as you asked, “How many years have we been in practice? Right.” I assume that you and Jerry went to medical school together. How attentive we were, how attuned to the mystery of you, which is why I am writing this letter. In that way, Doctor, the bus trip was like a love affair, and you were the beloved, or perhaps it was like a prayer meeting, with you as the distant God whose nature we speculated about. But you never thought about us as you said:

“Over fifteen years and I’ll never get used to the kinds of things people think are normal. The kid had totally fetishized food. He went on these crazy diets. Nothing but radishes and butter for two weeks, then hazelnuts and papaya. The hazelnuts had to be unshelled. Wait. It got worse. He did these … science experiments. Grew mold on stuff and ate it. Natural penicillin, he said. He ate it and threw up. And that was the stuff they knew about. I got this all from the mother. The father didn’t say a word. From time to time, he snorted. Every time he snorted the mother cried. Of course they despised each other. 
Of course she was in love with the kid. The father hated her for it. The usual family romance, Jerry. You’ve seen it a million times.”

Some months ago, Doctor, I argued a case against a public defender who claimed that my office’s accusations were not based on facts, as indeed they were, but on a series of coincidences. Coincidence, I’d repeated, as if it were another name for Santa Claus or the Tooth Fairy. But I myself have often noticed how often coincidence plays a role in our daily interactions, rolling the dice in ways we could not have predicted. For a while I kept a notebook just to see for myself if such things happen as often as I thought, and they did.

So maybe I am coincidence-prone. Or maybe it was simple statistics. Maybe half the people on that bus had children with serious emotional problems. Maybe that is modern life, and no one will say it, no more than I would come up to you or anyone else on the bus and say that my daughter is now a freshman at college and seems to be doing well. She has a therapist she likes and trusts. Doctor Janet Finch. Perhaps you know her, Doctor. She’s very much like her name.

But even with Doctor Finch’s help, my wife and I will never in our lives enjoy another moment when we aren’t holding our breaths. Which maybe was the point of it all. If you aren’t holding your breath, you should be. Certainly, in my daily work, I meet a lot of people who were never expecting to have something terrible happen. Who weren’t watching out. Who were not waiting, as they say, for the other shoe to drop. Perhaps you too have wondered about that expression, Doctor. Isn’t the logic inexorable? The other shoe will drop. How common is it for people to go to bed wearing one shoe?

Doctor, that hardly gives me hope, which merely compounds the gloomy residue layered on us by the hours that my wife and daughter and I spent in the offices of Gloomy Gus professionals not unlike yourself. How distractedly all the doctors said, “There’s always a chance.” They meant to reassure us by invoking the very slim chance that things would turn out to be all right.

Forgive me, Doctor, for second-guessing you. How you must hate when that happens. The layman, with a few fuzzy ideas he’s picked up from tv, presuming to understand how the medical mind works. Even so, Doctor, I guess you’re thinking you understand the reason why I am writing this letter. You think it’s about my daughter, that I associate you with her problems, or with the doctors who failed to help us. But you, as a Doctor, should know—just as I do, in my profession—that there is never just one thing, one reason, one motive.

Of course, it was just at this moment that the midtown traffic slowed and stopped and sealed us in that belching tin can ringing with your voice. Like my fellow passengers, though I can only assume this, I staved off panic by telling myself it couldn’t last. Sooner or later, the traffic would move. Your conversation would end. Perhaps I was the only one who wondered about your battery life, your calling plan. Dr. Janet Finch advised us to make certain boundaries clear. Our daughter can’t be on our cell phone plan, though we pay her bill, and sharing a plan would save money.

And of course we passengers were right. Traffic started moving again. But if it had ended there, if you had gotten off the bus in midtown, or if I had stepped down and stopped for that wonton noodle soup, I would have missed the end of the story. I would have left the bus with a very different impression of you than the one I eventually took away, and I would have no reason to be writing you this letter.

I must have had some instinct, Doctor. For some reason I stayed on the bus. You said, “Normally, I’d just hand them a referral. Not even charge for the consultation.” You laughed, Doctor. Presumably Jerry had made some joke about money. “But what made the difference, and I’m not kidding you about this, Jerry, was that weekend retreat I spent in Sedona with the Tibetan lama. I know you guys got a good laugh about it, but the guy was something. And 
I think it changed me, Jerry. It’s affected my practice. You want to know an example? I’ll give you an example.”

I was listening hard, Doctor, and trying not to be distracted by yet another coincidence, which is that my wife spends occasional weekends at a Zen Buddhist monastery up near Woodstock. We don’t talk much about it. I don’t ask, she doesn’t volunteer. She goes with a friend of hers, another teacher at her school. One night, we went out for dinner with the friend and the friend’s husband, and the husband kept mentioning the Zen stuff and rolling his eyes, much the way I imagined my fellow passengers rolling their eyes about your conversation, Doctor. But I couldn’t participate in the eye-rolling, if you know what I mean. Because the truth is that on the Sunday nights when my wife comes home from the monastery, I feel a special tenderness for her, even more than normal, and it seems to me that she is more placid, or in any case less afraid.

“Okay,” you said. “Here’s an example, Jerry. The lama said, ‘Always look harder. There is something you are missing.’ So I called the kid back in, and the three of us, I mean the four of us, we just sat there and looked. I mean, I looked. I kept looking. The kid was looking at the carpet. And then I saw it. The flecks of color, of paint, on the kid’s hand.

“‘You like art?’ I said. He nodded.

“‘How do you know?’ he said.

“‘I can read minds,’ I said. And you know, I think he believed me. People have that thing about doctors. The poor little fucker thought I was a magician. So I decided to run with it. I said, ‘I want you to paint for me. I want you to paint food. But the only way you get to paint it is to eat it afterward. Then you bring me the paintings. I buy them. They’d better be cheap.’

“‘How do you know I can paint?’ said the kid.

“‘I can see it,’ I said. ‘Trust me.’”

And now, Doctor, more than ever before, I positively longed to look around to actually see how many fellow listeners I had, and of those how many were as surprised as I was, to hear your story take this turn toward Buddhism and art.

“So here’s why I’m calling you, Jerry,” you said. “This morning the kid’s mother phones. And she says the kid has gained a few pounds, and he’s got this painting for me. A picture of a steak. A fucking steak, Jerry, can you believe that? He ate the steak. Right, right. I know it’s too good to be true, I don’t believe in quick fixes, either. You think I’m confusing a painting of some meat with a cure? But you can’t help admitting it’s interesting. The kid’s stopped losing weight. He’s bringing the painting in next week. You need any art for your office? Okay, here’s my stop. I’ll call you later. Gotta run.”

And that was it, Doctor. The bus stopped, I assume you left. I didn’t turn to see you go. Some delicacy prevented me from looking, I don’t know. But instantly, I wished I had looked, and I scanned the street for some sign of you. But you had already disappeared beneath the scaffolding at the base of the Empire State Building, and into the crowds swarming west on Thirty-fourth Street. I regretted not having seen your face, as if that might have provided some clue to the mystery of why you did what you did. Why you betrayed a professional confidence, why you told a bus full of strangers about the intimate life of a troubled boy, and your feelings about him. Was it so we could admire you, Doctor, so we could praise you, along with Jerry, even after we had been held prisoner by your voice, by your story?

And how should we weigh all that against the fact that you may have saved the life of this boy, that you saw something in him, and helped him? If you saved him, it would be worth it, whatever discomfort we felt listening to a story that we should not have been hearing, together with the more particular pains suffered by me and any other of the passengers who happened to have something in common with the characters in the story you were telling.

Was it worth it, Doctor? And how would we have chosen if we’d had a choice between your saving the boy and our having to listen to it, or your having failed with the kid—and our being spared? Because it seems less likely that you would have been telling your friend and, by extension, the whole bus the story of how you’d fucked up. Life is full of choices, Doctor, and part of my job as a lawyer involves thinking those choices through. And forming some opinion about innocence or guilt. I realize that we may have strayed here into some philosophical region, somewhere in the vicinity of that tired old question about saving the Rembrandt or the old woman. But what am I in that equation, the Rembrandt or the old woman? And what about the poor kid eating radishes and painting pictures of steaks, and eating?

Ever since that morning, I have been weighing it in my mind. And I find that the scale keeps tipping, first one way, then the other. Which is why I am writing this letter to you, as one professional to another, in the hope that you will come forward and tell me what you were doing that morning, and that a word of explanation from you will tip the balance this way or that, and let me put this matter to rest, and go back to my normal life.

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