Читать книгу An Eye For An Eye - Arthur Klepfisz - Страница 9

CHAPTER FOUR

Thursday, 22 August 1986

1.25 p.m.

In theory, Andrew’s appointment book allowed for him to take a lunchbreak of half an hour, but theory can evaporate in the face of reality. Frequently his break for lunch was gobbled up by going over time with some appointments or using the break to return phone calls that he felt shouldn't wait.

He had personally drawn up his own timetable and he wryly noted that there were occasions where an outside observer would have expected him to be in charge of his scheduling. However, to Andrew, it often felt as if the timetable controlled him, and for a long time it remained unaltered in spite of feeling that it wasn’t working out.

Today he decided to take charge and managed to secure his lunchbreak by taking himself down the street to buy his lunch, choosing some sandwiches together with a coffee. On most days he had brought the traditional paper bag lunch to work, and when possible, ate it at his desk as he wrote notes and made phone calls. He now realised that the only way he could secure a break during the day was to leave the building. He chuckled to himself how something that was bleeding obvious had felt like a revelation.

As he left the building and closed the door behind him, he became aware of a prickly discomfort, as if he was a truant wagging school, and realised guilt was at play, and uncertain why.

Just before he left his medical rooms, Andrew asked his secretary Rosemary whether he could get her anything down the street and told her he'd be back in time for the next patient. Rosemary had been with him for close to ten years now, and he felt she was a wonderful secretary, admired by both his patients and himself.

Years back, a work colleague had told him that the criteria for picking a perfect secretary was to find a middle-aged woman, possibly in her mid-forties, someone who had never married and wasn't in any current relationship – a “spinster”. God, Andrew hated that term – single men didn't have a label put on them.

‘You need to find a single woman who is generally unhappy in her personal life and would be married to the job,’ came the unsolicited advice from his colleague. At the time Andrew thought these comments were cynical and in poor taste, and he continued to feel that. Yet Rosemary in fact did fulfil those criteria, and Andrew reflected on how unfair life could be, as Rosemary showed so much warmth in her dealings with the patients, and yet, away from work, this warmth dissipated in the barren waste that was her personal life.

1.41 p.m.

Andrew seated himself at the back of the local coffee shop where he was able to observe the other people and not be disturbed. He had always enjoyed watching people and their interactions. The waitress brought the sandwich and blueberry muffin that he had ordered, as well as a strong coffee. He thanked her politely before opening a copy of the Sun Herald that he had picked up from the counter. It was not a paper he rated highly and felt it was a rag, but ease won out over content, as he found the page size a lot more comfortable to read.

Not like some of the other daily papers where turning a page might cost you a coffee, accidentally knocked over, or impair the vision of the person sitting next to you.

On page 4 of the paper, he noted an article by Penelope Dee, who was distinguished by the title of “Investigative Journalist”. This label provoked a knee-jerk cynicism in Andrew as he had the impression that a lot of contemporary journalists cannibalised material from other outlets, often rehashing it and then presenting it as the fruit of their own labour. He reflected to himself how journalism was no longer seen as a noble profession by many in the community.

Personally, he conceded that there were a number of admirable journalists still around, but like many, he had the tendency to lump them all together and to judge journalism by the lowest common denominator.

What commanded his attention now was Dee’s article describing how many young females, often university students, worked as strippers or prostitutes to raise the money required to pay for their keep and ongoing education. The article alleged that in some brothels up to 50 per cent of the prostitutes working there were students.

Andrew could accept the premise that some female students did use prostitution as a source of income, but he strongly doubted the high percentages given. And at what price? he wondered.

It worried him about the possible long-term harm to these young women, risking the distortion of how they viewed men and even how they viewed themselves. The strength of his opposition to such practice was unclear to him, as the article presented many of these young women making a free choice, yet it left him feeling uneasy. He had often reflected on the complex force that sex could be. It could form part of a loving relationship, or it could be used for control. It might be a way of obtaining reassurance about one's self-worth, or used manipulatively to climb the promotion ladder at work. It could be used as a means of escaping poverty, or to feed a drug addiction. In fact, the range of outfits that it could be cloaked in resembled a Dulux colour chart of reasons and emotions.

Given all the above scenarios, Andrew couldn’t help wondering whether one should really be judgemental about the use of sex in prostitution compared to all the other ways that sex was used. Still, none of this took away the discomfort he experienced about the idea of university students using sex as a means of paying for their studies, given that most were not escaping poverty nor caught up in drug addiction or sex slavery.

He noted with a sardonic smile that medicine was often shifting from full time employment to sessional work, something that the so-called “oldest profession” had been doing for a long time.

He glanced at his watch and was startled by the time, realising he had better rush back as his next patient was due at 2 p.m. and there were only two minutes to go. Once again he had been kidnapped by his meandering thoughts. He phoned his secretary to warn her he would be at least five minutes late, and asked her to let his next patient know.

Not for the first time, he reflected about the difference between his practice and that of some of his colleagues in other specialties, where multiple bookings for the same time were not unusual. This certainly maximised the time efficiency for the specialist without any apparent concern that patients might have to wait one to two hours to be seen. By contrast, some of his patients would complain if he was over five minutes late. He could understand how patients objected to having to wait one or two hours, as they felt it showed a lack of respect towards them.

2.16 p.m.

As Andrew sat listening to his first patient after lunch, a Mr R, he found himself struggling to maintain concentration, as a wave of drowsiness started to envelop him.

The strange part and one that he didn't fully understand was that there were three other patients in his practice who appeared to have the same effect on him. He would struggle to listen carefully to what they were saying, a feeling he owed that to all his patients. Lately he had given a lot of thought to possible reasons for this, and excluded the possibility of it being caused by a lack of sleep the night before or a heavy meal or other factors along those lines. If it wasn't a factor within himself, he wondered, then what was causing this effect?

It troubled him that he had to struggle to listen carefully to what these patients were saying. It wasn't that these few patients spoke in monotones or that he found their histories boring, so why was there this impenetrable screen forming, creating a barrier between the patient and himself. He had begun to suspect these patients were coasting, and comfortable in not working on their problems. He heard them comfortably describing the same problems each session, appearing untroubled by their lack of progress. Rather, they appeared to be comfortably slipping into a groove where they recited the same problems in the same manner each session, without any sign of being troubled by their lack of progress. There was undoubtedly a level of frustration that he experienced, and probably, like those patients, he was becoming detached from their real issues. He knew that if he was going to be of benefit to them in therapy, he would need to start sharing his observations about their lack of progress, and their inclination to see themselves as victims, whilst they appeared to be only paying lip service to working on personal change.

Andrew was aware that it was easy as a therapist to be seduced into keeping a patient comfortable and winning their approval by just coasting along, but he also knew that the sessions would become meaningless if he was to do that. On the other hand, confronting the patient could result in them terminating therapy and obviously one couldn't treat a patient who did not attend.

Still, this wasn't a valid reason for avoiding facing issues with the patient. He was determined to start confronting Mr R in a manner that hopefully would not drive him away, but would make the sessions more meaningful for him.

Mr R suffered from a moderately severe obsessive-compulsive condition with associated depression and anxiety, but he did not have the emotional fragility of say, a young schizophrenic patient, where confrontation would be inappropriate.

Mr R’s life and emotions were severely shackled by his psychiatric condition, where he could not cope with the intensity of his emotions or the uncertainty of what each new day might bring. He had developed a rigid and restrictive set of rituals to create the illusion that everything in his life was predictable.

Andrew realised that his thoughts were drifting and that he had stopped listening to his patient. It was close to the end of the session, but he had come to a decision that from the next session onwards, he would commence sharing his thoughts with Mr R, including describing how the sessions made Andrew himself feel, thus providing a mirror where Mr R could commence looking at himself, to facilitate seeing the real person underneath all the restrictive defences he had built up.

4.06p.m.

By the time he reached the last appointment of the day, Andrew had to admit to himself that he was looking forward to finishing work and going home. His last patient, Samantha, was a 41-year-old woman with a Rubenesque build, who tended to be clinging in therapy, and had been attending for close to 12 weeks now.

As Andrew gently guided her to the door at the end of the session, his hand on her left shoulder, she turned towards him, addressing him by his first name and asked if she could have more frequent sessions. She explained that she felt she would make more rapid progress that way. Hesitantly he clarified that it wasn't necessary and wouldn’t speed up her progress, but he knew that the query would arise again.

6.08 p.m.

Andrew nervously fiddled with the car radio, trying to distract himself from the flood of the many emotions and thoughts enveloping him, and he felt as if there was a weight on his chest causing his breathing to be shallow and rapid.

Just before entering his driveway at home, he stopped his car and heard himself phoning and talking to Samantha, as if a stranger to his own thoughts. He was aware of an awkward, detached voice telling her that he had thought about it some more and decided they could give weekly sessions a try.

Prior to then, Samantha had been attending therapy every three to four weeks, so Andrew reassured her that he would avoid her being out of pocket by continuing to bulk bill the sessions.

Each progressive step Samantha took towards intimacy met no resistance, so she continued. Two months after her weekly sessions began in August 1986, they commenced having sex in a motel room that he rented not far from her home.

By now Andrew was experiencing a kaleidoscope of feelings and found himself immersed in lies that brought him no peace. He had difficulty looking Karen in the eye, and the blue ink shadow of guilt slowly enveloped his life from 1986– a year he would never forget.

He became increasingly anxious about being trapped in what felt like a sexual spider web, where he began to fear that the moment he attempted to stop the relationship with Samantha would be the very moment she would retaliate, reporting him to the Victorian Medical Board. Not that he wanted to leave the relationship, as he clung to her throaty laughter, to the scent and feel of her fulsome body. He allowed her to continue calling him Andrew and whilst he referred to her as Mrs Richards, he thought of her as Samantha. In their intimate moments, he did not call her by any name. He didn't usually address patients by their first name and didn't encourage them to call him Andrew, but a few, like Samantha, chose to do so.

He had always strongly believed that it was important to maintain a doctor – patient relationship, where his own personal life and needs would not intrude on the therapy, nor would there be inappropriate intimacy. At least that's the theory, he said to himself with heavy irony.

After several months of therapy and sex, unsurprisingly, Samantha continued to be a needy soul, prone to recurrent bouts of depression and occasional suicidal thoughts. Her childhood appeared to have been a normal one until her father died from a massive heart attack when she was eight years of age. Her mother then struggled to cope with four young children, aged from fourteen years down to the youngest, aged three. There followed a procession of men intruding, as her mother attempted to replace her husband with an urgency akin to a woman dying of thirst. Unfortunately the men she chose were totally different to her late husband, and had no interest in supporting a young family.

Samantha married when she became pregnant at the age of nineteen and escaped the family home, but found no solace in her new home either. Her husband was four years older than her, worked as a bricklayer and outside of work his only interests were the local pub and the local football team. They separated soon after their daughter was born, following three years of a loveless marriage.

Samantha and her daughter lived on their own at first, but in time, like her mother she began inviting a regular stream of men into her life. They accepted her invitation, took what they wanted and left.

Six months after the affair began, Andrew found himself becoming increasingly concerned about ending the relationship with Samantha and encouraged her to form a relationship with another man that she had recently met, in the hope that this would offer Andrew the escape route that he so desperately sought now. Privately, he wondered why he wanted to end the affair, and the best explanation he could arrive at, was that with diminishing excitement he had started to look at the destruction he was causing to his marriage and to the ethics and morals that had guided his life in the past.

For twelve months, his manipulation (for he could not call it ‘therapy’) failed to achieve what he so desperately craved by then. Then when he had stopped hoping, Samantha stunned him with the news that she had met a widower with two young children, who appeared to genuinely care about her. She rang Andrew, and told him that she wanted to terminate therapy as she was not prepared to risk damaging her new relationship. She no longer needed Andrew's therapy nor his sex.

Having penetrated that moral barrier once, Andrew struggled to avoid doing it yet again – and it was a struggle at times. He determined that if a difficult transference developed in treating a female patient, where either he or they developed a strong attraction to the other, he would refer them on to another psychiatrist. He was aware that in psychiatric practice, there was only he and the patient in the room and no nurse to chaperone the situation. Whilst errors tend to occur in the company of other errors, he knew that this was not the type of company he could afford again, as he would risk losing his family, his profession and his self-worth.

Andrew now felt a foreigner in his own moral landscape, struggling to make himself understand what had occurred and why. Karen and his friends noted that he appeared distracted and at times daydreaming. He came very close to confessing to Karen, but avoided giving in to that urge, knowing it would be disastrous to do so.

He had believed for a long time that to confess all was self-serving and the wrong approach. He had seen it happen in many of his patients, where in the guise of an open relationship they confessed wrongdoings, dropping the grenade in the lap of their partner. For a short while it seemed to ease their own guilt, but at the expense of burdening their partner and destroying the relationship.

Andrew had felt for some time, probably since late 1986, that things had cooled in the way Karen related to him. Silently he queried whether Karen could have possibly suspected he had been having an affair, and he continued to live with a lie that brought no peace. He knew he had to sort it out himself, possibly with professional help, rather than dumping the problem onto Karen.

During his medical training he came to understand that the basic goal in medicine was to cause no harm, and then to try and help the patient. He struggled to understand why he had failed to adhere to these guidelines when treating Samantha. Certainly he had recently lost both parents, and struggled to grieve over the loss of his father, a man who had only been a shadow in his life. He was wary of possibly using this as an excuse for behavior that only he could be responsible for. Andrew had been fascinated about the concepts of good and evil for many years, pondering the question of whether people were intrinsically good or intrinsically bad. If they were good, was it the fear of punishment that made them act so? He had come to believe that anyone was capable of doing bad things if their controls were loosened and depending on the circumstances around them. He knew about the mob effect where large numbers of people could be dragged into an environment where they carried out acts of evil, often feeling safe to do so under the umbrella of anonymity that a mob generated. He believed that there was a ripple effect, where having done one bad thing it would be easier to do more of the same.

Apart from his own behaviour, he thought back to his family's experience during the Holocaust where seemingly educated and cultured people could become sadists and murderers. He reflected on how the victims of these atrocities could also be part of a ripple effect, where the damage the victims suffered could cause further damage to the generations that followed because of how they related to each other.

Hannah Arendt’s concept of the banality of evil was something he totally agreed with, and recalled how during the Holocaust the people who murdered their victims could have been a former friend, or a teacher whose class the victim attended or even a doctor who used to treat them. People who once had been close to their victim now became their brutal executioners.

Andrew wondered how his own behaviour in having sex with a patient fitted into these concepts. Had his resolve been weakened by events in his life or was he totally to blame? What did it say about him as a person? He worried that he was becoming too preoccupied with these thoughts and whilst they addressed important issues, he feared that he could be buried in an avalanche of emotion. Once the thoughts squatted in his mind, it was difficult to evict them. They were issues he would eventually need to confront, but he increasingly believed that involving a therapist would be a safer approach. The idea of a psychiatrist needing to see another psychiatrist did not sit comfortably with him, but he acknowledged it was necessary. He knew that the saying “physician heal thyself ” didn’t mean going it alone but rather, admitting to himself that he required outside assistance.

He had never felt so alone before.