As if weights were attached to my feet, I trudged out of Toshiba sometime after nine at night.
A neat thin man in a tweedy sport jacket and Woody Allen glasses stopped me, asking, "Are you a doctor?"
My guard went up, like an off-duty pediatrician is on guard around kids. "Yes."
"My name's Sedders. I think I need admission to the hospital."
I clicked on what I'd learned to be the first question of any psychiatric interview, and as empathetically as possible asked, "Do you have insurance?"
"Yes, that's the problem."
"How's that the problem?" I asked, framing a Chief Complaint of I have insurance.
"It's managed care, an HMO. 'Healthy Incorporated.' Admission has to be approved by two doctors from the HMO, and none will return my calls. I've been trying all day. Most of the time all I get is a busy signal. The office is in Washington State."
"Keep hitting 'redial'."
"I do. When I do get through, I get a secretary, never a doctor."
"Is it an emergency?"
"That's what the secretaries all ask. I'm not sure. It's certainly urgent. I'm thinking seriously of killing myself."
"How seriously?"
"I'm not sure. I have no standard of comparison."
"Tell them it's urgent. Be a little more self-assertive."
"You think that if I say that, they'll get the doctors to call me back?"
"It's worth a try. Keep redialing."
"Thanks muchly, Doctor -- " He read my name tag.
" -- Basch. You're the first doctor who's taken the time to talk to me. I feel a little better already."
"Good."
Now, a
few weeks later, with Primo for security, I interviewed a violent
middle-aged Italian bricklayer with a chief complaint of "I am God."
"How do you know you're God?" I asked.
"Because I was chosen."
"Why were you chosen to be God?"
"Because I was in hell. You want proof?" He unbuttoned his shirt. On his belly was a magnificent tattoo of The Last Supper. Clearly, it had been done many years before, when what was now his belly had been his chest, and when he'd been thinner, for now it had expanded, so that Christ and the apostles were all wearing broad grins.
"What do you think, Doc?" Primo asked after we'd locked him up.
"298.80. Brief Reactive Psychosis."
"You don't think he's God?"
"He may be, but it's not reimbursable."
I headed off to the Farben for Lloyal von Nott's Christmas reception. On my way out, I was button-holed again by the Woody Allen look-alike in the tweed sport coat and tie, the man named Sedders who didn't know how suicidal he really was and who was trying to get in touch with the doctors of his HMO -- Healthycare Inc.-- to certify his admission to Misery.
"I finally got through to a doctor!" he said, excitedly.
"Great. I knew your persistence would pay off."
"I said that if he didn't authorize my admission to Mount Misery before the end of the year -- next week -- that I was going to kill myself, and that my lawyers were aware of this fact."
"Good thinking. When you mention lawyers, doctors start listening."
"That's what I thought, but then he said, 'You've been saying the same thing to our allied health professionals for several weeks now, and you haven't even made a suicide gesture, let alone an attempt. It doesn't sound all that much like an acute emergency anymore.' I told him that it was, but he said, 'I have to put you on hold.' I waited for almost half an hour, but he never took me off hold. Now what do I do?"
"Call back, start out sounding rational, and then start screaming."
"Okay. Merry Christmas! Oh God! Now I've offended you, I'm sorry!"
"How have you offended me?"
"You're Jewish, right? You don't believe in Christmas."
"Who does anymore, I mean, really?"
"Yeah." He squirmed and looked away, the way men do when they are about to try to make contact. "Dr. Basch, you're turning out to be my only friend."
A week later, I chatted with Viv until Primo came back. "More bad news, Doc."
"Yeah?"
"They found a body, way, way back in the woods, frozen solid. And on the body was a letter, and it was addressed to you."
He handed me a letter the size of a Christmas card. I opened it. Inside was a handmade Christmas card. Within a crude, child's outline of a Christmas tree was written:
Life is Tough, Life is Hard, Here's Your F@*$&%# Christmas Card.--Mandy
On the reverse side was a message for me:
Dear Dr. Basch,
My wifa Mandy made me this card. You tried hard, but Healthycare kept putting me on hold. In my safety deposit box is all the information, which our lawyer will use to sue the pants off Healthycare. My wife and kids will be taken care of. Thanks for your help.
Sincerely,
Sedders.
"You know him, Doc?"
"Not really."
"Died of exposure."
"Don't we all, "I said, "we should give the guy a medal."
"Why's that, Doc?"
"He killed himself first. Before killing his wife and kids. Yes, my friends, this man was a great American. I'm off duty. Happy New Year."
Samuel Shem is clinical instructor in psychiatry at Harvard Medical School and director of the Bill W. and Dr. Bob Project at the Division on Addictions. He has written several books, plays and has taught courses on "How to Stay Human in the Healing Professions." His novel "The House of God" and its sequel "Mount Misery" are currently available through Ballantine Books, New York.
