| Off the Couch |

Still Alive

"There’s nothing more rewarding than helping a young man like Jonas to conquer his demons"

 

I’ve written about Jonas before — the chronically-depressed and suicidal young man with muscular dystrophy and a gift for the game of chess. Well, he was still my patient and I was still the medical student in charge of him at the State Psychiatric Hospital. And the sharp-tongued, often impatient, but brilliant Dr. Curling was still my supervisor.

“What kind of progress are you making, young man?! Do you want to be a half-decent psychiatrist one day or are you planning on ending up as a geriatrician in South Dakota?” he snapped at me as we discussed the case.

And even though I knew enough to expect this sort of comment from the medical professional with half a century of clinical wisdom under his belt, I responded somewhat sheepishly, “Well, we are connecting, I mean, he plays chess with me every day and even though Larry, his orderly and suicide watchdog, falls asleep all the time, he hasn’t killed himself.”

“Yet,” Dr. Curling spoke, slamming his hand down on his ancient wooden desk. “He hasn’t killed himself yet.”

I paused, knowing that even if it came with a tongue-lashing, Dr. Curling was about to reveal a deeper insight.

“He’s a fellow whose entire identity is wrapped around his sick persona. He’s slowly dying from muscular dystrophy and would rather do it expeditiously, with a horrific suicide to show his parents, you, and me how much G-d doesn’t care about him.”

I got it. My job was to help him redirect his self-perception.

Movement was slow, but Jonas became increasingly talkative and with time the subject moved beyond chess, the hook at the beginning of our yet-stilted relationship. He began to open up about his family, his love of Indian food — and even his dreams of continuing to study and work in artificial intelligence, which got derailed by his illness.

By the end of the week, even Dr. Curling was ready to give me a compliment. “You’re slowly fixing him. Maybe you won’t need to be exiled into the field of radiology somewhere deep in Alabama after all.”

As Jonas was now more engaged in treatment, Dr. Curling was also considering freeing him from his orderly.

“What do you think? Can we try him without Larry for a bit and see if he’s still alive at the end of the day? Maybe you can even take him for a stroll around the hospital grounds if you feel he’s up to it,” Dr. Curling said. “But remember, if he regresses and ends up killing himself, it might be my license but it’s on your conscience.”

I considered this as I left the office to meet with Jonas for our daily chess match, but not before telling Larry that Dr. Curling had put in the order to absolve him of the suicide-watch protocol. Larry shrugged nonchalantly and performed a half-hearted Navy salute as he walked off to smoke before checking in at the nurse’s station to find his next assignment.

Jonas observed Larry walked away and muttered loudly, “Stupid Larry, stupid hospital, stupid medical student,” as he set up his pieces. With Larry gone, Jonas was all business, using a move called the double fianchetto to control the board from the get go. He vanquished me in less than 20 moves and joked as he knocked over my king triumphantly, “I guess Larry couldn’t stand to watch me crush you again.”

My competitive nature aside, I ignored the jeer and asked Jonas if he’d like to go for a walk on the hospital grounds.

“Really?” Jonas asked with a look of surprise. “Like go outside for the first time in months and see the sky? The trees? I mean... sure, of course I would!”

I was thrilled to see some optimism in his eyes and positivity in his tone. Seizing the opportunity, I told the charge nurse we’d be going for a walk, and didn’t pay attention to the raised eyebrows that could have warned me to think twice.

Because in my mind, there really wasn’t anything to be concerned about. Jonas didn’t move too fast due to his neuromuscular condition and couldn’t outrun me. Furthermore, the hospital grounds were surrounded by an electric barbed wire fence to prevent anyone from breaking out and escaping.

Jonas smiled as we walked out of the unit and the door locked behind us. He didn’t make a run for it and stayed by my side as we walked down the path, away from the building that had confined him for close to half a year.

Jonas began talking about the trees, the sky, the sunshine — he sounded so calm and relaxed. As we reached the main road and began to walk alongside it, he pointed out a bird sitting on an oak by the side of the road. As I squinted to see it through the sunshine, Jonas made his move — he lunged in front of the Chevrolet that was pulling out of the parking lot.

In a split second I grabbed Jonas by the collar and the car swerved to the side and onto the opposite curb. These combined efforts prevented Jonas from being run over, and the driver — a nurse from a neighboring unit who recognized us — jumped out of his car and called for help.

Jonas was scraped up pretty bad on his elbows and knees but didn’t look like he needed more than a few bandages. He lay silently on the ground and I stood above him, my heart racing and sweat dripping down my face.

The security guards picked up Jonas and carried his intentionally limp body back to the unit. I followed them, and then went in to find Dr. Curling, who was waiting for me in his office.

“Well, you almost killed your patient,” he said with his characteristic bluntness.

He was right. I had nothing to say as I wiped my brow.

“Looks like he almost killed you too.”

I shook my head in complete agreement.

“Listen,” he said. I knew Dr. Curling was wise, but this was the first time I saw compassion there too. “You can’t blame yourself. In the end, many psychiatric patients will end up doing crazy and terrible things. We expect our patients to blindly follow our advice and to never kill themselves, hurt other people, or do other horrendous and dangerous things like jumping in front of cars. It’s not realistic.”

“But still, how can I not feel like a failure?” I asked myself, Dr. Curling, and Hashem.

“Dr. Freedman, how can you possibly feel like a failure when all that happened is that your patient got a couple of Band-aids and some antibiotic cream? No one died and we all learned something! I call this a success!”

Dr. Curling stood up and slapped me on the back as hard as he could. “Look, unless you want to be a plastic surgeon doing nose jobs in Beverly Hills, you’ll have real patients and real things happening to them. Psychiatry is a hard field, Dr. Freedman, and it’s about as heartbreaking as it gets. But if you can stick it out, there’s nothing more rewarding than helping a young man like Jonas to conquer his demons.”

“You think it’ll happen, Dr. Curling?” I asked. “I mean, you think he’ll get better?”

“For sure. If he really wanted to be dead, he would have already done it — and not you, me, G-d, or even Larry could’ve stopped him. Now go play another game of chess. You’re bound to win sooner or later.”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman can be found learning Torah in the Old City or hiking the hills outside of Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

(Originally featured in Mishpacha, Issue 815)

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