Then one of the residents said, “I think Cassi should get him to stop smoking.”
The group laughed and her tension evaporated.
“My plans for Colonel Bentworth,” said Cassi, are ... ” she paused, “that I’m going to have to do a lot of reading over the weekend.”
“Fair enough,” said Jacob. “In the meantime I’d recommend a short course of a major tranquilizer. Borderlines don’t do well on extended medication, but it can help them over transient psychotic states. Now then, what else happened last night?”
Susan Cheaver, one of the psychiatric nurses, took over. With her usual efficiency, Susan summarized on the significant events that had taken place since late afternoon the previous day. The only happening out of the ordinary was an episode of physical abuse suffered by a patient called Maureen Kavenaugh. Her husband had come for one of his infrequent visits. The meeting had seemingly gone well for a while, but then there were angry words followed by a series of vicious openhanded slaps by Mr. Kavenaugh. The episode occurred in the middle of the patient lounge and severely upset the other patients. Mr. Kavenaugh had to be subdued and escorted from the ward. His wife had been sedated.
“I’ve spoken with the husband on several occasions,” said Roxane. “He’s a truck driver with little or no understanding of his wife’s condition.”
“And what do you suggest?” asked Jacob.
“I think,” said Roxane, “that Mr. Kavenaugh should be encouraged to visit his wife but only when someone can be with them. I don’t think Maureen will be able to retain a remission unless he’s brought into the therapy in some capacity, and I think it’s going to be hard to get him to cooperate.”
Cassi watched and listened as the whole psychiatric team participated. After Susan had finished, each of the residents had an opportunity to discuss their patients. Then the occupational therapist, followed by the psych social worker, had a chance to speak. Finally Dr. Levine asked if there were any other problems. No one moved.
“Okay,” said Dr. Levine, “see you all at afternoon rounds.”
Cassi did not get up immediately. She closed her eyes and took a deep breath. The anxiousness engendered by the team meeting had hidden her exhaustion, but now that the excitement was over she felt it with a vengeance. She’d had only three hours of sleep. And for Cassi rest was important. Oh, how nice it would have felt to just lay her head down on her arm right there on the conference table.
“I bet you’re tired,” said Joan Widiker, placing her hand on Cassi’s arm. It was a warm, reassuring gesture.
Cassi managed a smile. Joan was genuinely interested in other people. More than anyone, she had taken time to make Cassi’s first week as a psychiatry resident as easy as possible.
“I’ll make it,” said Cassi. Then she added: “I hope.”
“You’ll make it fine,” assured Joan. “In fact you did marvelously this morning.”
“Do you really think so?” asked Cassi. Her hazel eyes brightened.
“Absolutely,” said Joan. “You even drew a compliment of sorts out of Jacob. He liked your description of Colonel Bentworth as inconsistent.”
“Don’t remind me,” said Cassi forlornly. “The truth is I wouldn’t know a borderline personality disorder if I met one at dinner.”
“You probably wouldn’t,” agreed Joan. “Nor would many other people, provided the patient was not having a psychotic episode. Borderlines can be fairly well compensated. Look at Bentworth. He’s a colonel in the army.”
“That did bother me,” said Cassi. “It didn’t seem to be consistent, either.”
“Bentworth can upset anyone,” said Joan, giving Cassi’s arm a supportive squeeze. “Come on. I’ll buy you some coffee in the coffee shop. You look like you could use it.”
“I can use it all right,” agreed Cassi. “But I’m not sure I should take the time.”
“Doctor’s orders,” said Joan, getting up. As they walked down the corridor, she added, “I got Bentworth when I was a first-year resident, and I had the same experience as you did. So I know how you feel.”
“No kidding,” said Cassi, encouraged. “I didn’t want to admit it at the meeting, but I found the colonel frightening.”
Joan nodded. “Look, Bentworth’s trouble. He’s vicious, and he’s smart. Somehow he knows just how to get at people: find their weaknesses. That power, combined with his pent-up anger and hostility, can be devastating.”
“He made me feel completely worthless,” said Cassi.
“As a psychiatrist,” corrected Joan. “As a psychiatrist,” agreed Cassi. “But that’s what I’m supposed to be. Maybe if I could find some similar case histories to read.”
“There is plenty of literature,” said Joan. “Too much. But it’s a little like learning to ride a bike. You could read everything about bicycles, for years, yet when you finally tried to ride it yourself, you wouldn’t be able to. Psychiatry is as much a process as it is knowledge. Come on, let’s get that coffee.”
Cassi hesitated. “Maybe I should get to work.”
“You don’t have any scheduled patient meetings right now, do you?” asked Joan.
“No, but ...”
“Then you’re coming.” Joan took her arm and they started walking again. Cassi allowed herself to be led. She wanted to spend a little time with Joan. It was encouraging as well as instructive. Maybe Bentworth would be willing to talk after a night’s rest.
“Let me tell you something about Bentworth,” said Joan, as if reading Cassi’s mind. “Everyone that I know who has taken care of him, myself included, was certain they would cure him. But borderlines in general and Colonel Bentworth in particular don’t get cured. They can get progressively better compensated but not cured.”
As they passed the nurses’ station, Cassi left Bentworth’s chart and asked about her page. “It was Dr. Robert Seibert,” said the aide. “He asked for you to call as soon as possible.”
“Who’s Dr. Seibert?” asked Joan.
“He’s a resident in pathology,” answered Cassi.
“As soon as possible sounds like you’d better call,” said Joan.
“Do you mind?”
Joan shook her head, and Cassi went around the counter to use the phone next to the chart rack. Roxane came over to Joan. “She’s a nice kid,” the nurse said. “I think she’s going to be a real addition around here.” Joan nodded, and they both agreed that Cassi’s insecurity and anxiety were a function of her commitment and dedication.
“But she worries me a little,” added Roxane. “She seems to have a special vulnerability.”
“I think she’ll be fine,” said Joan. “And she can’t be too weak being married to Thomas Kingsley.”
Roxane grinned and walked down the hall. She was a tall, elegant black woman who commanded respect for her intellect and sense of style. She’d worn her hair braided in corn rows long before it was fashionable.
As Cassi put down the phone, Joan eyed her carefully. Roxane was right. Cassi did seem delicate. Perhaps it was her pale, almost translucent skin. She was slender but graceful, only slightly over five-feet-two. Her hair was fine and varied in color from a shiny walnut to blond depending upon the angle and the light. At work she wore it loosely piled on her head, held in place with small combs and hairpins. But because of its texture, wisps spilled down around her face in gossamer strands. Her features were small and narrow, and her eyes turned up ever so slightly at the outer corners, giving them a mildly exotic appearance. She wore little makeup, which made her look younger than her twenty-eight years. Her clothes were always neat even if she’d been up most of the night, and today she was dressed in one of her many high-necked white blouses. To Joan, Cassi appeared like a young woman in an old Victorian photograph.
“Instead of going for coffee,” said Cassi with enthusiasm, “how about coming with me to pathology for a few minutes?”
“Pathology,” said Joan, with some reluctance.
“I’m sure we can get coffee up there,” said Cassi, as if that was the explanation of Joan’s hesitation. “Come on. You might find it interesting.”
Joan allowed herself to be led down the main corridor to the heavy fire door which led into the hospital proper. There were no locked doors on Clarkson Two. It was an “open” ward. Many of the patients were not allowed to leave the floor, but compliance was up to them. They knew if they ignored the rules they risked being sent to the State Hospital. There the environment was significantly different and much less pleasant.
As the door closed behind her, Cassi felt a sense of relief. In sharp contrast to the psychiatry ward, here in the main hospital building it was easy to distinguish the doctors and nurses from the patients. The doctors wore either suit jackets or their white coats; the nurses, their white uniforms; and the patients, their hospital johnnies. Back in Clarkson Two everyone wore street clothes.
As Cassi and Joan threaded their way toward the central elevators, Joan asked, “What was it like being a resident in pathology? Did you like it?”
“I loved it,” said Cassi.
“I hope you don’t take this as an insult,” laughed Joan. “But you don’t look like any pathologist I know.”
“It’s the story of my life,” said Cassi. “First nobody would believe I was a medical student, then they said I looked too young to be a doctor, and last night Colonel Bentworth was kind enough to tell me I didn’t look like a psychiatrist. What do you think I look like?”
Joan didn’t answer. The truth was Cassi looked more like a dancer or a model than a doctor.
They joined the crowd of people in front of the bank of elevators serving Scherington, the main hospital building. There were only six elevators, which turned out to be an architectural blunder. Sometimes you could wait ten minutes for a car and then have to stop at every floor.
“What made you switch residencies?” asked Joan. As soon as the question left her lips, she regretted it. “You don’t have to answer that. I don’t mean to pry. I guess it’s the psychiatrist in me.”
“It’s quite all right,” said Cassi equably. “And actually it’s quite simple. I have juvenile diabetes. In choosing my medical specialty, I’ve had to keep that reality in mind. I’ve tried to ignore it, but it is a definite handicap.”
Joan’s embarrassment was increased by Cassi’s candor. Yet as uncomfortable as Joan felt, she thought it would be worse not to respond to Cassi’s honesty. “I would have thought under the circumstances pathology would have been a good choice.”
“I thought so too, at first,” said Cassi. “But unfortunately during the past year I began to have trouble with my eyes. In fact, at the moment I can only distinguish light and dark with my left eye. I’m sure you know all about diabetic retinopathy. I’m not a defeatist but if worse comes to worst, I could practice psychiatry even if I became blind. Not so with pathology. Come on, let’s get that first elevator.”
Cassi and Joan were swept into the car. The door closed, and they started up.
Joan had not felt so uncomfortable in years, but she felt she had to respond. “How long have you had diabetes?” she asked.
The simple question hurled Cassi back in time. Back to when she was eight and her life began to change. Up to that point, Cassi had always liked school. She was an eager, enthusiastic child who seemed to look forward to new experiences. But in the middle of the third grade it all changed. In the past she’d always been ready for school early; now she had to be pushed and cajoled by her mother. Her concentration dwindled and notes to that effect began to arrive from her teacher. One of the central issues, something that no one recognized, not even Cassi herself, was that Cassi had to use the girls’ room more and more frequently. After a time the teacher, Miss Rossi, began on occasion to refuse Cassi’s requests, suspecting that she was using trips to the toilet to avoid her work. When this happened, Cassi experienced the awful fear that she would lose control of her bladder. In her mind’s eye she could picture what it would look like if she had “an accident,” and her urine dripped down from her seat and puddled under her desk. The fear brought on anger and the anger, ostracism. The kids began to make fun of Cassi.
At home an episode of bedwetting surprised and shocked both Cassandra and her mother. Mrs. Cassidy demanded an explanation, but Cassandra had none and was, in fact, equally appalled. When Mr. Cassidy suggested they consult the family doctor, Mrs. Cassidy was too mortified to do so, convinced as she was that the whole affair was a behavioral disorder.
Various punishments had no effect. If anything they exacerbated the problem. Cassi began to throw temper tantrums, lost her few remaining friends, and spent most of her time in her room. Mrs. Cassidy reluctantly began to think about the need for a child psychologist.
Things came to a head in the early spring. Cassi could remember the day vividly. Only a half hour after a recess, she began to experience a combination of mounting bladder pressure and thirst. Anticipating Miss Rossi’s response so close to recess, Cassi tried vainly to wait for class to end. She squirmed in her seat and clutched her hands into tight fists. Her mouth became so dry she could barely swallow, and despite all her efforts, she felt the release of a small amount of urine.
In terror she walked pigeon-toed up to Miss Rossi and asked to be excused. Miss Rossi, without a glance, told her to take her seat. Cassi turned and walked deliberately to the door. Miss Rossi heard it open and looked up. Cassi fled to the he girls’ room with Miss Rossi at her heels. She had her panties down and her dress bunched in her arms before Miss Rossi caught up to her. With relief, the little girl sank onto the toilet. Miss Rossi stood her ground, putting her hands on her hips, and waited with an expression that said: “You’d better produce or else ...”