Before Christine's regular appointment one morning, I was caught in a traffic jam on the freeway. Sitting in a sea of bumper-to-bumper cars, I began to remember dream fragments from the night before. I had seen Christine wandering down a maze of streets in downtown Manhattan, late at night. The sounds of the city enveloped her, and for moments she would disappear from my sight, swallowed up by the darkness. As I watched her from a distance, she looked alone and lost, searching for something. I called out, but she was too far away to hear my voice.
The dream took me by surprise. In medical school I had stopped dreaming completely. Or at least I couldn't remember my dreams anymore. It was years since I had been able to recall them in such detail. It seemed particularly odd that my dream was about Christine, because we hadn't made much of an emotional connection: I rarely thought about her outside of appointments.
Later in the day, escorting Christine from the waiting room into my office, I apologized for being a few minutes late. She didn't seem bothered, however, which was unusual for her. She was typically annoyed if I wasn't on time. Now, as we sat down opposite each other, she looked tanned and cheerful.
“For the first time in years,” she told me, “my depression seems to be lifting. The medication has helped a lot. I don't feel so cut off or afraid of everything anymore.”
Observing Christine, I recalled how she'd looked on previous visits: slump-shouldered, eyes dull and downcast, monotone voice, wearing heavy makeup. Today she sat up straight, her eyes animated and alive, her voice strong, her face bright and natural. Over the past six months I had noticed other such positive signs, slow but steady improvement, a good indication that the antidepressant had taken effect. I listened while she described the beginnings of a new romantic relationship. I knew she had also reconciled with her estranged daughter recently, and they were talking about taking a vacation together. I was pleased: Christine was emerging from a cocoon, determined to get well, making plans for the future.
As she spoke, I glanced out the window and noticed a billowy white cloud formation. I stopped hearing Christine, momentarily, lost in watching the changing shape across the sky. Her voice sounded miles away, her words reaching me in slow motion, yet my mind was perfectly lucid. I felt peaceful, as if I were surrounded by freshly fallen snow. Everything was cool, still, silent. I breathed easily, and my body relaxed. I don't know how long this lapse lasted, but in a state of deep quiet and despite everything she was saying, all at once it hit me: Christine was about to make a suicide attempt.
This sudden knowledge felt like an arrow hitting the bull's-eye or a chord ringing clear and pure. But to be aware of a premonition in the context of being a physician felt alien, threatening. A part of me wanted to deny it, to block it out. I felt unsteady, almost faint. My stomach tightened into a knot.
Christine was my last patient that day. It was Friday, and I was exhausted. I left my office late, having signed out to another psychiatrist who would take my calls for the weekend. But the possibility of Christine making a suicide attempt kept gnawing at me.
That evening, I took a walk with a girlfriend in Santa Monica Canyon, a wooded section of Los Angeles, far from the smog and congestion of the inner city. The air was crisp and fragrant, unseasonably warm, like a spring day. As we passed through a quiet tree-lined neighborhood, admiring fields of wildflowers in bloom, I finally began to unwind, but the image of Christine's face kept appearing in my mind.
I saw her as she had been in the dream, directionless and alone, with me chasing her through the streets of Manhattan. Of course, I had no hard evidence that Christine would try to end her life. In fact, everything I knew logically pointed in exactly the opposite direction.
Reminding myself of this, I tried to rationalize my fear, to explain it away. Only at the end of the walk, when my friend observed how edgy I seemed, did I tell her about my premonition. A practical woman, she didn't make too much of it but suggested that the following week I could gently bring up the subject with Christine, just to lessen my own anxiety. I agreed. If Christine's response warranted it, we would then explore her feelings further. For now, since she was doing so well, there was no urgency.
Bur Christine never made it to her appointment; the next time I saw her she was hooked up to life support in a stark, airless ICU. On the surface I strained to remain professional, but my mind was reeling. By discounting my premonition, I had betrayed both Christine and myself. I couldn't think straight. I felt like Alice when she stepped through the looking glass; suddenly there were no safe landmarks, nothing familiar.
For nearly a decade I had worked night and day. I knew the medical literature backward and forward. I knew all the signs of improvement, all the danger signals too. Over and over again I asked myself what I had missed. My entire professional foundation was crumbling beneath me.
After poring over my library of medical books, I finally called David, a friend and colleague who had finished his residency a few years before. He tried to reassure me that I hadn't missed anything, but I wasn't convinced. Medically, he was right. But it wasn't my medical competence that concerned me. I was shocked by my blatant disregard of intuitive information that could have benefited Christine, that might have made the difference between her life and death. Because the source of my impressions hadn't fit the traditional model, I had ignored them.
During my medical training I had opted to trust the scientific method above my intuition, which seemed inexact and undependable in comparison. When making critical decisions that affected other people's lives, I had chosen a system that was more concrete and absolute. I had lost track of the fact that such a system, whatever its virtues, rarely tells the whole story.
All that month I made daily visits to the hospital, checking Christine's medical charts, watching the shallowly breathing form on the white bed, the almost unwrinkled sheets pulled over her body. I listened to the wheeze and chug of the respirator beside her; I watched the drip of the IV. Christine looked like a ghost of herself, pale and gray. I longed to hear her voice, to witness some signs of life so that my guilt would be assuaged. But there was only a deathly quiet.
Many days I pulled the curtains around Christine's bed and sat beside her, reviewing her case in my mind from every conceivable angle, thinking of all the ways I might have broached the subject of suicide with her. In the course of my medical education, I had been taught guidelines to follow, rules to rely on. To act on a premonition in making clinical decisions would have been sacrilege. We had been taught that many people don't consider suicide on a conscious level until the last moment. Such thoughts may churn in their minds, unnoticed and unheeded, breaking through only when they are alone, beyond the reach of a therapist. And so it was in dealing with the unconscious that my premonition could have best served Christine.
The only mention of premonitions or other psychic abilities I ever found during my medical education was in textbooks labeling such claims a sign of profound psychological dysfunction. I took great pride in my status as an active member of the American Psychiatric Association, in being an attending staff physician at prestigious hospitals, in the respect of my peers. Sitting there at Christine's side, however, I suddenly felt as if two distinct parts of me had collided. I could see my face as a young girl in the early 1960s overlaid on the outline of my face now: two disjointed images, positioned on top of each other, about to merge. What had I been running from for so long? I felt a fluttering in my chest, a cold, still tension. I became rigid inside, afraid that if I moved I would shatter into a million pieces of broken glass.
The truth of my premonition both validated and terrified me. But I had to acknowledge the facts of Christine's case. If I could draw on both intuitive and medical knowledge, I had the tools to stay one step ahead of a patient, keeping tabs on thoughts and feelings before they became irreversible actions. Used with care, my psychic abilities would do no harm and, more important, might prevent suffering.
As I looked at Christine's face on the pillow, plastic tubes protruding from her nose and mouth, I realized that as a responsible physician I could no longer dismiss information simply because it came to me in forms traditional medicine had not yet accepted. There had to be a way to integrate the psychic into mainstream medicine. When brought together, each could enhance the other and become more powerful than either was alone.
After several long weeks, during which I wasn't sure if she would live or die, Christine came out of her coma. I had tried to prepare myself for the possibility that she wouldn't survive, but deep down I knew her death would have devastated me. I would always have felt in some way responsible for not having acted on my premonition. Thus, despite the long nightmare of her coma, I was relieved and grateful. We had both been given a reprieve.
When we resumed our therapy together, my approach as a psychiatrist changed. I took a vow that became part of my own Hippocratic Oath: not only to do no harm, but also to seek a therapeutic relationship in which I could give my all. I wasn't sure how I was going to accomplish this, but one thing—which Christine had taught me—was certain: The penalty for me not trying was too high.
My struggle with Christine played a pivotal role for me both personally and in my practice. From this experience, I understood that I had to reopen a part of myself that long ago had shut down—no matter how much it frightened me. In truth, I was a child when I started down the path to this critical crossroads. For years, though I fought it, I knew that something set me apart from others, as if I were guided by a different rhythm, a different truth. Now, looking back on my life, I could see that a series of unusual and, to me, unexplainable events had set the stage.
Initiations
T
HE
B
EGINNINGS OF
W
ISDOM
I am large…I contain multitudes.
—W
ALT
W
HITMAN
It was 3:00
A.M
., the summer of 1968. A magical southern California night. I was sixteen years old and had spent the weekend partying at a friend's house in Santa Monica, oblivious to my exhaustion. The soft, warm Santa Anas whipped through the eucalyptus trees, blowing tumbleweeds down deserted city streets. These winds were seductive, unsettling, conveying a slight edge of danger.
The scene was Second Street, two blocks from the beach, in a one-bedroom white clapboard bungalow where my friends and I hung out. We were like animals huddled together for a kind of safety, apart from what we saw as a menacing outside world. Brightly painted madras bedspreads hung from the ceiling, and candles in empty Red Mountain wine bottles flickered on the floor. Barefoot and stretched out on the couch, I was listening to Bob Dylan's “Girl from North Country.” I was restless; I wanted something to do.
A young blond man I'd met only an hour before invited me to go for a ride up into the hills. He was a James Dean type, cool and sexy, dressed in a brown leather jacket and cowboy boots, a pack of Camels sticking out of the back pocket of his faded jeans: the kind of guy I always fell for but who never paid much attention to me. I wouldn't have missed this opportunity for anything.
The two of us headed out, stepping over couples who were making out on a few bare mattresses placed strategically on the living room carpet. We jumped into my green Austin Mini Cooper, my companion at the wheel, and took off for Tuna Canyon, one of the darkest, most desolate spots in the Santa Monica range, a remote place the Chumash Indians had consecrated, made sacred.
The road snaked up into the mountains to an elevation of about 1,500 feet; we could see the entire Malibu coastline laid out before us in a crescent of lights all the way from Point Dume down to the southernmost tip of the Palos Verdes Peninsula. The balmy night air blew through my hair, filling my nostrils with the scent of pungent sage and fresh earth. A few lone coyotes howled to one another in the distance.
For a moment, the man I was with glanced over at me and I felt something inside me stir. The softness of his voice, the easy way he moved his body excited me, but I did my best not to show it, determined to play the game of acting as if I didn't care. The heat of his aim extended across my body, his hand now on my leg. I reached my hand over to meet his, slowly stroking each fingertip, one by one. I felt intoxicated: He was a stranger, completely unknown to me. It was the ultimate risk. The closer our destination became, the more my excitement grew. I was anticipating what would happen when we reached the breathtaking view at the top.
The higher we climbed, the more treacherous the curves in the road became. But we were paying little attention, talking nonstop, high on a potent amphetamine we'd taken an hour before at the house. On the last curve before the top, he didn't respond quickly enough and the right front tire plowed into the soft gravel along the shoulder. The car lurched wildly as he wrestled with the steering wheel in a frantic effort to regain control. He slammed on the brakes. I heard the tires shriek and then we were skidding off the pavement and hurtling over the edge of the cliff, plunging down into the darkness below.
I recall only fragments of what happened next. I do know that time slowed down and I began to notice things. The night sky was swirling beneath my feet instead of above me. I could hear peculiar sounds, as though amusement park bumper cars were crashing into each other. I made the emotionless observation that something was distinctly odd, but couldn't quite pinpoint what it was. The horror of my predicament—my imminent death—never really registered. Instead, something shifted; I found myself standing in a sort of tunnel, feeling safe and secure. It didn't occur to me to question where I was or how I got there. Although far in the distance I could hear the wind rushing past the open windows of the car, I was now suspended in this peaceful sanctuary while we fell through space toward the canyon floor hundreds of feet below.