“Are you uncomfortable, Ronnie?”
“I can’t do it, I can’t do it, Doctor. I get too scared.” He whined like a wrongly accused child. Then suddenly growing reasonable he said conversationally, “It’s the can opener mostly.”
“Was it the kitchen? All the work in the kitchen?”
“No no no,” he whined. “The can opener. It’s too much. I don’t see why you don’t understand it.”
Kohler’s body was racked by a yawn. He felt a painful longing for sleep. He’d been awake since 3:00 a.m. and had been here, at the halfway house, since 9:00. Kohler had helped the patients make breakfast and do the dishes. At 10:00 he shuttled four of them to part-time jobs, conferring with employers about his patients and mediating little disputes on their behalf.
The rest of the day he spent with the remaining five patients, who weren’t employed or who had today, Sunday, off. The young men and women each had a psychotherapy session with Kohler and then returned to the mundane chores of running a household. They divided up into project groups that did what to healthy people were absurdly simple tasks: peeling potatoes and washing lettuce for dinner, cleaning windows and bathrooms, separating trash for recycling, reading aloud to each other. Some lowered their heads and completed their assignments with furrowed-brow determination. Others chewed their lips or plucked out eyebrows or cried or came close to hyperventilating from the challenge. Eventually the work got done.
Then, catastrophe.
Just before dinner, Ronnie had his attack. A patient standing beside him opened a can of tuna with the electric opener, and Ronnie fled screaming from the kitchen, triggering a chain reaction of hysteria in several other patients. Kohler had finally restored order and they sat down to dinner, Kohler with them. The food was eaten, dishes washed, the house straightened, games played, television programs hashed out (a Cheers rerun was the majority selection of the evening and the M*A*S*H minority abided grudgingly by the decision). Then meds were taken with juice, or the orange-flavored liquid Thorazine was chugged, and it was bedtime.
Kohler had found Ronnie hiding in the corner of his room.
“What would you like to do about the noise?” Kohler now asked.
“I don’t know!” The patient’s voice was dull as he chewed his tongue-an attempt to moisten a mouth painfully dry from his Proketazine.
Adaptation causes stress-the hardest thing for schizophrenics to cope with-and, Kohler reflected, Ronnie had plenty to adapt to here in the halfway house. He had to make decisions. To consider the likes and dislikes of the other people living with him. He had to plan ahead. The safety of the hospital was gone. Here he was confronted daily with these matters, and a downhearted Kohler could see the young man was losing the battle.
Outside, vaguely visible in the darkness, was a lawn that had been kept perfectly mowed by the patients all summer long and was now hand-stripped of every leaf that made the mistake of falling upon it. Kohler focused on the window and saw his haggard face in the black reflection, his eyes socketlike, his chin too narrow. He thought, for the thousandth time that year, about growing a beard to flesh out his features.
“Tomorrow,” Kohler said to his unhappy patient, “we’ll do something about it.”
“Tomorrow? That’s just great. I could be dead tomorrow, and so could you, mister. Don’t forget it,” snapped the patient-sneering at the man to whom he owed not only such peace of mind as he possessed but probably his life as well.
Even before he’d decided to attend medical school, Richard Kohler had learned not to take personal offense at anything schizophrenic patients said or did. If Ronnie’s words troubled him at all, it was only because they offered a measure of the patient’s relapse.
This was one of Kohler’s clinical errors. The patient, involuntarily committed at Marsden State hospital, had responded well to his treatment there. After many trials to find a suitable medication and dosage Kohler began treating him with psychotherapy. He made excellent progress. When one of the halfway-house patients had improved enough to move into an apartment of her own, Kohler placed Ronnie here. Immediately, though, the stresses accompanying communal living had brought out the worst of Ronnie’s illness and he’d regressed, growing sullen and defensive and paranoid.
“I don’t trust you,” Ronnie barked. “It’s pretty fucking clear what’s going on here and I don’t like it one bit. And there’s going to be a storm tonight. Electric storm; electric can opener. Get it? I mean, you tell me I can do this, I can do that. Well, it’s bullshit!”
Into his perfect memory Kohler inserted a brief mental notation about Ronnie’s use of the verb “can” and the source of his panic attack tonight. It was too late in the evening to do anything with this observation now but he’d review the young man’s file tomorrow in his office at Marsden and write up a report then. He stretched and heard a deep bone pop. “Would you like to go back to the hospital, Ronnie?” he asked, though the doctor had already made this decision.
“That’s what I’m getting at. There isn’t that racket there.”
“No, it’s quieter.”
“I think I’d like to go back, Doctor. I have to go back,” Ronnie said as if he were losing the argument. “There are reasons too numerous to list.”
“We’ll do it then. Tuesday. You get some sleep now.”
Ronnie, still dressed, curled up on his side. Kohler insisted that he put on his pajamas and climb under the blankets properly, which he did without comment. He ordered Kohler to leave the light on, and did not say good night when the doctor left his room.
Kohler walked through the ground floor of the house, saying good night to the patients who were still awake and chatting with the night orderly who sat in the living room, watching television.
A breeze came through the open window and, enticed by it, Kohler stepped outside. The night was oddly warm for November. It reminded him of a particular fall evening during his last year of medical school at Duke. He recalled walking along the tarmac from the stairs of the United 737. That year the trip between La Guardia and Raleigh-Durham airports had been like a commute for him; he’d logged tens of thousands of miles between the two cities. The night he was thinking of was his return from New York after Thanksgiving vacation. He’d spent most of the holiday itself at Murray Hill Psychiatric Hospital in Manhattan and the Friday after it in his father’s office, listening to the old man argue persuasively, then insist belligerently, that his son take up internal medicine-going so far as to condition his continuing financial support of the young man’s education on his choice of specialty.
The next day, young Richard Kohler thanked his father for his hospitality, took an evening flight back to college and when school resumed on Monday was in the Bursar’s Office at 9:00 a.m., applying for a student loan to allow him to continue his study of psychiatry.
Kohler again yawned painfully, picturing his home-a condominium a half hour from here. This was a rural area, where he could have afforded a very big house and plenty of property. But Kohler’s goal had been to forsake land for convenience. No lawn mowing or landscaping or painting for him. He wanted a place to which he might escape, small and contained. Two bedrooms, two baths and a deck. Not that it didn’t have elements of opulence-the condo contained one of the few cedar hot tubs in this part of the state, several Kostabi and Hockney canvases and what was described as a “designer” kitchen (“But aren’t all kitchens,” he had slyly asked the real-estate broker, “designed by somebody?” and enjoyed her sycophantic laughter). The condo, which was on a hilltop and looked out over miles and miles of patchwork woods and farm-land during the day and the sparkling lights of Boyleston at night, was-quite literally-Kohler’s island of sanity in a most insane world.