The Good Patient: A Novel

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9780312326074: The Good Patient: A Novel

Darien is a young woman who seems to have everything: a successful job, an adoring husband, and a bright future. She also has a tendency towards violent, self-destructive outbursts when she's alone. When her private life spirals out of control, her husband and her therapist desperately try to help her uncover her horrible secrets before she destroys herself. Unfortunately, she just as desperately tries to keep them hidden.

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About the Author:

KRISTIN WATERFIELD DUISBERG is a graduate of Bowdoin College and the Creative Writing program at Boston University. The Good Patient is her first book.

Excerpt. Reprinted by permission. All rights reserved.:

One

1
From the inside out, these are my layers: bad, good, bad, good, and now--new--again bad. They attach beneath my skin, nested one inside the other like Matruschka dolls, anchored with a pin through each skull at the top. They ring like a bell, scream and peal, complain, when layers and outsides clash. Beneath the layers, there is nothing: unbounded emptiness like the equation of the universe inverted so that one equals zero.

I was born with just bad, in New York City in August, a twin, half dead, half orphaned. My mother told me the story once, in the hospital, how she'd gone into labor early on a Queens-bound F train, in the dead heat of the Summer of Love. When the first contraction came, a tightened belt beneath her skin, she dropped her purse and grabbed hard on my three-year-old brother's hand. He screamed, and people crowded in to help; she announced she wasn't moving, and I likely would have died somewhere between Prospect Park and Far Rockaway if an off-duty EMT hadn't been there to hustle her off. At Bellevue, the attending obstetrician cut a clean line up the front of her peasant blouse and told her he was going to do the same thing to her stomach: her baby--her babies<$>--were in serious trouble. Both babies were in breech, the one closer to the cervix in extreme distress. The umbilical cord was caught. It was a matter of minutes before one or both of us was dead.

"Well, you can imagine my shock," she had said to me. Her fingers trailed through the air like water. "Your father had left us without a word of where he was, I had your two brothers at home and no job and no money. Babies--zuh, plural? It was the first time I heard the word. I told him I didn't want you, naturally, in the heat of the moment I didn't want any of us. I told him just let me die, me and my babies, but by golly you were determined to be born."

By golly, indeed; you might even say, My stars. I pushed my way right past my dead sister, bottom forward, dragging that umbilical cord like a piece of toilet paper stuck to a shoe. Broke my collarbone and tore a hundred-stitch hole in my mother, just to get into the world.

"Hey--check this out. Do you suppose if a hemophiliac cut himself accidentally and didn't bother to stop the bleeding, it would be considered suicide?"

Twenty-eight years later, another dying August New York day, and I'm attempting my own ass-backward introduction to the world once again. This time I'm already at the doctor's office, however; an imposing mahogany-and-leather suite filled with furniture that looks like it would be at home at the Harvard Club on 44th. Today is my first appointment with Rachel Lindholm, MD. She's a psychiatrist, and she is late. The source of my question is a pamphlet I'm reading on chronic depression in hemophiliacs. The audience is my husband, Robert, who's looking awfully uncomfortable for a guy who's pretty used to sitting on $5,000 couches. I repeat the question-

"Get it? Bleeding? Hemophiliacs?"--and tickle his thigh with the pamphlet. It's a joke.

Robert gives me a baffled, uncomprehending glare and doesn't even glance down at the pamphlet. Have it his way, I suppose, but for my dollar, why not enjoy yourself if you're going to have to wait? I go back to my reading and think that's one thing I can add to my short list of advantages psychiatrists hold over psychologists: better waiting-room literature. I should know. I'm a junior account manager for Pharmaceuticals at Boylan & Westwood, which is New York City's premier public relations company, if you're willing to believe our collaterals, and plenty of this stuff crosses my desk. I also should know because I've spent a goodly portion of my life doling out fifty-minute dollops of my mind to head doctors--PhDs and MSWs, even an EdD, one time. Dr. Lindholm is my fifth. She's my first psychiatrist, though.

Shall I give it all away, right up front? I'm here to see her because of the splint on my right hand, a hard shell of plastic that protects three broken metacarpals and two dislocated knuckles, which throb dimly even though it's been two days and a half-dozen schedule four drugs since I hit the bathroom wall. It was a screwup, a momentary indiscretion, a judgment lapse. I admit it, freely and adultly, with full cognitive rationality, and I suppose I'd beat myself up for it if that wouldn't constitute overkill. But I should have known better than to pop a wall with my right hand, of all things, with bones so fragile and used to this routine they crack like stale cookies. If I had to hurt myself--and it seems, at least in the moment, that I had--I should have done something less ostentatious, like burning my palm on the stove, or tripping in front of a subway. Not breaking my hand again. Not something so token, so recidivist.

Out on the street, a car alarm goes off, and I take a second to rearrange myself on the couch, unfurling the pamphlet across the top of my splint like a sommelier's towel. Briefly, I think about what's awaiting me and consider carrying myself into the inner sanctum thus disguised. I can almost laugh at the ridiculousness of it, the sight gag, but the truth is I hate the idea of walking into Dr. Lindholm's office, any doctor's office, with malady so obviously declared. Why tip the balance beyond where it inherently starts? For a semester or two in high school, I saw a male therapist, Dr. Zobel, a bald and bearded Freudian, and the very first thing he did at my first session was point his chin my direction. "Why don't you start by telling me what's wrong with your chest," he said.

"My chest?" I was there for the ever-disappearing Bourbon in the kitchen drawer, a tendency to fuck my brothers' friends. "You mean the size of it? Or lack thereof?"

"Do you think there's something wrong with the size of your chest?"

I'd looked down to assess--are you kidding me?--and then I saw. I was wearing a scoop-necked T-shirt and I was covered in hives, scarlet roses blooming from sternum to clavicle. Panicky heat prickled my throat and my palms went damp. "I have a rash."

"Ah?"

"A necklace. From my boyfriend. I'm allergic to electroplate."

After that first hour, I made a point of wearing high-necked shirts to his office and, in the winter, turtlenecks, and while he was quick after five or so visits to point out the change, it made me feel better, as if I had won at least one small victory against myself, and therefore, by association, him. Stupid, treacherous body. It's forever giving me up like a weepy john in a raid.

Today, I'm wearing a slate blue silk pantsuit, high-collared and wide-sleeved, to give the impression that I just dashed over here from the office. I tried to pick something that would say quietly expensive, suggest that I was an impossibly well-put-together young woman. The purply-blue of the fabric almost matches my fingers, a detail Robert didn't comment on when he swung by home to pick me up. Instead, he just winced a little and patted my hair, as if that was the one thing on me he could be sure wasn't about to break. He's not here because we're doing marriage counseling or because he thinks I couldn't make it here on my own (though might be another story), just in case you were wondering. He has taken a few hours away from his still seventy-to-eighty-hours-a-week-after-a-decade job--corporate law, for Adelstein & Kravitz; M&A services at your service--because I have a bad habit of lying, and he is here to make me tell the truth, to this doctor, and to him.

Easier said than done. I'm a terrible liar, impulsive and indiscriminate. I try not to be, but a good lie is just too much fun to resist. The patterns and protocols, the sheer superfluity, extravagant as an Elizabethan dance--

Robert sighs loudly and shoots his left cuff. His thumb rubs the face of his watch a couple of times, then both hands lift and rotate against the orbits of his eyes.

I clear my throat. "Time is it?"

"Four-ten. Four-eleven." He sighs again.

"Sorry about that."

He squeezes my good fingers once, a quick pulse like a farmer's hand on a cow's full teat, and half-smiles at a ficus tree across the waiting room. It's just us and the ficus, the swanky sofa, a pair of club chairs, and a spring water dispenser that emits occasional burps. At the other end of the room, Dr. Lindholm's receptionist sits with her profile to us, typing industriously away. She is middle-aged, the mother of college students, perhaps; still styling her hair in the Dorothy Hamill she chose when the eldest was born. She has on glasses and brick red lipstick; her back is Miss Porter's School, I'm-not-listening straight. She yanks a sheet of paper from her typewriter and rolls another in.

"So that's--what? Like, thirty-three bucks, huh?" I tip my head to the side, toward Dr. Lindholm's door. "Think she'll give us a discount if we complain?"

"Goddammit," Robert says quietly. He pulls his hand away and tucks it under his arm. His other hand comes up and clamps itself around his biceps, the naughty fingers that had tried to socialize with mine now locked securely away. The tips peep out from under his armpit, his fingernails reproachful. That's not funny, they say to me. You're not one bit funny at all.

"Sorry," I say again.

Robert stares straight ahead.

"I'm sorry, Robert."

Not like this has to be such a big, freaking deal.

I refurl my depressed-hemophiliacs pamphlet. "Like many other of the `silent diseases,"' I read, "the emotional effects of hemophilia on adolescent males, in particular, can be invidious." On the cover, there's a picture of a neurasthenic young man sitting on a bed, his chin in his palm. He's wearing a Nirvana T-shirt and a pair of enormously wide-legged jeans with ratty, frayed cuffs, a compromise between grunge and hip-hop circa 1993. He is definitely not some ad company's stock photo. He is pimply-faced and weak-chinned; his hair has only recently begun corkscrewing into coarse curls. His upper lip is sooted with scraggly growth and for a second I take pity; he needs a lesson from his father. He needs to sneak open the medicine cabinet and squirt the pile of Foamy in his hand, Now where did I see that razor again? One stroke across his cheek, another along the naked boomerang of his jaw...Would a single nick, a dull, crusty blade do the trick?

Briefly, I'm taken back to my earlier question to Robert, my joke. A little of my Nirvana-boy pity comes along for the ride, however, changing something of its shape along the way, and this time the whole thing strikes me as less funny. After all, I never mean to hurt myself, either. My injuries usually evolve from a minor bump or bruise that I nag into a major medical issue. I guess I've always thought it was okay to hurt myself because if something really horrible came of it--an amputation, say, or something fatal--I could blame the original, unintended wound: I didn't do it to myself; it just happened to me. Years ago, when we used to talk about this stuff, Robert told me he would never forgive me if I killed myself, and you wouldn't think that was the kind of statement that allowed for wiggle room, but I suppose if anything could provide it, unintended injuries might just be the ticket. But it's no longer a negotiable topic--it hasn't been for years; bad me, to have brought it up--and so I sit silent and studious, waiting for Dr. Lindholm, and Robert sits locked behind his angry arms. This is the way she finds us.

"Darien Gilbertson?" She smiles.

That's me. I stand up.

Dr. Lindholm's eyes fall briefly, assessingly, to my blue fingers, and then skip back up to my face. "Pleased to meet you. I'm Rachel Lindholm." A quarter turn. "And you must be Robert." Robert agrees that he is. "Shall we?" Dr. Lindholm takes a crab-step in the direction of her office, and Robert and I follow her in.

"So, Darien. Robert." Dr. Lindholm fixes each of us with a brilliant, competent smile. We take our places on furniture carried over from the Harvard waiting room: Robert and me thigh-to-thigh on a burgundy leather sofa with such a high polish you could probably see your reflection in it; Dr. Lindholm in a gray leather easy chair with one foot tucked up under her, casual-like. Two vanity-sized boxes of tissues mark either end of the coffee table that separates us, his and hers in neutral ecru. "Gilbertson? Do I have that right? I look at my notes and I can barely read my own writing." Dr. Lindholm screws up her forehead and frowns down at a leather portfolio in her lap, turning it to one side and then the other, an Etch-a-Sketch. She shakes her head. "Gilbertson. I'm sorry you had to wait."

We both nod mutely, awaiting the explanation. Dr. Lindholm beams at each of us a little more. "So, let's get down to business, then," she says. "Can I get either of you coffee? Coffee? No? Okay." Her eyes shift meaningfully to my hand. "Where should we start?"

I measure Dr. Lindholm before launching in; there's no way this is going to work. Already, I hate this woman too much. Dr. Lindholm is tall and willowy, and Aryan to the extreme: corn silk hair in a chin-length bob, pale blue-gray eyes and skin with an enviable translucence I swear you can see bones and blood vessels through if you catch the light right. She's dressed in a sage green suit, discreet letter Cs stamped on the buttons, and heels that actually match, Garanimals for the professional set. I look for a run in her stockings, lipstick on her teeth, nothing. She looks like somebody's wife, a social trophy with a standing date for tea in the Oak Room and a box seat at Lincoln Center. She looks nothing like a doctor to me.

Robert got Dr. Lindholm's name from a nurse in the emergency room, who said that she was the best for self-mutilation cases. We apparently were lucky to get an appointment so quickly, though lucky wouldn't exactly be the word for how I feel at the moment. With Dr. Lindholm sitting across from me like some giant bar of Ivory soap, I feel dull and grubby, and suddenly ludicrous in my suit. I'm five foot two and tend toward skinny, pasty-skinned, Elvira-haired; I wear makeup and keep my hair long as much as anything to minimize the chances of being mistaken for a boy. For a second, I shift my gaze to Robert and then back again, mentally pairing the two of them, Robert and Dr. Lindholm, she's a little old for him, RobertandLindholm, but then again, he's a little old for me, thirty-five in October. I wonder if he finds her attractive.

As if pondering this possibility himself, Robert leans forward, his elbows on his thighs. "We start right here, with this hand," he says. "I think I told you all of this on the phone yesterday, right? We're here because Darien needs some...needs a whole lot of help. She's always had this self-destructive streak, but for the most part she's been okay. We've kept it under control." He pauses and glances quickly at me. "But then Monday night she broke her hand while I was at work. Actually broke her own hand, and won't tell me why. It's something that she used to do when she was younger, and that's just--it's just a big freight train we need to put a stop to right now. I'm scared as hell. I'm really pissed off. And I jus...

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