Just After Sunset(67)

I give him my card and tell him to call-day or night-if the idea of suicide begins to seem more attractive. He says he will. But then, almost all of them promise.

"In the meantime," I say at the door, putting my hand on his shoulder, "keep going steady with life."

He looks at me, pale and not smiling now, a man being pecked to pieces by invisible birds. "Have you ever read 'The Great God Pan,' by Arthur Machen?"

I shake my head.

"It's the most terrifying story ever written," he says. "In it, one of the characters says 'lust always prevails.' But lust isn't what he means. What he means is compulsion."

Paxil? Perhaps Prozac. But neither until I get a better fix on this interesting patient.

June 7, 2007

June 14, 2007

June 28, 2007

N. brings his "homework" to our next session, as I fully expected he would. There are many things in this world you can't depend on, and many people you can't trust, but OCDs, unless they are dying, almost always complete their tasks.

In a way his charts are comical; in another way, sad; in another, frankly horrible. He is an accountant, after all, and I assume he's used one of his accounting programs to create the contents of the folder he hands me before proceeding to the couch. They are spreadsheets. Only instead of investments and income-flow, these charts detail the complex terrain of N.'s obsessions. The top two sheets are headed COUNTING; the next two TOUCHING; the final six PLACING. Thumbing through them, I'm hard put to understand how he finds time for any other activities. Yet OCDs almost always find a way. The idea of invisible birds recurs to me; I see them roosting all over N., pecking away his flesh in bloody nibbles.

When I look up, he's on the couch, once more with his hands laced together tightly on his chest. And he's rearranged the vase and the tissue-box so they are again connected on a diagonal. The flowers are white lilies today. Seeing them that way, laid out on the table, makes me think of funerals.

"Please don't ask me to put them back," he says, apologetic but firm. "I'll leave before I do that."

I tell him I have no intention of asking him to put them back. I hold up the spreadsheets and compliment him on how professional they look. He shrugs. I then ask him if they represent an overview or if they only cover the last week.

"Just the last week," he says. As if the matter is of no interest to him. I suppose it is not. A man being pecked to death by birds can have little interest in last year's insults and injuries, or even last week's; he's got today on his mind. And, God help him, the future.

"There must be two or three thousand items here," I say.

"Call them events. That's what I call them. There are six hundred and four counting events, eight hundred and seventy-eight touching events, and twenty-two hundred and forty-six placing events. All even numbers, you'll notice. They add up to thirty-seven hundred and twenty-eight, also an even number. If you add the individual numbers in that total-3728-you come out with twenty, also even. A good number." He nods, as if confirming this to himself. "Divide 3728 by two and you come out with eighteen-hundred and sixty-four. 1864 adds up to nineteen, a powerful odd number. Powerful and bad." He actually shivers a little.

"You must be very tired," I say.

To this he makes no verbal reply, nor does he nod, but he answers, all the same. Tears trickle down his cheeks toward his ears. I am reluctant to add to his burden, but I recognize one fact: if we don't begin this work soon-"no ditzing around," as Sister Sheila would say-he won't be capable of the work at all. I can already see a deterioration in his appearance (wrinkled shirt, indifferent shave, hair badly in need of a trim), and if I asked his colleagues about him, I would almost surely see those quick exchanged glances that tell so much. The spreadsheets are amazing in their way, but N. is clearly running out of strength. It seems to me that there is no choice but to fly directly to the heart of the matter, and until that heart is reached, there will be no Paxil or Prozac or anything else.

I ask if he is ready to tell me what happened last August.

"Yes," he says. "It's what I came to do." He takes some tissues from the Eternal Box and wipes his cheeks. Wearily. "But Doc...are you sure?"

I have never had a patient ask me that, or speak to me in quite that tone of reluctant sympathy. But I tell him yes, I'm sure. My job is to help him, but in order for me to do that, he must be willing to help himself.

"Even if it puts you at risk of winding up like I am now? Because it could happen. I'm lost, but I think-I hope-that I haven't gotten to the drowning-man state, so panicky I'd be willing to pull down anyone who was trying to save me."

I tell him I don't quite understand.

"I'm here because all this may be in my head," he says, and knocks his knuckles against his temple, as if he wants to make sure I know where his head is at. "But it might not be. I can't really tell. That's what I mean when I say I'm lost. And if it's not mental-if what I saw and sensed in Ackerman's Field is real-then I'm carrying a kind of infection. Which I could pass on to you."

Ackerman's Field. I make a note of it, although everything will be on the tapes. When we were children, my sister and I went to Ackerman School, in the little town of Harlow, on the banks of the Androscoggin. Which is not far from here; thirty miles at most.