Dr. Caroline
You can tell me anything.
When you’re in this room, and we’re sitting across from each other, and your mind is reeling with all the bad things you’ve done to people and all the bad things they’ve done to you, you can let it all out into the air between us. All the weird sex stuff, the compulsive jerking off, the period blood staining the gym shorts when you were thirteen, the infidelities, the regret about having kids or not having kids. You can tell me about the time you did mushrooms and made out with a window for three hours, or that time with your dad’s friend, that time you felt a stranger’s boner press against you on the subway, how you wish your mother would just die already, how you accidentally screwed that IT girl in the conference room, how the rape scene in Deliverance turns you on, how you obsessively think about sex or food or death, how you should get more sleep and make more money, how you should eat more ugly foods and buy more reusable bags, how you lied about voting for Obama. How you wish you were a better person, a better spouse, a better parent, a better worker, a better citizen. How there is something else you should be doing, how you feel trapped in this life and in this body and every day it’s like you’re living and reliving that Talking Heads song. Well, how did I get here?
You can tell me any of it; you can make a list ahead of time or just barf it all up when you sit down, and I will never tell anyone.
Imagine weighing yourself on a bathroom scale, and all the little black lines represent all the things you can tell me—the dial can bounce up and down as many times as you want, and your secrets will be safe with me. There’s only one red line we have to worry about, only one little tick mark where the dial has to land in order for me to break my promise, and that would be if you told me you were going to kill someone.
My anorexics love this metaphor.
And yes, of course, if you were going to harm or kill yourself, I’d have to make a call, but if you’re telling your shrink in person you’re planning to do yourself in and didn’t happen to stash your chosen weapon in your purse, chances are you are open to being talked out of it.
My patients call me Dr. Caroline for a couple of reasons. One, because the goal is to make them comfortable, to convince them I am like their smart, impartial friend who has their best interests at heart. Two, because of the Marvel thing. There is a superhero, Doctor Strange, who travels through time/space and knows physics, I guess? I’ve only seen a couple of those movies with my family and don’t care for them. All that Sturm und Drang, so much emotion and wrestling with life choices. I get that day in, day out, eight-thirty in the morning to eight-thirty at night, so when I go to a movie, I just want to see cars blow up and perhaps a nice pair of tits I can admire wholesomely from afar.
I live in a wealthy neighborhood in a wealthy city. Where Botox meets craft butchery, and even the homeless people can do a mean upward-facing dog. It’s Brooklyn, so there is still a little edge here and there—the tall, thin vape twins who can barely keep their eyes open even as they blow smoke into your face as you pass them on the sidewalk; the guy with the elaborate facial tattoo asking for coffee money in front of the pediatrician’s office; the lady who sits on a tuffet of garbage bags in the bank vestibule. I like this about where I live. I grew up in a sleepy Wisconsin suburb where the most exciting thing that ever happened was two rival dentists got into a fistfight at a sports bar once. When I came to New York City for school, I never looked back.
My patients are primarily from the privileged masses: Prospect Park soccer moms and aging hipster dads, anxious gainfully employed millennials and their oddly relaxed unemployed counterparts.
The lot of them were silenced for a few weeks by the collective sonic boom of the pandemic. In the beginning they resisted the Zoom sessions, but then they caved one by one, and those first appointments were cacophonies of panic; whatever trivial transgressions they’d experienced or caused in their former lives were crushed like a kombucha can under a Prius tire. Very few of them got the virus or knew anyone who’d died, but still, their wild fear seeped through the screen, and I was there to absorb it.
I felt extra-useful in those days, shepherding them from one day to the next, so many of them moving through the most precious realizations (I should spend less time on social media and more time with my kids!, I should listen more than I talk!, I should stop forcing people to look at my dick!). But then, after a couple of months, they realized they would probably not die, that they were safe in their little corner of the world, so they went back to old habits and old complaints, running out our time together wringing their hands about emotional affairs with their work husbands, or how Dad had yelled too much, and I’d send them off with a virtual pat on the head and a prescription for their Lexapro/Klonopin refills.
So it’s not triage in the ER, who cares? This is my job, and, not to put too fine-tip a point on the scrip pad, all those complaints and meds paid for the brownstone where I live with my family on the parlor and upper levels and meet with patients in the ground-floor office.
I still get a flutter of excitement when I see a new patient, because it really is like a blind date in many ways: will we gel; will we click; will he recognize me as a fellow human and show me something. But between you and me, it doesn’t matter if he decides to show me anything, because I’ll see it anyway. I watch the hands; I watch the legs crossing; I watch the gazes toward the window. I listen for the vocal modulation when he’s speaking about money/sex/Mom/Dad. Give me an hour, I’ll tell you who you are.
Second thought, make that fifty minutes.
It’s a steaming June day after arguably the worst year humans have seen in a good long while, and a new patient is coming without a referral, which is even more exciting, a blind-leading-the-blind date.
There is an internal staircase leading from my home down to my office, but I walk outside and down the stoop and enter through the door under the stairs just so I can see what he will see: in front of the windows, a cream-colored couch with a small cylindrical table at one end where he can place his phone and water bottle. Also on the table are a box of tissues and a dimmable-display alarm clock, which is for me to keep track of the time. He will also have an identical clock to look at, on another cylindrical table next to my wood-framed chair, an office chair that isn’t supposed to look like it belongs in an office. But he has a choice—on the other side of his table is a plush swivel chair.
Where he sits will tell me the first thing. Most people will take the couch because it is more directly positioned in front of me. They’re not thinking too much about it. But those who choose the swivel chair don’t mind sitting at an angle, or they enjoy swiveling, or they don’t want to feel like a patient; they’ve been taught to associate couches with shrinks and they don’t want any part of that. So if they choose the swivel chair, they’re making a little statement, crossing their arms and digging in their heels: Nope, not gonna tell you anything.
There are two doors behind my chair, one leading to the kitchen, where I keep a Nespresso machine for myself, and the other to a half bath that patients can use. There’s a full-length mirror hung on the door of the patient bathroom, and how long they spend in there after the business is done, scrutinizing, muttering, fixing hair, and checking teeth, also tells me a great deal.
I don’t use the patient bathroom—for that I’ll go upstairs to my home—but I do like to review myself in the mirror. I wear a white suit for my sessions every day. Alexander McQueen wool blends—single-button blazer with boot-cut pants. The white is for both of us: for them, to see me as a blank sheet of paper on which they can write whatever they want; for me, an extra boundary. I’ve known therapists who wear distressed-hem jeans and cowl-neck sweaters with their patients, who sit cross-legged on beanbag chairs, and that is just not for me. It’s not a fucking square dance; it’s work.
The patients need the boundaries, even if they buck against them. And some, I would say most, end up appreciating them. Where will Nelson Schack fall?
I position the two linen-covered pillows, one to either side of the couch. Only certain patients use the pillows, always for support—clutching for emotional, tucked behind them for lumbar.
I adjust the temperature on the split AC unit by one degree. Some patients expel their sadness through sweat instead of tears, I’ve found, so better cool than hot.
I check myself in the mirror once more. The suit is pressed, but the silhouette is simple—I don’t look like I’m going to a Wall Street hedge fund or a wedding. Every morning I blow out my hair and style with a rotary brush; the result is natural but controlled, which is the goal.
Then come the three tones of the digital doorbell.
I open the French double doors into the hallway, where there is a single chair and a small table with recent New Yorker magazines in a fan. I answer the front door, and here is Nelson Schack. An inch or two taller than me, slender. Hair almost buzz-cut-short but not quite. Swimming-pool-blue eyes and clean-shaven except for a spot missed under the nose. Collared polo shirt, sweat circles in the pits. Khaki pants with slanted lines crisscrossing at the knee, ironed haphazardly.
“Hi, Nelson,” I say. “I’m Dr. Caroline.”
I hold up my hand in a still wave. Even though he and I have sent each other copies of our vaccination cards via email, I don’t need to put anyone through the pros and cons of a handshake with a stranger.
“Hi,” he says, only meeting my eyes for a moment.
“Come in,” I say, warm but professional.
I hold the door open for him, and he walks past me, giving off a scent of a musky deodorant with a little BO spike.
He stands in the hallway as I close the door, and then turns to me for instruction.
“Please, have a seat,” I say, gesturing toward the office.
I know he’ll take the couch before he takes the couch. He’s nervous; he’s never done this before; he won’t even think about it.
He sits on the couch, the middle cushion, and crosses his arms over his chest, his fingers cozy in the twin saunas of his pits.
I slide the double doors shut and take my chair.
“Before we begin, I need to make you aware of one thing,” I say.
He gets a caught-raccoon sort of look, so I don’t keep him in suspense.
“You can tell me anything,” I say, turning my finger in a small circle. “This is a safe space.”
Then I smile, and he smiles, relieved.
“What brings you here today, Nelson?”
He laughs and puts his hands on his knees, then says, “It’s a couple of reasons, Doc. I’m just not sure which one to talk about first.”
I nod, because I know. Their first time in therapy, they don’t know where to start. How did my life end up this way? is a big old rabbit hole to fall into, every rock you hit another loved one to blame.
“Why don’t you try just saying whatever comes to the surface first?” I ask, as if I’ve never suggested it to a patient before.
“Yeah, that’s a good idea,” he says.
His voice is unexpectedly high, as if he’s leading up to a question. Then he pats his knees with an air of decision and says, “Well, here goes.”
I give him another smile meant to convey the tell-me-anything rule, and he must truly understand it, because then he says something that I never could have predicted he or any other patient would ever say to me, not in my thirteen years of primary and high school, twelve years total in undergrad, med school, residency, and eleven years of private practice:
“I think I’m going to kill someone, Doc,” he says in that strange high register, his eyes scanning the corners of the room. Then he looks straight at me and says, “And I know who you really are.”
* * *
I’ll tell you a little bit about narrative omission in therapy. All of us—you, me, your mom, the dry cleaner—we all rewrite the stories of our lives as we tell them to other people. Sometimes we change things, but more often than not we just omit. We tell our listeners what they need to know, and nothing else. We do that because it’s human nature to get to the point, and to a lesser extent not bore the listeners. Why? Because we want them to keep listening to us.
No one cares that a Paleolithic-era caveman took a dump in a hole or was on the receiving end of a nut-cracking BJ from the missus. We care that he killed the bison, and somehow, even with his underdeveloped Neanderthal brain, he recognized that, so that’s what he painted on the wall.
My patients do this all the time; however, there’s a slightly more devious edge to it. I have a patient, let’s call her Meandering Marjory. Marjory drinks too much and pretends she doesn’t, which makes her as unique as half of America. So sometimes she’ll come in and tell me all about her day leading up to our appointment, how she got coffee in the morning and dropped the kids off at school and went grocery shopping and walked the dog, and it takes her twenty minutes to get through this much of the story and she keeps blowing air out, her upper lip flapping like a doggy door, and adopts a street accent arbitrarily (“You feel me, girl?”), and yet it takes me about thirty seconds to get her to admit that she also drank a pint of dark-and-stormies before showing up.
If you have been in therapy, you have done the same in some way. Sometimes you do it to cut to the chase; sometimes you do it because you don’t want your therapist to know something.
Here’s a hot tip: we know.
But rest assured, we do it, too. Because we’re all cavepeople together! All of us shitting in holes and performing/receiving fellatio, and yet we only pick up the charcoal to draw that pesky bison.
So when I said I grew up in a sleepy Wisconsin suburb where the most exciting thing that ever happened was a fight between two dentists at a sports bar, that wasn’t the whole story. Dr. Brower and Dr. Nowak did get in a fistfight at Gator Sam’s, but the town is known for something else entirely.
It made national news at the time, but Jeffrey Dahmer had been caught only two years before, and people on the coasts can only take so much news about the goings-on in the middle, even if it’s bloody. But in the Upper Midwest it was a big deal for a while.
In late June of 1993 in the village of Glen Grove, Wisconsin, a man murdered his family with a pair of hedge shears. The wife was thirty-eight at the time of her death; the children sixteen and thirteen. The blades on the shears were eleven inches long.
About now you’re rushing, skimming, skipping—you want to know it all, don’t you? You’re desperate for details—how did he do it with the shears, did he stab them, cut off their fingers or their heads? Or worse, you think, did he cut out their hearts … did he cut out their hearts and eat them whole, did the police find a pentagram drawn in blood on an altar in the basement?? No, wait, did he … no, it’s just too awful, he couldn’t have … did he have sex with their headless fingerless hollow corpses???
We all think we’ll be the ones so mature and self-realized that we won’t look at the car accident, but of course we look; we hope to see something horrible in order to capture the relief that it didn’t happen to us. It’s natural! Don’t beat yourself up about it, but really, satanic-inspired cannibalism and necrophilia are not that prevalent, despite what some swaths of the intellectually damaged population would tell you.
Yes, the Glen Grove murders were gruesome and gory and worse than the worst images from the first slasher movie you saw, which have burrowed into your unconscious so deeply you sometimes wonder if you didn’t actually imagine them yourself—Jason chopping off his mom’s head, Freddy gutting Johnny Depp (before he was Johnny Depp).
And I happen to have a personal connection to the event, which is not exactly a secret but also not exactly broadcasted, and so when Nelson Schack offers this pair of confessions, I think it best to focus on the one that feels more urgent.
“How long have you been thinking about killing someone?” I say.
He laughs, but not nervously. He seems delighted by my question.
“This one?” he says. “Not long.”
He touches his face, fingers to lips and around to the back of the neck. They are the moves of an anxious person, but again, he does not project anxiety. His eyes flicker like candlelight, and his smile, though slight, is genuine. Someone with a wonderful secret. He dropped “this one” thinking I may not notice. This one, as in there have been others. Though I’m always driving, I sometimes like to let my patients think that they are. It occurs to me that Nelson could use a sudden turn.
“Have you decided whom you’re going to kill yet, this time?” I ask, casual as can be, as if I were asking one of my older son’s idiot friends which extracurricular sports he’s doing in the fall.
He stops moving his hands around, and they stay at the back of his neck. Something doesn’t please him. Loses the smile.
“Yes, I have.”
I realize now would be the time for me to get nervous, if I got nervous. Which I don’t. Nelson Schack may be a few inches taller than me but doesn’t look like he works out like I do. I can’t make out his biceps, but from what I see of his forearms, I doubt he’d make it through a single resistance class at Pure Barre. The way his clothes hang suggest he’s not carrying a weapon, and if he is, it’s slight and ineffectual. Likely similar to his genitals and/or prefrontal cortex activity.
“Is that information you’d like to share with me?” I ask.
“Uh, no, not yet.”
“Okay,” I say. “We can pause on that. Have you decided the method of how you’re going to kill this person?”
Copyright © 2024 by Louisa Luna
