Time it was,

When I was a child, hospitals were different. They smelled of Hexol, of the carts of dirty laundry in the corridors, and of sick people rotting. Now: nothing. No smells at all. Hospitals are clean, bright, odorless, medical malls. Leaving the phone noise and computer tapping at the nurse's station behind, the hallway got quieter and quieter as I walked to find room 417, the only sounds were my steps on the floor and the buzz-hum of a struggling fluorescent tube up ahead, overhead.

At one open door, a bandaged head lay on a pillow moaning and a television murmured. At the next, a short, broad, old man wearing sagging briefs and a gaping green hospital gown shuffled to the door in the far corner of his room.

At 417, the late afternoon sunlight through the blinds made stripes on the floor. The room lights were out, the television dark and silent; of the two beds, only the one closest to the door carried a shape. Marie lay in shadows with her head sunken in the pillow, eyes closed, hands atop the covers on either side of her body. She had an I.V. tube running to the back of her right hand and the tip of her left index finger had a red light taped to it.

I stood at the door watching her breathe. I couldn’t tell by looking, so I asked softly: Are you asleep?

Hi, Artie, she said, then opened her eyes. She didn’t try to sit up or even turn her head to look at me. Instead, she felt for the control by her right hand and pressed a button. The foot of her bed whirred and began to rise, then sank. Then the head of the bed began to rise. She didn’t try to lift her head, but just let the bed raise her.

I knew she was 42, but I’m no good at assigning ages to people. I couldn’t tell whether she looked old, only that she seemed exhausted. Her eyes and cheeks were sunken, the hollows were bruised-looking. Her skin was too pale against the brown ringlets of hair on the pillow.

If you want to sleep, I can come back later, I said.

Don’t you dare go.

Okay. There was a chair next to the door; I pulled it beside the bed. You look like you should be in the hospital.

"I need to get out of the hospital before they kill me. You come in for something minor and almost don’t survive. Pity … ." She closed her eyes, the lids trembled.

Pity you did? I said.

Yeah. You know. Whenever I go to sleep, I wish I just wouldn’t wake up

Me too. I pray for it—hasn’t done much good. It would be nice to be gone and not have the responsibility for offing myself.

"Of hurting family. Friends. Coworkers. If they had just put me under anesthesia and I slipped away—nobody’s fault, just one of those things.

I’d miss you, Marie.

Yeah, I’m pretty entertaining. God, I’m tired. I wish I could sleep.

I thought they gave you sleeping pills. That they’d wake you up to make sure you took them.

They wear off. Then my eyes pop open and I can’t shut my mind off. So how are you? I’d rested an arm on the bed. She laid her hand with the I.V. tube on my arm.

Me? Oh, you know. The same. I was flustered having to go from concern for Marie to thinking about myself. She was good at bending the conversation back to the person asking questions.

Depressed?

Oh, sure. Yeah. I sighed. That never goes away.

Suicidal?

Not so much today. I’ve got someone else to worry about.

That would be me?

That would be you.

Thank you. It’s good to have someone worry about you.

"Sometimes. Sometimes having people care is a pain, though. What did they do to you in here?"

Well, they’re kind of reluctant to give me any details. It started out as a standard abortion … She paused for a few seconds and took a couple of breaths. … and—do you know what a D&C is?

Yes.

Well, they got to the scraping part of the D&C and they think they either tore loose a polyp or just gashed my uterus. I started bleeding. I hemorrhaged and it took them a while to stop it. Then they had to pump me full of blood to replace what I lost. She looked like she was about to cry. I’m too old for this.

I don’t think your age had anything to do with it.

"I don't mean the medical stuff. I mean the running around like a teenager.

I hear that you’re just—

"—Cut the being supportive crap! I need to vent. I’m angry!"

Okay, so vent!

I will if you’ll just stop being so damn understanding. She took a couple of breaths. Mark came to see me.

That was good of him. Mark was the boyfriend. My father used to have a saying: Not worth the powder it would take to blow him to hell.

You really don’t like him, do you? She had to defend him.

I think he’s a jerk. Maybe worse.

I love him. Anyway, he brought his daughter along.

"Here? To visit you? How did he explain that? ‘This is the lady your daddy is sleeping with behind your mommy’s back’?"

"She’s four years old! He didn’t have to explain anything. I was just a sick lady her daddy knew. Her name is Chrissy—Christina—she’s so cute. Marie smiled. He introduced us, and we were going to shake hands, but the I.V. tube scared her and she ran and hid behind Mark"

Christ, I said, what did he tell his wife? Amy is it?

"His wife! What did you tell your wife?" Now she was angry at me.

The truth, I said. That I was going to the hospital to visit you because you had surgery for female problems.

An abortion. Her anger would flash, then disappear. She was back to being tired.

What did he tell his wife?

They were having a father-daughter ice cream date and they stopped in to visit a sick lady from work.

Great. Use a four year old to—the man dropped in my esteem.

At least he came.

You didn’t expect him to.

No. She was on the verge of crying again. She sobbed once. Go away.

If you want me to. She often said she did, but didn’t want it. She spent so much time miserable alone that sometimes she thinks she prefers it.

I don’t want you to see me cry.

I’ve seen you cry.

I don’t care.

If I left every time you cried, I’d never see you at all.

"Just go away! Her tears had collected in the hollows of her eyes. She shook her head from side to side to clear them. Ouch!"

Hurts to move?

Yes.

What’s really the matter? Why are you crying?

I want a four year old daughter in a blue dress. She sobbed again. Ouch.

I took out my handkerchief and held it out to her, Here. It’s clean.

No!

What’s the matter? It’s clean—

You can’t take my tears home to your wife!

What? That’s crazy.

You can’t have my tears. Get me some toilet paper please.

I went in the bathroom a few feet away. There was a tissue dispenser built into the wall. I pulled out a couple of tissues and took them back to her. I didn’t think it was necessary to point out the irony of wanting a child after having an abortion.

Maybe you’re not the right person to raise a child—

"Why not? What’s wrong with me? Clients are having kids and raising them all the time."

I don’t think you want to compare yourself to our clients. They’re raised on welfare and they raise kids who get pregnant and go on welfare. You can’t live that life.

No. She blew her nose, ouch!

You can’t raise a child by yourself.

Well, why wouldn’t Mark leave her and marry me?

—Well, you’re crazy and he’s detestable.

Maybe he wanted a four year old daughter with a blue dress too.

"He left his first wife and the two boys when he got Amy pregnant, and he married her. Why couldn’t he leave her to marry me?"

You’re lucky he wouldn’t. If he’d leave her for you, he’d leave you for the next one.

He loves me!

No, you love him. He screws you. Look, I don’t want to talk about him. You’re not going to change, you won’t dump him, there’s no point in me criticizing the guy you’re in love with. He’s made it clear he won’t leave his wife whether you’re pregnant or not. Don’t count on him helping you raise a baby.

Outside, the sun went behind a cloud; the room got dim.

Why can’t I raise a baby?

You’re … complicated. You can barely hold a job and take care of a dog. Babies are a hundred times harder than a dog.

"As if you’d know." She had moved from being sad to being angry.

You asked, I told her, so I tried to give an answer.

Every question doesn’t need an answer. Every problem doesn’t need a solution.

"I know. I have this conversation every month or so with Emma. Why are we fighting?"

I want to fight!

"I know, you’re angry. But you’re not angry with me, you’re mad at Mark."

No, she said. At God. And you believe in God.

But you don’t. How can you be mad at God if you don’t believe in her?

Don’t go making God female. That’s a trick. God is an old man with a white beard.

I don’t believe in that God, I said. It was pointless to argue God with her again. What does God have to do with anything?

God hates me.

God doesn’t hate you. You’re just pissed because God doesn’t fix all your problems.

"Then you hate me!"

I do? And why do I hate you?

Because of the abortion.

I sighed. I think you made the right decision, I don’t see what else—

"You’re Catholic!"

Yes, but I’m not a very good Catholic. I can’t condemn you. You’re dear to me.

You can’t make me feel better. She tried to move, probably to cross her arms and winced with the effort. She lay still.

I know. You have to be angry, and you have to cry for Mark and the baby.

"Damn you! It was almost a hiss. You’re so damn wise. Get away from me!"

I got up and put the chair back beside the door and stood in the doorway. I’ll come by tomorrow. You’ll be in a better mood by then—

I’m going home tomorrow.

Don’t be ridiculous, you can’t even move without—

They’re discharging me tomorrow morning!

Okay, okay. Do you need a ride home?

John from work is driving me.

Okay, good. I’ll call you at home. Let me know if you need anything. Groceries, whatever.

Thank you. she said. She sank back into the pillow and closed her eyes. I love you.

I love you. Goodnight, get some rest.

—God bless you.

Outside, the sun was on the horizon, lighting the undersides of the tattered clouds and painting a pink and red roof over the sky. The colors reflected from the puddles left by the day’s rain, and from the wall of windows that made up the side of the hospital. It was one of those dramatic shows that God puts on for no discernible reason.

The February air was heavy with moisture, clear, and cold. A good time to smoke.

The hospital had declared all its property off-limits to smoking except designated benches where smokers could huddle with no protection from the weather. The bench was only slightly damp; I lit my cigarette and slumped down. Had you noticed me sitting there—you wouldn’t, I am quite ignorable—you would see a slouching 52 year old man. I’m ten years older than Marie, with straight brown hair turning gray at the sides and a small pot belly.

My face is a testimony to the wisdom of my older sister. She predicted that, if you keep making that face, it will freeze like that, and so it has. I have bags of creped skin under my eyes and my mouth is set in a frown. The lines and creases have been worn into the flesh by years of pessimism and fret; the resting mask of my face is worry and sadness.

My sister also observed early on that I had pig-eyes: black glittering, irises sunk beneath overhanging brows, though I have never made the oinking, grunting, noises she made when pointing out the feature.

My fingernails are bitten down. Still, after all these years, I bite my nails and gnaw at my cuticles. It’s a little better now that I’ve begun smoking again. I smoked for twenty years, quit for eight years, then—when the medication quit working—took up smoking again. I’ve been doing it for five or six months.

Smoking is wonderful. The cough and possibility of cancer aside, the first, immediate, lift that comes from lighting up is one of the few predictable joys in my life. It worked when the medication didn’t. And the smoke lifts our prayers to heaven.

—I need to die, god.

By the time I had finished my cigarette, the low ceiling of clouds was purpling. I got my car out of the lot, and by the time I got home, it was dusk.

The first thing to hit me as I came in the front door was the warmth and comfort of the house. Then, raw onions. Emma was cooking stir-fry. She was in the kitchen, her chef’s apron looped around her neck and tied at the waist. As I came into the kitchen and stood next to her at the stove, I smelled garlic. On the cutting board was broccoli, garlic, chopped ginger-root, carrots, a couple of sliced mushrooms, and chopped onion. The chicken had already been browned and waited on a paper towel, the rice was spurting steaming water from under the lid, which ran down the pot to hiss on the gas burner. The wok was on its stand over a burner on high. Emma cooked everything on high.

We two have a custom. When ever we separate from each other—to go to work, to take a walk—we kiss. And when we see each other again, we kiss. Standing next to her, I was within kissing distance, and she was ignoring me.

—So she is angry.

She was sniffing, sniffing sniffing. She could be crying, it could be the onions.

So how is she? Emma said. She didn’t look up, kept her head bowed over the wok though there was only a puddle of rippling oil in it. Her hair, brown like mine, had held its color better than mine; I had more gray, though she was five years older, 57. As she kept her head bowed, her shoulder-length hair swung forward and hid all of her face but her thin nose.

She hemorrhaged and almost died, but they finally got the bleeding stopped.

That’s good. Emma startled herself then added: That she didn’t die.

Are you crying? I asked.

No, it’s the onions. I need to start cooking now. Go away. I could see her shoulders were tense. It would not be a good idea to touch her.

Okay. I went into the living room. We didn’t speak of Marie again until much later that night.

Emma was in bed burrowed under the covers. I couldn’t tell if she was asleep or not. The light was out, I got out of my clothes in the dark and put on my sleeping shorts. I knelt down beside the bed.

You always pray, she said. What do you pray for?

Sixteen or seventeen years I’ve prayed. You’re just curious now?

Tell me.

This is what I pray: Thank you god for today’s sobriety. Thank you for the good things you’ve given me, the good things you’ve taken from me, and the good things you’ve left me. Thank you for the bad things you’ve given me, the bad things you’ve taken from me, and the bad things you’ve left me. Make me the man you need me to be. Thank you, god, I love you. I got up and slid into bed.

Maybe you already are, she said.

Am? I was a little confused.

—Such a poor tool, certainly god can do better!

You mean I’m already the person god needs me to be?

Yes.

Perhaps, was all I could say.

She was quiet for a few minutes, then started sniffing. Now she was crying.

What is it? I said.

"Don’t you ever pray for people?"

Of course. I lie in bed and bless everyone I’ve met during the day.

Me? It came out as a sob.

Always. Every night for however many years—

"Her?"

Marie? Yes, for the last few months that I’ve needed her—

"Needed her! Needed her! What is it she gives you that I don’t? I’m your wife. What’s going on?"

She listens to what you don’t want to hear.

"You tell her things you don’t tell me?"

Things I told you that you said you didn’t want to know—

What things? Tell me now!

You won’t like it.

Do you talk about me? Tell me!

No. Not about you. I tell her that from the moment I wake up until the time I go to sleep I want to be dead. Even before I wake up—as I’m waking, I realize what’s coming and the depression sinks on me and I’m smothering, and I think, ‘Fuck, another day. I can’t do another day.’

Stop it. Stop it. She is gulping air. I don’t want to know you spend all day wanting to die.

I know, Emma. That’s why I don’t tell you.

So I just get the silences.

If I have anything happy to say, I say it.

But you don’t have anything happy to say, so I just get the silences.

Sometimes it’s a lot of work to stay quiet.

"And she listens to your gloom. What about your damn therapist?"

You know we can’t afford for me to go to the therapist more often than every two or three weeks—

"It’s her job."

And she’s very well educated, and has met with hundreds of depressed people. She knows everything you can know about depressed people that you can learn from reading or secondhand.

Why isn’t she good enough?

I’m depressed all day every day. And she can’t say the one thing Marie can: ‘I know how you feel.’

What?

Marie is the same way I am.

So you spend the day talking about killing yourselves?

We spend a few moments, most days, agreeing that we don’t need to kill ourselves. It’s been so important to find someone as screwed up as I am—

What about me?

You? You’re a comfort. I—

Don’t I do anything for your depression? Don’t I matter?

—You are the reason I’ve stayed alive. To keep from hurting you. But you don’t want to know that either.

I love you. You’ve changed my life, but no one ‘does anything’ for depression. It just is. It smothers everything. Nothing touches it, now.

"I’m jealous!"

I see that. I’m sorry. But I love you. I haven’t gone anywhere, I haven’t done anything. I’m here. I love you. She was lying on her back, I put my hand on her stomach, covered by her flannel nightgown. She said nothing.

I love you, I said again.

She said nothing.

—How long is my life going to go on?

Ambrose, the black and white shorthaired cat, slept between us at the foot of the bed.

Chapter 2

A New Doctor

The fourth floor waiting room was warm and stuffy after the cold wind outside. I’d taken sick leave from work for a doctor’s appointment—a psychiatrist’s appointment, actually. I’d never seen a psychiatrist, and it seemed about time.

A boy of about five, bucking, twisting, and sliding out of his chair, and whose only answer to his mother’s calm murmuring was, NO! was holding the room hostage. There was a teenager, probably female, with dyed black hair and a ring through her lower lip who sat doing nothing and seemed surprisingly accepting of the heat, noise, and wait. A dark-haired woman in many layers of clothes had an Elle magazine open in front of her face, her elbows on the armrests, but it was a shield; she watched the room over the top of it.

There had been some confusion and a short conference about my copay when my turn came to the receptionist’s window. They decided it would be $35. I had no idea what my copay really was. They gave me the medical history form on a clipboard and I sat down to fill it out. There were no surprises, I’d even remembered to bring a list of medications I was on.

I turned in my clipboard, picked up a copy of Highlights for children, and sat down to wait. I read the magazine from beginning to end. A child had already circled all the hidden objects in the full-page puzzle picture. The door that the receptionist had to buzz people through opened, and a bald man wearing half-glasses and reading an open folder called my name. I passed him into the hall, then waited while he caught up and led me to his office. He closed the door.

His office was pleasantly messy. The desk was pushed against the wall next to the door, there was one chair for me between the desk and door, and an office chair for him at the desk. There were 12 to 15 fat plastic pens on the top of his desk, all of them advertising psych drugs. File folders covered the end of his desk opposite where I sat. He was wearing a white, short-sleeved shirt, and a blue tie with no food stains. His arms and the backs of his hands were covered with wiry black hair. He was about 50, so his eyebrows had started growing in unexpected directions. He was mostly bald.

I’m Dr. Robert Smith, he said removing his reading glasses. He didn’t seem the type to welcome being called Doctor Rob, so I just said, Good to meet you.

There are a few preliminaries to get out to the way before I can accept you as my patient. He leaned back in his chair and laced his fingers over his stomach.

Fine.

Do you own a gun?

What? I was expecting something medical.

Do you own a gun or have access to one? I don’t accept patients who have guns, they’re too prone to—

No, I don’t.

—have a fit of depression and guns make it too easy to complete the act.

What about a BB gun?

What? It was his turn to be confused.

One of those Daisy Red Ryder BB guns: if you shot yourself with that, it wouldn’t even break the skin, you’d just have little round bruises where the BBs hit.

"Do you own a gun?" He was testy.

I said, ‘No.’

The second thing is that I’m a doctor, not a therapist. If you are having some sort of crisis, there is no point in calling me. You wouldn’t get me in any case. Call your therapist.

Actually, I said, my therapist doesn’t want to be bothered either. She said to call the suicide hot line.

"Fine. He had lost his place. He hunched over his folder. Then he remembered: Do you hear voices?"

Of course. My hearing is fine. Oh, wait, you said you were a doctor, so I thought—never mind. Do you mean voices of people that aren’t there? Son of Sam voices?

"YES."

No. Just the voices of people who talk to me.

"Do you see things that aren’t there? That other people don’t see?"

I don’t hallucinate sounds or visions.

Do you have thoughts of harming yourself?

—What a quaint way of talking about suicide.

Yes.

About how often?

Four or five times a day. Actually, it varied. Every ten minutes or so. Sometimes more often.

Have you made any plans?

To kill myself? Dozens, maybe hundreds. And got the materials together. And got rid of the materials. Part of my brain is always looking for ways to die. So far, I’m okay.

So why are you here to see me?

About eight years ago my depression got so bad that I mentioned it to my doctor— Dr. Smith interrupted me to get the details of my primary care physician, though I’d written it all down on the sheet I filled out earlier. —Anyway, my doctor prescribed Paxil. It made me panic to go indoors and made my hands numb. So we stopped that. Next he tried Zoloft which worked great. My wife might say too well, because sometimes I got silly. And the sexual—droop? shall we say—was hard to live with. But it helped enough that I stayed on it for eight years. Then last October, Zoloft stopped working and I crashed worse than ever. Much worse. Since then, we’ve been trying other medications.

Such as? Dr. Smith dropped my folder in his lap and let his left hand fall on the desk top; he wore a heavy gold wedding ring. He picked up a pink plastic pen that said, Zoloft, clicked it to extend the point, clicked again to retract the point, then he gently placed it back on the desk.

Oh, Trazadone, I said. It didn’t do anything. I shouldn’t say that. It worked well as a sleeping pill.

You have trouble sleeping? He looked like he might be about to open my file and write something.

Sometimes. Not always. He decided it wasn’t worth writing down.

What else? His hand hovered above the pens.

Serazone. It made my depression worse.

Interesting. He picked up the the Zoloft pen, ignoring a perfectly good gray one that advertised Serazone, opened my folder and wrote for a while. He lay the pen down on the desk, to the right of the Serazone pen. Anything else?

Wellbutrin. It did nothing. Well, it made me forget to smoke, I guess.

So you’ve quit smoking?

I started again when I stopped the Wellbutrin. Now I’m on Effexor.

What dose? He picked up a green pen. I didn’t want it to say Effexor, but it did.

150 milligrams, timed-release, in the morning.

And—

Nothing. No help.

You’re on a fairly low dose. Effexor is good. We can raise the dose.

I sighed. We can try that.

What’s the problem?

"I’m tired. Tired of drugs that don’t work, tired of having to gradually go up on them and stay there for two weeks to make sure, then taper off before we can start slowly going up on another drug that doesn’t work."

Yes, primary-care physicians tend to be conservative. We won’t do that.

Won’t do what? I had no hope of anything different.

We’ll go up much faster and just stop the medication when it clearly doesn’t work. We’ll cycle through medications faster.

The process of testing the drugs is infuriating. That’s why I asked for a referral to a psychiatrist.

Hmmm, yes, I expect you had some trouble finding a psychiatrist to take you as a patient.

How could you possibly know that?

Your HMO is well-known for underpaying psychiatrists. I expect we raised your copay.

I don’t understand.

Suppose your copay is ten dollars, at least that’s what your HMO says. But your HMO doesn’t fully reimburse us for seeing you, so we charge you the difference between what we bill them and what they pay us.

They short you $25 so you add it to my copay.

I don’t know any such thing happened, I don’t participate in the financial end of things. And by the way, we never had this conversation.

That’s very generous of you, I told him. He looked at me sharply, sensing sarcasm, but I was depressed, for god’s sake: nothing made it through my dead affect. I thought I would reassure him, It’s been difficult finding a psychiatrist. He seemed to buy that I was not being ironic.

—Idiot.

He picked up a prescription pad and started writing. Interestingly, he wrote in legible, block, letters. I’ll give you a prescription for 300 milligrams of Effexor. He tore it off and handed it to me, then stood up and walked to a small credenza. He opened the drawer of the credenza. It was about six inches deep and at least four inches of the drawer was full of sample packages of drugs. Get it filled, but hold off taking it. Let’s see, timed-release Effexor. Here’s some. He handed me a flat foil package of capsules. It was labeled 75 mg. Effexor XR and held seven blisters of capsules. Take your usual 150 milligrams plus one of the 75 milligram capsules for a week. Then start on the 300 milligram capsules after a week. We’ll get you up to the maximum dose in a week instead of a month.

He scribbled something on a slip of paper and handed it to me. Give that to the receptionist, I’ll see you in a month. That’s all. He wrote some more in my file; I was no longer in the room, though I was still standing there.

Chapter 3

Thursday

By Thursday, Marie still had not returned to work. The bureau chief, Marie’s supervisor, would know when she was due back, but I avoid the bureau chief. The other sources of accurate information are the clerks, who field all our phone calls, deliver mail, assign cases, and generally warn us when something ugly is headed our way. The clerks hadn’t any idea when Marie was due back.

I e-mailed her Yahoo address, but got no answer. I telephoned her house and got her machine, then left a long, rambling message, because, even though she has never returned a phone call to me, she will occasionally be sitting, listening to the message as it records, and pick up the phone. She didn’t pick up the phone.

John, from the inter-county transfer unit, said that he did meet her Tuesday morning at the hospital and drove her home. She was in pain. He hasn’t heard from her since.

She might be dead. Or have had some medical complication, or be in a severe depression, I can't know. She has been known to disappear from work for weeks at a time, then return with no explanation, behaving as if she had not been gone at all. My understanding is that she has a network of people who check on her who have keys to her house: an ex-husband, an old boyfriend, several women friends. I’m not part of the network. I have learned not to worry about her; she has always eventually showed up. Of course, that is nonsense; I am no more able not to worry than I am not to bite my nails.

It’s only been a couple of days, but as I expected, going up on the dose of Effexor has done nothing. In a week I’ll see what doubling the dose does.

We work in the welfare department. It isn’t called that, it’s called the Department of Human Services and Aid. The human in the name is important, it keeps people from bringing in pets and livestock for services and aid. Except seeing-eye dogs, we do have a program for them.

The Department of etc., or DHSA, as we call it when we’re not calling it the welfare department, is only the latest name change in a series going back decades. No one in upper management uses the word welfare, anymore, they