“No,” said Cassi. “As I said before, Thomas is working harder than ever. But he did admit that he is getting less enjoyment from his work. And he seems to have less tolerance lately.”
“Tolerance for what?”
“For anything. For people, for me. Even his mother, who essentially lives with us.”
Joan rolled her eyes. She couldn’t help it.
“It’s not that bad,” said Cassi.
“I’ll bet,” said Joan cynically.
The two women studied each other in silence for a few minutes.
Then Joan asked tentatively, “What about your married life?”
“What do you mean?” asked Cassi evasively.
Joan cleared her throat. “Often physicians abusing drugs will suffer episodes of impotence and actively seek extramarital affairs.”
“Thomas has no time for extramarital affairs,” said Cassi without hesitation.
Joan nodded, beginning to think that Thomas did not sound very “impaired.”
“You know,” said Joan, “your comment about Thomas’s low frustration level and the fact that he’s getting less enjoyment from his work these days is suggestive. Many surgeons are slightly narcissistic and share some of the side effects of the disorder.”
Cassi didn’t respond, but the concept made sense.
“Well, it’s food for thought,” said Joan. “It’s an interesting idea that Thomas’s success could be a problem. Narcissistic men need the kind of structure and constant feedback you get in a competitive surgical residency.”
“Thomas did remark that there was no longer anyone for him to compete with,” said Cassi, catching Joan’s train of thought.
Just then Cassi’s phone rang. As Joan watched her friend pick up the receiver, she was pleased. Cassi was already acting less depressed. In fact, she managed a smile when she realized it was Robert Seibert.
Cassi kept the conversation brief. After she hung up, she told Joan that Robert was in seventh heaven because he got another SSD case.
“That’s wonderful,” said Joan sarcastically. “If you’re about to invite me to the autopsy, thanks but no thanks.”
Cassi laughed. “No, in fact I declined myself. I’ve scheduled patients all morning, but I told Robert I’d come up at lunch to go over the results.” Talking about time made Cassi glance at her watch. “Uh oh! I’m late for team meeting.”
The meeting went well. There’d been no catastrophes overnight nor any new admissions. In fact, the resident on call was pleased to report that he’d gotten nine hours of undisturbed sleep, which made everybody extremely jealous. Cassi got a chance to discuss Maureen’s sister, and the consensus was that Cassi should encourage Maureen to contact her herself. There was general agreement that it was worth the risks to bring the sister into the treatment process if possible.
Cassi also described Colonel Bentworth’s apparent improvement as well as his attempts to manipulate her. Jacob Levine found this particularly interesting but warned Cassi about jumping to premature conclusions.
“Remember, borderlines can be unpredictable,” said Jacob, taking off his glasses and pointing them at Cassi for emphasis.
The meeting broke up early since there were no new admissions nor new problems. Cassi declined an offer of coffee, as she did not want to be late for Colonel Bentworth. When she got back to her office, he was waiting by the door.
“Good morning,” said Cassi as brightly as she could, opening her office door and entering.
The colonel was silent as he followed Cassi in and sat down. She self-consciously took her place behind the desk. Cassi didn’t know why, but the colonel exacerbated her professional insecurities, especially when he stared at her with those penetratingly blue eyes which she finally realized reminded her of Thomas’s. They were both the same startling turquoise.
Bentworth again did not look like a patient. He was impeccably dressed and seemed to have totally regained his air of command. The only visible hint he was the same person Cassi had admitted several weeks earlier were the healing burns on his forearm.
“I don’t know how to begin,” said Bentworth.
“Maybe you could start by telling me why you’ve changed your mind about seeing me. Up until now you’ve refused private sessions.”
“Do you want it straight?”
“That’s always the best way,” said Cassi.
“Well, to tell the truth, I want a weekend pass.”
“But that kind of decision is usually made by the group.”
Group was Bentworth’s major therapeutic agent at the moment.
“That’s true,” said the colonel, “but the goddamn ignorant sons of bitches wouldn’t let me go. You could overrule them. I know that.”
“And why would I want to overrule the people who know you the best?”
“They don’t know me,” shouted Bentworth, slapping his hand on the desk.
The sudden movement frightened Cassi, but she said quietly, “That kind of behavior is not going to get you anywhere.”
“Jesus Christ!” said Bentworth. He got up and paced the small room. When Cassi didn’t react, he threw himself back into his chair. Cassi could see a small vein throbbing in his temple.
“Sometimes I think it would be easier just to give up,” said Bentworth.
“Why didn’t the members of your group think you should have a weekend pass?” asked Cassi. The only thing she was prepared for on Bentworth’s part was manipulative behavior, and she wasn’t going to fall for it.
“I don’t know,” said the colonel.
“You must have an idea.”
“They don’t like me. Is that good enough? They’re all a bunch of jerks. Blue-collar workers, for Christ’s sake.”
“That sounds pretty hostile.”
“Yeah, well, I hate them all.”
“They happen to be people like you with problems.”
Bentworth didn’t respond immediately, and Cassi tried to remember what she’d read about treating borderline personalities. The actuality of psychiatry seemed a thousand times more difficult than the conceptualization. She knew that she was supposed to play a structuring role, but she wasn’t sure exactly what that meant in the context of the current session.
“The crazy thing is that I hate them, yet I need them.” Bentworth shook his head as if he were confounded by his own statement. “I know that sounds weird, but I don’t like to be alone. The worst thing is for me to be alone. It makes me drink, and liquor makes me go nuts. I can’t help it.”
“What happens?” asked Cassi.
“I always get propositioned. It never fails. Some dude sees me and guesses I’m a stud, so he comes over and starts to talk to me. I end up beating the guy to a pulp. It’s one thing the army taught me. How to fight with my hands.”
Cassi remembered reading that both borderline personalities and narcissists wanted to protect themselves from homosexual impulses. Homosexuality could be a potentially fertile area for future sessions, but for the moment she didn’t want to push into areas that were too sensitive.
“What about your work?” asked Cassi to change the subject.
“If you want to know the truth, I’m tired of being in the army. I liked the early competition. But now that I’m a colonel, that’s over. I’ve arrived. And I’m not going to make general because too many people envy me. There is no more challenge. Every time I go into the office I get this empty feeling-like what’s the use.”
“An empty feeling?” echoed Cassi.
“Yeah, empty. I feel the same after I’ve been living with a woman for a couple of months. At first it’s intense and exciting, but it always goes sour. It gets empty. I don’t know how else to explain it.”