The Good Patient: A Novel

The Good Patient: A Novel

by Kristin Waterfield Duisberg

Paperback(First Edition)

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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.

Product Details

ISBN-13: 9780312326074
Publisher: St. Martin's Press
Publication date: 04/06/2004
Edition description: First Edition
Pages: 336
Sales rank: 774,387
Product dimensions: 5.40(w) x 8.20(h) x 0.90(d)

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.

Read an Excerpt



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."


"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 just—I don't know what to do."

Good Lord. He makes it sound as if breaking hands was a regular habit of mine, like collecting stamps or Barbie dolls, an extracurricular activity. I wait for Dr. Lindholm's alarm, but she only nods and says okay. All very reasonable and clear. "Thank you," she tells Robert. "That can't have been easy for you to say. Now," she turns to me, "Darien. What about you? Why do you think you're here?"

"Why do I think I'm here?" After five doctors, I have the first visit procedure down and can go through the routine on autopilot, laying out the relevant data points like setting the table for a five-course meal. Anorexia at age ten, bulimia at twelve, alcoholism and sexual promiscuity with the onset of puberty; lying, nightmares, and self-mutilation for as long as I can remember. Everything from the knife rest to the fingerbowl. "I know why I'm here. I'm here because I broke my hand, and because that's really just emblematic of a whole host of other things that are wrong with me, or that at least have been wrong with me in the past." I throw the last of that out there, eager for her to ask about what those other things might be. Starving, puking, binge drinking, sluttiness, pathological lying—did I mention these before? I don't mind talking about them.

Dr. Lindholm doesn't bite. She just nods and waits for me to continue. "So I guess I'm here to deal with some of those things before I become the personal target of my insurance company." When neither she nor Robert as much as smiles, I add, "And, of course, because I love my husband, and I know what I did, what I do, is hurting him, and it needs to stop."

Shit. I can hear how insincere, how careless it sounds, even though I mean it. I open my mouth to backpedal. "I do love him," I say again, and when I can't think of anything further, I join in the silence of the room, punched with tiny, regular holes by the tick-ticking of a pendulum clock set on the wall like Switzerland between Dr. Lindholm's chair and the couch. I study the diplomas on the far wall and feel her study me. Wellesley College, 1979; Columbia College of Physicians and Surgeons, 1983. It figures. Robert smiles down at the square of carpet braced between his shoes, thumbs at his temples.

"I'm glad to hear that," Dr. Lindholm finally says. "That gives us the very best base to work from." A pause. "Whose idea was it for you to come here?"

"Mine, obviously." Robert looks up from the floor. "As you can see, Darien sometimes has trouble taking things seriously. Hurting herself is about as serious as she gets. She hasn't done anything in a long time—well, just little, clumsy things, like running into things by accident. By accident?" He turns and looks at me. I shrug. "But this thing on Monday really came out of nowhere. It just sounds too much like—" He stops. "I just want to know what it is I can do to help. I'm willing to do whatever it takes to make her better. I just need her to tell me the truth."

rdActing out is what they used to call it, when I saw my first therapist back in Philadelphia. With Robert here playing the parent role, pushing me to tell Dr. Lindholm what happened, the scene takes on a perverted sense of deja vu, history revised and improved. Haven't I sat through this lesson before?

At that first session, at the tenderized age of eleven, my mother hustled me in by the elbow and sat so close to me that I could feel her knee burrowing into my thigh. "This is nutty," she had announced to Dr. Gladys Flynn, combing maroon-tipped fingers through her Ann-Margret bob. "I have no idea what we're doing here, why this is any business of the school's. Did you know Darien's teacher said they were going to send Social Services to investigate me if I didn't bring her here to see you? Not that it's any of your business, but there's nothing wrong with her. Girls just go through these phases. Being attractive is important to them." She shook her helmet of hair, plastic bangles clattering noisily to her wrist. "I'm a good mother," she said. "I do the best I can."

Now, as I study the diplomas, try to see if Dr. Lindholm graduated Phi Beta Kappa, wonder if she had to choose between field hockey and tennis for the fall varsity season, I hear her say, "Darien, would you be willing to talk a bit about what happened Monday night?"

"Monday night?" I straighten in my seat. "Oh, yeah, sure. Well, I broke my hand, which you know, and I did it by hitting a wall, which you also know. But it was really more an accident than anything else. It pretty much happened by accident."

Robert turns to look at me, incredulous, and I feel my face grow hot at having been so quickly caught. It's a lie, of course, but what a clumsy, obvious one! A cow patty, a turd of the tongue. I really am out of practice with this therapist crap.

"Accident?" Robert and Dr. Lindholm speak in unison.

"Okay, so maybe 'accident' is pushing it, but it wasn't exactly deliberate, either. There must be some semantic nuance in between that would cover it. You know, sort of a deliberate accident. Is there a word for that?"

Dr. Lindholm shakes her head and says she doesn't know. "It's an interesting question, isn't it? Why don't you just tell me what happened?"

"Right, well, it's just, there's not that much to tell. I was standing up in the bathtub, shaving my legs, and I lost my balance and fell onto my hand. It hurt, so I was sort of pacing around in the bathroom, waving my hand in the air, trying to kind of shake it out, and when I was shaking it I inadvertently hit the wall. It actually made it feel better, hitting the wall, so when it started to ache again, I hit it again, this time on purpose, but only because when I did it the first time it made it feel better and I figured that maybe something had gotten dislocated or out of place. You know, reducing it, maybe.

"Anyway, I guess I hit too hard because that's when I broke it, just then, on that second hit. As Robert said, I broke my hand a couple of times before when I was younger, so it wasn't like it took a lot of effort. I think my hand is really just pretty fragile from having gone through that before. There wasn't much to it at all." Telling it this way to Dr. Lindholm, I almost believe it myself.

Dr. Lindholm looks at me, not writing. "Actually, broken bones tend to knit stronger."

I look back at her. Neither of us blinks. Her eyes are an unreal blue. Like a sled dog's, husky's. "That's right, isn't it?" I finally say. "They do. Must be maybe I have osteoporosis."

"At any rate." She glances down at her notepad. "We can talk about this more at a later session. Why don't you tell me a little more about some of the things that have been wrong with you in the past, as I believe you described it."

Robert shifts on the couch, making little protesting noises, but Dr. Lindholm cuts him short. "Robert, I think I heard you say earlier that you're here to help Darien, and pushing her on something she's not yet ready to talk about isn't going to help her at all. Now, I know that's hard on you and I know it doesn't seem fair, but you've come to me for advice and for the time being my advice is to drop it. What we need to do today is establish a baseline, and I know Darien appreciates that you're here for support in doing so. When Darien is ready to talk about the rest, I'm sure you'll do so, either in privacy or perhaps back here with me. But unless she has more to say, I think we're done with the topic for now."

And suddenly I like Dr. Lindholm. She's my favorite person in the world. I settle in next to my slump-shouldered husband and begin with all the rest. He's heard this part a thousand times.

Forty-five minutes later we are back in the waiting room, me conferring with the receptionist from behind my splint and a half-chewed fingernail, Robert bent over his checkbook. I've found that most doctors like the first payment up front—which, to the uninitiated, can be even more traumatic than the causal first-time shock of having your soul split open and laid on the table for inspection—though after the initial go-round, waiting for the insurance to come through never seems to be a problem. Maybe they figure after two visits you're emotionally entrenched and can't help but return, and you'll make the money work one way or another, but for me, I have to admit the entrenchment begins the minute I walk through the door and settle in on the couch: today's burgundy drawing-room number; Dr. Zobel's naughty black leather; the slip-covered sofabed at Dr. Flynn's. I've never done a Freud-style analysis couch, though, and when I was in college that disappointed me. Whither the crossed ankles, the upturned gaze, the solicitous Mmm from above? I later came to appreciate the irony of regular, everyday, you-could-buy-it-at-Ethan-Allen couches, and to this minute, there's something to the notion of sitting arranged like a couple of genteel ladies having cucumber sandwiches while discussing stuff that could get you arrested if it weren't for patient-doctor privilege that sucks me right in. As long as I don't think about it too much, therapy is tremendous fun.

I think part of my fix is the sheer pleasure of embarking on a routine, a ritual, and God knows I need something new to do with my time. But the greater part is the unacknowledged pitting of intellects. Today's session was just the warm-up, and Dr. Lindholm and I both sailed right through. She asked questions and I knocked the answers back; easy lobs, Wiffle-therapy. She nodded and took notes as I spoke.

She impressed me, if only for not latching onto the broken hand business or any other single malady right out of the gate. My junior year in college, at Swarthmore, I spent six futile months with a social worker who pounced on bulimia within half an hour of our first session and clung to that as her focus throughout our entire, useless relationship. It was an issue I was somewhat bored with by then, eight years into the habit and more or less on the wane, but she, so freeze-dried thin that she couldn't endure a whole hour in her chair without cushions (and even then she would shift, painfully, from one buttock to the other, cupping the resting glute in her hand), managed to drag each discussion back to bingeing and purging with great avidity. She pronounced it "byoo-leemia," like bugle or beauty, and I would counter with "buh-leemia," like button. Our differing ideologies on pronunciation was only one of the things that fated that particular therapy to failure, and eventually I felt bad for her as I came to realize that my issues fell well outside the scope of her interest and experience. When I told Robert about her, years later, he observed that she was well compensated for her ineptitude and discomfort, and this afternoon, despite—or maybe because of—Dr. Lindholm's early rebuke, Robert's confidence in this new doctor seemed to grow as she digested each new piece of information with equanimity.

"So, I'm sorry," Robert's voice comes to me. "The co-pay will be twenty-five dollars when?"

0"Sessions five through eight," Dr. Lindholm's receptionist replies.

"But today it's ten?"

"Today, it's nothing. It will be ten dollars next time, sessions two, three, and four, but today you're paying it all up front, no co-pay." The receptionist hands Robert a pink form. "You'll send this to your insurer for reimbursement. Do you have the address?"

"Umm, somewhere. If you could put your hands on it, though, not too much trouble, that would be great." Robert smiles encouragingly and the receptionist reaches for a massive Rolodex with color-coded cards. Robert frowns down at the pink claim form in his hands. "And what happens if Darien needs to be seen more than eight times?"

"Robert." My voice comes out more sharply than I intend, but this is taking far too long, and though I don't want them to, the events of the last hour, of the last forty-eight hours, are beginning to find their places in my brain. I shake my head, pull on Robert's hand. I am back at Dr. Flynn's office again, an undependable, unhinged child, and a voice whispers in my ear: My God, Darien, what are you doing? I can't do this. I swallow. I just can't.

Robert closes his checkbook and slides it into his breast pocket. "Sorry," he says to the receptionist. "I suppose this all makes sense to you."

"Nothing about health insurance make sense to anyone these days." She turns back to me. "Can you come in on Wednesday nights? Six o'clock?" Her voice drops a discreet note, though Dr. Lindholm's door opened minutes ago, inhaled her five o'clock patient, and closed again.

Robert nudges me with an elbow. "That's fine, isn't it?"

"Yes," I say. "That's fine." Then we smile and the receptionist and I wish one another a very good rest of the day, a very good rest of our lives, and finally, Robert takes my healthy hand and steers me back in the direction of the ficus tree. We open the door to the street, and we are gone.

Robert expels a long breath as we make our way up Park Avenue, and after a brief consultation with his watch, suggests an early dinner before he heads back to the office. He looks a little weatherworn, sad around the eyes, and I try to mirror his expression, stamping down on the sudden, inane joy that fills me at the prospect of being out on the New York streets.

Dinner? I'd love dinner! The sunlight, the commuter hour makes the idea seem decadent, so I hop over the cracks in the sidewalk and yip, "Yes, yes, yes!" Robert mutters, "For chrissakes, Darien," and I subdue myself until we reach the restaurant, a tiny Italian bistro on 74th and Second, not far from our first apartment. We haven't eaten here for years, though, and by the time we sit down, I have forgotten again that I am supposed to be lugging around our visit to Dr. Lindholm like a doped-up hippopotamus. I address the back of Robert's menu happily.

"Wow! That wasn't so bad, was it? God, that angel hair pasta thingamajig looks good. Did you see it? It must be new, or at least relatively speaking. It's loaded with mussels. Probably got about two heads worth of garlic in it, though." I take a few preemptory practice breaths against my hand, hah and reach for the list of specials, lobster fra diavola, two different risotti. "You know, Dr. Lindholm was really nice. And smart as hell! She may be the first doctor I've seen who I didn't think needed help more than I did. And her suit! God, that was beautiful. I've never actually seen someone live, in person, wear Chanel. And to think if I'd stuck with that psych major, I could be in her Guccis now."

I laugh, aiming for self-deprecating, though in fact I've returned to mentally congratulating myself for the choice of my own slate blue suit. Dr. Lindholm and I could have been girlfriends on the town, practically; an aunt and niece. I look up from the second risotto and find Robert studying me, his face set in serious lines. A tic pounds in his left cheek. "But I guess a psych major wouldn't do it, since she has an MD and all..."

"Darien. Sweetheart." Robert reaches through a maze of glasses and candles to grasp my left hand. "I want you to talk to me. I mean"—he rubs his chin with his free hand and shakes his head, the gesture effortful, laborious, patronizing. "What's all this about? I mean, I sure didn't walk out of that office and just—just forget everything we talked about. And I know you, sweetie. You didn't either. So can we drop the manic charade and talk about this? Please?" His eyes are begging.

Goddammit, I think, Godfucking dammit. Impatience—panic—wrenches my stomach. I don't want to talk about this; I don't. I want to forget about it; put it on the shelf until next Wednesday night. Tonight I wanna—well, play.

"Yes, sirruh," I say, as MacGruff deep as I can. I knit my brows together and squinch my face up. "Your wish is my command. Life is a very serious business, nothing at all like a game of charades. Okay, then, I'll start. First word, three syllables. Rhymes with banana. Montana?"

Robert's eyes skid away from mine and he starts to draw his hand back, but I clutch it hard. I know he's—I understand but I—I can't. I will get a smile out of him if it kills me. "Ro-bert." I tickle his palm with my finger. "Work with me here. Okay? Okay. It sounds nothing like banana."

Dinner passes in almost complete silence, save the most perfunctory small talk—the food, the weather—every time a waiter drifts into earshot or a busboy rounds with the water jug. At one point, we agree with no little irony that the air is starting to feel like fall. I order the mussel and angel hair pasta dish, not so worried about the garlic, after all, and by the time I twist the last spaghetti strand up, Robert and I are into a limping dialogue about the mountain of paper awaiting him back at work. Will he be late? Absolutely. Will he have to work the weekend? He hopes not. He pays the check and tucks me into a cab before he heads back downtown.

"Listen, Dee," he says, smoothing my hair through the cab window, "I'm sorry. I've been angry, and I know that makes you defensive, but I'm scared to death right now. I just don't know where this thing came from, and I'm scared of what's behind it. I really need you to talk to me about what's going on in your head. We've been through so much stuff together, you know? I just don't understand where this is coming from now, and why you won't talk to me about it." Robert pauses and passes a hand through his own hair. "You don't have to be your mother's daughter; you don't. I know you don't believe me, but—it's a choice you're free to make, and I really hope you won't choose— Anyway. I love you more than anything. Please don't shut me out. Okay?"

He steps back from the cab with a pained smile, his sad eyebrows knitted together. Only for a second do I think, Aye-aye, sir. It's been a long time since I've looked at him, really looked at him, and I am shocked now by the deep lines around his eyes. He still looks like a college guy to me, tall and athletic. I hadn't noticed the little boy's tummy that now sways his swimmer's build or how heavily the gray laces his messy brown hair. He looks like a little boy, lost. He needs a haircut.

I want to reach out to him, kiss his forehead, breathe his soap-and-shave-cream smell, but I can only smile back and nod as the cabbie pulls into Second Avenue traffic and watch him as he grows smaller and melts away to nothing in a pool of city streetlight, and by the time I can form a kiss and throw it to him from my cast, he has already turned away, and it falls amid the garbage and tired soles of a late summer night.

rThis is what happened.

Monday night I was home alone with our dog, Walter, whiling away the time where I usually spend it when Robert is working late, or as he was that night, at a client dinner: in the bathroom. Waxing my eyebrows, painting my toenails, reading; it's all useful, more virtuous, somehow, than watching TV. Monday night it was time to shave my legs. Being perpetually behind the eight-ball in the mornings, I tend to sprint out the door on a to-the-knees dry shave, and since I often take a bath at bedtime to subdue my insomnia, I usually save the soap-and-Lady Schick routine for then. On Monday, despairing of my scratchy thighs but not quite disposed to sit in the tub, I turned on the taps and stepped in in my underpants. I was going to shave stork-style, one leg at a time, and it would have worked fine except halfway through the right leg I lost my balance and fell sideways out of the tub, onto my hand. Very glamorous. Very easy to do.

The razor took a good chunk out of my ankle en route, and I thought, hmm, some potential there, but it was the hand that came between the marble floor and the rest of my body that sent a delicious knife of pain through my arm and to the top of my skull, full of bittersweet promise. Ouch, it said to me. Rats. It cleared its throat and added, Oh, my. After a few bemused, inverted minutes on the bathroom floor, however, it became clear that my hand, while mildly abused, would take a good deal of work before it even approximated broken.

It's a routine, actually. After giving my hand a few hours and every opportunity to swell up of its own accord, I wander back into the bathroom, pressing my knuckles against the wall, fist stumbling over the towel bar. Start with a couple of practice swings: just light pops that bounce off the wall benignly; experimental, restrained, set to the soft music of Walter's whines outside the door. A slight jolting sensation, a pleasant little buzz of pain up to the elbow, then nothing. The next hit is harder; maybe not so girly. Once again, I have forgotten to take off my Swarthmore ring, and this hit breaks the skin between my pinkie and fourth finger. That's better. The next hit's the beginning of the mental game: can you do it? Hit just as hard, or harder, without taking off the ring or easing off the punch at the last second? Usually, and tonight, I can, and a number of these, strung together by brief intervals of squatting on the floor with my elbow squeezed between my knees, follow. This is prime time, when speed becomes of the essence, when the offended limb or digit begins to expand furiously, frantically, in an effort to protect itself. This is the game at its best. Now, each hit wins you less and hurts you more: you either gotta go over the edge and break the fucker or back off, a bruised failure.

For the most part, nothing goes through my head as I play this game. It is a soothing blank, green and cool as a kindergarten chalkboard; the pain is amazingly peaceful. Calming. But the final hit comes from a voice in my head, a grotesque parody of a Nike commercial, pushing me to love the pain; kick the final quarter mile, land the triple axel. This is my finest sporting event, mortal combat with a voice that hisses and sneers, "Pussy—chickenshit baby bitch—what are you so fuckin' afraid of? You can't do it? You can't do it?" Not once has the voice beaten me, not even the time when I was fifteen and crammed into the corner of the bathroom behind the toilet, legs drawn against my chest, gripping the hammer in trembling, terrified hands as the voice sneered, "Whassa matter? you can't take it? you can't take it? jesus, this is nothing. you can't take this pain? you can't take shit...okay, okay, okay, this is it!" and then the hammer lunged like a badly shanked golf swing and chipped a neat shot off my right kneecap, over the sandtrap and onto the eighteenth fairway through a lush jungle of pain. I dislocated my patella on that one and, rather embarrassingly, wet my pants, a fact I was only dimly aware of as I passed out, flopping back onto the black and white linoleum like a 4:00 a.m. catch at the Fulton Fish Market. But now—or, rather then, I should say—the voice is perfunctory, a cigarette-edged snarl of "Oh, come on, you know how to do this shit," as I pace a few excited circles into the bathmat and throw my shoulder and my passion into the wall and am rewarded with the delicate snap of bones like old chalk as they give against the plaster, and knuckles, familiar with this now thrice-visited routine, obligingly shift from their sockets and out of harm's way. The screaming is externalized, in counterpoint, in Walter's furious barks. Yes, indeed. Much better. Ten-fifteen and all is well.

Once I had finished my routine and was sure I wouldn't throw up, I took six Advil and headed for bed, hoping that by tomorrow my hand would be functional enough to heal without Robert ever discovering what I'd done. I surrounded myself with pillows, one for my pounding knuckles; put on my favorite nightgown and some Debussy. I drifted off to a vision of us on our last vacation. Anguilla, sunlight spanking off turquoise licks of ocean, me hanging onto Robert's shoulders, treading water thirty feet from shore.

At once, Robert is jerked out from under me, dragged to impossible, nightmarish depths by some unseen monster, disappeared in an instant, forever gone, and I bolt to full consciousness with a cry. It's a sign. I know it's a sign, and I sit shaking and brace myself for the call from the police. I look at the clock: almost 2:00 a.m., and terror washes me cold. Of course. Why didn't I know before? Selfish, selfish, caught up. Robert gone, shot through the heart, stripped of identification, knifed in the kidney in a subway tunnel, life gasping out of him in slow leaks. Oh, Robert! I leap out of bed and reach one-handed for my clothes. Should I call the police first? No. No. I should just go.

As I scrabble over the problem of where to bury him—with his father, in Winnetka? in Eastman, out in the apple orchard, with a rolling blue view of the Berkshires? would he want to be buried at all? cremated? I'd really like him embalmed, like Evita Peron—sobbing and steeling myself for the funeral and kindness to follow, he walks through the door, a little drunk but very much alive, and wearing a lopsided grin that suggests he's happy I waited up. Until I throw a shoe at him, which, launched from my right hand, misses his head by a mile.

"Jesus Christ!" I scream. "Do you have any idea what time it is? You said you'd be home at eleven. Eleven! It's almost two o'clock now. That's three hours. I thought you were dead. I thought you were dead!" Each statement comes out in a vicious bite, and Robert stands in dumb amazement as the assault continues. "Where the hell were you?" I grab another shoe to heave. "Who were you with? Why didn't you call?"

"Dee," he finally says. "Hey—"

I thrust my hand in his face and shrill, "And I think I broke my hand!"

Admittedly, it's a cruel thing to do. An evening of swelling and a couple of cursory attempts at holding things have left me with a hand that looks like it's made out of Play-Doh. It is swollen beyond its normal size again, a down mitten, ill-defined by a seemingly random arrangement of bones. The back side is highlighted with a mottled rainbow of bruise: reds, purples, and blues. The elephant wrinkles on all my knuckles have turned themselves inside out.

"Look, it's about the size of my head," I say. I point to the pinkie side to draw Robert's attention to the craze of blood that spreads out between my fourth and fifth fingers. In what now appears to be something of a tactical error, I neglected to take my class ring off before the final punch, and it is buried in bloated flesh.

Robert's briefcase drops to the floor. He falls to his knees in front of me, locks his arms around my waist, and drags me to him. He burrows his head in my stomach and cries. He shudders like a horse, rocking, pushing himself savagely against my pelvis. The words that come from him are unintelligible, the sound is something primitive, unearthly. A Guernica of grief. Darien! Oh, God. Oh, God. Darien."

"Hey. Hey," I croon, stroking the top of his head with my good hand. He keeps crying, so I keep stroking. "Robert. Robert. It's okay, sweetie, it's okay. I'm sorry. Everything's going to be okay."

His crying stops. He looks up at me, his face a ruined mask. "No, Darien, it's not okay," he says. He captures my broken hand by the wrist. "There's nothing okay about this at all."

Aside from guilt, I feel nothing, but I have the grace at this point to be ashamed, and silent, just as he is silent on the ride to the hospital, holding my good hand hard. He flinches only once, as the doctor positions my arm in the air and begins the artful, papier-mache process of setting my hand. He watches, furrowed in concentration, and as I catch his eye in the quiet room, I give a one-shouldered shrug and say in a facetious singsong, my very best Groucho Marx, "Oh well. Ya hits plaster, ya gets plaster."

My mother's daughter, indeed. It's a voice I learned from her.

Copyright © 2003 by Kristin Waterfield Duisberg

What People are Saying About This

Margo Livesey

Duisberg's bright, glittering prose makes this elegant novel a pleasure from first page to last.
—Margo Livesey, author of Eva Moves the Furniture

Reading Group Guide

Brilliant, acerbic, funny, and relentless, Darien Gilbertson appears to have it all: a successful career, a husband who loves her absolutely, and all the material comforts of a New York life. But Darien is in trouble – on the run from her emotions, and from a past that resurrects itself in acts of self-mutilation she neither understands nor cares to explore. After years of good behavior, Darien is hurting herself again. And this time it's so brutal that her husband, Robert, cannot help but recognize the woman he adores is unraveling before his eyes.

Darien has a history with therapists. She knows exactly what they want – and need – to hear. She has made a game of psychotherapy, spinning outrageous fictions, exposing her doctors' vanities, knowing when to reveal just a little of the truth. When Robert brings her to Dr. Lindholm, she is ready. But in Dr. Lindholm Darien may have met her match: a caring psychiatrist with the patience and skill to see beneath her façade. At once intrigued and resistant, Darien engages Dr. Lindholm in a battle of wits, sure only her pride is at stake. When she stumbles instead upon a buried truth about herself the consequences are devastating, threatening her marriage, her identity, and what she understands about life and love.

The Good Patient is about interiors and exteriors, knowledge and perception, the treachery and triumph of memory. Written in razor-sharp, sparkling prose, it is a story that takes dead aim at a question we all fear: how well do we really know the people we love?

1. The title of the novel is The Good Patient. IS Darien a good patient? In what way?

2. Some therapists believe that transference, or the process by which a patient begins to identify with a therapist (or even want to become him or her), is essential to successful treatment. Does Darien experience transference in her relationship with Dr. Lindholm? What scenes suggest this?

3. Darien says early in the novel that pregnancy is "dangerous territory in the Gilbertson household"; she and Robert fight about her unwillingness to have a baby, and she reacts with disdain and alarm to several minor characters who are pregnant. What is it that Darien fears?

4. Early on, Darien describes Robert as "her talisman, stroke of luck," and yet later she blames him for enabling her emotional dependency. To what extent do you think Robert is at fault in the dynamics of the relationship? Is it possible for both of Darien's descriptions of Robert to be accurate?

5. At Mt. Lebanon Hospital, Darien says of her marriage to Robert, " "two strangers should never come to know one another so intimately." What does Darien believe about love? Do you think she's right?

6. The electric fence at the Gilbertson's Eastman house makes two appearances in the novel. What is the particular significance of the fence to Darien?

7. Many readers have connected with Walter – the dog – as their favorite character, and Darien's mother as their least. How do you feel about these two characters? Is there any connection between them?

8. In recalling Dayton's death, Darien mentions that her sister switched outfits, so that when her body is found she's wearing Darien's clothes. Readers have offered several theories about the meaning of this: for example, that it was really Darien who died; that Darien and Dayton had a "suicide pact" and Darien chickened out. What do you think?

9. Darien imagines a conversation with an adult Dayton. Darien is surprised by the physical differences between herself and her twin, and she hastens to assure a bartender that the two are "the same." What does this scene imply about Darien's understanding of "twinship"? Does it play a role in her progress toward healing?

10. When Darien visits Dr. Mintzer in Culver, her writes her a "prescription": psychotherapy; forgive yourself; go back home & live your life. Is Dr. Mintzer being cruel and dismissive, or is this in fact the prescription Darien needs?

11. At the end of The Good Patient, much of Darien's past remains unexplored, and she acknowledges she will never know why her sister killed herself. Is this satisfying to you as a reader? Is it realistic?

12. If the book were to continue, what do you think would happen to Darien and Robert? Is there a deeper meaning to Darien's statement in the final paragraph, "I reach out for my husband"?

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