LITMIR.BIZ

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      My heart sank. This was not, after all, some silly woman in delusional denial about an absentee husband; it was, more likely than not, a case of psychotic paranoia. I was getting the sick feeling that the day might end with another forced hospitalization. I kicked myself mentally for allowing myself to be bullied into taking on these new additions to my caseload. Didn’t I have enough trouble? I should have stood up to that bitch and refused. I’d served my time in the trenches, and I was now an administrator. Didn’t that count for anything? How had I gotten myself into this mess?

      But even as I groaned at the hours of extra work, my diagnostic wheels were busily spinning. She was extremely dramatic in tone and mannerism, which was not typical for a schizophrenic. But then again, paranoid schizophrenics could surprise you—it couldn’t be ruled out. With such a full range of emotional expression, she certainly didn’t fit the pattern of a paranoid personality disorder. As a matter of fact, the most striking thing about her was her exaggerated affect, which suggested a histrionic or borderline personality disorder. Histrionics could be very loose in their reality testing, but her paranoia was extreme. And what about that neck? Histrionics often somatized their symptoms. Was this a physical manifestation of an extreme mind-body dissociation? Or maybe the whole thing was a manic episode. I needed more information.

      But before I could ask another question, she offered her own reality check.

      “No, of course you don’t understand, it sounds crazy to you,” she said. “You’re probably thinking you should lock me up. And maybe you’re right! I’ve been stuck in this insane relationship for so long I hardly know what’s real anymore.”

      I was relieved to hear her so lucid and self-reflective. It was a good sign. “So you question your own sense of reality?” I asked.

      “Sometimes,” she said, her voice soft and pleading. “But if you met him, even for an instant, you’d understand. There’s something about him. Once you’ve been in his presence you never forget it. When you meet his friends, crazy as they are, you’ll see how devoted they are to him, how they love him with all their hearts. Maybe then you’ll get an inkling of what kind of a man he is . . . and he chose me! Of all the women in the world he might have married, he chose me!” She turned her sad, luminous eyes toward me. “You think I’m totally crazy, don’t you?”

      Yes, I thought, you’re totally nuts, but something inside me was stirred by her story. For just a moment I could feel her love, shot through, as it was, with terror and wounded pain. Despite my dalliances, I had always been attracted to my wife. I was devastated that she’d thrown me out, already missed the life we’d had together. But now I was wondering: had I ever in my life loved anyone the way Israela loved her husband, or even, for that matter, the way Nava had once loved me?

      The feeling was gone in an instant, and I pulled myself back into role.

      “What’s his name?” I asked.

      She looked away, rubbing her neck as she stared out the window.

      “You don’t want to tell me his name?”

      She looked back at me. “Oh, no, I would, but . . . it’s just . . . very hard to pronounce.”

      “That’s OK. I don’t need to pronounce it.” I picked up my notebook and poised my pen expectantly.

      She stared at me a few minutes longer before responding. “I call him Y,” she finally said. “Everyone just calls him Y.”

      I let the notebook drop back into my lap. What the hell was she hiding? Was he some kind of notorious criminal whose name I’d instantly recognize? Could it be, even more bizarrely, that she didn’t know or couldn’t pronounce his name? Or, it suddenly occurred to me, was it possible that the husband didn’t even exist?

      Our time was almost up and I felt totally disoriented. Maybe it was the effect of sitting on the patient side of the room. Maybe I was just too distracted by my own problems. But I had just sat with this woman for almost an hour with nothing to show for it. I’d gotten almost no essential information, didn’t even have a diagnosis. Maybe I was just getting rusty.

      I debated getting an emergency psychiatric consult. The last thing I needed was word getting out that I’d failed to properly treat some psychotic patient. On the other hand, I was on the outs with all the psychiatrists, and any one of them would take perverse pleasure in the shoddy intake I had just done. She was paranoid and delusional, that was clear, but she was also lucid and calm. I decided to take the chance that she could hold on through the end of the holiday. Hopefully, she’d never come back. If she did, I’d be sure and do a full mental status exam, get a proper diagnosis. I decided to let it go.

      “Israela, there’s a lot more information I’ll need before I can know how to help you,” I said. “After Passover, I’ll want to get a full life history and a broader sense of your day-to-day life. I’m going to ask the receptionist to schedule you for the first day after the holiday. Will that work for you?”

      She nodded, her eyes glistening with new tears. “Passover is a hard time for me—I always miss him terribly during the holiday. I clean the house obsessively, trying to show what a good wife I can be, hoping that will draw him back to me.” We sat in silence for a long minute. “It never seems to work,” she finally said, “but at least the house gets clean.”

      I laughed, and she smiled back shyly. A sense of humor was always a good sign.

      “Are you sure you’ll be OK over the holiday?” I asked.

      She nodded slightly, her whole upper body moving stiffly with the effort. She took her appointment slip and got up to leave, her brow furrowing as she glanced around the room.

      “You know, Doctor, you should really speak to the cleaning lady. This office is littered with rubber bands and paper clips.”

      She wrapped her head tightly in her shawl and fearfully scrutinized the waiting room before venturing out the office door.

      4

      I picked up the forms from the now deserted reception area and stayed late to write up what I could remember of the intake, fudging the details I had neglected to ask. That evening, I plucked a cold schnitzel from Yossi’s refrigerator and, seated at his kitchen table, combed the classified ads for cheap rentals, while the twins engaged in a raucous shoot-out in the living room and Elizabeth chided me from the bedroom, insisting loudly to Yossi that I be out before the holiday.

      Even in the midst of an intifada, Jerusalem apartments were obscenely overpriced. Most of the secular, middle-class population had already fled to the coastal plain. American and French foreigners had bought up and renovated the vacated apartments, which now rented for outlandish prices—never mind that any minimally habitable flat would already be engaged for the Passover week. I decided to risk infuriating Jezebel and called in sick the next day so I could roam through the city looking at one bleak apartment after another. Desperate, I finally rented the first furnished flat I found that I could move into right away. It was a dark, ground-floor apartment on the edges of Kiryat Yovel, its empty-lot view obscured by black security bars.

      I transported my three garbage bags to the new flat that very evening. It was far from both work and home but had the advantage of being a month-to-month rental. It was just a temporary arrangement, I was sure.

      Two days later, as I was leaving the office on Passover eve, I found a neatly folded note in my mailbox. It was written in the oversized, boxy handwriting typical of American immigrants:

      Kobi,

      I appreciate your completing your intake in such a timely fashion. As you can see, the paperwork is less overwhelming when you do it quickly.

      Have an enjoyable and productive Passover break.

      Jezebel

      I crumpled the note and angrily threw it into the trash. Cheap gestures of appreciation were not going to soothe the stinging humiliation of my probation or the sheer degradation of having my intakes instantly scanned as if I were

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