Excerpt
WHERE HE WAITS
To get there, you turn left off the highway and drive down the
road bordered on one side by pasture. And then, a radio song
or so later, you turn right into the hospital's gated entrance,
easing your car up the slope that leads to the turreted place
where he waits. Safety screens cover all the windows. The stairs
are steep, and exit signs cast carmine shadows on the concrete
floors. Four flights you must travel, and then down several serpentine
corridors, before you finally come to his office.
I had never been here before. I had never heard the word Prozac
before. It was 1988, the drug just released. I was to be one
of the first to take Prozac, and, even though I didn't know this
then, one of the first to stay on it for the next ten years,
experiencing what long-term existence on this new medication
is actually like.
The Prozac Doctor is a busy man. He sees thirty, forty, sometimes
fifty patients a day. He is handsome in ways you don't expect
your medicine man to be. He has shining black hair and beautiful
loafers made of leather so fresh you can practically see the
hide still ripple with life. He wears one simple gold band on
a finger as tapered as a pianist's, topped with a chip of nacreous
nail sanded to perfect smoothness. He is host as well as doctor,
and that first time, as well as every time thereafter, he invites
me in, standing behind his desk and ushering me forward with
stately sweeps of his hand, bowing ever so slightly in a room
where you half expect caterers carrying platters of shrimp to
emerge from the shadows.
"Sit, Ms. Slater," he said to me the morning we met.
He gestured to a deep seat, and I sat. There was a silence between
us then, a kind of weighted silence, a grand silence, like the
sort you hear before a symphony begins.
And that day was the beginning, the bare beginnings of a story
very little like the popular Prozac myths-a wonder drug here,
a drug that triggers violence there. No. For me the story of
Prozac lies not between these poles but entirely outside of them,
in a place my doctor was not taught to get to-the difficulty
and compromise of cure, the grief and light of illness passing,
the fear as the walls of the hospital wash away and you have
before you this-this strange planet, pressing in.
But that first day, there was just Prozac pressing in. I looked
around me at the office. On the doctor's desk I saw a Lucite
clock with the word prozac embossed across the top. I saw a marble
mount holding four pens with prozac etched down their flanks.
The pads of paper resting on his bookshelf were the precise size
and shape of hors d'oeuvre napkins, and all had prozac in fancy
script across their borders, like the name of some new country
club.
"What is this stuff?" I asked. I heard my voice repeat
itself in my ears, as so many sounds seemed to do lately, the
screech of brakes, birdsong nipping at my brain.
The doctor leaned back in his seat. "Prozac," he said,
"is the chemical compound fluoxetine hydrochloride."
He told me it had a three-ring chemical structure similar to
that of other medications I'd tried in the past but that its
action on the body's serotonin system made it a finer drug. He
told me about the brain chemical serotonin and its role in OCD-obsessive-compulsive
disorder-the most recent of my many ills, for me the nattering
need to touch, count, check, and tap, over and over again. He
told me about synapses and clefts, and despite the time he took
with me that day, I felt him coming at me across a gulf.
He had all the right gestures. His knowledge was impeccable.
He made eye contact with the subject, meaning me. But still,
there was something about the way the Prozac Doctor looked at
me, and the very technical way he spoke to me, that made me feel
he was viewing me generally-swf, long psych history, five hospitalizations
for depression and anxiety-related problems, poor medication
response in past, now referred as outpatient for sudden emergence
of OCD-as opposed to me, viewing me, in my specific skin.
My skin: had little white lines on it from where I used to cut.
It had always crisped easily in the summer sun.
My ears: knew the difference between real and imaginary sounds.
That said, they sometimes heard voices, which doctors in the
hospitals had told me was a sign not of psychosis but of dissociation.
There was a blue baby who cried in my ears. There was a girl
in a glass case, who talked to me. The world was full of many
sounds-rushings, whirrings, soft and thunderous-and this was
both a pleasure and a problem.
My hands: had become a problem. Once they had been conduits for
pleasure. When I was a child they had held leaves and rabbits.
Today, however, they were one of the reasons I was here. They
were the part of me that seemed to have the OCD, tense and seeking,
tapping things forty, fifty, sixty times. Not people, thank God,
but objects, like stove switches, gas dials. Sometimes I looked
at my hands and remembered them as they used to be, fine-boned,
indigo-veined, lined with the tracery of all they had touched.
Not now, though. From my hands I had learned grief. I had learned
how the body can leave you, before you have left it.
I wanted to tell the Prozac Doctor about my hands. I wanted to
splay them across his desk and say, "Look at them. What
are they seeking?" I wanted him to touch my hands, not really
an odd desire, the laying on of hands a practice as ancient as
the Bible itself. The Prozac Doctor was biblical to me. I invited
him to take on that role, the role every sick person needs her
healer to play-not only technician, but poet, priest, theologian,
and friend. I know this was asking a lot, poor man, but few people
are as full of need and desire as the patient.
Instead, he reached down, opened a desk drawer, and pulled out
a sample pill packet. He did not need to ask me many questions,
as he had my entire chart before him, thick as an urban phone
book. The packet was rather unimpressive, plain white, with a
perforated top. To my surprise, he lifted it to his lips and
tore at it with his teeth, then gently tapped at it until a smooth
pill slid from its foiled pouch into the clean cup of his palm.
There it lay, cream and green. Tiny black letters were stamped
down its side-dista-which sounded to me like an astronomy term,
the name of a planet in another galaxy. On and on my mind went,
making from this small capsule many private metaphors-it was
candy, no poison; protein, no plastic.
I wanted to say these things to the Prozac Doctor. But he held
himself so politely, angled away from contact. And, after all,
he was a busy man, pressured by insurance companies to see throngs
of patients, all with their own little paint box of multiple
metaphors. Where would he have found the time to explore with
me the private poem of the medicine that would soon be mine,
a poem that had, as its first stanza, some song about failure?
Having tried for the past three years to achieve stability on
my own, determined to do it, I was here again, sick with this
OCD. How could that be? I was incomplete, apparently, without
the pill that was, among other things, a plug to stopper some
hole in my soul. Perhaps the hole came from a neuronal glitch,
the chemical equivalent of a dropped stitch in the knitted yarn
of my brain. Or maybe the hole was between my mother and me.
Because when I looked at the pill I also saw her, the little
capsule of her sports car we would speed in, clean and compact,
screeching to a halt in front of the florist's, where she bought
armloads of orchids. And then to the butcher's, where she purchased
great red wheels of beef. Nothing was ever enough, for there
was no plug to stopper the hole in her soul, no pill.
My pill. Sitting, still, in the Prozac Doctor's palm but moving
me backward in time, forward into hope. Much has been said about
the meanings we make of illness, but what about the meanings
we make out of cure? Cure is complex, disorienting, a revisioning
of the self, either subtle or stark. Cure is the new, strange
planet, pressing in. The doctor could not have known. And that
made me, as it does every patient, only more alone.
"We will start," he said to me, "with twenty milligrams
a day, a single capsule, although OCD, unlike depression, usually
requires a higher dose." He showed me how, if the dose made
me nauseous, I could split the pill and try half, and when I
asked him what, exactly, was inside, he told me the story of
the drug's design. He told me about Eli Lilly's campus in Indiana,
where Prozac was first made, how a man raised rats and then ground
their brains into something called a synaptosome, which became
this medicine. He told me how Prozac marked a revolution in psychopharmacology
because of its selectivity on the serotonin system; it was a
drug with the precision of a Scud missile, launched miles away
from its target only to land, with a proud flare, right on the
enemy's roof.
I pictured the proud flare. I pictured the grounds of Eli Lilly,
green and winding. Inside, the labs were clean. White-coated
technicians were plucking the gray matter from rats, extracting
the liquid transmitters, some kind of healing wet.
I hoped then.
I hoped to be helped.
And yet, I did not take this new pill. Back at home, in the basement
apartment where I lived, I looked and looked at it. I touched
it to the tip of my tongue, then moved it away. This was not
a tease, the drawn-out flirtation that will later come to love.
This was fear. Maybe more than anything else, taking a pill,
especially a recently developed psychotropic pill about which
researchers have more questions than answers, is always an exercise
in the existential, because whatever happens happens to your
body alone. Each time you swallow a pill you are swallowing not
only a chemical compound but yourself unmoored; you are swallowing
the sea, the drift and the drown. A pill makes the inscrutable
Sartre solid, brings to life the haunting solitude of a Munch
painting. It is not the doctor's job to populate the painting,
but if he has a flair for the medical arts, maybe he will. The
Prozac Doctor, for all his style, couldn't. Psychopharmacology
is the one branch of medicine where there is no need for intimacy;
neither knives nor stories are an essential part of its practice.
And in its understandable glee that it might finally move psychiatry
into a position as respectable as surgery, it risks forgetting,
or maybe never learning, what even many a surgeon knows: that
you must smooth the skin, that you must stop by the bedside in
your blue scrub suit, that language is the kiss of life.
I had a dream one night about the Prozac Doctor. This was four
or five days after our first visit in what would become over
a decade-long relationship. I dreamt I saw him in the supermarket
and he was buying bread. He was in a dark suit with brass buttons,
and he approached several loaves, newly baked, lying on wooden
boards, each with a scar down its center. I knew the Prozac Doctor
was hungry, because I could feel his pangs in me. I could feel
how he wanted to crack the caul of his professional persona.
I thought I should help him, that because I was a patient and
knew about proneness and heat, I could, maybe, instruct. Perhaps
this is the patient's task. Perhaps in every good medical encounter
each party must try to save the other.
So I showed the Prozac Doctor the bread. I showed him how to
test it for firmness, how to split it down its scar and spread
the salve of butter on it. He lifted a loaf-honey-wheat, I think-and
from the hidden folds of his jacket pocket took out a stethoscope.
I nodded at him, and he pressed the stethoscope against the breast
of the bread, eyes half closed, listening, listening, and then
the bread breathed back-a rush and a whir-sounds both thunderous
and soft in my ears. I woke up.
And later on that day I got up the courage to take my first dose.
A dream doctor, apparently, can bear witness and hold out the
promise of tenderness almost as well as a real doctor. It is
very fashionable in medical science these days to talk about
the power of visualization in healing. Your cancer cells are
turning fresh as healthy heartland apples; your tumor is bearing
milk. Although I say this tongue in cheek, I am serious too.
Perhaps we should instruct patients, especially psychiatric patients,
to visualize not only the transformation of their illness but
the transformation of their doctors as well. Maybe out of such
visualizations-insistent, intense, articulated-we will help to
midwife our medicine men.
I held the pill in my hand and then washed it down with water.
Afterward, things seemed so quiet. My eyes and ears were tilted
inward, listening, looking. I felt what might have been a burning
in my chest, something scampering up around my heart. Side effect?
Serious? A start? It was too early to know. So I sat on a stool
in my kitchen, and I conjured up the Prozac Doctor with his hand
on a curve of crusty bread, the hide of fresh whole wheat. I
stroked my own arm. I tried for calmness. I thought of yeast
and how it works, bubbles of fermentation, little spheres of
oxygen that must be kneaded, how maybe every good rising is a
combination of chemicals and touch.
Excerpted from Prozac Diary by Lauren Slater.
(Use of this excerpt from Prozac Diary by Lauren Slater may be
made online only for purposes of promoting the book, with no
changes, editing, or additions whatsoever, and must be accompanied
by the following copyright notice: Copyright© 1998 by Lauren
Sl. Excerpted by permission of Random House, a division of Random
House, Inc. All rights reserved. No part of this excerpt may
be reproduced or reprinted without permission in writing from
the publisher.
