Obsessed (3 page)

I was still getting used to what I was feeling now. Lust. I savored it.

W
HEN
I got up to my office, there was a piece of notepaper stuck to the door. “Appointment with Mr. B at 11,” it said. It was signed “E.” The note had printed at the top:
FREUDIAN SLIPS
. Cute.

A little past eleven, I entered the observation room and took a seat. Through one-way glass I could see a room the same size as the small one I was in. The room was anonymous but pleasant with its table lamps and eye candy impressionist landscape print. A vase of artificial irises and daffodils stood on the coffee table, and among the flowers was a microphone which connected to speakers on my side of the wall. We weren't trying to hide the microphone, just make it inconspicuous. Mr. Black had given his permission to be observed back when he'd started treatment.

I sat in the dark with the lights off and shades drawn. Emily was in the therapy room on the other side of the one-way glass. She sat in an armchair, legs crossed, light streaming in through the window behind her.

Facing her was Mr. Black. The middle-aged man with a receding hairline and a face and stomach that had gone to paunch was scribbling in a notebook he had balanced across his lap.

“You know, you won't be able to do that if you go ahead with the operation,” she said.

He lifted the pen and looked at his arm. “I'll learn to write with the other hand.”

“What are you writing?”

“Just a note to remind myself of a bunch of things I need to do—find my passport, get a Spanish phrase book.” He closed the notebook. “I'm waiting to hear when they can take me. Sometimes they get a cancellation and you've got to get down there right away.” I suspected they had quite a few last-minute cancellations—patients who fantasized about having a limb amputated and then, when the moment of truth came, backed out. “This is going to save my life.”

“It's a very big step.”

“Don't you think I know that? It's not like it's a sudden decision,” he said, setting the notebook down alongside his chair. “It's like I said, this is about becoming whole, not becoming disabled.” He looked at his arm as if it were a piece of meat past its expiration date. “I feel like I've got this…this alien object attached to me.”

“And what if something happens and the operation falls through?”

He gave a sly smile. “Don't worry. I won't lie down on a railroad track.”

It was a brutal thought, but I remembered reading about a man who'd been obsessed with amputating his legs. Unable to find a doctor to do the job, he'd lain on a railroad track and let the train do the job. Even survived to tell about it.

Though an obsession with limb amputation was rare, the syndrome had a name—apotemnophilia. The phrase had been coined by an expert in sexuality at Johns Hopkins. Apotemnophilia victims, he wrote, wanted to cut off their limbs so they could have better sex. The suffix
philia
grouped it with the psychosexual disorders that the average person thinks of as perversions. Emily and I had discussed whether this diagnosis fit Mr. Black. To both of us, the way he talked about his desire for amputation seemed more about being stuck in the wrong body—body dysmorphia—than about sexual desire.

“And how do you think things will be different after the operation?” Emily asked.

“Much better. Infinitely. With this”—he stretched out a perfectly normal-looking arm—“I know how odd I look.” He crossed his other arm over the one he despised.

“So you think your arm makes you look deformed?”

“It doesn't belong there.”

“Um-hmm.”

“I don't feel right, and it's all I think about. It's cost me my marriage. My job.”

“Your boss fired you because of your arm?”

“Yes.”

“That's what he said?”

“No, of course not.”

“What did he say?”

“Some mumbo-jumbo about inadequate job skills. I didn't swallow it for a minute.”

“Did he offer you job training?”

He shrugged. “It wasn't about that. I could've learned the goddamned computer shit. It was about
this
, not that.”

“But they'd promoted you before.”

“Out of pity. That's all it was. They felt sorry for me so they gave me the promotion. But I know the truth. No one can stand to look at me. I've never had a healthy relationship with anyone. It's why my wife left me. How could she make love to someone as deformed as I am? Not when I've got this thing that doesn't belong to me. I get such an overwhelming sense of despair sometimes.” He glanced quickly up at Emily, then back down. “I don't want to die, but there are times I don't want to keep living in a body that doesn't feel like my own.”

“I'm sorry—” Emily started.

“I don't need your pity,” he said, spitting out the words. “I just need to fix what's wrong with me. It's so simple. Why is it such a big deal?”

“Think about what it's going to mean,” Emily said. “You cut off your arm, you won't be able to write, shake hands.”

He blinked at her, as if unsure how to respond. Then he seemed to stare right at me with a look of loathing. I realized he was looking at himself in the one-way glass.

“If I had a great big nose, no one would think twice if I got a nose job. And what about all those Hollywood actors who get half their body fat suctioned away? My brother rubs Rogaine into his scalp every day and no one tells him he's nuts.”

“Those are different, and I think you know that.”

“My brother actually suggested maybe what I needed instead of an amputation was a new car. After his divorce he got himself a Hummer.” Mr. Black rolled his head around so the bones in his neck cracked. “You drive a red Miata. Isn't that about the same thing?”

Emily opened her mouth. She seemed at a loss for words.
Course correction
…I tried to telegraph the thought. Therapy is about the patient, not the doctor. This was classic resistance. Mr. Black was using this remark to shift the focus onto the therapist. The next thought wouldn't have occurred to me if Emily hadn't been stalked: How the hell did Mr. Black know she drove a red Miata?

“Are you sure this is what you want? You won't be able to change your mind later.”

“I know what I want. I've known it ever since I was seven. I still remember the first time I saw a man who had one arm. It was like a light went on in my head.”

“You were seven years old.”

“That's when I realized why everyone was staring at me. It was my arm. It didn't belong there, and they could all see it just as clearly as I could. Now I can't wait until it's fixed and I can get on with my life. Get
started
with my life.”

“Did you tell your parents about this?” Emily asked. “Or a teacher?”

“Of course not. It would only make them stare more.” There was a pause. “Like you're doing now.”

Emily recrossed her legs. “I'm just trying to understand what makes you hate it so much.”

Mr. Black leaned forward. Now he was staring at Emily's legs. “It's easy for you to say. You have a beautiful body.”

She shifted her notebook so it covered some of the exposed knee.

Mr. Black sat back. “One thing that
has
changed. At least now I know I'm not alone.”

He talked about the people he'd met on the Internet, men and women who wanted to have parts of themselves amputated. One man had already had a leg removed and claimed he felt reborn, at peace for the first time. A woman had had four fingers from one hand removed and was waiting for surgery on her other hand.

Mr. Black showed Emily where he wanted the surgeon to cut, precisely two inches above the elbow. Then everything would be better. He could begin looking for a new job in earnest. Reconnect with his estranged daughter. Go out in public without feeling like a leper.

The session ended and Mr. Black got up to leave. He collected his notebook. Emily shook his hand and then held on, her other hand on his forearm. She didn't seem to notice Mr. Black's shudder.

“I'll see you tomorrow evening at the lab?”

He nodded, his gaze riveted on the arm that Emily held. He cleared his throat.

“You gave me the address already.”

“Right. Park in the building. If anyone asks, tell them you have an appointment with Dr. Shands.”

When she let go, a look of relief washed over Mr. Black's face. He stumbled as he left the room.

After the session Emily and I went to my office to talk. She stood, surveying my walls. Her eyes flicked over my Wines of Provence poster. She pointed to the crayon drawing of the brain and gave me a questioning look.

“I did that when I was eight. My mother had it framed when I got my doctorate in neuropsychology.”

Emily gave a wry smile and shook her head. “You're amazing. You knew from the get-go that this is what you wanted to do.”

I laughed. “Who knows? She saved
all
my drawings. If I'd become an astronaut she'd have framed one of my moon rockets. A baseball pitcher? I drew a whole series of Yankee Stadium.”

“You played baseball?”

“Stoop ball. We didn't have ballfields in Flatbush, we had front stoops. You throw a Spalding,” I said, pronouncing it
Spaldeen
. “You know, a pink rubber ball.”

“How fascinating. And?” Emily said, facing me now, her chin resting on her fist.

“You really want to hear this?” She nodded, her eyes wide. It had been ages since I'd thought about stoop ball, though I'd played it with Danny Ellentuck just about every day after school. “You throw it against the steps and the other guy tries to catch the ball on the rebound. After one bounce it's a single, two a double. Catch it on a fly and you're out. Three outs and you switch and the other person gets to throw the ball. The real object of the game is to hit the edge of the step on the stoop because then the ball goes flying and you get a home run.”

Emily smiled appreciatively. “Where I grew up there were no front stoops, or ballfields either.”

She picked up a matted photograph I had lying on my bookcase. It was a black-and-white picture of a woman in black with a mournful face and long flowing hair. She stood intertwined with the sinuous trunk and limbs of a tree. Undulating lines merged nature and woman into a single form.

“A patient gave that to me,” I told her. “She knew I liked Annie Brigman's work.”

“It's a pretty disturbing image.”

“I guess that's why I haven't put it up. Not something I want patients to have to confront while they're in therapy.” I paused. “That's the thing about therapy. It's why that therapy room is so neutral. The point is for the patient to deal with what
they
bring into the room, not what we put in there or what we bring of ourselves.”

Emily sat down in a chair. She tilted her head to one side, alert to the nuance. “Are you saying that I'm bringing something into that room?”

I ducked under the ceiling overhang and sat at my desk, my back to the dormer window. “I noticed you trying to keep a therapeutic distance. That's good. But shaking Mr. Black's hand, holding on to his arm the way you did—it made it uncomfortable for him.”

“But I was just—” Emily started. She took a breath and started over. “Yalom says therapists should make a point to touch a patient during each session. Touch makes a patient feel valued.”

“I know there are therapists who make a point of shaking hands when the patient comes and when they leave. That's not inappropriate. But perhaps touching a man with this particular disorder is pushing it. For him, it may be as intrusive as if your own therapist patted you on the behind.”

She swallowed. “Do you think I upset him?”

“He definitely reacted. It's hard to gauge whether he took it as an aggressive intrusion, as a sexual overture, or just as a too-friendly gesture.” I rested my elbows on the blotter and folded my hands. “You want to be a neutral presence and deal with his
mishigas,
not yours.”

“Of course. You're absolutely right. I guess I'm a toucher. And it's not always the right thing to be doing.” Emily wrote in her notebook. “I'm so glad you called me on it. It's something I need to watch.”

It was gratifying to work with a bright post-doc who didn't go all defensive in the face of constructive feedback. Who actually wrote down suggestions. Who knew she hadn't arrived at this rotation knowing all the answers.

As she leaned toward me, her buttoned suit jacket gaped. I caught a glimpse of skin and a transparent, flesh-colored camisole that Emily wasn't wearing anything underneath.

“And, uh…” I tried to remember what I'd been saying. “Everything you do, what you wear…”

She tugged at the hem of her skirt.

I needed to say more. But how to do it without sounding like a lech or a prig? “You have to be careful about the signals you're sending,” I said, raising my eyebrows and looking at her suit jacket as I touched my hand to my chest. “You might be encouraging the wrong kind of attention.”