Infinite jest - David Wallace

In this dream, which every now and then still recurs, I am standing publicly at the baseline of a gargantuan tennis court. I’m in a competitive match, clearly: there are spectators, officials. The court is about the size of a football field, though, maybe, it seems. It’s hard to tell. But mainly the court’s complex. The lines that bound and define play are on this court as complex and convolved as a sculpture of string. There are lines going every which way, and they run oblique or meet and form relationships and boxes and rivers and tributaries and systems inside systems: lines, corners, alleys, and angles deliquesce into a blur at the horizon of the distant net. I stand there tentatively. The whole thing is almost too involved to try to take in all at once. It’s simply huge. And it’s public. A silent crowd resolves itself at what may be the court’s periphery, dressed in summer’s citrus colors, motionless and highly attentive. A battalion of linesmen stand blandly alert in their blazers and safari hats, hands folded over their slacks’ flies. High overhead, near what might be a net-post, the umpire, blue-blazered, wired for amplification in his tall high-chair, whispers Play. The crowd is a tableau, motionless and attentive. I twirl my stick in my hand and bounce a fresh yellow ball and try to figure out where in all that mess of lines I’m supposed to direct service. I can make out in the stands stage-left the white sun-umbrella of the Moms; her height raises the white umbrella above her neighbors; she sits in her small circle of shadow, hair white and legs crossed and a delicate fist upraised and tight in total unconditional support.

The umpire whispers Please Play.

We sort of play. But it’s all hypothetical, somehow. Even the ‘we’ is theory: I never get quite to see the distant opponent, for all the apparatus of the game.

YEAR OF THE DEPEND ADULT UNDERGARMENT

Doctors tend to enter the arenas of their profession’s practice with a brisk good cheer that they have to then stop and try to mute a bit when the arena they’re entering is a hospital’s fifth floor, a psych ward, where brisk good cheer would amount to a kind of gloating. This is why doctors on psych wards so often wear a vaguely fake frown of puzzled concentration, if and when you see them in fifth-floor halls. And this is why a hospital M.D. — who’s usually hale and pink-cheeked and poreless, and who almost always smells unusually clean and good — approaches any psych patient under his care with a professional manner somewhere between bland and deep, a distant but sincere concern that’s divided evenly between the patient’s subjective discomfort and the hard facts of the case.

The doctor who poked his fine head just inside her hot room’s open door and knocked maybe a little too gently on the metal jamb found Kate Gom-pert lying on her side on the slim hard bed in blue jeans and a sleeveless blouse with her knees drawn up to her abdomen and her fingers laced around her knees. Something almost too overt about the pathos of the posture: this exact position was illustrated in some melancholic Watteau-era print on the frontispiece to Yevtuschenko’s Field Guide to Clinical States. Kate Gompert wore dark-blue boating sneakers without socks or laces. Half her face obscured by the either green or yellow case on the plastic pillow, her hair so long-unwashed it had separated into discrete shiny strands, and black bangs lay like a cell’s glossy bars across the visible half of the forehead. The psych ward smelled faintly of disinfectant and the Community Lounge’s cigarette smoke, the sour odor of medical waste awaiting collection with also that perpetual slight ammoniac tang of urine, and there was the double bing of the elevator and the always faraway sound of the intercom paging some M.D., and some high-volume cursing from a manic in the pink Quiet Room at the other end of the psych-ward hall from the Community Lounge. Kate Gompert’s room also smelled of singed dust from the heat-vent, also of the over-sweet perfume worn by the young mental health staffer who sat in a chair at the foot of the girl’s bed, chewing blue gum and viewing a soundless ROM cartridge on a ward-issue laptop. Kate Gompert was on Specials, which meant Suicide-Watch, which meant that the girl had at some point betrayed both Ideation and Intent, which meant she had to be watched right up close by a staffer twenty-four hours a day until the supervising M.D. called off the Specials. Staffers rotated Specials-duty every hour, ostensibly so that whoever was on duty was always fresh and keenly observant, but really because simply sitting there at the foot of a bed looking at somebody who was in so much psychic pain she wanted to commit suicide was incredibly depressing and boring and unpleasant, so they spread the odious duty out as thin as they possibly could, the staffers. They were not technically supposed to read, do paperwork, view CD-ROMs, do personal grooming, or in any way divert their attention from the patient on Specials, on-duty. The patient Ms. Gompert seemed both to be fighting for breath and to be breathing rapidly enough to induce hypocapnia; the doctor could not be expected not also to notice that she had fairly large breasts that rose and fell rapidly inside the circle of arms with which she hugged her knees. The girl’s eyes, which were dull, had registered his appearance in the doorway, but they didn’t seem to track as he came toward the bed. The staffer was also employing an emery board. The doctor told the staffer that he was going to need a few moments alone with Ms. Gompert. It is a sort of requirement that a doctor whenever possible be reading or at least looking down at something on his clipboard when addressing a subordinate, so the doctor was looking studiously at the patient’s Intake and the sheaf of charts and records Med-Netted over from trauma and psych wards in some other city hospitals. Gompert, Katherine A., 21, Newton MA. Data-clerical in a Wellesley Hills real estate office. Fourth hospitalization in three years, all clinical depression, unipolar. One series of electro-convulsive treatments out at Newton-Wellesley Hospital two years back. On Prozac for a short time, then Zoloft, most recently Parnate with a lithium kicker. Two previous suicide attempts, the second just this past summer. Bi-Valium discontinued two years, Xanax discontinued one year — an admitted history of abusing prescribed meds. Depressions unipolar, fairly classic, characterized by acute dysphoria, anxiety w/panic, diurnal listlessness/agitation patterns, Ideation w/w/o Intent. First attempt a CO-episode, garage’s automobile had stalled before lethal hemotoxicity achieved. Then last year’s attempt — no scarring now visible, her wrists’ vascular nodes obscured by the insides of the knees she held. She continued to stare at the doorway where he’d first appeared. This latest attempt a straightforward meds O.D. Admitted via the E.R. three nights past. Two days on ventilation after a Pump & Purge. Hypertensive crisis on the second day from metabolic retox — she must have taken a hell of a lot of meds — the I.C.U. charge nurse had beeped the chaplain, so the retox must have been bad. Almost died twice this time, Katherine Ann Gompert. Third day spent on 2-West for observation, Li-brium reluctantly administered for a B.P. that was all over the map. Now here on 5, his present arena. B.P. stable as of the last four readings. Next vitals at 1300h.

The attempt had been serious, a real attempt. This girl had not been futzing around. A bona fide clinical admit right out of Yevtuschenko or Dretske. Over half the admits to psych wards are things like cheerleaders who swallow two bottles of Mydol over a high-school breakup or gray lonely asexual depressing people rendered inconsolable by the death of a pet. The cathartic trauma of actually going in somewhere officially Psych-, some understanding nods, some bare indication somebody gives half a damn — they rally, back out they go. Three determined attempts and a course of shock spelled no such case here. The doctor’s interior state was somewhere between trepidation and excitement, which manifested outwardly as a sort of blandly deep puzzled concern.

The doctor said Hi and that he wanted to ascertain for sure that she was Katherine Gompert, as they hadn’t met before up till now.

‘That’s me,’ in a bit of a bitter singsong. Her voice was oddly lit-up for one who lay fetal, dead-eyed, w/o facial affect.

The doctor said could she tell him a little bit about why she’s here with them right now? Can she remember back to what happened?

She took an even deeper breath. She was attempting to communicate boredom or irritation. ‘I took a hundred-ten Parnate, about thirty Lithonate capsules, some old Zoloft. I took everything I had in the world.’

‘You really must have wanted to hurt yourself, then, it seems.’

‘They said downstairs the Parnate made me black out. It did a blood pressure thing. My mother heard noises upstairs and found me she said down on my side chewing the rug in my room. My room’s shag-carpeted. She said I was on the floor flushed red and all wet like when I was a newborn; she said she thought at first she hallucinated me as a newborn again. On my side all red and wet.’

‘A hypertensive crisis will do that. It means your blood pressure was high enough to have killed you. Sertraline in combination with an MAOI[28] will kill you, in enough quantities. And with the toxicity of that much lithium besides, I’d say you’re pretty lucky to be here right now.’

‘My mother sometimes thinks she’s hallucinating.’

‘Sertraline, by the way, is the Zoloft you kept instead of discarding as instructed when changing medications.’

‘She says I chewed a big hole out of the carpet. But who can say.’

The doctor chose his second-finest pen from the array in his white coat’s breast pocket and made some sort of note on Kate Gompert’s new chart for this particular psych ward. Crowded in among his pocket’s pens was the rubber head of a diagnostic plexor. He asked Kate if she could tell him why she had wanted to hurt herself. Had she been angry at herself. At someone else. Had she ceased to feel as though her life had meaning to it. Had she heard anything like voices suggesting that she hurt herself.

There was no audible response. The girl’s breathing had slowed to just rapid. The doctor took an early clinical gamble and asked Kate whether it might not be easier if she rolled over and sat up so that they could speak with each other more normally, face to face.

‘I am sitting up.’

The doctor’s pen was poised. His slow nod was studious, blandly puzzled-seeming. ‘You mean to say you feel right now as if your body is already in a sitting-up position?’

She rolled an eye up at him for a long moment, sighed meaningfully, and rolled and rose. Katherine Ann Gompert probably felt that here was yet another psych-ward M.D. with zero sense of humor. This was probably because she did not understand the strict methodological limits that dictated how literal he, a doctor, had to be with the admits on the psych ward. Nor that jokes and sarcasm were here usually too pregnant and fertile with clinical significance not to be taken seriously: sarcasm and jokes were often the bottle in which clinical depressives sent out their most plangent screams for someone to care and help them. The doctor — who by the way wasn’t an M.D. yet but a resident, here on a twelve-week psych rotation — indulged this clinical reverie while the patient made an elaborate show of getting the thin pillow out from under her and leaning it up the tall way against the bare wall behind the bed and slumping back against it, her arms crossed over her breasts. The doctor decided that her open display of irritation with him could signify either a positive thing or nothing at all.

Kate Gompert stared at a point over the man’s left shoulder. ‘I wasn’t trying to hurt myself. I was trying to kill myself. There’s a difference.’

The doctor asked whether she could try to explain what she felt the difference was between those two things.

The delay that preceded her reply was only marginally longer than the pause in a regular civilian conversation. The doctor had no ideas about what this observation might indicate.

‘Do you guys see different kinds of suicides?’

The resident made no attempt to ask Kate Gompert what she meant. She used one finger to remove some material from the corner of her mouth.

‘I think there must be probably different types of suicides. I’m not one of the self-hating ones. The type of like “I’m shit and the world’d be better off without poor me” type that says that but also imagines what everybody’ll say at their funeral. I’ve met types like that on wards. Poor-me-I-hate-me-punish-me-come-to-my-funeral. Then they show you a 20 X 25 glossy of their dead cat. It’s all self-pity bullshit. It’s bullshit. I didn’t have any special grudges. I didn’t fail an exam or get dumped by anybody. All these types. Hurt themselves.’ Still that intriguing, unsettling combination of blank facial masking and conventionally animated vocal tone. The doctor’s small nods were designed to appear not as responses but as invitations to continue, what Dretske called Momentumizers.

‘I didn’t want to especially hurt myself. Or like punish. I don’t hate myself. I just wanted out. I didn’t want to play anymore is all.’

‘Play,’ nodding in confirmation, making small quick notes.

‘I wanted to just stop being conscious. I’m a whole different type. I wanted to stop feeling this way. If I could have just put myself in a really long coma I would have done that. Or given myself shock I would have done that. Instead.’

The doctor was writing with great industry.

‘The last thing more I’d want is hurt. I just didn’t want to feel this way anymore. I don’t… I didn’t believe this feeling would ever go away. I don’t. I still don’t. I’d rather feel nothing than this.’

The doctor’s eyes appeared keenly interested in an abstract way. They looked severely magnified behind his attractive but thick glasses, the frames of which were steel. Patients on other floors during other rotations had sometimes complained that they sometimes felt like something in a jar he was studying intently through all that thick glass. He was saying ‘This feeling of wanting to stop feeling by dying, then, is —’

The way she suddenly shook her head was vehement, exasperated. ‘The feeling is why I want to. The feeling is the reason I want to die. I’m here because I want to die. That’s why I’m in a room without windows and with cages over the lightbulbs and no lock on the toilet door. Why they took my shoelaces and my belt. But I notice they don’t take away the feeling do they.’

‘Is the feeling you’re explaining something you’ve experienced in your other depressions, then, Katherine?’

The patient didn’t respond right away. She slid her foot out of her shoes and touched one bare foot with the toes of the other foot. Her eyes tracked this activity. The conversation seemed to have helped her focus. Like most clinically depressed patients, she appeared to function better in focused activity than in stasis. Their normal paralyzed stasis allowed these patients’ own minds to chew them apart. But it was always a titanic struggle to get them to do anything to help them focus. Most residents found the fifth floor a depressing place to do a rotation.