[2016] Rubbing Stones Read online

  RUBBING STONES

  Nancy Burkey

  Copyright © 2016 Nancy Burkey

  All rights reserved.

  ISBN: 1534989323

  ISBN 13: 9781534989320

  Library of Congress Control Number: 2016911159

  CreateSpace Independent Publishing Platform

  North Charleston, South Carolina

  For Mark

  Without whom this book, and my life, would not have been the same.

  CONTENTS

  CHAPTER 1

  CHAPTER 2

  CHAPTER 3

  CHAPTER 4

  CHAPTER 5

  CHAPTER 6

  CHAPTER 7

  CHAPTER 8

  CHAPTER 9

  CHAPTER 10

  CHAPTER 11

  CHAPTER 12

  CHAPTER 13

  CHAPTER 14

  CHAPTER 15

  CHAPTER 16

  CHAPTER 17

  CHAPTER 18

  CHAPTER 19

  CHAPTER 20

  CHAPTER 21

  CHAPTER 22

  CHAPTER 23

  CHAPTER 24

  CHAPTER 25

  CHAPTER 26

  CHAPTER 27

  CHAPTER 28

  CHAPTER 29

  CHAPTER 30

  CHAPTER 31

  CHAPTER 32

  CHAPTER 33

  CHAPTER 34

  ACKNOWLEDGEMENTS

  NOTE FROM THE AUTHOR

  ABOUT THE AUTHOR

  CHAPTER 1

  “First impressions. That’s what the initial psychiatric interview is about.” Jane looked briefly into the eyes of each of the eight psychiatric residents. Just two weeks before, they had been mere medical students, not fully responsible for their patients’ outcome—but that all changed at graduation.

  She felt their eagerness, excitement, fear, resistance, self-doubt, and, there it is, she smiled, there’s always at least one, cockiness. The tension of their newly realized role gets filtered through their own not yet fully examined character. Jane started to stroll back and forth in front of them again. They scribbled down notes, readjusted themselves in their seats, one cracked his neck, another his knuckles, anything to avoid the scene behind her.

  “Why?” She wanted their participation, their engagement. “Bill?”

  He sat in the center of the front row—a seat usually chosen to ensure being called upon.

  “Your first impression begins the process of forming the diagnosis.”

  Jane nodded slowly. “So, one way to see my question is to think about the clinician’s impression of the patient. Good. As doctors we’ve been taught to think about diagnosis. But why?”

  “Treatments are always determined by the diagnosis, otherwise you’re just covering over symptoms, like treating a fever without figuring out why it’s there.” He sounded confident. First-year residents arrived so influenced by their general medical training. Her job was to reshape their image of who they were in relation to their patients.

  “Okay, what else?” Jane looked around the room. No one moved. “Might we need to be cognizant of the patient’s first impressions of us? Could that also be important?” A young woman in the second row raised her hand. “Cathy?”

  “Obviously you want the patient to like you.” Cathy tapped her pen rhythmically on the arm of her chair.

  “Why?”

  “So they’ll come back, continue in treatment.”

  Jane cocked her head. It was interesting how residents started with the same stereotypes of psychiatry that the rest of the world held. “I suppose that could be one goal for the first session. Any others?”

  Cathy’s crossed leg started to bounce. She glanced at the resident seated next to her. John, a large man with an infectious smile.

  “Getting the patient to return is the primary goal if you have as many student loans as I do,” John said.

  Jane waited until the snickers died down. This was going to be a good group—interactive, not overly competitive. She began to stroll again in front of the class.

  “So far we have diagnosis leading to treatment.” Jane nodded toward to Cathy. “And the development of rapport, much like any other area of medicine. But is it the same in our field? Or is there something different in what we do?”

  “Actually,” Cathy said, “you can be afraid of a diagnosis. It can feel like you’re being judged. It’s not as clear cut as in general medicine and maybe it’s a matter of opinion.”

  Jane watched the young woman avert her gaze. She didn’t want Cathy to expose her sense of vulnerability to her fellow residents, not yet, if ever. They were colleagues, not friends.

  “Very good,” Jane said.

  Cathy’s leg stopped shaking.

  Jane looked around the room. She wanted more from them. She focused on an attractive curly-haired man in his late twenties at the end of Cathy’s row. He wore khaki pants, loafers, and a pinstriped shirt—casual but professional enough. He hadn’t laughed at John’s joke.

  “Mark?” she said. “Any thoughts?”

  He straightened up in his chair and looked right at Jane—focused but relaxed. “People want to know that you can be trusted.”

  She waited for more. None came. “That’s all?”

  He nodded.

  “Why?” His simplicity intrigued her. Most fledgling psychiatrists got themselves in trouble by saying too much. Not this guy.

  “Because they want to be able to tell someone things they can’t tell anyone else, things they’re ashamed of.”

  “So trust is the critical factor?”

  “Maybe they’ll like you, maybe not, but it doesn’t really matter, it’s irrelevant. They want to believe you can help them. They like their friends but there’s limitations.” He paused and took a short breath. “Patients need to know you’ll handle their problems, their thoughts, their most intimate secrets carefully—with more respect than they feel for themselves.”

  The group sat silent. Jane glanced at the wall behind her. It was a soundproof one-way glass mirror. They were facing what looked like any other psychiatric consultation room—desk, chair, sofa, nondescript art on the walls—but with one big difference. Whoever was chosen to demonstrate the first interview would be observed by all his fellow interns and critiqued by their professor.

  “You’ve just earned the hot seat.” Jane nodded toward the door.

  “So, you’re trying to figure out what’s wrong with your marriage. Why you’re so unhappy.” Mark shifted in his seat and rubbed the back of his neck. It was twenty minutes into the interview and it still wasn’t clear why the woman had come in for therapy. She appeared to be in her late thirties, wore simple makeup, and had light auburn shoulder-length hair. She pulled at the white sleeve that was barely visible at the cuff of her well-tailored suit jacket—she made the ring of white perfectly even.

  “Maybe I made the wrong choice from the beginning.” She stared at the wall above Mark’s head, unfocused. “Maybe I rushed things.”

  “It sounds like you feel he hasn’t been there for you.” Mark’s tone was soft.

  Jane cringed. So clichéd; maybe he’ll recover.

  The woman bit her upper lip and looked away. “You’re probably right…it’s just a feeling.” She wiped her eye, dabbed it gently in order not to smear her eyeliner.

  Mark held out the Kleenex box from his desk. The woman nodded her appreciation and took two tissues.

  “I was so naïve—young, full of dreams. I just thought it would be different for us.”

  “You seemed pretty upset earlier,” Mark said. “Is there something specific your husband’s done? It might be hard to say, but you’ll feel better if you can get it out.”

  Jane saw Mark sneak
a glance over at the clock on the desk. His time was almost up. Be patient, take it slow.

  “He’s never home, Jim works all the time. Not his fault, I suppose. It takes a lot to support a family these days. I just thought he’d have made partner by now.” She looked down at her lap. “I’m afraid he might not have what it takes.”

  “So if your husband didn’t work so much, maybe gave up his dream to be a partner and was around more?”

  “His dream?” John whispered to Cathy, but loud enough for the class to hear. “Take a look at those designer boots.”

  “We couldn’t afford that. The private schools alone cost a fortune in this town. And I’m not really in a position to work myself.” She looked up at Mark and smiled. “I used to be in nursing, but I’ve been away too long. Things change quickly and if I tried to brush up, well…” She let out a big sigh. “I wouldn’t be around for the kids—soccer, volleyball, gymnastics, you name it. It might sound silly, but while they’re in school I’m taking a class at the Culinary Institute, you know, in case he does go further.”

  “That must be interesting. And your husband…” He looked down at his notepad. “Jim, he doesn’t appreciate you?”

  The woman’s face stiffened. “He doesn’t seem to notice me.”

  “And that’s a change?”

  She nodded slowly.

  “Do you have any thoughts about why?”

  She shifted in her chair and adjusted the hem of her skirt. “It’s not like I’ve lost my figure—at least some of his friends seem to notice.”

  Mark leaned forward and uncrossed his legs. He sat in silence for a moment, then set his pad down.

  Jane took a step back from the glass. Oh, no, don’t do it.

  “Does he know you’re having an affair?” Mark looked at her without blinking.

  Jane closed her eyes for just a moment. When she looked back, the patient was heading out the door.

  “Class, we’ll take a ten-minute break and meet back here to discuss the interview.”

  Steve Jackson, the newest member of the faculty, held the door to the staff lounge for Jane. She walked slowly over to the coffee pot, lost in thought. How was she going to approach Mark’s debacle? When a coffee mug was waved in front of her, she flinched.

  “I’m sorry, how rude of me—a bit preoccupied.” She smiled and held out her hand. “I’m Jane O’Neill, welcome to California.”

  “Thanks,” he said. He took her hand briefly before searching the station for sugar and cream. “Dr. Mtubu speaks very highly of you. ”

  “He’s quite a gifted teacher himself.” Jane said, pointing to the cupboard on their right.

  “He seems devoted to teaching.” He filled her cup, leaving just enough room to add cream if she used it. “And very charitable.”

  Jane nodded, then frowned. “No, he didn’t.”

  “I’m sorry?”

  “Sam didn’t hit you up for his Botswana project already, did he?”

  “I’m not sure it was as forceful as hitting me up,” Steve said. “But yes, he did mention an opportunity to assist in some clinic he’s helping build…”

  “Sam means well, even if his timing’s a bit off. I hope you don’t take offense, I know you’ve got a lot to adjust to without feeling obliged to travel even further. Can’t really blame him for wanting to focus on giving back to his homeland.”

  “No, from the sound of it they’re in real need.”

  “Actually, I’d love to go myself, but…” Jane shook her head and sipped her coffee.

  “Why not? It’s bound to be an unforgettable experience.” He leaned back in his chair.

  “My husband’s job keeps him so busy, I can’t imagine getting away for that long.” She straightened the pile of department announcements sitting on the table. Why was she blaming Rick? It was really the boys—charity didn’t seem to hold much panache for them these days.

  “So. Go without him.”

  Jane glanced at the gold band on his left hand.

  He fidgeted a moment with his pen, then got up for a second cup of coffee. “Just a thought. So what does your husband do that keeps him so busy?”

  It was refreshing to meet someone who didn’t know. “He’s a state legislator.”

  He poured the coffee slowly into his cup. “Must be interesting.”

  “Why? I mean, it is, but why do you think so?”

  “You know, he must be…decisive. Politicians seem to be so sure of themselves, so forthright in their positions. We psychiatrists, on the other hand, are always questioning the various nuances of any topic.” Steve sat back down and swirled the spoon in his cup.

  “I really don’t know what Rick is like at work.” Decisive? Glenn had been decisive. Glenn had been strong, charismatic, like most surgeons. It had initially been so compelling. She bit the inside of her cheek. She’d married Rick, in part, for his softness.

  “No, I don’t suppose you would.”

  She could feel him watching her.

  “Personally, I like ambiguity.” He blew lightly over the lip of his coffee mug. Jane glanced at her watch.

  He seemed to scan the staff room, taking it all in, making it his own. He didn’t come off like the kind of guy who’d been persecuted in the dog-eat-dog life common in some academic institutions. He was too smart, too good-looking, too socially astute. He’d have navigated it all just fine. She glanced over at him as she stood to leave. Their eyes met and he smiled, attempting to hold her gaze.

  “I think I’m going to like it here,” he said.

  They stopped talking as soon as Jane entered the room. One last resident rushed in and quickly took his seat in the back. Jane looked at each one in turn—permission to speak. The two women in front responded with a sudden need to shuffle through the papers in their bags and search for an unnecessary pen. Mark sat stiffly in his chair, braced for critical feedback.

  “I guess we don’t need to worry about the second appointment for her,” John said. It got a few giggles. Broke the tension.

  Mark stirred. “I can’t believe she did that. I only wanted to say what was obvious, get it out in the open, make her feel that she could trust me.”

  Nobody said anything. Their silence more damning than anything they might say to him.

  “So, ironically,” Jane said, “Mark’s goal was to be accepting and gain trust, yet the patient ends up storming out. What happened?” She pulled up a chair and sat facing them.

  Cathy’s leg started bouncing again. “I thought he did really well.”

  John laughed.

  “He did,” Cathy said, “before she left, I mean. He seemed to have good rapport.”

  “I thought your intervention was right on.” It was a resident from the back. “She just couldn’t stand hearing the truth. You can’t be fully responsible for the outcome.”

  “So it was the truth that alienated her?” Jane scanned the group.

  A woman at the end of the front row shrugged. “She’s either having an affair or thinking of having an affair. Maybe she even wants Mark to make that okay, wants his approval. Sure puts you in a tough position.”

  “But I don’t care if she has an affair,” Mark said. “I didn’t disapprove of her having an affair.”

  The residents broke out in a general murmur.

  “What?” Mark looked at Cathy. She held her hand over her mouth, but her bouncing shoulders gave her away.

  John turned to the back wall. “Can we see that in instant replay?”

  Jane spoke softly, directly to Mark. “Obviously the class thinks differently.”

  The young woman to his right shifted in her seat. “You sounded like you were interrogating her, whether you meant it that way or not.”

  “I was just trying to say it out loud—so she’d know it didn’t have to be a secret, that I could handle it.”

  “Yeah, well, it sounded more like you were accusing her of something. I would have felt like scum if you’d said it to me that way.”

  Jane
stood and walked over to Mark. “Tell me, why do you think the patient walked out when she did? Things seemed to be going well enough, then suddenly she’s out of there. What do you think happened?”

  He looked down at the floor. “Maybe I do have issues with infidelity. See, in my family—”

  “Good point. We all bring our own histories into the room, and sometimes they get intertwined with the work in ways that sneak up on us. We think we’ve worked it all out, that it’s behind us, then suddenly it’s there, exposed. That’s part of what the next four years will be about, and it’s good we get to see an example of this risk early in the training. Believe me, it’ll continue to come up.”

  “Yeah, maybe good for us, but not so good for her.”

  Cathy sat up straight again. “So if you’d just said it softer, not judgmental—”

  “Possibly.” Jane walked across the front row. “It’s likely that she was already critical of herself—changing his tone might not have changed the outcome.”

  “She’d have felt accused, either way,” the woman to Mark’s right said quietly, almost to herself.

  “Why?” Mark looked over at the resident. But she seemed lost in thought. He turned back to face Jane. “How?”

  “We have to assume there was a breakdown, an empathic failure. She bolted because of something you did, however inadvertent and well-intended.”

  “But I had empathy for her. She seemed quite sweet, was being ignored at home. And however I might feel personally about what she’s doing, it makes sense.”

  “To you.” Jane smiled at Mark. “You were empathic to her story, but not her affect—not her self-hate.”

  “How?”

  “You named something too early, it was too raw. You frightened her by exposing her before she was ready to reveal herself, in her way, at her pace—that’s how she experienced you as untrustworthy. She—”

  Three sharp raps at the door were followed immediately by Teresa sticking her head in.

  “Dr. O’Neill? May I see you a moment?”

  It was highly unusual for the clinic administrator to come to the interview room. Jane looked at her watch before stepping out.