Every Fifteen Minutes (2 page)

Mrs. Teichner gestured at Laurie. “Dr. Parrish, how come you don't wear a white coat like her?”

“It makes me look fat.” Eric didn't add that many hospital psychiatrists didn't wear white coats, to be more relatable to the patients, and he had on a blue oxford shirt and no tie, with khakis and loafers. The look he was going for was Friendly Suburban Dad, because that's what he was, but he suspected he'd achieved only Cialis Guy.

“Ha!” Mrs. Teichner laughed. “You're funny!”

Laurie rolled her eyes. “Mrs. Teichner, please don't encourage him. Dr. Parrish doesn't need any more female fans in this hospital.”

Mrs. Teichner's hooded eyes twinkled. “You're just jealous.”

“I agree.” Eric smiled at Laurie. “Jealous.”

“Hardly.” Laurie snorted.

Mrs. Teichner cackled. “Now she's embarrassed.”

“Bingo.” Eric mentally ran through the elements of the MSE, the Mental Status Examination, whenever he met a patient, and he assessed their level of consciousness, appearance and behavior, speech and motor activity, mood and affect, thought and perception, attitude and insight, as well as his reaction to the patient and the patient's own cognitive abilities. Mrs. Teichner was already scoring well on most of the factors. Eric's gestalt reaction to her was that her mood was euthymic, or completely normal. “So, how can I help you, Virginia?”

“Eric,” Laurie interjected, answering, and her expression changed, falling into professional lines. “Unfortunately, Mrs. Teichner has been dealing with congestive heart failure and advanced-stage lung cancer. Two months ago, she was admitted upstairs, spent three days in cardiology, and was just about to begin palliative care at home.”

Eric listened, hiding his emotions. It was the worst possible prognosis, and he couldn't help but feel sympathy for Mrs. Teichner, as Laurie continued.

“She came in tonight because of a choking incident at dinner. I ordered new X-rays, and we found another mass growing in her throat, impacting her ability to swallow.”

“I'm sorry to hear that,” Eric said, meaning it, but he felt surprised by Mrs. Teichner's calm demeanor, given the dire state of her health. She didn't seem distraught or even depressed, nor did she present with the vagueness of aspect or speech that characterized any memory or other issue he'd expect in a geriatric patient, though he'd test her later to confirm.

“Thanks, Doc, but I know I have cancer, it's not new news.” Mrs. Teichner's tone turned matter-of-fact. “My grandson, Max here, wanted us to call you. He's seventeen years old, so he knows everything. He keeps telling me I'm crazy and—”

Max interrupted, “Not crazy, Gum. Depressed. I think you're depressed, and the doctor can help with that. He can give you some antidepressants or something.”

Eric shifted his gaze to Max, who was short and slight, maybe five two and 130 pounds, which made him look younger than his age. His face was round, and he had a small straight nose, eyes of a pale, washed-out blue, and a shy smile with a single dimple. His longish hair was light brown in a shaggy cut, and he had on baggy jeans and a black T-shirt that showed an undeveloped skinniness to his upper arms, as if he never lifted anything heavier than an iPhone.

Mrs. Teichner waved him off with a hand gnarled by arthritis. “He calls me Gum, Gummy, Gumbo, all kinds of names like that, because he couldn't say grandma when he was little. He likes to play with words. He's smart as a whip, he's a National Merit scholar, got perfect SAT scores, tops in his class, and that's why he's such a know-it-all—”

“Gummy, please,” Max interrupted her again, gently. “We need to talk about
you,
not me, and about why you're not eating.” Max turned to Eric, looking at him with a direct blue-eyed gaze that echoed his grandmother's. “Dr. Parrish, the cardiologist told us that if she eats, she can keep her strength up. He said he could give her a feeding tube if she doesn't eat, but she doesn't want the feeding tube and she doesn't want to eat either. I know that's the depression talking. I think she should get the feeding tube. She has to.”

Eric realized why Laurie had called him. End-of-life care presented an array of emotional issues for patients and their families, and Eric knew he could do some good. “Max, thank you for that information, that's helpful. If you would step outside for a moment, I'd like to examine your grandmother.”

“Sure, great.” Max stood up, letting go of his grandmother's hand, and smiled at her. “You behave yourself, Gummy.”

“Don't tell me what to do,” Mrs. Teichner shot back, cackling, and Eric could see the love that flowed easily between them. Max shuffled out of the room, and Eric glanced at Laurie.

“Let's talk after I've evaluated Mrs. Teichner.”

“Good. Come find me when you're finished.” Laurie patted Mrs. Teichner on the shoulder. “My dear, you're in excellent hands.”

“No kidding. Now get out so we can be alone.” Mrs. Teichner cackled again, then gestured at the medical students, standing at the wall. “Can't they leave too, Doc? I need a peanut gallery like I need a hole in the head.”

“They have to stay,” Eric answered, amused. “Try to ignore them.”

“How'm I gonna do that? They're
looking
at me.”

“I do it all day, it's easy. Now, seriously, tell me how you are. Are you feeling depressed? Blue? No energy?”

“No, I'm right as rain.” Mrs. Teichner shook her head of short white hair, which swiveled on her neck like a baby snow owl.

“You sure about that? It would be natural, given your illness.”

“I tell you, I'm fine.” Mrs. Teichner snorted. “I don't need my head examined, but where were you when I married my second husband? Sheesh!”

Eric smiled. “Okay, let me ask you a few questions. What is today's date?”

“What difference does it make?”

“I'm doing an assessment and I need you to answer a few questions. Who's the president of the United States?”

“Who cares? All politicians are crooks.”

Eric smiled again, persisting only because he had to for legal reasons. “Listen carefully, I'm going to say three words.”

“I love you?”

Eric chuckled. “The three words are banana, strawberry, milkshake. Can you repeat those words?”

“Of course! Banana, strawberry, milkshake! Dr. Parrish, there's nothing wrong with my brain.” Mrs. Teichner's smile vanished into her deep laugh lines, evidence of a life well-lived. “I'm not depressed, I'm worried.”

“What about?”

“My grandson Max. He lives with me, I raised him. He's the one who's depressed, and I don't know what's going to happen to him after I die.” Mrs. Teichner's forehead buckled. “He's different, Max is. He's got no friends, he's always alone.”

“I understand, but you're my patient tonight.” Eric didn't want to neglect her, even if she was inclined to neglect herself. “You're here seeking treatment, and I'd like to evaluate and, if necessary, treat you.”

“I'm not asking you for treatment. Max wanted us to call you, not me. I let him do it because I think
he
needs the help. I can't get him to a psychiatrist any other way, he won't go.”

“You mean he's the real reason I was called down?” Eric was coming up to speed. It was one of those situations where the identified patient wasn't the real patient.

“Yes. He knows I'm dying, but he can't really accept it and he'll be all alone when I'm gone. Can't you help him?” Mrs. Teichner grasped the sleeve of Eric's shirt, newly urgent. “Please, help him.”

“Explain to me what makes you say he needs help.”

“He tells me that if I just eat, I'm going to get better or live longer or whatever, but I'm not. I'm going to die, and he can't deal with it.” Mrs. Teichner didn't blink, her gaze steady and knowing. “I don't want a feeding tube. I'm ninety, I've lived a long time, and when my pain pills wear off, I hurt all over. I want nature to take its course, at home.”

“I understand.” Eric hoped that he would face his own demise with as much bravery. He decided it wasn't necessary to conduct a mini-evaluation. Mrs. Teichner was remarkably sane, and since she was refusing treatment, he was on safe legal terrain if he addressed what was bothering her about her grandson. “Where are Max's parents? What do they say?”

“My daughter is his mother, but I'm embarrassed to say, she's worthless. She lives with me, but she's never home. She drinks too much and she can't keep a job. She used to work for the phone company but they fired her for absenteeism.”

“How about his father?”

“His father ran away when Max was only two. He drank, too.”

“That's too bad.” Eric felt a bitter pang of resentment, one that would never go away. His father had been an alcoholic, a truck mechanic who'd been driving drunk when he swerved into a tree, killing himself and Eric's mother. Eric had just left for freshman year at Amherst. But he pressed the memory away, to stay present. “Does Max have any brothers or sisters?”

“No, he's an only child. He doesn't even have any friends. At home, he never leaves his room except to take care of me or eat dinner and he plays those computer games all night. I'm all he has.” Mrs. Teichner blinked away tears. “What's going to happen to him? He could hurt himself, after I'm gone.”

“Please, take this.” Eric pulled a Kleenex from a box on the bedside table and handed it to her. As a psychiatrist, he spent a lot of time handing people tissues, but it still tore his heart out when women cried, especially older ones. They reminded him of his mother, whom he still thought about, every day.

“I don't know what to do, I'm worried sick about him.”

“Do you really think he'd harm himself?”

“Yes, I really do.” Mrs. Teichner dabbed her nose, which came to a curved point. Pinkish mottling on its sides told him her oxygenation was poor, which was to be expected. “He's an odd duck but he's a good kid, with a good heart.”

“Has he ever tried to hurt himself? Or said words to that effect?”

“No, he doesn't talk about himself or his feelings. His father was the same way, that good-for-nothing.”

Eric let it go. “Has Max gone to a therapist or gotten counseling at school?”

“No, he's embarrassed. He says he'll get teased if people find out.” Mrs. Teichner sniffled, wiping her nose. “I'm beside myself. I pray on it all the time. It's just so hard. I've asked around but nobody comes through. Please, help him.”

“Well, I do have a private practice,” Eric found himself saying, though he hardly needed a new client. “I could make time to see him if he wanted.”

“Really?” Mrs. Teichner's hooded eyes rounded with hope. “Would you?”

“I would, if he wants to come.”

“Thank you so much!”

“You're welcome.” Eric's heart eased to see her relieved. “But you have to understand that psychotherapy is a serious undertaking, and you've probably heard that it helps only if the person really wants to do it. I'll make the offer to Max, but it's up to him.”

“He'll go, I know. You've lifted such a load off.” Mrs. Teichner clapped her arthritic hands together, holding her Kleenex. “Really, there's nothing on earth that matters to me as much as that boy. I can be at peace if I know he's okay. You understand, if you have kids.”

“I do.” Eric thought of Hannah, but kept that to himself. His daughter was only seven years old, and he worried about what would happen to her if he wasn't around. Since his separation from his wife, that worry had become more than academic.

“And, Doc, I can pay you, don't worry about it. What does it cost to see you, fifty or sixty dollars an hour?”

“About that, yes,” Eric answered. His fee was $300 an hour, and for clients who couldn't afford that, he had a sliding scale that was never less than $250—except for crying old ladies facing terminal diagnoses. Psychiatry was among the lowest-paying medical specialties because it required virtually no procedures, with the highest fees generated by procedure-heavy practices like orthopedics, with its hip replacements and Tommy John surgeries, or plastic surgery, with its face-lifts, nose jobs, and boob jobs. Every psychiatrist hated the irony that the best-paying specialty was cosmetic surgery, as if you could fix your psyche by changing your face.

“Then it's a deal. Thank you so much!”

“Happy to help.” Eric rose, brushing down his khakis. “Before I leave, are you sure you don't want to talk to me about yourself? I've treated patients coping with a diagnosis like yours, and it's understandable if you want some help.”

“Nah. I'm a tough cookie. Except for the cancer, I'm fine.” Mrs. Teichner waved him off with an ironic smile.

“Virginia, it was a pleasure meeting you.” Eric slid his wallet from his pocket, extracted a card, and set it down on the bedside table. “If you change your mind, feel free to call me. Don't hesitate. You
are
one tough cookie.”

“You bet your ass,” Mrs. Teichner shot back.

Eric smiled, trying not to wonder if he would see her alive again. He gave her a final wave and motioned to the medical students to leave. “Mrs. Teichner, 'bye now. I'll send Dr. Fortunato in. Best of luck.”

Eric followed the medical students out of the room, then spotted Laurie at the nurses' station and Max heading for the vending machines. Eric was about to go see him when he felt a touch on his elbow and turned to see it was the female medical student, Kristine Malin. “Yes, Kristine?”

“That was such a sweet thing to do, Dr. Parrish,” Kristine said, her hand on his arm. She had a gorgeous face, big blue eyes, long dark hair, and a dazzling smile, like a toothpaste model.