Cabiling / A Prison of Mirrors /

A PRISON OF MIRRORS

By Alaric Cabiling

I met my old boyfriend in med school. He was brilliant at anatomy class, and he planned on specializing in surgery. I loved that about him; surgery is exciting to any med student. There’s the benefit of big insurance payments, fewer patients on Medicare. After all, if you’re a geriatric patient, surgery might prove risky, if not more costly. Anatomy is exciting for any med student; it’s hard to remember so many terms—quite accurately, a catalog of innumerable body parts and their functions. If you can understand me correctly, the prospect of being an excellent surgeon might also translate to being good in bed. Besides the aforementioned reasons, my old boyfriend’s anatomy also earned high marks. He looked like an Instagram model, after all.

His case studies specifically drew my interest. Because of his fatalist approach with perfectionism, he wasn’t predisposed to outright failure by incompetence; he was even a sore loser—a fierce competitor, he’d once claimed instead—but it was more than that. He was a bad loser at everything but poker (he did the poking). He approached all undertakings with the same furor—perfection being an impossible standard. He endeavored to reach heights previously unreached—to the fringes of what could be considered acceptable or real.

But then, he would meet me in the hallways with jubilation. “Rory,” he would call out. “I got an A in Biochemistry.” But, of course, you did, I’d think to myself. Or else, you wouldn’t be bragging about it. I eked out good grades with significantly less effort, but I ended up slogging under the label ‘jaded’ for my trouble. “Psychiatry requires very little knowledge you obtain from med school,” I’d offer up as hyperbole. We were neck and neck to win valedictorian as seniors, but his competitive edge would prove decisive. He would later claim an impassioned victory, although, in a sense, graduation was in the bag.

The med school years flew by so fast. I remember how we drank on the weekends, making drunken love in our shared dorm room. We would do a study group in study halls and cafes, joking about topics of interest like difficult sex positions, hormones, and the use of medical aids and appliances during sex. He thought about urological surgery as a subspecialty, and I jested about sexual deviance like sadomasochism and roleplaying becoming my area of focus. We even rented out a place when school was out and made love there for days on end. What did it come down to the moment graduation came, and our separation threatened to change everything?

Sunny days were brighter with his smile. His smile belied quiet confidence—despite whatever brazen ambition he had. I kept a picture of him in my wallet. Whenever I felt disappointed, I took out my wallet and looked at him.

* * *

I remember the day forever came crashing down. It was late, and I was paged to go to Central State Hospital to evaluate a patient; Central State Hospital was a psychiatric facility for people with acute mental illness.

“Yes. I’m on my way,” I told the hospital operator.

I got up from bed, rising quickly despite sleep deprivation. Years removed from med school, I was now a practicing psychiatrist in the state of Virginia after having done my residency at the University of Virginia in Charlottesville. I was sleepy but used to being paged at odd hours. Central State Hospital couldn’t wait, housing some of the most difficult psychiatric cases in the state: the criminally insane, those unfit to stand trial, and those whose personality disorders were so disruptive they could not responsibly interact with others during outpatient care. Such patients needed to be confined to a long-term facility until social services could determine whether they could reasonably care for themselves without being a threat to others’ safety.

I got dressed and drove out to Central State Hospital to evaluate my patient. It was 4 AM, and it was still a little early for people to be rushing to work. Therefore, I leisurely drove my BMW while listening to Dido’s “Thank You” playing on the radio.

I got off the interstate and wove through smaller streets before turning onto a wide two-lane road replete with overgrown hedges and abandoned houses. En route to the hospital, I sensed eyes watching from the dark windows of derelict homes, from the windows of broken-down vehicles, from behind the unpruned hedges in yards, from behind slides and swings in playgrounds where needles passed hands at odd hours.

The hospital emerged from behind a thick patch of woodland. Beyond an expanse of grassland and a perimeter of high fences topped with barbed wire, Central State Hospital buildings looked massive. Windows had bars to keep inhabitants in. Checkpoints and door locks at each station ensured that all patients (not just patients with little hope for progress) would not escape. It was true that society feared the relapse of their conditions, believing that they could no longer be trusted. These patients and their disorganized thoughts and anomalous behavioral patterns comprised society’s worst nightmares. Amassed in one place, Central State Hospital was a dystopia—only real.

* * *

I drove up to the main gate and handed the guard my credentials. It was SOP (Standard Operating Procedure), so even if he recognized me, and he did, he would still need to press me for my badge.

He radioed in and verified my arrival with the head of security. Then, he said, “Good morning,” before letting me in.

I made my way through the parking lot, leaving my car at a designated spot. I found a van standing in the intake area—a sign that a dangerous patient had been escorted in.

It was likely my patient. After all, I handled acute cases.

Shortly after parking some distance away, I walked over to the intake area and slid my badge at the card reader. The reader chimed, and the light went from red to green. I pushed the door and went in.

I said good morning to staff members at the information desk. I likewise greeted security personnel when I entered the restricted area, where I regularly conducted my evaluations. Since new patients needed to be evaluated before being escorted to their rooms, one of the first things security had to do was strip-search them for foreign objects and potential weapons. My particular patient would be wearing a hospital gown when I would see him; he would have been strip-searched and restrained.

A staff member, I trusted offered me coffee. I asked her how she was, and she replied that she was fine.

I approached the clinical area, and more guards were waiting. They greeted me, stepped aside, took a chart off the rack by the door, and handed it to me. The head of security waiting for me by the entrance to the infirmary addressed me. “This one’s cuckoo for sure, Doc. Guy lacerated himself all over and then tried to burn himself alive.”

Then, he went on. “He’s a flesh sculpture. Carved himself up like it was Thanksgiving because he had nothing to serve his guests.”

“Did you say sculpture?” I asked him.

“Yup,” he responded bluntly. “Police was called to a homeless shelter after a disorderly man showed up with cuts all over him. He also got in a dispute with another person at the shelter and attempted to burn the person’s possessions. After the police arrived and the volunteers at the shelter were interviewed, he was brought to the ER, stabilized, and then brought here to await trial for charges of attempted arson.”

I shook my head after hearing it, acknowledging his implication that it had been ugly.

“What’s the first guess at a diagnosis, Doc?” the Head of Security asked sarcastically.

“Problems with women... anyone’s guess,” I said aloud, trying to lighten the mood.

No one laughed.

“Well, let’s find out,” I followed by saying.

The Head of Security opened the door to the infirmary, and the guards escorted me in. The Head of Security conducted an inspection and found the man adequately restrained. The man’s hair was a mess, and his eyes seemed immutable to reason. He resembled nothing like you—in terms of demeanor, decorum—but I knew from the moment I saw the man that he somehow reminded me of my old boyfriend.

* * *

We were at a bar not far from the med school building. It was a short walk from the dorm, and we held hands some of the ways. Everyone could see the smiles on our faces. No one dared to seize that sort of happiness—two lovers who believed they were meant for each other, two lovers free of the doubts that plagued many trysts—two lovers who trusted each other beyond reasonable measure. Yes, we were two lovers overjoyed to be together: you and I.

The bar was filled with other med students, students from other programs, professors even. We said hi to some of them, then sat down on barstools and ordered drinks.

“Graduation from med school,” you said, “Is not far away. Where will you go?”

“I might stay,” I replied, despite hurting. “I don’t get to do my residency at Harvard.”

“Come with me. If you don’t, I’ll miss you terribly. We’ll exhaust all options.”

“We’ll write or call,” I said, smiling. You took a shot of vodka from the tray on the bartop.

We must have realized that our love was doomed. Love wasn’t meant to last the distance, and many couples would have recognized it. Having wanted to attend Harvard for ages, you’d booked the plane ticket, short of confirming your intent to do your residency there afterward.

“We’ll make it work somehow, Rory,” you said with some seriousness. You put down the empty shot glass and took another one from the tray in front of us. Who would have risked the possible repercussions with vodka shooters on the last night before graduation? It seemed fucked up, but we wanted to make love while drunk.

We returned to our dorm room, arm around the shoulder to keep from falling down. You relaxed on our couch, propped your feet up on the ottoman, and nudged your shoes off while I poured us some alcohol to extend the drinking session. We were more than a little drunk; in fact, I was so drunk that I poured red wine vinegar into our glasses instead of brandy. We took sips and found the taste strange, but we laughed and made out anyway. We undressed and continued making out; I groped for your arms and thighs, and you touched my face and neck. You slid on top of me, and we coiled around each other’s bodies while dancehall played from the computer speakers on the desk.

After the lovemaking was done, I sat in my office chair, watching you sleep. When you finally opened your eyes, you scanned the room and saw my face; our eyes met, and you smiled. Your cheeks were pink with alcohol consumption, your hair still slicked back and immaculate despite the sex. Your eyes were still scanning the room while lying in bed half-naked. Those same eyes seemed to be asking me what was wrong, so I told you that nothing was. You had guessed right at the time—our time was coming; we were parting ways soon.

“I’ll always love you,” you had said in between gulps of vodka in the bar, smiling at me afterward—a forlorn smile that I sensed had meant the opposite.

Surely, graduation would come, so I began choosing where to do residency—the inevitable certainty of going our separate ways. I didn’t want to leave you, nor did you want to do the same, but I was decided on psychiatry, and you felt the same about surgery, besides the fact that we were accepted by different schools. The time for us to say goodbye came on our very last night before moving out of our dorm room. We made love one last time and began packing. After we were done, you threw your medical gowns on the bed and started crying. I held you, trying to be strong for us both. You turned around to hug me and kiss me, but then you did something that surprised me.

You suddenly smiled.

* * *

After instructing forensics to compare a picture of the patient with a picture of you in med school that I kept in my wallet, I didn’t feel anxious. I felt certain of the results despite the apparent need for confirmation. “See if these two are a match,” I said to the staff member. “Age the young man’s picture here until you get a composite.”

She didn’t ask me questions. Instead, she merely confirmed receipt. The guards didn’t seem to care. Patients were occupational hazards to personnel—this explained their outlook. Furthermore, the salaries didn’t match the harsh job conditions, which would undoubtedly reinforce the aforementioned impressions.

I returned to my evaluation and realized that I somehow had to know just what had happened to my patient. This patient had inflicted countless lacerations on himself and was found attempting to commit suicide via arson. The patient’s face, which I admittedly found attractive, was spared cuts or wounds, but his arms and legs were like bloody loaves of bread.

I wanted to believe it wasn’t possible.

“My name is Dr. Corbett. What is your name?” I asked him.

The patient was silent. His stillborn words echoed like a silent howling: a cold, incalculable cry of ruin reverberating somewhere deep inside him.

“I want to help you,” I said. “Do you know why you’re here?”

Silence still greeted me like the ghost of a long-lost friend, almost accusing me of having something to do with this shadow of the man that stood before me.

I read his chart. The patient’s history was unclear. Without establishing his identity, a history and physical would be impossible to obtain.

The guards stared hard at the patient. At Central State, they braved the long drive through streets with derelict homes, playgrounds empty of children, long stretches of road lined with rusty, iron fences where men watched from behind the shadows. These staff members attended to each lost soul in various shades of distemper as they made their way through the infirmary in the intake to be given a diagnosis. This diagnosis was, for some, a death sentence. For others, it was a passphrase to ensure their segregation from the life they used to live, the people they used to know.

The walls were painted gray and green and were peeling in places. Patients didn’t always bathe, and guards and staff members hardly ever complained. In the old days, when the institution’s resulting stench was too much to bear, patients were hosed down—patients would shiver against the cold water under high pressure, naked, only the cold surface of the concrete wall for consolation.

Mattresses and sheets were soiled, and patients were left to sleep on them for days. Fights would break out, sometimes in stairwells where it was most dangerous. The isolation wards were never empty, always housing a violent patient under heavy sedatives. Patients sat in dayrooms, drooling from one corner of the mouth, rocking to and fro, and yet some were frozen in catatonic silence, like Edvard Munch’s painting, The Scream.

It was hardly acceptable that the mentally ill had to suffer such plights but hardly feasible to provide them care twenty-four hours a day, seven days a week—not when the hospital was insufficiently-staffed due to a limited budget. Not when the limited visibility and access afforded to acutely mentally ill patients helped justify the lack of concern over the disappointing recovery rates. It was also because the system was broken, besides the fact that affluent, influential entities couldn’t farm the mentally ill the same way the school system produced skilled workers in more significant numbers.

But, of course, this was common knowledge to me. I was a practicing psychiatrist and madness was supposed to mean money.

To some of us, madness wasn’t confined to the ill. There was absolute madness in prejudice, cruelty, indifference, and apathy for others—as there were disorganized thoughts and violence. This was ironic because mental illness was treated with the same prejudice.

* * *

“What do you have for me?”

“Dr. Corbett, I aged the picture you sent me, like this…”

I saw your picture—an old passport photo—aged to the point when I knew it would match the patient’s photo as a composite. Bingo! My patient was, in fact, you.

I couldn’t believe my eyes. I immediately wondered how it could have happened—you deteriorating into a person I could barely recognize—my old flame cut up like confetti at a party and looking like a homeless man on the street who hadn’t showered in days. What mental state drove you to such lengths? Were you bipolar and intensely suicidal? What could have caused a physician such as yourself to ignore personal hygiene and abandon self-care when both things were fundamental and paramount to a man with your distinction?

I was at a loss. You looked splendid in your old photo. The composite image presented a vastly warped version of your beautiful soul. My eyes welled up, and my fists clenched tightly. I bit my lips so hard I almost bled from the corner of my mouth.

Words could not express the sadness I felt after seeing what you’d look like since you’d fallen ill after leaving med school.

I thanked the staff member and made my way back to intake.

* * *

I told the guards that it would take some time before any progress could be made. They looked at me like they found it dubious. No one expected you to recover so quickly. Not them. Not me.

It was easy to see that even a prominent physician could end up down on his luck and out of a job and career under the worst circumstances—and the horror of mental illness was an apt reason. I instructed my assistant to begin making cold calls to investigate just how or when you first presented with symptoms. What did people notice? How did your illness worsen like it did without you even getting help? Did you lose your assets early after many years of unemployment? Why didn’t any family or friends intervene? How could this be, I asked myself yet again. You were the love I couldn’t do without, and I did without you for so many years even though I still thought about you. I felt guilty.

I peeked into the window and watched you as the head of security instructed the guards. "In the event of an emergency, use justifiable force," he said to them. It was SOP. I couldn’t tell them, no, don’t hurt him. My eyes bled empathy as I looked at you right then.

I knew that you were a long-term case. Treatment wasn’t going to take days or weeks; it was going to take years. Try even decades’ worth of therapy and medication adjustments. The thought occurred to me that decades would not suffice. That, perhaps, this was the day forever had come crashing down in my mind. The way it already had when we’d lost touch years ago, and I quietly went out of my mind during that difficult time in my life—even though I later moved on—somewhat.

The guards were about to take you upstairs to your room. They stood in position, awaiting my last instructions.

A love that was supposed to last forever ended when you came back full circle—to me. The world was similar to Central State Hospital—a prison of mirrors; we face ourselves; we face others. We cannot deny fate. We choose our fate. Fate does not choose us. We run; we hide; destiny simply comes back full circle.

You were once my beloved, now my patient. You weren’t ready to be entrusted with living life on your terms after carving yourself up like a turkey and attempting to roast yourself in the fire. Perhaps, that characterization was crude to an extent. It was a vulgar description of your self-mutilation made in a suggestively dismissive way. Maybe, I attempted to reconnect with you on a visceral level, quite unable to grasp the conscious motivations behind your actions without even a History and Physical Examination before treatment. Perhaps, I attempted to relate with you in terms that men from all walks of life more easily did—layman’s speak—in place of elaborate explanations that required a starting point. You stood before me like a locked door into a labyrinth psyche—the diagnosis and ensuing treatment requiring the all-important skeleton key—the piece to the puzzle.

Why did you do it? What was the trigger?

I was ready to let the guards take you, looking forward to empty bottles of alcohol at home after I’d gulped them down. I wasn’t looking forward to telling intimate friends that I’d seen you that way. Neither was I looking forward to showing them that I was fine despite what I couldn’t tell them—that you would never be the same again—and I would have to watch that happen, or not happen, all the same.

Yes, I knew what was in store for you–days and nights in a drugged stupor, surrounded by rubber walls without windows—days and nights, never telling dawn from dusk, Father Time non-existent.

In contrast, I could remember summers when we walked down trails at nearby parks and rowed our kayaks on the lakes. I remember nights on sandy beaches in the Caribbean and lovemaking memorable for rare ardor and passion.

I remember you for how I’d known you then—the only man I’d ever loved, the best friend I’d ever had. We promised we’d stay in touch, but we never did make it work. I tried calling you to say hello, and you tried doing the same during the holidays. We couldn’t make an urgent stop out of our busy lives during residency to drop by and make a surprise visit—perhaps, out of pride. Still, I would give anything to see you doing well. Anything than seeing you in Central State Hospital, years later, with stitches covering your entire body, eyes incapable of masking insanity.

I stared into those eyes and saw nothing about you that resembled the man I once called the love of my life.

“I know your name,” I told that man. I told you. That was our starting point. “You and I will get to know each other. Again.”

I could barely contain myself. I felt like freeing you from your bonds, driving you back to my home, and making love to you the way I hadn’t known for years—not since you left. Moved to tears, I took my glasses off. I prepared to turn and face you, unsure how to greet a heap of memories and vignettes—the many images of you—frayed, delicate, composite images—sane to insane, moving in a matter of milliseconds. I would dream fondly of the man I’d loved more than anyone transmogrify into a man I was no longer capable of loving.

But then, you did something,

You suddenly smiled. Again.

When I drove out of the parking lot, the light had broken across the sky that early morning. Inside Central State Hospital, darkness brooded behind steel bars and behind steel doors, but not in the open stations and hallways, where men and women carried things like charts, syringes, or electronic badges.

Or their smartphones, browsing Instagram accounts.

THE END

Next Chapter: Fifth Story: Catharsis