WHERE HE WAITS
To get there, you turn left off the highway and drive down the road bordered on one side by pasture. And then, a radio song or so later, you turn right into the hospital's gated entrance, easing your car up the slope that leads to the turreted place where he waits. Safety screens cover all the windows. The stairs are steep, and exit signs cast carmine shadows on the concrete floors. Four flights you must travel, and then down several serpentine corridors, before you finally come to his office.
I had never been here before. I had never heard the word Prozac before. It was 1988, the drug just released. I was to be one of the first to take Prozac, and, even though I didn't know this then, one of the first to stay on it for the next ten years, experiencing what long-term existence on this new medication is actually like.
The Prozac Doctor is a busy man. He sees thirty, forty, sometimes fifty patients a day. He is handsome in ways you don't expect your medicine man to be. He has shining black hair and beautiful loafers made of leather so fresh you can practically see the hide still ripple with life. He wears one simple gold band on a finger as tapered as a pianist's, topped with a chip of nacreous nail sanded to perfect smoothness. He is host as well as doctor, and that first time, as well as every time thereafter, he invites me in, standing behind his desk and ushering me forward with stately sweeps of his hand, bowing ever so slightly in a room where you half expect caterers carrying platters of shrimp to emerge from the shadows.
"Sit, Ms. Slater," he said to me the morning we met. He gestured to a deep seat, and I sat. There was a silence between us then, a kind of weighted silence, a grand silence, like the sort you hear before a symphony begins.
And that day was the beginning, the bare beginnings of a story very little like the popular Prozac myths-a wonder drug here, a drug that triggers violence there. No. For me the story of Prozac lies not between these poles but entirely outside of them, in a place my doctor was not taught to get to-the difficulty and compromise of cure, the grief and light of illness passing, the fear as the walls of the hospital wash away and you have before you this-this strange planet, pressing in.
But that first day, there was just Prozac pressing in. I looked around me at the office. On the doctor's desk I saw a Lucite clock with the word prozac embossed across the top. I saw a marble mount holding four pens with prozac etched down their flanks. The pads of paper resting on his bookshelf were the precise size and shape of hors d'oeuvre napkins, and all had prozac in fancy script across their borders, like the name of some new country club.
"What is this stuff?" I asked. I heard my voice repeat itself in my ears, as so many sounds seemed to do lately, the screech of brakes, birdsong nipping at my brain.
The doctor leaned back in his seat. "Prozac," he said, "is the chemical compound fluoxetine hydrochloride." He told me it had a three-ring chemical structure similar to that of other medications I'd tried in the past but that its action on the body's serotonin system made it a finer drug. He told me about the brain chemical serotonin and its role in OCD-obsessive-compulsive disorder-the most recent of my many ills, for me the nattering need to touch, count, check, and tap, over and over again. He told me about synapses and clefts, and despite the time he took with me that day, I felt him coming at me across a gulf.
He had all the right gestures. His knowledge was impeccable. He made eye contact with the subject, meaning me. But still, there was something about the way the Prozac Doctor looked at me, and the very technical way he spoke to me, that made me feel he was viewing me generally-swf, long psych history, five hospitalizations for depression and anxiety-related problems, poor medication response in past, now referred as outpatient for sudden emergence of OCD-as opposed to me, viewing me, in my specific skin.
My skin: had little white lines on it from where I used to cut. It had always crisped easily in the summer sun.
My ears: knew the difference between real and imaginary sounds. That said, they sometimes heard voices, which doctors in the hospitals had told me was a sign not of psychosis but of dissociation. There was a blue baby who cried in my ears. There was a girl in a glass case, who talked to me. The world was full of many sounds-rushings, whirrings, soft and thunderous-and this was both a pleasure and a problem.
My hands: had become a problem. Once they had been conduits for pleasure. When I was a child they had held leaves and rabbits. Today, however, they were one of the reasons I was here. They were the part of me that seemed to have the OCD, tense and seeking, tapping things forty, fifty, sixty times. Not people, thank God, but objects, like stove switches, gas dials. Sometimes I looked at my hands and remembered them as they used to be, fine-boned, indigo-veined, lined with the tracery of all they had touched. Not now, though. From my hands I had learned grief. I had learned how the body can leave you, before you have left it.
I wanted to tell the Prozac Doctor about my hands. I wanted to splay them across his desk and say, "Look at them. What are they seeking?" I wanted him to touch my hands, not really an odd desire, the laying on of hands a practice as ancient as the Bible itself. The Prozac Doctor was biblical to me. I invited him to take on that role, the role every sick person needs her healer to play-not only technician, but poet, priest, theologian, and friend. I know this was asking a lot, poor man, but few people are as full of need and desire as the patient.
Instead, he reached down, opened a desk drawer, and pulled out a sample pill packet. He did not need to ask me many questions, as he had my entire chart before him, thick as an urban phone book. The packet was rather unimpressive, plain white, with a perforated top. To my surprise, he lifted it to his lips and tore at it with his teeth, then gently tapped at it until a smooth pill slid from its foiled pouch into the clean cup of his palm.
There it lay, cream and green. Tiny black letters were stamped down its side-dista-which sounded to me like an astronomy term, the name of a planet in another galaxy. On and on my mind went, making from this small capsule many private metaphors-it was candy, no poison; protein, no plastic.
I wanted to say these things to the Prozac Doctor. But he held himself so politely, angled away from contact. And, after all, he was a busy man, pressured by insurance companies to see throngs of patients, all with their own little paint box of multiple metaphors. Where would he have found the time to explore with me the private poem of the medicine that would soon be mine, a poem that had, as its first stanza, some song about failure? Having tried for the past three years to achieve stability on my own, determined to do it, I was here again, sick with this OCD. How could that be? I was incomplete, apparently, without the pill that was, among other things, a plug to stopper some hole in my soul. Perhaps the hole came from a neuronal glitch, the chemical equivalent of a dropped stitch in the knitted yarn of my brain. Or maybe the hole was between my mother and me. Because when I looked at the pill I also saw her, the little capsule of her sports car we would speed in, clean and compact, screeching to a halt in front of the florist's, where she bought armloads of orchids. And then to the butcher's, where she purchased great red wheels of beef. Nothing was ever enough, for there was no plug to stopper the hole in her soul, no pill.
My pill. Sitting, still, in the Prozac Doctor's palm but moving me backward in time, forward into hope. Much has been said about the meanings we make of illness, but what about the meanings we make out of cure? Cure is complex, disorienting, a revisioning of the self, either subtle or stark. Cure is the new, strange planet, pressing in. The doctor could not have known. And that made me, as it does every patient, only more alone.
"We will start," he said to me, "with twenty milligrams a day, a single capsule, although OCD, unlike depression, usually requires a higher dose." He showed me how, if the dose made me nauseous, I could split the pill and try half, and when I asked him what, exactly, was inside, he told me the story of the drug's design. He told me about Eli Lilly's campus in Indiana, where Prozac was first made, how a man raised rats and then ground their brains into something called a synaptosome, which became this medicine. He told me how Prozac marked a revolution in psychopharmacology because of its selectivity on the serotonin system; it was a drug with the precision of a Scud missile, launched miles away from its target only to land, with a proud flare, right on the enemy's roof.
I pictured the proud flare. I pictured the grounds of Eli Lilly, green and winding. Inside, the labs were clean. White-coated technicians were plucking the gray matter from rats, extracting the liquid transmitters, some kind of healing wet.
I hoped then.
I hoped to be helped.
And yet, I did not take this new pill. Back at home, in the basement apartment where I lived, I looked and looked at it. I touched it to the tip of my tongue, then moved it away. This was not a tease, the drawn-out flirtation that will later come to love. This was fear. Maybe more than anything else, taking a pill, especially a recently developed psychotropic pill about which researchers have more questions than answers, is always an exercise in the existential, because whatever happens happens to your body alone. Each time you swallow a pill you are swallowing not only a chemical compound but yourself unmoored; you are swallowing the sea, the drift and the drown. A pill makes the inscrutable Sartre solid, brings to life the haunting solitude of a Munch painting. It is not the doctor's job to populate the painting, but if he has a flair for the medical arts, maybe he will. The Prozac Doctor, for all his style, couldn't. Psychopharmacology is the one branch of medicine where there is no need for intimacy; neither knives nor stories are an essential part of its practice. And in its understandable glee that it might finally move psychiatry into a position as respectable as surgery, it risks forgetting, or maybe never learning, what even many a surgeon knows: that you must smooth the skin, that you must stop by the bedside in your blue scrub suit, that language is the kiss of life.
I had a dream one night about the Prozac Doctor. This was four or five days after our first visit in what would become over a decade-long relationship. I dreamt I saw him in the supermarket and he was buying bread. He was in a dark suit with brass buttons, and he approached several loaves, newly baked, lying on wooden boards, each with a scar down its center. I knew the Prozac Doctor was hungry, because I could feel his pangs in me. I could feel how he wanted to crack the caul of his professional persona. I thought I should help him, that because I was a patient and knew about proneness and heat, I could, maybe, instruct. Perhaps this is the patient's task. Perhaps in every good medical encounter each party must try to save the other.
So I showed the Prozac Doctor the bread. I showed him how to test it for firmness, how to split it down its scar and spread the salve of butter on it. He lifted a loaf-honey-wheat, I think-and from the hidden folds of his jacket pocket took out a stethoscope. I nodded at him, and he pressed the stethoscope against the breast of the bread, eyes half closed, listening, listening, and then the bread breathed back-a rush and a whir-sounds both thunderous and soft in my ears. I woke up.
And later on that day I got up the courage to take my first dose. A dream doctor, apparently, can bear witness and hold out the promise of tenderness almost as well as a real doctor. It is very fashionable in medical science these days to talk about the power of visualization in healing. Your cancer cells are turning fresh as healthy heartland apples; your tumor is bearing milk. Although I say this tongue in cheek, I am serious too. Perhaps we should instruct patients, especially psychiatric patients, to visualize not only the transformation of their illness but the transformation of their doctors as well. Maybe out of such visualizations-insistent, intense, articulated-we will help to midwife our medicine men.
I held the pill in my hand and then washed it down with water. Afterward, things seemed so quiet. My eyes and ears were tilted inward, listening, looking. I felt what might have been a burning in my chest, something scampering up around my heart. Side effect? Serious? A start? It was too early to know. So I sat on a stool in my kitchen, and I conjured up the Prozac Doctor with his hand on a curve of crusty bread, the hide of fresh whole wheat. I stroked my own arm. I tried for calmness. I thought of yeast and how it works, bubbles of fermentation, little spheres of oxygen that must be kneaded, how maybe every good rising is a combination of chemicals and touch.From the Hardcover edition.
Excerpted from Prozac Diary by Lauren Slater. . Excerpted by permission of Random House, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.