At 6:20 p.m., in my office in the outpatient psychiatry department, Briget was lying on top of the toy cabinet, sucking in air, showing me how fat she could make her stomach. I reminded her she was showing me instead of telling me. She thought that over. Progress. The month before, in response to the same intervention, she’d toppled the bookcase and cracked my mother-and-child sculpture.

The phone rang. It was Lou, at the crisis clinic. “Kim-babe, got you a manic. Unloaded a stack of fifties at Fisherman’s Wharf. Took Jon and me, two guards, and the cops to get him comfortable.” I moaned and said I’d be over.

Lou is my favorite tech. He is writing a Ph.D. thesis on “Mental Health Care Delivery.” He’s a cynic. He says our operation is a flimsy first-aid station at the bottom of a cliff; we catch the miserable lemmings who had finally screwed up the courage to jump. I like his outlook; it’s an antidote to my irrational belief that I should be able to help everyone. The other techs can remove knives and guns, spot drug-induced psychosis, talk down bad trippers, but they don’t make me feel secure. They are really only a giant step up from their wards, enduring their own abusive parents, Liquifast diets, twelve-step groups. I listen to their sad stories, too. They get angry when patients cave in. Jon, a black belt in karate, works on ludes. He is heavy-footed, thick-tongued, with pupils big and slow as pansies. Sara, a perfect size four, orders banana splits, pizzas, burgers and fries, then stuffs and purges. One Sunday she smashed the glass on the empty candy machine with the in-case-of-fire hatchet to get at the display bars.

I had told Briget our hour might be cut short. Now I made a face that it had been. We walked out of the building. Briget’s black Honda Hurricane looked inviting. I subscribe to the theory that anyone else’s problems are better than one’s own. Briget sat on her motorcycle like a rock, angry at me. It took about as long to trigger abandonment and rage in her head as panic in mine. I waved. She squinted and didn’t wave back.


I hate working at the crisis clinic. As a third-year resident, I get two shifts a month. The supervisors are supposed to help, but most of them haven’t been front line in thirty years. Others are overly optimistic. They tell you what you could have said and done the next morning, as if it were possible to have one positive experience after another in the bowels of the hospital. I am still unable to assess who needs a hospital bed and who doesn’t. If a person wants to be hospitalized, in they go. If they resist, I make them promise to stay on the planet until I am off duty. Major depressions, impending operations, the entire contents of The Merck Manual — “A-B-C’s of heart-lung resuscitation” to “Zoonoses” — terrify me.

My survival depends on being pathologically likable. Alcoholics, addicts, and con men find me easy. One night, when all available beds had been filled, I let five patients sleep in the hall on gurneys. I got a note from the regular staff about “toughening up.” The techs have dubbed me “the doc I’d most like to be hospitalized by.”


By one a.m., I had gotten a contact high listening to the excess endorphins at the manic’s neurotransmitters abolish doctors, hospitals, mental illness, crime, and poverty. I had my mood reversed by a panicky borderline — her shrink on vacation — who lost it when she got home and found no milk in the refrigerator. I hospitalized an obsessive-compulsive depressive who had been trying to kill himself for four years. Fifty times he’d removed his head from the noose to check the lock on the door, change the color of his socks, tie a better knot. I talked with a woman who washed her hair in peanut butter. I let an allegedly homicidal maniac convince me he didn’t have an arsenal under his bed. He stuck out his hand. I took it. I always get excited when a guy offers me a hand to shake. I think, phew, he isn’t going to molest me. But it never works. I got my fingers crunched.


Jon and Lou had started a game of Go. I like to watch. The black and white stones are smooth and comforting to touch.

“The ninety-nine-pound devil bit me. Now she’s suing. Claims I broke her arm,” Jon groaned. “It snapped like a Clark Bar.”

“Osteoporosis,” I said.

“I’ll tell my lawyer.”

I made a face of sympathy, got more tales of woe. Jon’s wife left him to join Rajneesh. His ’66 customized Mustang was stolen and totaled. He chain-smokes extra longs. I felt like I was suffocating.

I escaped to the on-duty room. It is in a deserted wing of the hospital. The bed has a lumpy mattress and matching pillow. The male residents stock the night table with sleazy magazines. I stood on the sink, squatting to pee, rather than brave the trek down the hall my imagination populates with throat-slashers and perverts. I crawled into bed in my clothes, took half a Valium to cancel the effects of my last cup of caffeine. The all-nighters are supposed to make you a better doc, but getting an earful of the frightening things in people’s lives and the terrible problems they try to cope with makes me feel like a real softie, inadequate and weak, for minding the loss of sleep, the crummy room. Yet I do. Outpatient is better for me. If someone is on the way down, someone else is on the way up. I need to feel I am making a big difference. Like with Briget. She was off disability now, driving an ambulance, studying to be a paralegal. I could feel good about that. I came to California from Boston in the sixties, against my parents’ wishes, to paint and redo my adolescence; ten years later, I was Dr. Babs. Sometimes I wish I was back at art school, and the patients were models for me to draw. I flipped through the erotica, searched for sexual fantasies. Boobs. Tummies. Elbows and knees. Without my glasses they looked like Braques and Picassos. They were the horses that drove me to dreams.


I got woken at three. It is like the pain I felt as a kid when I’d try to stop my bike without the brakes and the metal bar smacked my pubic bone.

“Sorry, babe. Got a lemming for you with dreams of flying off the Golden Gate. A cabbie spotted him on the bridge, dragged him in. Young Asian, fancy bags. I don’t think he speaks English,” Lou said.


He was no more than eighteen years old, skinny, dressed neatly in pencil-thin brown cords, blue-and-white striped button-down shirt, beige crew-neck sweater. He carried a green loden three-quarter length coat and leather luggage.

We sat catty-corner, one elbow each on the huge desk.

He shivered.

I looked at him.

He wouldn’t look at me.

He stopped shivering.

“Dr. Babs,” I said.

“Toshi Mizume,” he said.

And tried to tear up his airline ticket.

I stopped him. He had a super-saver round trip, departing San Francisco at six a.m. for Tokyo.

“Why?” I asked.

He shook his head.

“What happened?”

He said something in Japanese. He grinned.

I shook my head.

He grinned, and spoke more Japanese.

I thought the grin might mean anything. It had no mirth in it.

He took out books with U.C. Berkeley laminated covers, Beyond Calculus, Quantum Mechanics, spiral notebooks, a calculator, and two rapidographs.

What to do? I asked questions, made guesses, gave up. I had heard of foreign students who got so homesick they looked psychotic, but that’s first semester.

Toshi read his books. I could count his heartbeat in the pulse behind his eyelid. It was fast. Maybe I should have looked in his wallet for information. Found a friend to call. An address. I didn’t. An hour passed. No one came to interrupt us. I sat, waiting for something to happen. Then I imagined falling asleep, waking to find Toshi sprawled at my feet. Hara-kiri. A tribunal of shrinks would kick me out. I’d never have to be on duty again. I felt relief and shame. You are supposed to look at your fantasies for leads about the patient. Why this particular fantasy? Why now? I looked down at the intake form, drummed my bitten fingernails, compared them with my patient’s manicured hands.

Toshi picked up a pen and wrote an equation. Underneath it, he filled the page with tiny numbers, letters, and symbols. It was beautiful and mysterious. A show of strength. I smiled. He smiled. It was different than the grin.

I doodled, “Toshi” and “Japan” to the left, “USA” to the right. I put arrows in both directions.

Toshi crossed out the arrow to Japan.

I made a question mark.

Toshi put his hands over his eyes, his ears, his mouth. I thought of the three monkeys, “see-no-hear-no-speak-no evil.”

I made an equation: “Japan,” “Mother,” and “Father” on one side; “Toshi,” “U.C.,” and an “X” on the other, hoping for clues about his conflict. Love? Man? Woman? Rape? Pregnancy? Rejection?

He crossed out “Father,” circled “Mother.” He stared at the circle. Toshi’s face went gray, then refrigerator white. His eyes hit the floor. Ashamed. I thought he was trying to protect his mother. Shame is big in Japan.

I enclosed the “X” in brackets. Toshi’s eyes returned. “Tell me, instead of your mother,” I said. I thought he understood. If not my words, then the accompanying gestures and exaggerated facial expressions.

Toshi drew a dormitory with little rooms. He really got into the tiny desks and beds and lamps. He filled in the spaces with jagged lines like flashes of lightning.

I wanted to know what was hidden behind the precise ink strokes. “What happened?” I asked. “Where are the people?”

He drew a picture of a man with correct anatomical parts.

I nodded.

He drew another man with the same parts.

I nodded.

He drew the two men very close. He looked straight into my eyes.

I nodded, put a frame around the men.

It was four-thirty. Toshi stretched and yawned. His panic seemed to have subsided.

I drew four boxes. I drew upside down, so he could see, like football coaches do during timeout. Drawing is fun for me. I said, “This is what I think.”

I drew a picture of Toshi on the Golden Gate Bridge with one leg over. I drew a big balloon for his thoughts. “Toshi feels bad. Thinks about telling Mother everything.” I drew a sad Mom, black hearts for tears, hair in disarray. “Toshi thinks it would be better to kill himself than make Mother sad.”

In the second box I drew Toshi and me at the desk, the picture of the two men in front of us. My balloon says, “It’s OK but don’t tell Mom.”

In the third box Toshi and Mom sip tea. Discuss E=mc2 and random clusters. I drew a happy smiling Mom, beautiful dark hair, swept back with pearl-studded combs.

In the final box I drew Toshi talking with a Japanese psychiatrist. I had heard there was latitude for sexual experimentation in Japan, even after marriage, as long as you kept up outward appearances. I said, “You get to decide what is good for you.” I hoped that was true.

Toshi took the piece of paper, studied it. He said, “OK.” I saw a flicker of relief along his high cheekbones.

I flapped my arms like a big bird.

He smiled and nodded.

I called a cab.


I finished the write-up and gave it to Lou to file. The completed Go game was still on the board. Jon was off in the ER on business.

“We even had a bed,” Lou teased.

I got my brown-bag supper from the fridge and sat next to Lou. He put away the stones. I relaxed. Lou takes care of himself.

“What d’you think? Homosexual panic or homophobic?” Lou asked, flipping through the report.

“I don’t know. I don’t know if he saw something or did something. Could have been either.” I was eating my peanut-butter-and-jelly sandwich, feeling happy. I’d done the right thing. Whatever had taken place between Toshi and me had made the night worth the trouble. “Hey, Lou,” I said. “I got one of the lemmings on a plane.”

“Nice,” Lou said.

My second wind came up. A rush of glad-to-be-alive. Maybe I’d specialize in children and adolescents. I was playful and did better work when I wasn’t scared.

“Want a game?” Lou asked.

“Don’t know how.”

“It’s about territory,” Lou said.

A woman, screaming her husband was poisoning her bobby pins, came flying in. She had a file as thick as a fist. I hid in the bathroom while Lou did the intake. He took pity on me and held her for regular staff.


At eight a.m., I went over the night’s cases with a supervisor. The dry-cleaning tag with a metal staple was sticking out at the wrist of his three-piece suit. The supe said, “The fellow was out-of-district. You should have sent him, by ambulance, to Cowell. If anything happens on the plane, we will be liable.”

I went home, pulled the plug on the phone, and slept for eighteen hours.


Briget gave it to me at our next appointment. She had tried to call. When she couldn’t reach me, she had passed out drunk and almost died falling down a flight of stairs on her way to the garage to asphyxiate herself. I got completely caught up in her accusations. A tyrant that had thrived in the rubble of her childhood had burrowed in with a phantom from my own. I promised never to turn off the phone.

A few months later I got a note from Toshi.


Dear Dr. Babs,

How are you? Do you still remember me? My name is Toshi Mizume and I’m Japanese foreign student at U.C. Berkeley.

I was taken care of you on June 28. Thank you very much for your treatment and help on the day, and I never forget you forever in my life.

Thanks to your help, I was able to arrive at Japan. And now, I go see my doctor. He said it takes a lot of time, to recover myself. Therefore, I still have some nervous problems even now, but my mental condition is quite well compared to when I was be there.

At any rate, I will take enough rest and treatment in Japan, and be able to consider my choices.

I really hope to see you again and say thanks to you, when I will go to the United States.

Thank you,                      
Very sincerely yours,
Toshi Mizume               


It is the only note of its kind I ever received. It meant a lot to me. By the time the letter arrived I was a zombie. Twenty hours of inpatient. Med-consults on the surgical floors. Briget’s calls. Madge’s dead cats. Barry, HIV-positive. Ants in my office from Neal’s coffee spills. I was exhausted and frustrated. But the note made me happy. In Japan I was a success.