Saturday, July 13, 1996
I'm going to be telling my patients to write a personal journal, so it seems
appropriate that I bend myself to the task.
The office is finished and it is just the way it should be. It's not too personal, so patients are free to fantasize about my personal life and project their own fantasies onto me. But the furniture is classy and the room itself is intimate without being close. It feels a little like a study. A far cry from the cold hospital rooms that Columbia boasts.
And I'm right across from Silicon Impressions. I stare out the window looking at the edifice across the street. I can see figures in their offices and coming and going from the lobby. Right now I am a complete outsider to their world. I know nothing about the problems and concerns of a technology company. But I am going to become completely intertwined into their lives.
There's a young woman working late on a Saturday in her office. What is she worried about? Could she be any more far removed from my world than she is right now? But Monday morning, she could be the Ms. Anna Green that is my 1 o'clock appointment. Maybe she's Sylvia Bows. Hell, this is San Francisco, maybe she's Hal Mainor! Will she tell me that she has no social life because she has to spend Saturdays at work? She came to the office on a Saturday, but she's wearing a dress. Isn't the computer ethic jeans and t-shirts even during the week?
Hal Mainor, Anna Green, and Sylvia Bows. Those are my appointments tomorrow. I bet after seeing the three of them for just one session, I'll know whether I can pull this off or not. I certainly will get a sense of what my life's going to be like for a while. I'm as jittery as I was during first year clinic practice. Well, it's a new life.
Sunday, July 14, 1996
Dreamed I was lying on the couch and couldn't talk. Someone, I think it
was Burger, was analyzing me, and kept on saying, "Well? Well? Well?"
louder and louder. He was pointing at me and demanding answers. I was paralyzed
and couldn't talk at all. Burger seemed on the verge of hitting me with
his notebook and I woke up. Classic anxiety dream related to professional
Spent a lot of time wandering the streets. Well, wandering is sort of euphemistic. At times it is more like mountain climbing and then you have to sort of crab walk sideways as you go down the hill so that you don't fall. If you fall going down a hill, it seems like you may just roll into the Bay. I have also never seen so many Starbucks coffee places in my life. I was wandering around the financial district, which is closed tight now--only an occasional security guard. But I was trying to get a feel for the area around my office. I would walk two blocks one way and then double back and walk three blocks another--just trying to canvas the area. There were four Starbucks within two blocks of my office. It's not an exaggeration. Four. This city lives on coffee. Walked around North Beach, sort of near the apartment. Again, lots of coffee. But tried to find a decent pastrami sandwich and I was out of luck. One place asked me if I wanted lettuce and mayonnaise on my hot pastrami sandwich! I changed to a turkey sandwich quick. Cultural differences are evident everywhere.
Wrote a letter to Bill. Told him that he was my "professional circle."
Monday, July 15, 1996
am. Initial session with Hal Mainor. Hal is 36, intelligent and articulate.
Hal complains of having trouble concentrating. First he grilled me on doctor/patient
privilege and then seemed to be satisfied. He has a wife who is more successful
than he is, (she is a lawyer and he writes technical manuals) and two kids,
Glen 14 and Lindy 11. He was a budding writer when family responsibilities
forced him to "grow up" and get a real job. He talks of the dream
slipping away and how he feels like drowning. Sounds like anxiety. I'm sure
there was some recent trigger. Recommended 4 weeks therapy and then an evaluation.
1 pm. Initial session with Anna Green. Anna is 26. She is quite attractive, presents herself with a great deal of care. She describes herself as shy, but is quite vivacious. Anna is quite scattered though. Her conversations flitters around like a butterfly, never really stopping on any particular topic. It seems that if she is talking about something important, she will get scared and flit away to another topic. She is using her verbal loquaciousness as a screen for insecurity. Anna seems like she might be setting herself up as a victim--she let's things happen to her. Anna complains of being unable to concentrate + sleep disorders. She says that she has been having long conversations in her mind with a boyfriend who evidently dumped her. My impression is that the dumping happened about a month ago, but I'm not sure. The facts of his actual departure are obviously painful to her, so she flits over it. She is looking forward to the time when he comes crawling back to her, so that she can scorn him. Apparently, she practiced fellatio on Bill for her first time, and she really liked the experience.
4 pm. Initial session with Sylvia Bows. Sylvia is 38. She is originally from France, but moved to the US when she was 12. Spent her teenage years in San Francisco in the early 70s. Parents ran a French restaurant that is still extant. She still maintains that distinctive accent. Her hair is blond, but blonder on the ends than at the roots. She is married to a man named Tom who is a successful businessman. Tom seems quite manipulative, but Sylvia does not seem to be the type who is easily pushed around. I bet Tom didn't know quite what he was getting when he got married. Sylvia was a newspaper editor when they married. They made a decision not to have children because of their lifestyles. Several years ago, Sylvia changed that decision and Tom reluctantly went along. Couple of years of trying and no luck conceiving. Doctor checks out Sylvia and she's fine. Somehow last week she finds out that Tom had a secret vasectomy. Standard reactions of shock and then rage. She is having physical symptoms--anxiety attacks, rapid pulse and respiration, abdominal involvement, dizziness and insomnia. She describes her rage as murderous. She is talking about a divorce. She admits she isn't rational. Prescribed Zoloft. Follow up carefully.
Tuesday, July 16, 1996
Had a dream with sexual content with Ms. Green as a participant.
At 10 am, spoke with Sylvia by telephone. Only took one dose of Zoloft, but seemed to sleep without dreams.
Talked with the Stanford Research Center again, but no word on whether they've approved my proposal.
At 9 pm, spoke again with Sylvia by telephone. She says that she feels more in control although she says that she feels detached. While before she said that she had lost 15 pounds since Tom's disclosure, now she reports an improved appetite. Strange because Zoloft usually causes appetite suppression. Told her to keep a log. The Zoloft seems to be effective. Since Zoloft is an inhibitor of neronal uptake of serotonin, Sylvia must be watched carefully for mania or hypermania, even though Zoloft is not a monoamine oxidase inhibitor. Although not likely because of Tom's unilateral vasectomy, Sylvia should be cautioned about the potential for Zoloft interaction and pregnancy. Zoloft reaches its peak after about a week of administration--adjust accordingly.
Wednesday, July 17, 1996
Went wandering around the city. Parking is as bad as Manhattan, so no car
for me. I can walk to work without any problem although the walk home can
be daunting. There is a cable car which drops me about 10 blocks from the
apartment, but at least it hauls me up the hill.
The City is great. I ended up at a science museum called the Exploratorium. It's in this Greek temple building with a big lake in front. But the Exploratorium itself is in this cavernous echoing warehouse. There are lots of unpolished scientific exhibits demonstrating human perception, biology, physics--just a whole range of stuff. They encourage you to play around with all the stuff, so I was busy pushing buttons and pulling levers--only dimly perceiving the scientific principles being demonstrated. But loads of fun. There were bus loads of kids there when I was there and tons of tourists--but the place just sucked them up. I really enjoyed the place. They also had T1 lines to the Internet. I was able to see a site with streaming video over the Internet. Just a taste, but what a flavor.
Wandered out and saw this guy who seems to be making his living sculpting these mermaid bathing beauties out of sand on these stairs which lead down to a beach. He is there with his girlfriend, evidently the model, and with a big plastic bucket filled with dollar bills. The mermaids are life sized and quite impressive. I threw the guy a buck. It's refreshing to see somebody panhandling with a talent.
Walked down Chestnut Street and found a magic store. Brought back my youth. I bought a Svengali deck--I'm really not sure why, just nostalgia I guess. They had a hypnotist's wheel, evidently for a stage act, that I have to admit I coveted. But they wanted $300 for it, which was a bit steep.
Found good pizza at Tommaso's in North Beach, right next to a fetish video store that had some of the most disgusting video tapes that I have ever seen. I thought I'd heard it all, but this had people nailing their genitals to tables. But Tommaso's is perfect and the pizza is great. Wonderful old Italian family atmosphere. You feel like you better eat your vegetables. But you can't get the pizza by the slice.
Thursday, July 18, 1996
Initial Session with Joseph Mazurka. Mr. Mazurka starts paranoid that
people are going to be rummaging through my desk for information on him.
Mazurka doesn't have any problems, except that everyone he comes in contact
with is against him. Mazurka is complaining of shoulder and arm pain. As
an initial matter, I concur with his doctor (Wilson) that his pain is psychosomatic.
Mr. Mazurka left the session early and with evident agitation after I followed
up on his reference to masturbation. I think it was an act, and I expect
to get a call from him next week. Some patients like to play the testing
12 pm. 2nd Session with Sylvia Bows. The woman surprised me. She laid a trap for me by opening a button on her blouse so that she exposed a nipple. Then she called me on looking at her. I didn't handle it well, denying that I had seen anything, but she knew I was lying. She said that she had done it on purpose. Apparently, the Zoloft has made her more distant from her own emotions. She describes being detached and observing her actions dispassionately. She says that she is more together at work, but it turns out that she skipped the day and instead went and had an affair with someone (Richard) she met at Starbucks. This was after silently taunting her husband by stripping in front of him, leaving the door open while she bathed, toweling herself dry in front of him, etc. She seems to have discovered that she can use sex as a controlling factor and as a weapon against Tom, who seems to be disconcerted not to be in control himself. Sylvia wants Tom to think about her all day, knowing that he can't have her. She is not having sexual relations with Tom since she found out about the vasectomy. I suggested that the Zoloft might be having an effect on her actions, and she denied it. I think I should be especially cautious about the dosage. Sylvia said that she had spoken with an attorney, but didn't particularly want to talk about that. Apparently, Tom is a good salesman. He is able to convince Sylvia's mother and others that he had the vasectomy for Sylvia's benefit. He uses his sister's bad experience with late pregnancy as a justification.
4 pm. 2nd Session with Anna Green. She says that she cries four hours a day, clearly an exaggeration. But she is upset. She has been sleeping an estimated 5 hours a night. She describes herself as a victim of Bill and his lying. She fantasizes about having long conversations with him and also that someone will end up murdering him. I told her to start a journal. Monitor the sleep disturbances.
Got a letter from CalaCare, this guy named George Eisenstadt. I can't believe it. They expect me to turn over all the transcripts of patient sessions to them. And it's not even for some form of consultation or even professional evaluation. Rather, it's so they can expedite their review of their caseload!
I wrote CalaCare a letter but had to throw it in the trash. I'll sound more professional when I cool down a bit.
Friday, July 19, 1996
a response and spent a good portion of the day getting the files together
that I promised to them.
Worked more on the Stanford project. I'm hopeful that I'll hear from them soon, but they seemed tied up in bureaucracy. When I call them, they mumble excuses.
Joe Mazurka called and made an appointment for Monday.
Got a look at the doodle that Sylvia brought me. It is on a cocktail napkin from a place called "Bull Market." It depicts an Octopus with one of its tentacles severed and dripping blood. The severed piece is still in evidence and the Octopus has a tear dripping from one eye. Great attention is paid to the suckers on the tentacles and to the oozing blood itself. Certainly, an image of primal pain and sorrow.