By: Rick Edelstein
Please sit, Dr. Jiminez.
Good to meet you finally Dr. Eslinger.
So, how was your flight, do you find your apartment suitable, Zurich is such a long way from New York, sleep off the jet-lag, and that should complete the social necessities of small talk, doctor.
Yes, yes, yes, not quite.
Small talk, small answers.
Ah, so noted, Doctor.
Dare we use first names or is it too son?
Not at all, Alice.
Ah, yes. Maxime.
When I first read about you, not only your world-wide rep but your name is impressive. Names mean something. Maxime is a very substantial name.
I was named after my mother’s brother.
He must have been pleased.
Hardly. He committed suicide. My mother’s banal effort to keep his memory alive. And so, tell me about you?
After all of our emails, phone conversations, and I assume you’re scanning my curriculum vitae even as we speak…not much to add.
Why are you here?
That’s an odd question with an obvious answer.
To work with you and, do you call them patients, applicants, what nomenclature do you use?
People first and then applicants, petitioners, clients…a rose by any other name. Now, Alicia, why are you here?
I feel like I turned in the term paper late. All right, besides my credentials and professional choices, you want the personal why, is that correct?
The Clinic is not your standard help the sick, heal the ailing. Why would an attractive, divorced, no children psychiatrist with a substantial practice choose to work thousands of miles from home facing professional demands never previously encountered?
Times like this I regret giving up smoking. Okay, you actually gave me the why-answer.
Facing professional demands never previously encountered, unquote.
I need more, doctor.
Well, let’s see now…someone wise once said life is solving problems. Frankly, I admit I became a bit bored with upper class white people’s predictable problems dealing with divorce, affairs, sexual identity, patients who too often indulged our sessions in self-absorption rather than do the work to transcend the insoluble enigma a-k-a the human condition.
Also known as.
Ahh yes. Until you make the unconscious conscious, it will direct your life and you will call it fate.
Carl Gustav Jung, yes.
Gustav, another strong name. I’m losing the thread.
Of our conversation. Oh yes, why am I here? I needed, I need challenge. I need problems to solve that are beyond comforting bromides.
May I ask you a personal question as in turn around is fair play?
I am not familiar with that expression but yes, ask what you will although I do not promise to answer.
Maxime, did your uncle’s suicide contribute to your choice of establishing this highly reputed clinic?
Your work as a psychiatrist is, as they say, in action even as we speak.
You did say ask what you will. Did your uncle’s suicide…
No. Not him, no. Other questions?
Since you opened the clinic decades before attitudes started to crawl towards consideration, when you opened The Clinic I assume there were significant adversaries?
Oh yes. They even had effigies burning in the back of my office. The church was and still is very adamant. I am the devil incarnate.
And with such confrontations, what impelled you to open The Clinic?
Everything we share is under the rubric of confidentiality, doctor?
Max. All right Alicia.
You pronounced my name beautifully. My Puerto Rican mother would be proud. Please…everything shared is of course confidential. How did The Clinic get started in the face of burn-him-at-the-stake?
My mother, with whom I had a very complex relationship, she became ill. Metastatic cancer. Inoperable. She was ninety-two. In severe pain. To such a degree that an I.V. dripping morphine was not enough to dull the excruciating agony. She begged me to end her life. At the time public opinion was extremely strident…and to some degree, still is. The laws, which are still interpretable, prohibited such an act of, well, what I consider an act of kindness. I, as your culture so aptly describes, fought the good fight and in time, opened The Clinic.
And your mother?
She passed in her sleep.
With your help?
She passed in her sleep. Tell me, Dr. Jiminez, are you religious?
You mean do I believe in God?
Is that your way of construing my question to fit your comfort zone of owning this exchange?
Was that what I was doing? Your silence is not golden. Owning this exchange…yes, I do like to own…be in control. Not necessarily a bad thing in a world threatening to lose control. Nothing? Okay, all right your question, am I religious? No, not in the sense of participating with or obeying some edict from any religious sect, no. Why do you ask?
Many religions mandate, attempt to impose their belief systems which would hinder this work.
I am not, never will be ready to subsume my identity by belonging to any establishment, religious or political that has pejorative rules imposed upon my life’s choices.
Sounds like an editorial for your doctorate.
Just attesting to the fact that I am not subject to do’s and don’ts that infringe on my own values or choices.
There is some history in that response, Alicia.
When I feel pressured or unfairly criticized…
Are you confusing me with some authority figure from your past?
I do not respond favorably to being judged, past or present.
Is that what you think I’m doing? Judging you?
Evaluating not judging.
You’re tough, aren’t you?
If I were a man you’d say I was strong but a woman who defends her choices is tough. Doctor…Max…we have had a myriad of emails, phone conversations, recommendations submitted by accredited professionals whom both of us respect.
And? And I feel like I’m being reviewed for the first time which is ludicrous. My orals for my Ph.D. were less stressful. Aren’t we beyond that at this point?
Doctor…Alicia…the work here, in this clinic is never casual, serene, sedate or polite.
I never assumed otherwise. Are we having a disagreement or is this my introduction to Dr. Maxime’s button-pushing methodology?
When you interview, question, work with one of our people, when you use your professional and personal insights with one of our petitioners, who are never the same, your buttons will be pushed beyond your bastions of protected solace. If you feel that I, Alicia, am pushing you too close to the edge, perhaps you may wish to reevaluate your participation at The Clinic.
You’re going for the jugular and this doctor is not biting.
More, please. Sans biting of course.
He wants more. All right. I feel like I’m running for office and about to make a speech to the multitudes.
Be my guest.
I have a set of principles which determine my participation in life, personally and professionally. I do the best I can to keep in touch with empathy, compassion for others, as long as it is not misused to support someone’s weakness. Do I get your vote, Doctor?
When they could do better I work with them…to do better.
I have another question.
This may evoke discomfort.
As if our time up to now was just easy and flowing. Ask away.
Did you ever want to die? And please do not be glib.
Did I ever want to…where did that come from? You really want an answer to such a hypothetical question?
Not hypothetical. Literal.
I always loved being surprised but now I’m not so sure. Did I ever want to die? This surely is not what I anticipated as a welcome to The Clinic first meet. Okay, here goes, dive off the cliff and assume wings will sprout. Did I ever…okay, yes…I can’t believe I’m going to…you really want to know for some purpose which eludes me but what the hell. Okay, breathe. Relajante nina. Did I ever want to die? Yes. I was pregnant. With a girl. I so wanted a girl but Michael, my then-husband insisted on an abortion. We’re not ready for a kid, we’re just starting on our careers, a child would make it impossible he ranted on and on with a hidden agenda that he would leave me if I didn’t accede. I was not strong. As I am now. Oh God, a life force ripped out of me with no replacement. We never healed, Michael and me. It was a terrible, ugly time. I divorced Michael although I did fantasize killing him and then so righteously dispatch with my mortally wounded self. There. You have it! Now, tell me good doctor, why does such a personal trauma matter to you?
For those of us, you, me, and others working in The Clinic…because we have seriously and personally considered death, we will respect the people who come to us, without judgment. I want you to look at something. Adjust your chair so we both can see the monitor and review an applicant.
You record all applicants?
Yes, and some are digitally sent from other locations, countries. If we choose, the person is invited to The Clinic and we do a subsequent interview, or more.
If clarity of the client’s choice is not established, or if one of our consulting doctors is not one hundred percent secure with a decision…
Suppose you reject the petitioner’s choice, disqualify or whatever term you use, what then?
In some situations we inform said client of other options. Again, doctor, inform not advocate, not even recommend. Every offering from us must be from a neutral perspective.
And when you accede to their request for, what is the word?
That nails it, closure. Recorded?
Yes, and even then an eight-day waiting period before the implementation.
Why is that?
Some who have been approved for closure may change their mind.
Does that happen often?
Some. Enough questions for the moment. Watch the monitor and share your response to this applicant.
Just watch, listen, share your response.
She was four, playing on her…she was supposed to be in the house…with my husband…she was so small, almost like a doll you just want to hug and kiss and…I always look in my side and rear-view mirrors…even when it’s unnecessary…like pulling out of my driveway…one of her toys was in front of my right side, I could see it, I asked David, my husband…take the toy inside…he did not…I backed up to be able to turn forward and not crush Charlene’s toy but…the son of a bitch bastard was watching a game on TV instead of Charlene…I crushed her…I backed over my little baby girl…three times…for three times I tried and had, three times miscarriages but then God was good…God…where was God when I killed my baby daughter…I cannot…please…if you do not relieve my grief I shall go mad and kill David and jump off a bridge or in front of a train…I do not want…I cannot go on like this…please!
So, Doctor Jiminez?
I would have to pass.
I have empathy but she does not fulfill acceptance for closure at The Clinic.
Even as she is threatening to kill her errant husband and then herself?
I would recommend immediate therapy, perhaps even hospitalization with medication if warranted, communicate with the husband…and there are additional choices.
There are organizations, gatherings of parents who have lost their children. Very supportive groups. I had such a patient.
This particularly bereft mother has been attending three so far.
Ah, you do follow up?
Even after they no longer have a relationship with the Clinic?
Curiosity, caring, or…
Curiosity or caring? Alicia, those are elements that are not appropriate in our work.
You say we should never care about our…people?
Respect, yes. But care as in emotional identification, a very strong no. You, we, must be impartial or we will burn out and make inappropriate decisions.
All right, yes, I get that. And empathy? Not emotional but in appreciation for what our client is handling?
Not emotional are your key words, detached empathy if you will.
Do you have a problem with that?
No. Everything you say makes total sense. I’ll just have to do the work to disengage on certain levels.
Can you do that?
Seven years as a working psychiatrist, absolutely.
But then why follow up on people who have cut all ties to the clinic?
Data collection of alternative choices.
I don’t understand.
If at the end of a year we review people who have chosen other than closure…how many are functioning and how many have reverted to closure. If the data does not support alternative choices, we must look at that from a realistic point of view.
Excuse me, when this private-line intercom buzzes it is important. Yes? All right, Helmut, I shall. That was our Administrator, Helmut.
He was very courteous in giving me the tour.
He prompted me to check on the news. I am still learning to be adept on our new computers…push this button, here we are, scroll down until Canada…uhmmm hmmm, the print is a bit small and my reading glasses are not to be found at this moment. How is your eyesight?
Very good. Would you like me to read this?
The Supreme Court of Canada said mentally competent, consenting adults who have intolerable physical or psychological suffering from a severe and incurable medical condition have the right to a doctor’s help to die.
Helmut is concerned as one third of our clientele are from the Western hemisphere.
Giving them the choice of Canada or The Clinic.
Exactly. Here’s Helmut again. Yes, we have read it. I am with Dr. Jiminez. Yes, I am sure she remembers as you gave her the welcoming tour. Yes, I understand but The Clinic’s world-wide renown may be substantial enough to offset…I am going to put you on speaker.
Helmut here, Doctors. These Canadians may substantially affect our levels of income, expenditures, operating profits, bonuses, research and eventually perhaps, excuse me Doctor Jiminez, reduction in staff.
That is a little bit of the cart before the horse, don’t you think, Helmut?
My responsibility as Administrator is to protect against negative impacting possibilities. If the boat shows signs of wear it is prudent to cork up possible leaks before we sink.
Interesting imagery, Helmut, but I think you are hitting the
proverbial panic button before…
Not panic, Maxime, responsibility. I urgently suggest that we review our operation, cut unnecessary expenditures, cease any new staff additions, nothing personal Dr. Jiminez, no profit sharing until…
May I jump into the fray?
Fray? What is a fray?
I’d like to suggest that we consider other alternatives. Instead of contracting, expand. Excuse me for sounding like a bumper sticker.
I do not understand. What is a bumper sticker?
Autoaufkleber. We’ll have to learn some American references from Dr. Jiminez.
Yes, all right, but expand? Dr. Jiminez, you are new to our operation so I will take your suggestion under consideration but expand? We do what we do. And what we do is the very best in all of Europe and dare I say the world which even I would imagine better than Canada. Expand to what?
Our services. Those who do not qualify for closure we, as experienced psychiatrists offer therapy, individual and group and when appropriate, medication. When a client lives in a distant location we can do our work on Skype, seeing each on monitors at home or even on smart phones, all in real time.
Very substantial ideas worth considering, don’t you think so, Helmut?
Yes. We will require a reorganization of our services. We will meet and consider all aspects, agreed?
Yes, we will schedule a meeting. But for now we shall continue doing what you describe as the very best in all of Europe…
And the world.
Thank you, Helmut, we will talk about the reorganization in time but not just yet. We will talk later. Wiedersehen, Helmut.
Wiedersehen, Maxime…and Dr. Jiminez.
Alicia, with your excellent suggestions for future consideration, welcome to our team. But for now, work. I cannot stress too strongly that one of the most important factors to be recorded during our sessions is to establish with clarity that our petitioner is of sound judgment.
Do you have a set of questionnaires or can I use my own judgment?
As a psychiatrist your professional opinion will suffice and perhaps during the process you might engage them in conversation that will attest to their awareness, a conscious choice for closure which must be stated by our client without ambivalence. Not by us. Our client. I cannot stress that enough.
You say that as if your work has been challenged.
Many times and in each encounter we evidenced the recording of the individual electing a choice of closure from a conscious position without advocating from us. We have been sued three times and found innocent of charges of manipulating the client for financial or other reasons. Clear?
Good. When you are settled into your office, recording equipment tested, we will schedule consultations.
I have one more question.
Ah, I was waiting for that one.
That one? As if you know my question?
Every new doctor initially avoids and then finally the uncomfortable query. The method used in effecting closure.
Yes. It is a bit uncomfortable. Is the process painless?
You want details?
No, yes, please.
An oral dose of antiemetic drug, one hour later a lethal overdose of powdered phenobarbital dissolved in a glass of water or fruit juice. Our client will fall asleep within 5 minutes of drinking it, progress to coma, respiratory arrest and closure, all of which occurs within 30 minutes of ingesting the phenobarbital.
Thank you. I am ready for the work.
I know you are.
We are recording. I am Dr. Alicia Jiminez with our client, say your name, please.
Is this necessary?
I filled out the forms, gave you the medical records from two hospitals and three doctors, paid your exorbitant fee so can we just get on with what you quaintly call the closure-procedure? Hmmm…closure-procedure. How is that for a metaphor of avoidance.
If you insist which obviously you do, Malachi. Hebrew for messenger, a prophet in the 5th century. Beware of the prophet that profits. I don’t where that came from but it matters-not as here I am in Zurich ready to leave the premises…another metaphor. I never met-a-phor I liked.
Your full name, Malachi.
I assume I have to go through this with you before, well, before there are no more befores.
How old are you and what is your profession?
Fifty-eight. A script doctor which means I rewrote movie scripts, America, England, even one in France. The French and Malachi Fisher of Hebrew heritage did not get along all that well and who gives a shit. Did you know that thousands of Jews have emigrated from France to Israel. From one fucked up country to another. You want to know about my profession? Have a problem with the script? Get Malachi Fisher. He’s the fastest rewrite man in the world and as long as we pay him generously he will not get the WGA involved for credits. I am, was, a highly specialized, very rich whore.
And why are you here, Mr. Fisher?
You must be kidding. Why am I here? You wouldn’t let me charge American Express which pissed me off but then again, of course that card will be null and void come closure time.
Why are you here, Mr. Fisher?
That is ludicrous. I’ll bet you cleared my check for five
thousand six hundred and eighty three dollars, and you are asking why?
Why do you want our assistance for closure?
Did you check my medical record?
There it is.
We need you to be specific in support of your request.
We, the infamous editorial we. When I would meet with the director, the star, the producer, a triumvirate of gleaming corruption who always said we think we need we suggest you buss our butts…I thought that in Zurich I would be finished with the wicked we’s.
I, Dr. Jiminez, requests, Malachi Fisher, that you cite the specifics, the reasons you have for …
For how about ending my life? Death. Instead of closure, your comfort-zoned vocabulary, this estimable client chooses death. Specific enough for you, Doctor?
Why, Mr. Fisher?
You can call me Malachi. Reminds me of a Dylan song, you can call me Zimmy.
It never stops does it. Why? Let’s start with the easy one. Stage Two Emphysema. Had to give up smoking two packs a day and the doctor wants me to exercise. Fill up the lungs. The only exercise I do of late is from the couch to the bathroom.
You know there is treatment. Anoro Ellipta inhaler. Once per day.
Can I have a cigarette with that?
Stage Two, Malachi, not advanced meaning you can improve . I urge you to consider that.
Are you forgetting why I’m here?
No. And it is my responsibility to make you aware of alternatives, other choices.
Malachi Fisher is now aware. Next.
You said start with the easy one. What’s the more difficult concern?
Concern. Another word to make your mission palatable? My concern is colon cancer. Got an inhaler for that?
There are very specific medical procedures in dealing with…
Procedures? Remove the colon leaving an ileostomy bag attached to the outside of my body to catch the…no, not the polite poop, to catch the shit which I would have to empty and…no, my profound vanity will not accede to such an appendage. And there is no guarantee that the maddening pain will lessen or that my cancer will be in total remission. You want more? How about I am fucking bone-tired of the depravity, the decadence of fist-pumping two-day old beard semi messed hair blinding white-on-white teeth smiling over fetid phrases lying fallow in the mouths of…I am weary of…of my…of my…of it all. I‘m beginning to sound like a victim. I abhor victims.
As a psychiatrist, Malachi, I appreciate what you have been handling without even knowing the specifics.
Appreciation from the good doctor will get me what? Oh God…God is some kinda’ pain the butt, literally, the hurting throb is a mean-spirited continuum and the so-called pain-killers are a misnomer which makes me stupid thick nauseous and like a monster Lebron dunk in yo’ face, the pain persists. Result? The life I have led, creatively, sexually, has ceased to exist, ergo, this man known as Malachi Fisher, consciously of sound mind and righteous judgment chooses to cease to exist. Do you need more, doctor?
I assume your medical practitioners informed you of the possibility that in time, perhaps 4 months, the bag can be moved to internal.
I have been informed of the possibility but then again two other doctors said it is unlikely and the bag will remain an external appendage, a reminder of a life’s tribute to the presence of crap. You want me to live with that, do you, Doctor?
I worked with one patient who is living with such a condition and she has a loving husband, one child, friends, culture, a life of…
Dr. what is your name again?
How did you know that? Most people assume Mexican or some other Latin American country. Interesting that you nailed it.
Alejandro Miguel Jiminez, Borinquen bad ass, best friend, any relations, doctor?
No. And is Alejandro with you on this journey?
Journey, concerns, closure. Anything but what it is. No…the last time, oh the painkillers…I took what, when, maybe an hour before this…or maybe thirty two minutes are beginning to kick in and trip me out. Kick in, trip out, oxymoron for days. Alejandro you ask. Hah. Me and Alejandro sitting on a porch at night hearing the distant huge semis plowing a highway at excessive speeds and the sneaky porch light which attracts mosquitos and moths exorcising those suckers with a sizzling killing zap, killing not closure for those bugs. Hah. Alejandro and I would laugh, toast our cervezas, have another toke…and do you believe my relishing rant?
I find it interesting, Malachi.
The truth Ruth is that we were in his funky apartment mid-city where the primary sounds were his neighbor’s TV blasting Ellen which was obviously recorded earlier and…whew, the pain isn’t going anywhere but what the hell it’s almost like a companion with a limp ‘cause right this now I feel like I smoked a sizeable blunt…where was I?
Reruns of Ellen.
You’re a good listener.
Yes, I am.
The paradoxical polarity of the American who will beat up what he conveniently tags a faggot finding no contradiction in worshipping an Ellen-lesbian, and there is no need to deal with a contrary conundrum of values as the knots that held what we believed to be America are untying at a rapid rate propelling us to a foretold destiny in the persona of a tattooed beer bellied macho impersonator with a gun bigger than his dick tormenting in jingoistic shouts of freedom or die…the American way, hear him blast the words of freedom behind which is hiding a cowardly misfit midst the spittle escaping from the corners of his grubby mouth…freedom…freedom…freedom of what? Freedom of ignorance.
What drugs did you take before this session? You said thirty-two minutes or an hour.
Whatever they are, I am ranting through the pain with…what were we talking about doctor?
The pain relievers you took.
Let’s see. First dropped a coupla’ percs.
Percodan. Didn’t do the trick though.
First? And then?
Hillbilly heroin. Oxy…
Our guidelines to be read and adhered to by each client are very specific. Two hours before the interview, no ingestion of drugs. How many did you take?
Guidelines don’t give a rat’s ass when it comes to smothering some of the physical agony even as we speak.
More than what the doctor recommends but then again the pain is substantially more so turn around is fair play, no harm no foul … oh God, good Puerto Rican doctor, when can we…the editorial we…see I didn’t forget…when can you, we, schedule the procedure of closure. I need to end this.
We’re…yes, we…are going to wait.
Wait? For fucking what? ‘Til I am out of my mind with this…
You have to be of sound judgment, clear of any opioids. Any hallucinatory drug influencing your choice of closure is unacceptable.
I want to see your boss, another doctor. What you are saying is intolerable, offensive, obnoxious and as you have no doubt cashed in my silken sell-out monies it is time for you, for the infamous we to deliver the goods, a-k-a closure.
As…yes, I will speak with Dr. Eslinger and…
Yes. And Malachi, perhaps you might consider another choice, to endure and choose life. You are obviously a strong-willed man. I would expect, Malachi, that you can handle…
Why, why are you doing this to me?
Because despite your very severe challenges, you are still a man of intelligence, wit, obviously a gifted writer, a career and even handsome looking younger than fifty-eight. Do you have a wife?
Exes. Two, one of which will be sad as she loves me despite my insistent inconsiderate divorce and the other will be in considerable grief about my demise as alimony will go the way of closure. I want, I need to end this, this existence of…of…talk to me, doctor!
I will arrange for Philip to escort you back to your room and after I speak with Dr. Eslinger, we will…
Yes, we will get back to you. I promise.
I have been promised promises enough to fill chasms of deceit. Today!
I promised him we would get back to him today.
Yes. I reviewed your session and I did call and assure him I would meet with him in two hours. But I am concerned, doctor.
As am I. Malachi either did not read the guidelines or chose to ignore them.
No, I am not concerned with Mister Fisher…or as you call him, Malachi.
His preference, as recorded.
Yes, I got that, Alicia, but in reviewing your work with, yes, Malachi, is, how can I put this, involved, advising him to consider, asserting your point of view, not neutral, not detached, even personally involved.
Personally involved! Maxime, you are over-stating….
Allow me to play this back. I have it…here it is: …consider a choice to endure and choose life. You are obviously a strong-willed man. I would expect, Malachi, that you can handle...and let me go forward to…here it is: you are still a man of intelligence, wit, obviously a gifted writer, a career and even handsome. Handsome, doctor? And as I recall you even asked whether he was single or shall I play it back, doctor?
Two ex-wives. No, do not play it back.
I have no problem with informing him of alternatives, however I do have an issue with your urging him, you used that word I believe, urge…of being an advocate, of caring to a degree beyond a neutral position, of identifying personally with our client, of…
No more, Max. Please. I…you…look at me…burnt out before I even lit a match.
It is important for you to recognize inappropriate positions in our sessions with clients. You must do the work on yourself, Doctor, so this does not occur again.
It will not.
How can I be certain? Convince me, Doctor.
I profoundly apologize.
Apology accepted. Now about your work today and in the future let us make specific observations in our review…
This is painful but as they say, no pain, no gain.
I am missing the point, Alicia.
Oh dear God…it took a man who wants to die to shock me to my own fraudulence. I don’t know whether I am embarrassed or ashamed.
You made mistakes, Alicia, none of which are terminal. I will facilitate Mr. Fisher, and then you and I will spend time to take a more profound look at your issues which in time will no doubt…
Maxime, I have been deceiving myself. I…my life in New York was…was…crushed paradigms of what would make my life meaningful, marriage, children, profession, being of value…after abortion, divorce, my life dissolved into a stasis of comfort but with the absence of joy…so I did a one-eighty. Change location, change profession, assist people towards closure. I ignored the edict: Wherever you go, you take you with you. I assumed that helping people die would bring joy back into my life.
Do not make light of the work we do at The Clinic.
Please, I do not intend to disparage The Clinic. I totally respect your work, Maxime, which is why I came here. But I was misleading myself, big time or as Malachi would put it Lebron doing a monstrous slam dunk on my fallacious escape mechanisms. No, Doctor, your work is noble but this woman cannot detach from empathy, from personally caring, from wanting to help people live, not die.
Are you certain? One session does not a failure-make.
I will return to New York where my work is, to fulfill the cliché, physician heal thyself.
I will miss you.
No, you won’t