Ирвин Ялом - The Schopenhauer Cure

The Schopenhauer Cure

A Novel

Irvin D. Yalom

To my community of older buddies who grace me with their friendship, share life`s

inexorable diminishments and losses, and continue to sustain me with their wisdom and

dedication to the life of the mind: Robert Berger, Murray Bilmes, Martel Bryant, Dagfinn

Føllesdahl, Joseph Frank, Van Harvey, Julius Kaplan, Herbert Kotz, Morton Lieberman,

Walter Sokel, Saul Spiro, and Larry Zaroff.

Contents

1Julius knew the life–and–death homilies as well as…

2«Hello, is this Philip Slate?»

3Union Street was sunny and festive. The clatter of silverware…

41787—The Genius: Stormy Beginning and False Start

5Leaving Philip`s office, Julius felt stunned. He gripped the banister…

6Mom and Pop Schopenhauer—Zu Hause

7At five minutes to seven Julius knocked out the ashes…

8Halcyon Days of Early Childhood

9Julius`s spacious Pacific Heights home was far grander than any…

10The Happiest Years of Arthur`s life

11Philip`s First Meeting

121799—Arthur Learns about Choice and Other Worldly Horrors

13Jerking his head to dislodge the annoying couplet from his…

141807—How Arthur Schopenhauer Almost Became a Merchant

15Pam in India

16Schopenhauer`s Main Woman

17At the start of the next meeting all eyes were…

18Pam in India (2)

19Bonnie opened the next meeting with an apology. «Sorry to…

20Foreshadowings of Pessimism

21At the onset of the following meeting, just as Bonnie…

22Women, Passion, Sex

23Bonnie`s concern about the group proved unfounded: at the next…

24Philip walked for hours after the meeting, past the Palace…

25Porcupines, Genius, and the Misanthropist`s Guide to Human Relationships

26At the next meeting Gill plunked himself down, his huge…

27After the session the group gathered for about forty–fiveeir…

28Pessimism as a Way of Life

29«I`d like to continue where we left off,” said Julius,…

30When the group left, Julius watched them walk down his…

31How Arthur Lived

32Julius entered the group room the following week to an…

33Suffering, Rage, Perseverance

34As time raced by, Julius looked forward with increasing anticipation…

35Self–Therapy

36Pam opened the next meeting. «I`ve got something to announce…

37Leaving the group room did not clear the muck from…

38In the following meeting Philip shared neither his frightening experiences…

39Fame, at Last

40Members filed in for the penultimate meeting with contrasting feelings:…

41Death Comes to Arthur Schopenhauer

42Three Years Later

NOTES

ACKNOWLEDGMENTS

ABOUT THE AUTHOR

ALSO BY IRVIN D. YALOM

CREDITS

COPYRIGHT

ABOUT THE PUBLISHER

1

_________________________

Every breath we draw wards off

the death that constantly

impinges on us.... Ultimately

death must triumph, for by

birth it has already become

our lot and it plays with its

prey only for a short while

before swallowing it up.

However, we continue our life

with great interest and much

solicitude as long as

possible, just as we blow out

a soap–bubble as long and as

large as possible, although

with the perfect certainty

that it will burst.

_________________________

Julius knew the life–and–death homilies as well as anyone. He agreed with the

Stoics, who said, «As soon as we are born we begin to die,” and with Epicurus, who

reasoned, «Where I am, death is not and where death is, I am not. Hence why fear

death?» As a physician and a psychiatrist, he had murmured these very consolations

into the ears of the dying.

Though he believed these somber reflections to be useful to his patients, he never

considered that they might have anything to do with him. That is, until a terrible moment

four weeks earlier which forever changed his life.

The moment occurred during his annual routine physical examination. His

internist, Herb Katz—an old friend and medical school classmate—had just completed

his examination and, as always, told Julius to dress and come to his office for a

debriefing.

Herb sat at his desk, rifling through Julius`s chart. «On the whole, you look pretty

good for an ugly sixty–five–year–old man. Prostate is getting a little swollen, but so is

mine. Blood chemistries, cholesterol, and lipid levels are well–behaved—the meds and

your diet are doing their job. Here`s the prescription for your Lipitor, which, along with

your jogging, has lowered your cholesterol enough. So you can give yourself a break: eat

an egg once in a while. I eat two for breakfast every Sunday. And here`s the prescription

for your synthyroid. I`m raising the dose a bit. Your thyroid gland is slowly closing

down—the good thyroid cells are dying and being replaced by fibrotic material. Perfectly

benign condition, as you know. Happens to us all; I`m on thyroid meds myself.

«Yes, Julius, no part of us escapes the destiny of aging. Along with your thyroid,

your knee cartilage is wearing out, your hair follicles are dying, and your upper lumbar

disks are not what they used to be. What`s more, your skin integrity is obviously

deteriorating: your epithelial cells are just plain wearing out—look at all those senile

keratoses on your cheeks, those brown flat lesions.» He held up a small mirror for Julius

to inspect himself. «Must be a dozen more on you since I last saw you. How much time

you spending in the sun? Are you wearing a broad–brimmed hat like I suggested? I want

you to see a dermatologist about them. Bob King`s good. He`s just in the next building.

Here`s his number. Know him?»

Julius nodded.

«He can burn off the unseemly ones with a drop of liquid nitrogen. I had him

remove several of mine last month. No big deal—takes five, ten, minutes. A lot of

internists are doing it themselves now. Also there`s one I want him to look at on your

back: you can`t see it; it`s just under the lateral part of your right scapula. It looks

different from the others—pigmented unevenly and the borders aren`t sharp. Probably

nothing, but let`s have him check it. Okay, buddy?»

«Probably nothing, but let`s have him check it.» Julius heard the strain and forced

casualness in Herb`s voice. But, let there be no mistake, the phrase «pigmented

differently and borders aren`t sharp,” spoken by one doc to another, was a cause for

alarm. It was code for potential melanoma, and now, in retrospect, Julius identified that

phrase, that singular moment, as the point when carefree life ended and death, his

heretofore invisible enemy, materialized in all its awful reality. Death had come to stay, it

never again left his side, and all the horrors that followed were predictable postscripts.

Bob King had been a patient of Julius`s years ago, as had a significant number of

San Francisco physicians. Julius had reigned over the psychiatric community for thirty

years. In his position as professor of psychiatry at the University of California he had

trained scores of students and, five years before, had been president of the American

Psychiatric Association.

His reputation? The no–bullshit doctor`s doctor. A therapist of last resort, a canny

wizard willing to do anything he had to do to help his patient. And that was the reason

why, ten years earlier, Bob King had consulted Julius for treatment of his long–standing

addiction to Vicodan (the physician–addict`s drug of choice because it is so easily

accessible). At that time King was in serious trouble. His Vicodan needs had dramatically

increased: his marriage was in jeopardy, his practice was suffering, and he had to drug

himself to sleep every night.

Bob tried to enter therapy, but all doors were closed for him. Every therapist he

consulted insisted that he enter an impaired physician recovery program, a plan which

Bob resisted because he was loath to compromise his privacy by attending therapy groups

with other physician–addicts. The therapists wouldn`t budge. If they treated a practicing

addicted physician without using the official recovery program, they would place

themselves at risk of punitive action by the medical board or of personal litigation (if, for

example, the patient made an error of judgment in clinical work).

As a last resort before quitting his practice and taking a leave of absence to be

treated anonymously in another city, he appealed to Julius, who accepted the risk and

trusted Bob King to withdraw on his own from Vicodan. And, though therapy was

difficult, as it always is with addicts, Julius treated Bob for the next three years without

the help of a recovery program. And it was one of those secrets that every psychiatrist

had—a therapeutic success that could in no way be discussed or published.

Julius sat in his car after leaving his internist`s office. His heart pounded so hard

the car seemed to shake. Taking a deep breath to quell his mounting terror, then another

and another, he opened his cell phone and, with trembling hands, called Bob King for an

urgent appointment.

«I don`t like it,” said Bob the next morning, as he studied Julius`s back with a large

round magnifying glass. «Here, I want you to look at it; we can do it with two mirrors.»

Bob stationed him by the wall mirror and held a large hand mirror next to the mole.

Julius glanced at the dermatologist through the mirror: blond, ruddy faced, thick

spectacles resting on his long imposing nose—he remembered Bob telling him how the

other kids taunted him with cries of «cucumber nose.» He hadn`t changed much in ten

years. He looked harried, much as when he had been Julius`s patient, huffing and puffing,

arriving always a few minutes late. The Mad Hatter`s refrain, «Late, late for a very

important date,” often had come to mind when Bob rushed into his office. He had gained

weight but was as short as ever. He looked like a dermatologist. Whoever saw a tall

dermatologist? Then Julius glanced at his eyes—oh oh, they seemed apprehensive—the

pupils were large.

«Here`s the critter.» Julius looked through the mirror as Bob pointed with an

eraser–tipped stylus. «This flat nevus below your right shoulder under your scapula. See

it?»

Julius nodded.

Holding a small ruler to it, he continued, «It`s a shade less than one centimeter. I`m

sure you remember the ABCD rule of thumb from your med school dermatology—”

Julius interrupted, «I don`t remember squat from medical school dermatology.

Treat me like a dummy.»

«Okay. ABCD.A for asymmetry—look here.» He moved the stylus to parts of the

lesion. «It`s not perfectly round like all these others on your back—see this one and this

one.» He pointed to two nearby small moles.

Julius tried to break his tension by taking a deep breath.

«Bfor borders—now, look here, I know it`s hard to see.» Bob pointed again to the

subscapular lesion. «See in this upper area how sharp the border is, but all around here on

the medial side it`s indistinct, just fades into the surrounding skin.C for coloration. Here,

on this side, see how it`s light brown. If I magnify it, I see a tad of red, some black,

maybe even some gray.D for diameter; as I say, perhaps seven–eighths of a centimeter.

That`s good–sized, but we can`t be sure how old it is, I mean how fast it`s growing. Herb

Katz says it wasn`t there at last year`s physical. Lastly, under magnification, there is no

doubt that the center is ulcerated.»

Putting down the mirror, he said, «Put your shirt back on, Julius.» After his patient

finished buttoning up, King sat down on the small stool in the examining room and

began, «Now, Julius, you know the literature on this. The concerns are obvious.»

«Look, Bob,” replied Julius, «I know our previous relationship makes this hard for

you, but please don`t ask me to do your work. Don`t assume I know anything about this.

Keep in mind that right now my state of mind is terror veering toward panic. I want you

to take charge, to be entirely honest with me, and take care of me. Just as I did for you.

And, Bob, look at me! When you avoid my gaze like that, it scares the shit out of me.»

«Right. Sorry.» He looked him straight in the eyes. «You took damn good care of

me. I`ll do the same for you.» He cleared his throat, «Okay, my strong clinical impression

is that it`s a melanoma.»

Noting Julius`s wince, he added, «Even so, the diagnosis itself tells you little.

Most—remember that—mostmelanomas are easily treated, though some are bitches. We

need to know some things from the pathologist: Is it melanoma for certain? If so, how

deep is it? Has it spread? So, first step is biopsy and getting a specimen to the pathologist.

«Soon as we finish I`ll call a general surgeon to excise the lesion. I`ll be by his side

throughout. Next, an examination of a frozen section by the pathologist, and ifit`s

negative, then great: we`re finished. If it`s positive, if it is a melanoma, we`ll remove the

most suspicious node or, if necessary, do a multiple node resection. No hospitalization

required—the whole procedure will be done in the surgery center. I`m pretty sure no skin

graft will be needed, and, at most, you miss only a day of work. But you`ll feel some

discomfort at the surgical site for a few days. Nothing else to say now until we learn more

from the biopsy. As you asked, I`ll take care of you. Trust my judgment on this; I`ve been

involved with hundreds of these cases. Okay? My nurse will call you later today with all

the details about time and place and prep instruction. Okay?»

Julius nodded. They both rose.

«I`m sorry,” Bob said, «I wish I could spare you all, this but I can`t.» He held out a

folder of reading material. «I know you may not want this stuff, but I always distribute it

to patients in your situation. Depends on the person: some are comforted by information,

others would rather not know and just toss it on the way out of the office. Hope after the

surgery to tell you something brighter.»

But there was never to be anything brighter—the later news was darker yet. Three

days after the biopsy procedure, they met again. «Do you want to read this? said Bob,

holding out the final pathologist`s report. Seeing Julius shake his head, Bob scanned the

report again and began: «Okay let`s go over it. I gotta tell you: it`s not good. Bottom line

is that itis a melanoma and it has several...uh...notable characteristics: it`s deep, over

four millimeters, ulcerated, and there are five positive nodes.»

«Meaning? Come on, Bob, don`t talk around this. ‘Notable,` four millimeters,