Michael O’Brien
Cough Shmoff
I have this scene in my head. Guy has a horrendous cough, he’s at the doctor, nurse is taking his history, she’s barely there, typing on a laptop, hasn’t looked at him once. Responds to all of his answers with this quiet “awesome,” the awe- lingering, the some bitten off. Have you ever been hospitalized? Yes, once. Awe-some. And what were you hospitalized for? Leptospirosis. Awe-some. Any surgeries? When she comes to medications, he lists a bunch, she asks what for, he says depression. Awe-some. And how is the depression?
Guy is speechless—unanswerable question, not to mention irrelevant—but says, finally, “It’s really good.” Awe-some. “No,” guy says. “It’s bad.” Nurse registers something odd, looks at him. “It’s the depression that’s really good,” guy says. “It’s, like, thriving. Which means I feel really bad.” Nurse is like a hypnotized person coming out of it. Says she’s sorry to hear that, would he like to talk to Dr. X about the depression? “No,” guy says. “Just the cough.”
Simple setup, right? Guy in midst of major depression goes to doctor because of bad cough and against better judgment calls nurse’s attention to the depression; subsequently, something happens that otherwise might not have.
I don’t know who this guy is yet, but, nonetheless, in comes the doctor. In part, this doctor is a doctor my wife saw fifteen years ago, in Los Angeles, when she thought she had West Nile virus. I wrote a story back then about a woman who thought she had West Nile virus and went to a doctor like my wife’s, and I had a handle on him. Nice guy, kind of goofy, told my wife a story about almost being the guy who pieced together the puzzle of Lyme disease back in the early seventies. Story didn’t make sense, but my wife didn’t mind. I don’t know how she described him, but the image I formed, or at least the image that stayed with me, was Clarence the Angel from It’s a Wonderful Life but heavier, with a blotchy red face. A few years ago we moved to Chicago, and the doctor I found looked uncannily like the West Nile doctor of my imagination. He, too, was quirky, more interested in conversation than my health, so it’s these two doctors, blended, who walk in to examine the guy with the cough.
For years, I’ve studied my surroundings while waiting for doctors, so I have a handle on the room, too. There’s an exam table, a swiveling stool, and a sitting chair. Fluorescent lights and pockmarked ceiling panels. A little sink, paper towels, a dispenser for hand sanitizer. A little counter stocked with tongue depressors, latex gloves, etc. A cabinet above it. Instruments arranged along the wall, a wall-mounted telephone, and maybe some anatomical illustrations or a glass-framed photo reproduction of an abstract painting. This one is spacious, as exam rooms go.
Doctor introduces himself, says, “So, tell me about this depression.” Guy is so deep in the maw of it he’s having trouble forming speech, but manages to tell doctor he’s seeing someone for the depression. He’s here because of his cough. Forces a cough (which he’s been doing periodically, knowing the coughs are audible to people in the movie theater two buildings down, because he’s afraid otherwise the doctor won’t take him seriously) that turns into a real cough that leaves him gasping for air, gagging, basically, and doctor says, “OK, shirt off, up on the table.”
Doctor starts his patter before guy can get arms out of sleeves. “Don’t ever let someone auscultate through your shirt. I know, it sounds like ‘Don’t take wooden nickels,’ but these young guys, trying to save time”—he’s applying the stethoscope now to guy’s back—“eventually they’ll decide they can listen from across the room. How long did it take you?”
Guy has to think about it. “To take my shirt off?”
“Yeah.”
“Not long.”
“See?”
It’s around here I sense I’m in trouble. Doctor wraps up cough investigation quickly—prescribes a nasal spray, maybe an inhaler, maybe some Vicodin cough syrup. While guy gets dressed, doctor says he hates not getting to know new patients; ideally, the first time he sees someone it’s for a physical, an “annual,” the insurance companies want him to call it, but do you have a few minutes to chat? Guy shrugs, doctor asks a few getting-to-know-you questions, steers toward the depression.
And here I have to stop. Because now I’ve lost my handle on the doctor. Don’t know how self-aware he is, don’t know to what extent he’s concerned about the depression versus likes hearing himself talk and/or wants to be a hero, don’t know what he’ll inspire this still-nebulous guy to say, don’t know what he’ll say in response.
So back to the guy. My instinct now is to make him the character from a story I wrote once called “The SAHD Guy.” “SAHD” for stay-at-home-dad, “guy” because a fellow dad addresses him as “that stay-at-home-dad guy.” Upshot of the story is the SAHD guy’s wife wants to have a second child but only if the SAHD guy does, which is what he tells her, even though he doesn’t. After the SAHD guy goes to an outpatient lab for a semen analysis, his internist calls and delivers an offbeat, self-deprecating explanation of the results. The SAHD guy remembers him as being “a pleasant enough eccentric with a thatch of white hair and a drinker’s nose,” while I imagined him looking very much like Clarence the Angel.
This feels right. It will be the appointment in which the SAHD guy is supposed to request the order for the semen analysis. He hasn’t met the doctor because he and his wife only recently moved to Chicago from Los Angeles. On the way to the appointment, he has decided not to have his semen analyzed because he’s going to tell his wife the truth, leaving only his backbreaking cough to worry about. Obviously, given future events (as detailed in “The SAHD Guy”), he does ask for the order, so that’s what changes in the course of the story. Something about this conversation with the doctor, the conversation only having taken place because of what the SAHD guy said to the nurse, causes him to reconsider the baby question.
Small snafu in the beginning, because the SAHD guy is dealing with depression but not of the major kind, not the kind he would say is “thriving,” but that’s fine, I realize, because he might be in the midst of a severe dip, and even dips of a few days, I know, start to feel like they’ve been going on for weeks, and promise to last forever, creating the sensation of despair that fits with what he says to the nurse.
The SAHD guy, whose internal monologue is rife with hesitation and doubt, actually looks forward to visits with new doctors, knowing that his near-death leptospirosis experience will yield ten minutes of easy conversation, but the awkward start, the “Tell me about this depression,” throws him, and his acute awareness of his flabby chest, of the pale gut hanging over his belt, intensifies his physical unease. He’s afraid, by the way, perhaps irrationally, that his wife is close to leaving him, and his being fifteen pounds heavier than usual tilts the scale (so to speak) further in that direction. So doctor advises him re: clothed auscultation, applies the stethoscope, asks if he has a few minutes, opens with, “What line of work are you in?” The SAHD guy answers, braces for the usual forced enthusiasm, but doctor says—maybe empathetically, maybe intrusively, I’m still not sure about him—“By choice?”
The SAHD guy starts to say, “It’s complicated,” instead says, “Definitely.” Doctor asks next logical question, the one the SAHD guy really hates, which triggers a long, convoluted passage describing his thinking re: having a second child—not his current, at-that-moment thinking, because currently he’s trying to converse with the doctor, but the narrator’s characterization of his recent thinking—and by the time the doctor asks how the SAHD guy’s sex life is, no details needed, just a scale from one to ten, I know the SAHD guy is a dead end. The problem is twofold: (1) I don’t think this doctor is going to change the SAHD guy’s mind about anything, and (2) even if he were capable, I’m telling the same damn story all over, which hypothetically is okay, some writers come back again and again to the same conflict or scenario—the source, presumably, of the “wound” that drives them to write in the first place—but I don’t think the wound a man suffers in wrestling with whether to have a second child is likely to be of the smelly, suppurating, Philoctetian type.
Back to the beginning, then. Cough, nurse, depression. But here’s the problem with main characters afflicted with major depression: they have no agency. The depression is calling the shots. Worse than that. They’re so numb, the hopelessness is so entrenched, there’s very little that can affect them in a meaningful way. If you’re looking for “change” from one of these characters, there’s only two ways it can go. Either he emerges with a temporary sense of lightening, or he feels even worse. So when I come back to a guy so depressed he’s having difficulty forming speech, I can safely say he’s having, at a minimum, a few unbidden thoughts of suicide, and feeling “worse” could only take him deeper into that territory.
Immediately, I think of “A Perfect Day for Bananafish” and a story I’ve always wanted to write that evokes it. Guy is at a big grocery store late at night, picks up a prescription from the twenty-four-hour pharmacy, wanders around, inspects the produce, observes a few of the strange people always present late at night in grocery stores, stops in front of the toothpaste—he’s paralyzed by the range of choices—an old woman with a cart stops next to him, asks how on earth could anyone possibly decide, then keeps talking, asks a lot of questions that don’t demand actual answers, just talks, every time guy tries to walk away, she starts with something new (“Did you see what they’re charging for the frozen shrimp?” “No, I don’t eat fish.” “Who can afford that?” “I don’t know.” “Well. It’s beyond me why anyone would pay that kind of money for frozen shrimp.”), guy eventually gets away, pays for toothpaste, drives home, kills himself.
In other words, just like “Bananafish,” except he talks to an old lady in the toothpaste aisle instead of a little girl at the beach and he’s not (evidently) married, so the story doesn’t begin with his shallow wife talking on the phone with her mother. What’s interesting is that the original “Bananafish” did not include the scene with Seymour Glass’s wife, but when The New Yorker told Salinger they liked the piece but felt it lacked “any discoverable story or point,” Salinger added the opening scene, whereas my story was going to risk not being published in The New Yorker by remaining entirely enigmatic (unless The New Yorker liked it but requested changes).
So. Guy tells nurse about depression, doctor asks, guy says just the cough, doctor shrugs, auscultates on naked back, talks a lot, he’s likable, guy finds tongue to a certain degree, doctor gives samples of nasal spray and inhaler, guy goes home, kills himself. Some readers will ask what “happened” to make guy kill himself after keeping an appointment to have his cough looked at. I’ll say that, by definition, there’s something that didn’t happen, i.e. the infinite number of things that could have, and I don’t think it requires a philosophical inquiry to agree that something not happening, especially when the non-events precede a person killing himself, is akin to something happening.
But still. Something feels wrong. For one thing, I still don’t know this guy. Is that a problem? Well, I knew the guy in the grocery store. He was similar to a character that killed himself in one of my oldest stories (in which the narrator, while being observed by the character who kills himself, is waylaid at the grocery store by an old woman who asks if he knows where the Cream of Wheat cereal “in the cellophane wrapper” is located and goes on to share with him her long history of dietary restrictions), which, come to think of it, is probably why I never wrote the grocery store story. It seems stupid to write story after story in which basically the same guy kills himself.
Which at last defines our guy as not mute or befuddled, not tortured by dread, not bereft of hope. Rather, not unlike the SAHD guy, he’s floundering through a severe dip, tongue a bit thick in his mouth, some lethargy, some anxiety, some pessimism, in the midst of something chronic but manageable.
And he has a terrible cough. Which brings him to a doctor’s office. Where he mentions to the nurse that his depression is acting up. As a result, the doctor won’t take his cough seriously. Absurd on the face of it, right? So why not stop worrying about who the guy is, who the doctor is, etc. Why not just run with the absurdity?
Okay, spitballing here, it’s morning, nine o’clock sharp, nurse stays the same, asks if guy would like to talk to Dr. X about the depression, guy says no, just the cough. Waits, wishing he’d brought reading material, notices, on the desk, a copy of Anna Karenina, a book that once upon a time he had always meant to read. Has just opened it when a woman with short gray hair enters, lab coat that’s much too big for her, introduces herself as Dr. X, takes a seat, asks what she can do for him today. Guy hesitates, stammers, I mean, he chose a doctor with an unambiguously masculine name, gray-haired woman laughs, says, “Just kidding, Dr. X will be with you in a minute.”
Instead it’s a young man, black curly hair, big nose, pointy chin, introduces himself as a resident working with Dr. X. Says, “So you’re depressed, huh?” Guy starts to protest but resident, scanning guy’s chart, interrupts: “That’s a shitload of meds you’re on.” Guy starts to protest again, resident interrupts again. “Leptospirosis, huh?” “Yeah,” guy says, ready to tell the story. Resident says, “Huh, I don’t remember that one.” He’s ready to move on but guy begins story anyhow, it may be the only interesting thing that’s ever happened to him—Jamaica, the rat, the 106-degree fever, the bacteria devouring the flesh in his legs, the kidney failure, the liver trauma, the platelet count near zero . . .
“No fucking way,” resident says. “If they had dropped you, you would’ve died.” Guy says, “I think they were pretty careful not to,” resident says, “Dude, that must have sucked okay let’s take a look at this cough.” Guy starts toward exam table, resident says, “No, don’t bother,” guy starts to take off shirt, resident says, “No, don’t bother,” auscultates through guy’s shirt, tells guy to cough, guy thunders, gasps for air, gags, basically, resident says, “Holy shit,” removes stethoscope, nods, starts to leave. Hand on doorknob, says, “He’ll probably give you a nasal spray and an inhaler, but that’s pretty much for the placebo effect. From what I’ve seen, and I’m talking not just since going to med school, but, like, going back to when I was a kid, cough like this, you just gotta learn to live with it.”
Long wait, guy can’t concentrate on Anna Karenina. Finally, a full-fledged doctor. Introduces himself as Dr. X, lab coat says Dr. X, but guy could’ve sworn the insurance website said Dr. X graduated med school thirty years ago and this man can’t be older than forty—looks, in fact, like the resident but ten years older, hair cut short, receding slightly. “So,” full-fledged doctor says, “tell me about this depression.” Already, guy can’t picture resident exactly, figures he’s overlaid full-fledged doctor’s face on the resident and the resemblance is only passing. Guy shakes his head, says, “Excuse me?” Full-fledged doctor raises eyebrows. “That bad, is it?”
Basic idea is appointment lasts all morning. Doctor is happy to talk about anything except the cough. Can’t get enough of the leptospirosis details, laughs with guy at the crazy turns the episode took, says he’s gotta get his phone number—he teaches a class for second-years at County, he’d like him to give a lecture. Then fatherhood, California, liberal arts colleges, baseball, the TV show “Friends” (which the doctor and his wife have been binge-watching), the governor’s race, Amelia Earhart, a recent fossil find that aged Homo sapiens by a hundred thousand years, particle accelerators, Fellini movies, and other increasingly esoteric topics that would ordinarily suffocate guy with chagrin at his stupidity, but doctor isn’t spouting off, he’s talking on guy’s level, making conversation.
At one point, guy asks what time it is, says, “Oh my gosh, I’m supposed to pick my son up from kindergarten,” but doctor tells him don’t worry, the office called his wife, her mother is picking the boy up and keeping him for the afternoon. Guy realizes he hasn’t coughed since doctor walked in, says, “Okay, but can you take a look at my cough?” Doctor says don’t worry about that, he’s gonna get him some samples of a nasal spray and an inhaler that will knock it right out. Guy says, “Don’t you need to, you know, listen . . .?” Doctor says, “You mean auscultate? Nah, I can tell from here what’s going on. The cough is no problem. But I’m concerned about the depression. I’d like for you to talk to a colleague of mine.”
Guy says sure, give me his number, doctor says no, he’s in-house, he’ll be joining us shortly, guy remarks that he’s actually getting kind of, doctor says, “Hungry? Give me a minute.” Guy sits there puzzling, door opens, nurse rolls in a dinner tray, lifts the cover. “Your wife says the chicken fettuccine alfredo from Sgambati’s is your favorite. Can I get you some white wine with it?” Guy says no, thanks, water is fine.
Awe-some.
Pasta is steaming, bruschetta is straight from the kitchen, stuffed mushrooms—the ones his wife loves but he’s been refusing to try—are delicious. At some point the resident hurries in, grabs Anna Karenina, says, “Dude, that smells incredible,” or maybe it’s the gray-haired woman, asks if she can have a bite, guy says sure, offers his fork, she laughs, says, “Just kidding.” Better the resident, though, because guy is sure now he and the doctor could be brothers.
It’s the doctor who removes the tray, says he’s running a little behind, he won’t be able to sit in with his colleague but very nice meeting you, I’ll be in touch about that lecture. When colleague enters he looks like full-fledged doctor aged ten years, guy is sure of it. Or resident, aged twenty. Fleshier, jowlier, but eyes and mouth the same. Chin the same. Black hair mostly receded now but long enough around the fringes to curl. Guy is reminded of someone else, too, can’t place it.
Basic idea is this doctor’s a psychiatrist but doesn’t ask about guy’s history or symptoms, just tells him without preamble that he needs to get off his medications “pronto,” proselytizes for three hours about “positive psychology,” a.k.a. “happiness research,” i.e. the importance of, in so many words, attitude, purpose, relationships, community. Quotes endless chapter and verse, study after study, and guy doesn’t argue because there is no arguing, all of it makes sense, in fact, he’s read multiple books on the subject and is familiar with most of the studies, but psychiatrist keeps haranguing him. Every time guy says, “You know, I really have to get going,” psychiatrist says, “Hold on, hold on, I’m coming to my point here,” and guy sits back down. Midway through, guy’s bowels prompt him and he sees his out, tells psychiatrist he has to use the restroom. Psychiatrist, though, nods at a door guy hadn’t noticed, sure enough, it’s a bathroom, a gleaming white single-seater, and while guy voids himself, psychiatrist keeps talking at him through the door.
Around three o’clock, a wave of drowsiness sweeps over guy. He struggles to keep eyes open, psychiatrist asks if he needs a nap, guy apologizes, psychiatrist says seriously, he can get some blankets and a pillow. Guy, smothered by fatigue, says actually, that would be great, psychiatrist is disgusted. “You thought I was serious? It always amazes me, some people just don’t want to be happy.” Guy is too tired to answer, psychiatrist heads for the door, stops. “My advice? Go to church.” Guy fights through fog, says, “I don’t think it’s enough to just go.” Psychiatrist says, “You know, I told this friend of mine that pets lower people’s blood pressure, so he got a cat. A couple weeks pass, he complains his blood pressure’s the same, and I ask how much time he spends petting the cat. ‘I have to pet it?’ he says. Next time I’m at his house? No cat. Few years later, he dropped dead from a stroke. Go to church.”
Before guy can collect himself, a ten-years-older, completely bald version of the doctor shuffles in, and now guy has it, the person whom the psychiatrist reminded him of. It’s Clarence the Angel. The resemblance isn’t exact—Clarence has hair, this man’s nose is smaller, and his voice and mannerisms aren’t Clarence’s—but once guy’s realized the resemblance he can’t get over it. “Don’t worry,” he tells the doctor. “I’m not thinking of killing myself.” Doctor says, “Oh, good, but I’m here to look at that cough of yours. The manager of the movie theater’s in our waiting room complaining you’re drowning out the dialogue. Up on the table, please; clothes off down to your underwear.”
Basic idea is doctor is very worried about the cough, wants to sell guy on an experimental procedure where they vacuum out the lining of your airways and replace it with fiberglass, says there’s probably zero risk and the upside is you never cough again. Guy vacillates, doctor says he didn’t want to play the depression card but there’s new research suggesting cough causes mental illness, which gets guy’s attention. Tells doctor he’ll have to do some research of his own, but he’s interested. Doctor says, “Of course, let me grab some literature.” Guy, still on exam table, says, “Wait, wait, can I get dressed?” Doctor is reluctant but consents.
A few minutes later he returns, ten years older, wearing a bad Clarence the Angel wig. Tells guy they’re invoking Section K, they’re holding him overnight for observation, spontaneous mention of suicide is a big red flag. Guy protests, says he was just referencing It’s a Wonderful Life, doctor is sympathetic but firm. “How do you think we would feel if you went home and killed yourself? I’ll send a nurse in with dinner and toiletries.”
And then . . . I don’t know. Lots of directions to choose from. Maybe wig doctor leaves and guy, who has a hard time bucking authority, is paralyzed. Replays the day’s events, as if waking from a bizarre dream and concentrating on its details, for sharing with his wife. Realizes he should call her, has no bars, finds a corner of the room with reception, texts stream in: Where are you? Why didn’t you pick G---- up from school? What’s happening? You’re not answering. I’m calling the police. Or maybe no bars, no texts. Maybe he acquiesces, eats dinner, brushes teeth, falls asleep. Goes home the next day and his son is in high school, wife is remarried, etc. Or goes home at daybreak, wife comes downstairs, kisses him good morning like nothing has happened.
Maybe this guy, normally so compliant, musters the courage to leave on the spot. Door, presumably, is unlocked. Two ways this can go. One is the surreal, e.g. a white hallway/maze with no doors that keeps leading him back here, or to different nursing stations, all manned by his nurse, or maybe to a floor-to-ceiling window from which he looks out on the street, people going about their business, but when he pounds on the glass, nobody responds. The other is normalcy, e.g. he cracks open door, nothing amiss, runs toward exit sign, almost crashes into nurse, lady with short gray hair is at reception, shouts after him, would he like to schedule his follow-up, curiosity gets the better of him, he asks what for.
“You know, your condition.”
Or maybe the less resolution the better. Along the lines of no bars, no texts, no food arrives, no toiletries. Maybe wig doctor told guy not to get dressed, time passes, he’s in his underwear, freezing, starts coughing, checks the cabinet, empty except for a blanket. Wraps himself in blanket, waits. Tries to remember, for purposes of sharing with wife, everything that’s happened. Struggles. Finally curls up on exam table, coughs, tries to remember why he’s here. Can’t. Falls asleep. Coughs.