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CHAPTER 1

ALL YOU NEED KNOW ABOUT ME

For our vanity is such that we hold our own characters immutable and we are slow to acknowledge that they have changed, even for the better.

— E. M. Forster

Since I mean to speak of the lives of others, it is only fair that I speak of mine.

My name is Armando. I turned seventy last month. Generally, people think I am older. It has been that way my entire life. I have come to expect it when I meet someone for the first time. I appear older than I am. This visible premature aging is common among psychiatrists. We absorb our patients' problems. We grow old for them.

I am one of the city's best doctors. It may sound immodest, I know, to refer to myself in such a manner, but that is how I am referred to when my work is mentioned. I am proud of the recognition I have earned over the years. I am vain, but it does not bother me. I have always thought modesty an overrated quality.

I realize vanity can be a treacherous thing. I think, however, that in my life, it has played a constructive role. My vanity has meant I have rarely found it necessary to diverge from the natural dictates of my will. As a professional, I have opted not to make compromises. I have approached my profession on my terms. Things might not have worked out. But fortunately they did.

My father was also a doctor. When I was a child, I liked to watch him get into his car in the morning to go to the hospital. In my child's mind, knowing he was a doctor meant my family and I were shielded from pain or death. It gave me a sense of security. When we ran into people who knew him, I was proud of the respect and deference they showed him.

I wanted to be a doctor just like him. I grew up idolizing him. My father died in a stupid traffic accident when he was forty-eight. I had just turned sixteen. After his death, my desire to be a doctor only became stronger and deeper.

And that is what I did.

In 1967, I obtained my degree from the University of São Paulo's Medical School as a member of its fiftieth graduating class. I was at the top of my class, every year, beginning my freshman year. I did my residency in the United States and returned to Brazil for my PhD. After that, I took the necessary exams and obtained my teaching credentials. I started as an associate professor of medical psychology. I retired as department chair.

In addition to my academic responsibilities, I have always treated a varying number of private patients. Throughout the years I have had good results. I think I have helped some people.

My father, Miguel, was my mother Ondina's first boyfriend. She was widowed at forty-five and never remarried. When she died, she was a year younger than I am now. From the time she became a widow until I graduated from college, a day did not go by when she did not visit Alba and Yeda, her two sisters, who lived together in an old house in the Moema neighborhood.

At 11:30 A.M. Joel, the driver, would drive her to my aunt's house on Jauaperi Street. The three women would sit down for lunch. Then they would sit on the couch and watch television. Every day, they would sip their coffees while watching the news and then the featured film for that afternoon, whatever that might be.

Around 4:30 P.M., Maria José, the maid, would serve them more coffee, this time with a slice of cake, cookies or whatever other treats were in the kitchen that day. Sometimes, instead of staying at home, they would go to the mall or to a doctor's appointment. Joel would drive them, and they would all ride in the backseat together.

When I moved to New York for my residency, my mother temporarily moved in with her sisters. She never moved back. Ondina, Alba and Yeda lived together on Jauaperi Street until they died.

They vanished, one by one, like birds, over a space of ten months. The first to go was Alba, hit by a motorcycle courier while she hailed a taxi in front of the bank where she collected her pension. She died in January. The second to go was my mother, who had been diagnosed with pancreatic cancer at the end of the previous year. She passed away in May. Yeda, the last one to go, suffered a stroke in the middle of the night and never woke up to see August 19th.

I am also a widower. My wife, Heloísa, died nearly seven years ago. After her death, my most palpable feeling was one of relief. It hurt to see her slowly wasting away in the hospital. To shield myself from the pain, about a month before her actual death, in my own mind, I declared her dead. I killed her before she died. But, all along, I was by her side, until her heart finally stopped beating.

I have managed to move on. I lead a normal and satisfactory life. I do not feel alone. But it bothers me to talk about the fact that I am a widower. Not because it moves me or makes me sad. It is just the opposite. I think it should move me more. This is what disturbs me.

My marriage, which lasted thirty-seven years, was a happy one. In the photo on the dresser in the bedroom we shared together, it still is a happy marriage. But now that picture of my wife is enough for me. It suffices.

I may seem cold, even contemptible, but if I lay bare my feelings in this way it is only to show my sincerity and good faith in writing this report.

Heloísa and I had only one child, Mariana, who is now an adult and lives in Chicago. She married an American she met while getting her master's. I have no grandchildren yet.

Since Mariana left home to study abroad, four years after her mother died, I have lived alone in a four-bedroom apartment on Ceará Street, in Higienópolis in São Paulo, in the same house where the three of us once lived.

With my marital obligations concluded and my parental ones suspended, patients have come to occupy a larger space in my life. Nowadays, I do not know what I would do without them. If all of them were to disappear, wiped out by some plague, let us say, I could probably find things to do. I would not die of boredom. But the truth is I need to define what I will do when the day comes and I have no one left to treat.

The most natural thing would be for me to move to the beach house, which is where most of my books are. However, I know that I will be here for as long as I still have patients in São Paulo, because nothing in life gives me more pleasure. When my mother complained that my father saw too many patients, he answered: "A doctor without a patient is a nobody." I agree.

It is in my patients that I find the raw material for my life's major achievements. I care for them as best I can. I get involved in their cases. For each one of them, I read, I reflect, I give of myself. I try to understand what pains them. I ponder it at length. I am meticulous. I take my time in reaching my conclusions.

If I were not careful, my life would be overwhelmed, consumed by the personal problems of others. I would look even older than I do now. To avoid this, I now see only five patients. One a day, Monday through Friday. This allows me to organize my time more efficiently.

I used to take detailed notes of each session. However, ever since I was diagnosed with early arthritis in my right hand, that has changed. Christmas 2003, my daughter gave me a digital recorder, one of those that do not need cassette tapes. From then on, I have only jotted down generic notes while discreetly recording sessions for future reference.

This allowed me to calmly recopy my notes after each session. This change made my work more consistent. I could play back the recordings as many times as I wished. I could hear the pauses, the silences. I could perceive changes in the breathing. I gained elements of analysis that the previous method of note-taking did not offer me.

Whenever my interest in a patient began to wane, I would try to discharge them as soon as possible. In such situations, my logic went something like this: I do not want to devote my time to this patient, therefore he does not need me. He will be better off with someone else.

There were times, though, when a case genuinely interested me and, for reasons beyond my control, I could not arouse the patient's interest in being treated. When this happened, I was the one who was discharged.

When a patient left me, I would feel a deep sadness: infantile and unjustifiable. Something similar to the impotence a child feels when he discovers another child, younger than him, has broken his favorite toy, and that there is nothing that can be done about it.

Whenever I took interest in the case and the patient also showed interest in the therapy, at some point, I would invariably become obsessed. My obsession persisted for as long as the mystery lasted for me. It would last for as long as I could lose myself in the case in my attempts to understand it.

Some obsessions were easily overcome. Others, however, haunted me for years, even after the patient-therapist relationship had ended. I believe this is what happened with Sergio Y.

With him, I learned that some patients realize before the doctor when the optimal point in their treatment has been reached — when to stop, the moment when the returns start diminishing. It was with Sergio that I discovered the importance of humility.

I never did understand, however, in this story that I am about to tell, whether somebody in fact abandoned somebody else.

I want to make clear that, at this point in my life, I have no desire to lay bare the intimate details of a person who has entrusted his privacy to me. However, if I comment on this case and am somehow remiss with regard to my professional oath, my reasons for doing so have great merit.

It is true: I have not kept secret what my eyes have seen and my ears have heard. I know. But I do have principles. My intention in telling this story is not to do harm. I want to become a better doctor and a more principled human being. My intent is to learn.

The patient I will speak of came to my office recommended by his school principal, a friend of mine from college. In her e-mail, she said a seventeen-year-old student, "articulate, intelligent and confused," would call. According to her, it was an "interesting case."

I took note of that.

THE INTERESTING PATIENT

It was a very hot day in São Paulo. On the streets that morning people walked around hoping rain would come and cool things off. No one imagined, though, that it would grow dark so suddenly, or that so much water would fall from the sky. The hour and a half of rain was enough to disturb the entire flow of traffic in the city.

My office is on the twentieth floor of an office building. From my window, I can see the Marginal Pinheiros highway below. Sitting in my armchair, I could see the dark clouds move in and cover the sky and darken the entire horizon.

I turned the lights on at the front desk and walked to the pantry to make some coffee. I returned with my mug, resigned to the fact that the possible new patient would never make it to our first session. He would never make it on time, he would get stuck in traffic. Such was life in São Paulo.

Sitting under the office lights I expected at any moment to receive a phone call, the minimum courtesy under the circumstances, canceling the appointment. Meanwhile, so as not to waste time, I began to read the thesis of a student I was advising.

Sergio Y.'s appointment was the last item on my calendar that day, but since he could not make it, I would end my day early. I would stay in the office until the traffic eased up and then I would have an easy commute home.

I would not meet the intelligent and confused young man my college friend had referred to me, but I would have time to read Luciana Cossermelli's thesis, something I needed to do anyway. At that moment, it made no difference whether I met a new patient or finished reading a dissertation on the methodology for establishing public mental health centers. It was all work, and it had to be done.

However, at 5 P.M. on the dot, the office doorbell rang. To my surprise he had arrived on time. I was impressed.

Since the receptionist had left early because of the rain, I opened the door myself. He wore jeans, sneakers and a white T-shirt with a picture of Mickey Mouse. Before greeting me with a handshake, he introduced himself: "I'm Sergio Y. Professor Heloísa Andrade from the Rousseau School referred me. How do you do?"

I recognized the last name and deduced whose son he was. I knew his father by name. At the time, however, I had no way of knowing he owed his straight dark hair to his mother.

In the office, he waited for me to invite him to sit. Then, looking straight at me, very confidently, he took the initiative, and began. He said he had asked the school principal to recommend a therapist because he "wanted to guarantee himself a future that was minimally happy."

"I'm very pessimistic," he said.

He was aware, objectively speaking, that he had everything necessary for a happy life. Good health. Material comforts. Looks. A school he liked. Parents who were good to him.

Despite all of this, he was sad most of the time. Once, he told me: "I'm depressed by nature. I always have been. I can't escape it." Today, in retrospect, it seems clear that it was his refusal to accept this unhappiness that led him to me.

For reasons he could not understand, his mood invariably reverted to a state of unhappiness, which, according to him, seemed a permanent fact of his reality: a sense of constant sorrow, which he could not stop feeling and whose origin he could not identify. His innermost nature was unhappy. The statement "I'm a sad person," just like that, in quotation marks, is in my notes for our first session.

After he left — I remember it well — I needed to clean the office carpet, which his muddy shoes had soiled. While I erased his footprints, I thought that I liked the manner in which he had expressed his thoughts.

In our second session, Sergio Y. asked if he could move to the couch. There, he told me he did not have many friends, but that he did not feel isolated because of this. He spoke of recurring dreams involving his great-grandfather and Armenian ancestors whom he had never heard of and did not even identify with.

His way of expressing himself was unusual for a seventeen-year-old boy. He was loquacious without seeming anxious, and, most importantly, his tone did not irritate me, something that tends to happen with young patients who are referred to me.

It was in our next session that I decided that the case of Sergio Y. in fact interested me. I offered him the Wednesday, 5 to 6 P.M. slot.

He accepted.

THE HAPPINESS THEY PROMISED AND DID NOT DELIVER

I found Sergio Y.'s most appealing trait to be his integrity. He had all the necessary elements to lead a conventionally happy life. His family, the marketplace and society: everything pointed to a happy life. However, he refused to accept this self-delusion that life suggested to him.

My initial impression was that Sergio Y. tried to maintain a certain autonomy with regard to what family and people who knew him expected. By finding a psychotherapist at seventeen he had shown the courage to challenge the conventional wisdom that for him happiness was unavoidable. He was unhappy and was true to his feelings. For him that was enough.

He had enjoyed good health his entire life. He was 1.87 meters tall and weighed 78 kilos. He did not suffer from any congenital or infectious diseases. He had perfect teeth. Sergio Y. had the physical prerequisites for happiness in abundance.

He had led a sheltered life. Until the age of ten, he had always had a nanny to care for him when he was not in school. His parents were not always available. His father he saw practically only on weekends. His mother he saw sometimes before going to school in the morning and at dinnertime.

He had never seen his parents fight. Sergio's impression was that theirs was a good marriage. He had had a twin brother born with anencephaly who died eight days after birth. Sergio Y.'s only visual memory of his brother was based on a photo he found many years ago, while playing dress-up in his parents' bedroom and going through their wardrobe. There, in one of the drawers, was a photo of a three-day-old baby, eyes closed, face sunken, nestled in his mother's arms, with a cap pulled over his eyebrows to hide his missing skull.

He avoided thinking about that picture. He never opened that drawer again, but he told me he did not believe Roberto's death had anything to do with his sense of unhappiness. He assured me that it did not weigh on him at all.

"My parents made sure I was spared. They never mentioned my brother's death. I never shared in their pain. Had I not found that picture in my mother's wardrobe, I think I'd never have known I'd even had a brother."

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Excerpted from "Sergio Y."
by .
Copyright © 2015 Alexandre Vidal Porto.
Excerpted by permission of Europa Editions.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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