The writing class
Chapter 13: What's really true, Freud's cigars, the shape of sleep, a page he liked, she lived on my street, a familiar place
Dear reader,
Last night I went to see Brahms’ Symphony No. 4. The first chair violinist went so hard that he was head-banging by the end of the first movement. The music swelled and he was lifting himself out of the chair. It was honestly athletic. The violinist behind him had the arms of Hercules. My friend leaned over and whispered: “She’s jacked.” Anyway I like sitting up high in the concert hall because I like seeing it all from a distance. In today’s stack we’re doing just that :’) As always, thanks for reading, xo.
In my first year of university I took a creative writing class on Monday evenings. Our professor was a novelist, and he’d won a major award for his last book. On campus you’d recognize his silhouette from across the quad: a man of above-average height in a large black blazer with wild white hair. He looked like he might have smoked a lot when he was young. That year I studied life sciences, but I also wanted to write so I tried out for his class. The writing sample I sent was a story about a teenage girl with a crush on her English teacher. The professor emailed a few days later: “Ok, you’re in.” I was thrilled and I felt grown up. In class each week we’d bring our work, he’d read it out loud, and then he’d critique it. It wasn’t so much a critique as it was a swift dismantling of any ego we’d mistakenly brought to class. We hated it because everything he said was right. And I remember everything he said. To one classmate whose prose was very flowery, he said, “You’re writing with your hands down your pants, I can’t keep reading this.” To another who’d written her chapter in the present tense: “Every bargain basement is lined with books written in the present tense. This feels cheap.” To all of us, he said: “There is true, and there is really true. True is: she had red hair. Really true is: she covered her mouth when she laughed.” I think about this every time I write.
Psychoanalysts never talk about the way Freud died. His legacy is too important, and it’s easier to imagine him immortal. His death was not a death, but a quiet lifting, a transfer to something else. It’s too threatening to admit that the father of psychoanalysis made the decision not to live. At most it’s described as euthanasia: he had a malignant cancer of his palate from fifty years of smoking cigars. Cigars were his great pleasure, he smoked twenty a day. When his cancer was diagnosed, he refused to stop smoking. He underwent thirty-four surgeries, but the cancer continued. He suffered, and he continued to smoke the cigars that caused the cancer, because his cigars softened his suffering. The cancer invaded his mouth and necrotized the flesh to emit the smell of rot. I’ve been told the day he chose to die was the day when even his dog Lün wouldn’t come near him, because of the smell. Freud asked his physician, Max Schur, to give him enough morphine to end his life. Schur later wrote: “He soon felt relief and fell into a peaceful sleep. The expression of pain and suffering was gone… he lapsed into a coma and did not wake up again.”
In sleep, the waves on an encephalogram change as we move between stages. We go from light to deep sleep, and after that we dream. In light sleep, or N1, we make theta waves. As sleep gets deeper, in N2, the waves grow; we begin to see K complexes and sleep spindles. I love these shapes and their names. They look like crags and cliffs drawn out quickly across the page. A sleep spindle is a tight shallow coil, a low amplitude high frequency wave. A K complex is a sudden rise and drop, a steep cliff. The deepest stage is N3, also known as slow wave sleep. It’s made of massive delta waves, the life-giving rest we want when we go to sleep. Without N3 our bodies don’t feel correct. Without its slow waves our memories don’t solidify. We need this stage of sleep to remember what we learned over the day. After N3 comes the REM stage, the sleep in which we dream. In dreams we form connections between seemingly unrelated things. This is how we create — we need it for ideas and music and art. We will repeat the pattern, from N1 to REM, multiple times in a night. Many things will disrupt the shapes of our sleep, most often medications, alcohol, age, and illness.
My writing professor only ever liked one thing I wrote. Early in the term he told me, “You can’t write based on an idea. Readers don’t give a shit about your ideas. You have to go to the heat of the experience to write something true.” Halfway through the term I threw out my first idea and tried to write something true. That was the year I thought I might die, so I wrote about the day I found out. When my professor read my pages out loud, the words sounded good in the room. The cadence was correct. The syllables were comfortable. “His hand was unfamiliar; big and warm and dry.” That was his favourite line. He paused when he read it, and he hummed a bit. He said it was really true. After he finished reading he said I should cut the last few words of that line to make it: “His hand was unfamiliar.” He was right. But I could tell he was being delicate because he knew how true it was. I didn’t want pity, I just wanted to be good. I wished I could be good without being true, because being true meant being an eighteen-year-old with cancer. I tried writing more, but I soon stopped bringing my work to class. Then I stopped going to class altogether. I wasn’t ready to write about that moment of unfastening, when the self lifts out of its old place, and returns to a body you can’t trust. As patients we can’t show how terrible that is, because our doctors are too busy, and our families are too worried. There’s no room to feel it, so we shield ourselves from feeling. Instead the unfastening happens in other ways. We might cry in a CT scanner, or wake up in the early morning and spend hours going back to sleep.
In remission, cancer still sometimes invades the day. In my last year of medical school I saw a young woman admitted to the hospital who’d been recently diagnosed with cancer. Her suffering made the medical team uncomfortable, so they asked psychiatry to see her. The internists and ICU doctors often do this. When I see these patients now, I tell them it would be strange if they weren’t suffering. In the hospital room of the young woman, the psychiatrist listened to her for a while. After a few minutes the psychiatrist said: “You lost a part of yourself when you got sick.” I think everyone in the room was crying. What she said was really true. I’ve read many cancer memoirs over the years, but the most devastating one was a book by a cancer patient’s fiancé. It’s an elegy of letters, postcards, and drawings the writer did at the bedside — it’s about their life together before his partner died. It’s a grief book. You can’t write that kind of book when you’re sick. As patients we’re trying not to collapse. The armour stays on because cancer is a metaphor, and the metaphor is a fight. Language lets us talk about such complicated things in such clear ways. It’s the people around you who can feel it more fully. A few months ago I assessed a young woman in the ICU. She’d had cancer a few years before, and was very sick again. When I opened her chart on the computer her address came on the screen. I saw that she lived on my street, just a few houses down. She was so matter-of-fact, she didn’t cry, except for a moment. She’d been through a hell I’ve seen before, and at the same time hers was very different. She still needed the armour, so I didn’t ask her to remove it.
There’s an absurdity to medical life that’s quite beautiful. I remember the feeling of contrast dye injected in my IV before my first CT scan, which made my belly strangely warm. The technologist said with such seriousness: “You might feel like you’re peeing your pants.” I’m most aware of myself when I’m getting my blood drawn. The tubes that collect it are vacuum-sealed to pull the blood out faster. I’ll watch a bit of self spurt out, a dark collection rising quickly in the tube. Before it gets too high the nurse will switch it for the next one. We’ll repeat this many times, my little loss, my brief unfastening. As the tubes fill up we’ll make small talk and I’ll ask them about their day. After that I’ll buy an orange juice and a donut before I go upstairs to see my doctor. Now I see him twice a year. He’s known me since it started, and he’s watched me grow up. I used to find him terrifying. For years when he’d shake my hand at the end of appointments, my hand was always sweaty. Now he treats me like a colleague, and maybe a bit like family. His trainees have told me I’m his favourite patient. He hugs me on my way out, and every time it’s slightly funny because he doesn’t know his stethoscope is digging painfully into my chest. There’s a strange warmth in knowing he’s there — and in writing this now, at a distance. This is the absurdity of medical life: to be known so intimately by someone you’ll never really know. I think medicine in general, and psychiatry in particular, is the act of seeing a moment in a life, and saying what’s really true in it. It’s similar to writing in that way. When it’s good, it brings relief: the self can come back to a familiar place.
Love,
E
This is really true!