I remember driving my mother to the store as a senior in high school. Just as we reached the area of the Soldiers Home Park only five minutes from the store, she asked about my future plans. I told her I was going to start college next year and that I had decided to try to get into medical school. She nodded her head and seemed extremely pleased, but that was the end of it. We didn’t speak of my future plans again. When I think about it now, I wonder whether she and my father might have somehow been intimidated by me, whether they felt they could no longer relate to me, and had already lost me to a culture they didn’t understand.
Nonetheless, I took it for granted they would pay my tuition and all other expenses throughout college and medical school. Regardless of the state of our relationships, it would have been unthinkable in my parents’ culture for them to act otherwise, and I have followed their example with my own children.
Thus, for me and for my closest friends, undergraduate school was no dreamed-of destination: it was an obstacle to be overcome as quickly as possible. Ordinarily, students entered medical school after four undergraduate years and a bachelor’s degree, but, on occasion, medical schools accepted outstanding applicants after only three years of undergraduate work, provided they had taken all the required classes. I, along with my peers, opted for that plan and consequently took almost nothing but required pre-med courses (chemistry, physiology, biology, physics, vertebrate anatomy, and German).
What do I remember of my college days? During my three years of college I took only three electives, all of them literature courses. I lived at home and followed a brutal routine: hard work, memorization, laboratory experiments, staying up all night to prepare for exams, studying seven days a week.
Why such a frenzy? Why such a rush? It would have been absolutely unthinkable for me, or, for that matter, for any of my close friends, to have decided to take what is now called a “gap” year, to join an organization like the Peace Corps (which did not yet exist), or volunteer for humanitarian work in other countries, or choose one of the many other options so commonplace in the world of my children and their peers. For all of us there was the ever-present pressure of the medical admission process. It never occurred to any of us to take any longer than necessary to reach medical school. But I felt an additional pressure: I needed to lock in my relationship with Marilyn. I needed to succeed, to show her I would have a solid career and would become a person of such consequence that she would be persuaded to marry me. She was half a year behind me, and her French teacher urged her to apply to Wellesley College, which immediately accepted her. In her senior year of high school, her sorority big sister advised her that she was too young to be permanently pinned down and she should, at least occasionally, go out with other guys. This did not sit well with me and I still remember the names of the two boys she dated. As soon as she left for Wellesley, I grew extremely anxious about losing her: I felt I couldn’t compete with the Ivy League guys she would be meeting. I wrote her constantly expressing my worry that I could not possibly be interesting enough for her, that she was meeting other men, that I might lose her. My whole life at that time was lived in the pre-med sciences, in which Marilyn took no interest whatsoever. I saved Marilyn’s letters, and a few years ago, Wellesley, the college magazine, published a number of them.
During those years, I was so weighed down with anxiety and had such great difficulty sleeping that I should have seen a therapist, but it didn’t seem like an option then. However, if I were to have seen a therapist like me then, I imagine the dialogue would have gone something like this:
DR. YALOM: You said on the phone your anxiety was almost unbearable. Tell me more about that.
IRVIN: Look at my fingernails, bitten to the quick. I’m ashamed of them and I try to hide my nails when I’m with anyone: look at them. A vise-like pressure in my chest. My sleep is screwed up completely. I use Dexedrine and coffee to pull all-nighters to study for exams and now I can’t sleep without sleeping pills.
DR. YALOM: What are you taking?
IRVIN: Seconal, every night.
DR. YALOM: Who prescribes it for you?
IRVIN: I just snitch it from my folks. For as long as I can remember they’ve both popped a Seconal every single night. I’ve wondered if perhaps insomnia is genetic.
DR. YALOM: You mentioned a lot of academic pressure this year. How was your sleep in previous years—for example, in high school?
IRVIN: Sometimes I had too much sexual pressure and I had to masturbate to fall asleep. But in general I’ve slept fine until this year.
DR. YALOM: That provides the answer to your question about insomnia being genetic. You think your classmates are all having the degree of anxiety and sleep problems you’re experiencing?
IRVIN: I doubt it—certainly not the gentile pre-med students I know. They seem more relaxed. One of them pitches for the GW baseball team, others date a lot, or they’re busy with fraternity events.
DR. YALOM: So that suggests that it is neither genetic nor environmental but instead a function of the particular way, or maybe we should even say, the unique way, you’re responding to your environment.
IRVIN: I know, I know—I’m a fanatic. I’ve over-studied for every course, for every exam I’ve taken. Whenever a graph of the class grades for any exam is posted, I see the class curve and then I see my score, an outlier, far, far ahead of the score I would have needed for an A grade. But I need certainty: I’m frantic.
DR. YALOM: Why so frantic? What do you think is behind it?
IRVIN: Well, for one thing, there’s the 5 percent quota on Jews accepted to medical school: that’s pressure enough!
DR. YALOM: But you say you over-studied. That an A wasn’t enough—it had to be a “Super A.” Are your close Jewish friends in the same situation as frantic as you?
IRVIN: They work hard as hell too. We often study together. But they’re not quite as frantic as I am. Maybe a more pleasant home life. They have other things in their lives, do some dating, play basketball—I think they’re better balanced.
DR. YALOM: And your balance? What’s that like?
IRVIN: About 85 percent studying and 15 percent worrying.
DR. YALOM: Is the 15 percent worrying about admission to medical school?
IRVIN: That and something else—my relationship with Marilyn. I absolutely, desperately, want to spend my life with her. We went steady all through high school.
DR. YALOM: Do you see her now?
IRVIN: She’s at Wellesley in Massachusetts for the next four years but we write almost every other day. I phone sometimes, but long distance is way too expensive. My mother is giving me a very hard time about that. Marilyn loves Wellesley and is having a normal healthy undergraduate life that includes meeting other guys, and every time she alludes to some Harvard guy she went out with I go bananas.
DR. YALOM: You’re afraid of? . . .
IRVIN: The obvious—that she will meet some boy who has more to offer—better looking, upper class, sophisticated family, better future ahead of him—all that stuff.
DR. YALOM: And you can offer? . . .
IRVIN: That’s exactly why medical school admission means everything to me. I don’t feel I have much else going for me.
DR. YALOM: Are you dating other women?
IRVIN: No, don’t have time.
DR. YALOM: So you’re living a monastic life? But that must be hard, especially when she is not.
IRVIN: Right! In other words, I’m going steady but she’s not.
DR. YALOM: Usually these are the years of pressing sexual urges.
IRVIN: Yep, I feel half-crazed, sometimes three-quarters crazed by sex much of the time. But what can I do? I can’t meet a girl and say, “I’m in love with someone else who is very far away and all I want from you is sex.” So do I lie? I’m not good at that. I’m not what you call smooth and, for the time being, I’m sentenced to frustration
. I daydream all the time of meeting a beautiful, really horny next-door neighbor who pines for sex when her husband’s out of town. That would be perfect. Especially the next-door bit—no travel time involved.
DR. YALOM: Irvin, I’m persuaded you’re far more uncomfortable than you need to be. I think you could profit with some therapy—you’re carrying around a ton of anxiety and you’ve got a lot of work to do: to understand why your life is so out of balance, why you need to over-study, why you believe you have so little to offer, why you may be so smothering to this woman that you run the risk of driving her away. I believe I can help you and I suggest that we start meeting now twice a week.
IRVIN: Twice a week! And it takes me almost half an hour to get here—and half an hour to get back. That’s four hours a week. And I have an exam almost every week.
DR. YALOM: I suspected you might respond in this manner. So I want to make another point. You haven’t said this, but I have a strong hunch that as you go along in your medical studies you may find psychiatry of particular interest, and, if so, then the hours we spend together will serve a dual function: not only will these hours help you, but they will enhance your understanding of the field.
IRVIN: I can see the merit in that, but that future seems so . . . so . . . futuristic. Anxiety is the looming enemy right now, and I worry that taking four hours out of my week of study might just create more anxiety than we could assuage here in our talks. Let me think on it!
Looking back, I wish I had started therapy as an undergraduate, but in the 1950s I knew no one who had had psychotherapy. Somehow I got through those three horrible years. It helped enormously that Marilyn and I spent summers together as counselors. Those days at camp were free of academic stress, and I basked in my love for her and took care of my young campers and played and taught tennis and made friends with guys who were interested in something other than medicine. One year my fellow counselor was Paul Horn, who became a well-known flutist, and we remained friends until his death.
Aside from these summer interludes, my undergraduate years were relentlessly grim, involving huge classes and minimal contact with professors. However, despite the tension and the unimaginative lectures, I found the content of all my science courses fascinating. That was especially true for organic chemistry—I found the benzene ring, with its beauty and simplicity, coupled to endless complexity, fascinating, and for two summers I earned pocket money tutoring other students in the subject. My favorite courses, though, were my three electives—all literature courses: Modern American Poetry, World Drama, and The Rise of the Novel. I felt alive in these courses and relished reading the books and writing the papers, the only papers I wrote in college.
My course on world drama stands out in my mind. It was the smallest class I attended—only forty students—and the content was enthralling. In that class I had my only memorable personal contact with a teacher, an attractive middle-aged woman who wore her blonde hair in a tight bun and once asked me to come to her office. She critiqued my paper on Prometheus Bound by Aeschylus in the most positive manner, informing me that my writing was superb and my thinking original, and asked if I had considered a career in the humanities. To this day I remember her shining face—she was the only professor who ever knew my name.
Aside from a B+ in one German course, I had a straight A+ record in college, but, even so, applying to medical school was a nerve-wracking process. I applied to nineteen schools and received eighteen rejections and one acceptance (to GW Medical School, which could not reject a GW undergraduate with a near 4.0 average). Somehow the anti-Semitism in the medical school quota didn’t outrage me—it was ubiquitous, I had never known anything else, and, following my parents’ example, simply took it for granted. I never took an activist posture or even seethed at the vast unfairness of the system. Looking back now, I believe my lack of outrage was due to my lack of self-esteem—I had bought into the worldview of my oppressors.
I can still feel the shivers of exhilaration I experienced when I received my letter of admission from GW: it was the greatest thrill of my life. I rushed to the phone to call Marilyn. She tried to be enthusiastic but had never really doubted I would be accepted. My life changed after that—suddenly, I had free time. I picked up a Dostoevsky novel and began reading again. I tried out for the college tennis team and managed to play one varsity doubles match, and joined the university chess team, where I played second board for several intercollegiate matches.
I consider the first year of medical school the worst year of my life, not only because of the academic demands but because Marilyn was off to France for her junior year abroad. I dug in and memorized what I was asked to learn and worked perhaps even harder than I had as a pre-med student. My only pleasure in medical school sprang from my relationship with Herb Kotz and Larry Zaroff, my lifelong friends. They were my anatomy lab partners as we dissected our cadaver, whom we christened Agamemnon.
Unwilling to bear separation from Marilyn any longer, I decided, toward the end of my first year, to transfer to Boston and, mirabile dictu, I was accepted as a transfer student by Boston University Medical School, and when Marilyn returned from her year in France, we got engaged. In Boston, I rented a room in a large four-story Back Bay boardinghouse on Marlborough Street. It was my first year away from home, and my life, inner and outer, began to change for the better. Some other medical students lived in the same house and I soon made friends. Soon three or four of us were commuting together daily to school. One of them, Bob Berger, was to become a close lifelong friend. More on Bob later.
THE AUTHOR’S ROOM IN BOSTON DURING MEDICAL SCHOOL DAYS, 1953.
But the pièce de résistance of being in Boston for my second year of medical school was my weekends with Marilyn. Wellesley College had a very strict code about unchaperoned students spending time off campus at night, and so each week, Marilyn had to invent some legitimate-sounding excuse to be away and obtain an invitation from a broad-minded friend. We studied part of the weekend, took drives along the New England coast, visited museums in Boston, and ate dinner at Durgin-Park.
My inner life was also changing. I was no longer frantic, only minimally anxious, and I was finally sleeping soundly. I knew, even during my first year of medical school, that I would go into psychiatry, though I had only had a few psychiatry lectures, and had never spoken to a psychiatrist. I think I had decided upon psychiatry before even entering medical school: it flowed from my passion for literature and from a belief that psychiatry offered me proximity to all the great writers I loved. My deepest pleasure was to lose myself in the world of a novel, and over and over again I told myself that the very best thing a person could do in life was to write a fine novel. I’ve always had a hunger for stories, and since I first read Treasure Island as a young adolescent I have dived deeply into the narratives that great writers offer us. Even as I write these words at the age of eighty-five, I can hardly wait to return tonight to Joseph Roth’s The Radetzky March. I ration it and fight the urge to devour it all at once. When the story, as in that book, is more than a life narrative, and is an exploration of human desire, dread, and search for meaning, then I am enthralled, and enthralled that the drama is doubly meaningful—pertaining not only to a particular existence but to a parallel process taking place in an entire culture, i.e., the pre–World War I Austrian-Hungarian Empire.
Despite my love for literature, medicine was never a default decision, because I had always been fascinated by science, too, especially biology, embryology, and biochemistry. And also there was that strong desire to be of help, and to pass along to others what Dr. Manchester had offered me at my time of crisis.
CHAPTER TWELVE
MARRYING MARILYN
In 1954 when we married, Marilyn was already a confirmed Francophile. Having spent her junior year in France, she dreamed of a honeymoon in Europe, whereas I, a provincial lad who had never left the northeastern United States, had zero interest in going abroad. But s
he was canny: “How about a honeymoon in France on a motorcycle?” She knew I was fascinated with motorcycles and motorbikes, and knew, also, that one could not rent such vehicles in the United States. “Here, look at this,” she said, and handed me an advertisement about renting a Vespa in Paris.
So off we went to Paris, where I excitedly selected a large Vespa at a rental station a block from the Arc de Triomphe. Although I had never even touched, let alone driven, a Vespa, I needed to reassure the suspicious manager of the station that I was an experienced driver. I mounted the Vespa and, as nonchalantly as possible, asked him for the location of the starter and gas pedal. He looked seriously concerned as he showed me the small button starter and told me that turning the handlebars controlled the gas flow. “Oh,” I said, “it’s different in the US,” and, without another word, took off for a practice ride while Marilyn wisely waited for me at a nearby café. Alas, I was on a one-way street that immediately fed directly into the hectic ten-lane thoroughfare circling the Arc de Triomphe. That ninety-minute drive was one of the most harrowing experiences of my life: autos and taxis zoomed past on both sides of me, horns blaring, windows unrolled, shouts hurled, fists shaken. I understood no French, but had a strong feeling that the cacophonies of the phrases shouted at me were not words of welcome to France. I stalled perhaps thirty times in my heroic circumnavigation of the Arc de Triomphe, but an hour and a half later, when I ended up back at the café next to the rental stand to collect my wife, I knew how to drive a Vespa.
Three weeks earlier in Maryland, on June 27, 1954, we had been married, and our wedding luncheon was held at the Indian Spring Country Club owned by Marilyn’s wealthy uncle, Samuel Eig. Immediately afterward I set about raising money for our European vacation—my parents were supporting me and paying my medical school tuition, and there was no way I could ask them to pay for this trip. For the past couple of years, my cousin Jay and I had sold fireworks for the Fourth of July at a stand we had built (Jay was the one who had bet me thirty dollars that I would not marry Marilyn). The previous year had been disastrous for the firework-stand business because of heavy rains on July 3 and 4, and we had the brainstorm of buying the entire leftover inventory from the other stands at a very low price and storing it over the following year in huge steel oil barrels. We had tested such storage the year before and the year-old fireworks had performed perfectly. We were blessed with splendid weather in early July 1954, and I earned more than enough money for a European honeymoon with my bride.