The Schopenhauer Cure

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,

ulcerated, five nodes? Be straight. Talk to me as if I were a layman.»

«Meaning bad news. It`s a sizable melanoma, and it has spread to the nodes. The