Early one Saturday morning the telephone rang. My patient Christine's boyfriend had found her unconscious on the floor in her apartment. After taking an overdose of pills, some of which I had prescribed, she was in a coma in the intensive-care unit at a nearby hospital in Los Angeles.
I was stunned. For a few minutes I just sat there immobilized. How could this be? Nothing in my sessions with Christine had pointed to a suicide attempt. That is, nothing my medical education had prepared me for. Still, I agonized, filled with self-reproach. Then, suddenly, I realized that a part of me had been expecting it all along. A premonition had warned me, but I hadn't trusted it; I hadn't listened.
When I first met Christine I had been in practice as a psychiatrist for just six months. From the start she wasn't an easy person to work with. There was an invisible barrier between us that I found both frustrating and aggravating. Even my most tactful inquiries seemed to irritate her, as though I were violating her privacy. When I needed to get her to open up, the requisite mental calisthenics drained me. I got the impression that she wanted to finish each session and get out of my office as quickly as possible.
For years, Christine had gone from psychiatrist to psychiatrist, seeking relief from her depression. She'd been given a gamut of antidepressants, but either they'd had no effect or the side effects outweighed the benefits. When I told her about a new medication that had worked well with other patients, she agreed reluctantly to try it. Over the next few months, I. carefully monitored her progress.
Before Christine's regular appointment one morning, I was caught in a traffic jam on the freeway. Sitting in a sea of bumper-to-bumper cars, I began to remember dream fragments from the night before. I had seen Christine wandering down a maze of streets in downtown Manhattan, late at night. The sounds of the city enveloped her, and for moments she would disappear from my sight, swallowed up by the darkness. As I watched her from a distance, she looked alone and lost, searching for something. I called out, but she was too far away to hear my voice.
The dream took me by surprise. In medical school I had stopped dreaming completely. Or at least I couldn't remember my dreams anymore. It was years since I had been able to recall them in such detail. It seemed particularly odd that my dream was about Christine, because we hadn't made much of an emotional connection: I rarely thought about her outside of appointments.
Later in the day, escorting Christine from the waiting room into my office, I apologized for being a few minutes late. She didn't seem bothered, however, which was unusual for her. She was typically annoyed if I wasn't on time. Now, as we sat down opposite each other, she looked tanned and cheerful.
“For the first time in years,” she told me, “my depression seems to be lifting. The medication has helped a lot. I don't feel so cut off or afraid of everything anymore.”
Observing Christine, I recalled how she'd looked on previous visits: slump-shouldered, eyes dull and downcast, monotone voice, wearing heavy makeup. Today she sat up straight, her eyes animated and alive, her voice strong, her face bright and natural. Over the past six months I had noticed other such positive signs, slow but steady improvement, a good indication that the antidepressant had taken effect. I listened while she described the beginnings of a new romantic relationship. I knew she had also reconciled with her estranged daughter recently, and they were talking about taking a vacation together. I was pleased: Christine was emerging from a cocoon, determined to get well, making plans for the future.
As she spoke, I glanced out the window and noticed a billowy white cloud formation. I stopped hearing Christine, momentarily, lost in watching the changing shape across the sky. Her voice sounded miles away, her words reaching me in slow motion, yet my mind was perfectly lucid. I felt peaceful, as if I were surrounded by freshly fallen snow. Everything was cool, still, silent. I breathed easily, and my body relaxed. I don't know how long this lapse lasted, but in a state of deep quiet and despite everything she was saying, all at once it hit me: Christine was about to make a suicide attempt.
This sudden knowledge felt like an arrow hitting the bull's-eye or a chord ringing clear and pure. But to be aware of a premonition in the context of being a physician felt alien, threatening. A part of me wanted to deny it, to block it out. I felt unsteady, almost faint. My stomach tightened into a knot.
Christine was my last patient that day. It was Friday, and I was exhausted. I left my office late, having signed out to another psychiatrist who would take my calls for the weekend. But the possibility of Christine making a suicide attempt kept gnawing at me.
That evening, I took a walk with a girlfriend in Santa Monica Canyon, a wooded section of Los Angeles, far from the smog and congestion of the inner city. The air was crisp and fragrant, unseasonably warm, like a spring day. As we passed through a quiet tree-lined neighborhood, admiring fields of wildflowers in bloom, I finally began to unwind, but the image of Christine's face kept appearing in my mind.
I saw her as she had been in the dream, directionless and alone, with me chasing her through the streets of Manhattan. Of course, I had no hard evidence that Christine would try to end her life. In fact, everything I knew logically pointed in exactly the opposite direction.
Reminding myself of this, I tried to rationalize my fear, to explain it away. Only at the end of the walk, when my friend observed how edgy I seemed, did I tell her about my premonition. A practical woman, she didn't make too much of it but suggested that the following week I could gently bring up the subject with Christine, just to lessen my own anxiety. I agreed. If Christine's response warranted it, we would then explore her feelings further. For now, since she was doing so well, there was no urgency.
Bur Christine never made it to her appointment; the next time I saw her she was hooked up to life support in a stark, airless ICU. On the surface I strained to remain professional, but my mind was reeling. By discounting my premonition, I had betrayed both Christine and myself. I couldn't think straight. I felt like Alice when she stepped through the looking glass; suddenly there were no safe landmarks, nothing familiar.
For nearly a decade I had worked night and day. I knew the medical literature backward and forward. I knew all the signs of improvement, all the danger signals too. Over and over again I asked myself what I had missed. My entire professional foundation was crumbling beneath me.
After poring over my library of medical books, I finally called David, a friend and colleague who had finished his residency a few years before. He tried to reassure me that I hadn't missed anything, but I wasn't convinced. Medically, he was right. But it wasn't my medical competence that concerned me. I was shocked by my blatant disregard of intuitive information that could have benefited Christine, that might have made the difference between her life and death. Because the source of my impressions hadn't fit the traditional model, I had ignored them.
During my medical training I had opted to trust the scientific method above my intuition, which seemed inexact and undependable in comparison. When making critical decisions that affected other people's lives, I had chosen a system that was more concrete and absolute. I had lost track of the fact that such a system, whatever its virtues, rarely tells the whole story.
All that month I made daily visits to the hospital, checking Christine's medical charts, watching the shallowly breathing form on the white bed, the almost unwrinkled sheets pulled over her body. I listened to the wheeze and chug of the respirator beside her; I watched the drip of the IV. Christine looked like a ghost of herself, pale and gray. I longed to hear her voice, to witness some signs of life so that my guilt would be assuaged. But there was only a deathly quiet.
Many days I pulled the curtains around Christine's bed and sat beside her, reviewing her case in my mind from every conceivable angle, thinking of all the ways I might have broached the subject of suicide with her. In the course of my medical education, I had been taught guidelines to follow, rules to rely on. To act on a premonition in making clinical decisions would have been sacrilege. We had been taught that many people don't consider suicide on a conscious level until the last moment. Such thoughts may churn in their minds, unnoticed and unheeded, breaking through only when they are alone, beyond the reach of a therapist. And so it was in dealing with the unconscious that my premonition could have best served Christine.
The only mention of premonitions or other psychic abilities I ever found during my medical education was in textbooks labeling such claims a sign of profound psychological dysfunction. I took great pride in my status as an active member of the American Psychiatric Association, in being an attending staff physician at prestigious hospitals, in the respect of my peers. Sitting there at Christine's side, however, I suddenly felt as if two distinct parts of me had collided. I could see my face as a young girl in the early 1960s overlaid on the outline of my face now: two disjointed images, positioned on top of each other, about to merge. What had I been running from for so long? I felt a fluttering in my chest, a cold, still tension. I became rigid inside, afraid that if I moved I would shatter into a million pieces of broken glass.
The truth of my premonition both validated and terrified me. But I had to acknowledge the facts of Christine's case. If I could draw on both intuitive and medical knowledge, I had the tools to stay one step ahead of a patient, keeping tabs on thoughts and feelings before they became irreversible actions. Used with care, my psychic abilities would do no harm and, more important, might prevent suffering.
As I looked at Christine's face on the pillow, plastic tubes protruding from her nose and mouth, I realized that as a responsible physician I could no longer dismiss information simply because it came to me in forms traditional medicine had not yet accepted. There had to be a way to integrate the psychic into mainstream medicine. When brought together, each could enhance the other and become more powerful than either was alone.
After several long weeks, during which I wasn't sure if she would live or die, Christine came out of her coma. I had tried to prepare myself for the possibility that she wouldn't survive, but deep down I knew her death would have devastated me. I would always have felt in some way responsible for not having acted on my premonition. Thus, despite the long nightmare of her coma, I was relieved and grateful. We had both been given a reprieve.
When we resumed our therapy together, my approach as a psychiatrist changed. I took a vow that became part of my own Hippocratic Oath: not only to do no harm, but also to seek a therapeutic relationship in which I could give my all. I wasn't sure how I was going to accomplish this, but one thing—which Christine had taught me—was certain: The penalty for me not trying was too high.
My struggle with Christine played a pivotal role for me both personally and in my practice. From this experience, I understood that I had to reopen a part of myself that long ago had shut down—no matter how much it frightened me. In truth, I was a child when I started down the path to this critical crossroads. For years, though I fought it, I knew that something set me apart from others, as if I were guided by a different rhythm, a different truth. Now, looking back on my life, I could see that a series of unusual and, to me, unexplainable events had set the stage.