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Introspection   |    
Eight Ball
Joshua L. Roffman, M.D.
Am J Psychiatry 2008;165:956-957. doi:10.1176/appi.ajp.2008.07121950
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It is late Friday afternoon, time to fulfill a reluctant promise. Jim has been after me for a game of eight ball for weeks now, ever since I began to follow him on the unit. I find him watching TV in the day room, chatting with another patient about politics.

Seeing me, he stands up, tilting his head slightly as the right corner of his mouth slides up his cheek. “You’ll break. I always let the losing party go first,” his high-pitched, melodic voice decrees. “You can ask Mr. Chris in the nursing station to fill you in on the rules before you play.” Jim is, of course, well aware that I know the rules.

We walk into the patient lounge. Don, who is awkwardly sprawled across the sofa, waves hello. “Hi there. Hi. Hi,” he says with a hesitant smile, softly laughing to himself. A stale tobacco odor wafts through the screen door on the far side of the pool table; Steve is smoking in the courtyard.

Jim apologizes for the fact that the pool table is rather tilted, causing the balls to roll in less-than-straight trajectories. “I keep asking them to fix the durn thing,” Jim explains as he arranges the 15 balls in a perfect triangle. At the apex he meticulously positions the yellow one ball, with the eight ball in the center.

I break, sending the cue ball careening into the pile and restoring the lot to its preferred state of entropy. Nothing goes in.

Jim chuckles and smacks his lips. “Maybe you’d better use some chalk, there.”

I find some broken pieces of blue chalk on a small shelf nearby. “Open table,” Jim proclaims. “Ten ball in the corner pocket.” Jim takes the shot and misses. He rests his cue against the table and begins to crudely stroke his salt-and-pepper goatee; from experience, you just know that he’s cooking up something. The right corner of his mouth creeps northward. Here it comes. “When’s that new doctor supposed to start? Next week? I better do something to welcome her. Maybe I’ll write her a note.”

(Last week, Jim surreptitiously left sexually charged “notes” under the office doors of two attending physicians. He signed them “Sicko in Ward D.” Later in the week he owned up to the deed, grinning from ear to ear.)

“Now, why would you want to do something like that, Jim? That wouldn’t be very nice,” I said.

“I dunno. It’s just the voices again, I guess.”

The voices have been especially troublesome of late. Jim estimates that there are “at least a thousand.” He stays up at night counting them. Sometimes they come from the TV set. Earlier in the day, Jim told me that the voices wanted him to “kick [my] ass through the window.”

“Do you believe in the second coming of God and the horsemen of the apocalypse?” This comes from the sofa.

“I’m not sure, Don. Do you?” I ask.

“Well, sometimes I dream about the apocalypse at night,” Don continues in his slow but steady cadence. “I keep dreaming about it. I like to read the Bible too. I think that I’d like to find a wife soon and get married.”

“You’re a young man! You can still get married. You should, Don!” Jim says.

“Okay. All right. All right.” A nervous chuckle.

Jim grandly announces to the room that he will now attempt a “double-reverse bank shot.” I picture Michael Jordan at the pool table. In a mental hospital.

Steve bursts through the screen door, reeking of tobacco, grimacing, and laughing boisterously to himself. He does not respond when I say hello, and he heads for the hallway.

Jim pockets the fourteen. “So have you decided what kind of doctor you want to be? I think you should become a proctologist. Or a surgeon. They make hundreds of thousands of dollars, but they’re only in it for the money.”

Don stirs again. “I’d like to be a surgeon one day, to be able to stitch people up and make them better. I want to make a difference.”

“Yeah, but you have to pay for medical school first,” Jim retorts. He looks in my direction. “What does that run you—60, 70 grand a year?”

“Close, Jim, but not quite.”

Don points at me. “You should listen to him because he’s short. Short people have bigger brains.” Sometimes I think that for a man with schizophrenia, Don exudes great insight on occasion.

A soft shot gently sinks the five in the side pocket. Jim looks impressed. “Nice touch,” he says, “but you didn’t leave yourself a shot there.” He scans the table. “Unless you go for the seven ball.”

Steve reenters the lounge. He appears oblivious to everyone in the room. After shouting an unintelligible phrase into the air, he walks out toward the hallway. He will probably wander through the halls for the rest of the day, swinging his arms and muttering to himself.

Jim scratches on the eight ball, ending the game. He had been one shot away from winning.

We return our cues to the rack, and Jim extends his hand. “Well played,” he says with a grin. “Next time I’m gonna kick your ass though.”

“OK, Jim.”

“Are you coming back on Monday?” he asks.

“Sure am. You have a good weekend. You too, Don.” Don smiles and gives two short waves.

“When you come back, bring us a couple bushels of crabs, OK?” (Jim is really glowing now.) “We can all have a crab feast on Monday afternoon. I’ll arrange for the tables to be set up, and you can bring a few cases of beer too. That’ll be real nice.”

“You got it, Jim.”

I turn to head out of the lounge and toward the front door. The bluster and mayhem fade, and in their wake, I find that Jim’s grin has infected me. To my pleasant surprise, a game of eight ball has diffused the alienating, controlled chaos that I felt as a new student on the psychosis ward, like a prism to white light. How strange and marvelous and sad it is, to discover such familiar dreams and aspirations, refracted across a rickety pool table.

+Address correspondence and reprint requests to Dr. Roffman, Psychiatric Neuroscience Research Program, Rm. 2656, Bldg. 149, Massachusetts General Hospital, 149 13th St., Charlestown, MA 02129; jroffman@partners.org (e-mail). Introspection accepted for publication March 2008 (doi: 10.1176/appi.ajp.2008.07121950).

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