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Introspections   |    
The Night Watchman
William Houghton, M.D.
Am J Psychiatry 2001;158:1794-1795. doi:10.1176/appi.ajp.158.11.1794
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The telephone blares 2 feet from my head, ripping me out of sleep. My favorite position is curled on my right side, legs sprawling, right hand cupping my chin like a philosopher’s. I am jolted out of that, reach over the edge to pick up the phone on the floor, and mumble, "Houghtons’ residence."

Three seconds of empty air time from the other end, then a click, as the connection is broken: the lonely dial tone comes on.

Damn it! By now I’m awake and wondering who it is.

My first thought is fear for one of my three grown children, scattered now to the corners of the continent. The digital clock-radio reads 2:42 a.m., and I can easily conjure a desperate situation one of them is in. Perhaps they called and the connection was accidentally broken. They will call back in a minute or two.

I go to the bathroom and curl up in the warmth of the bed again. The phone remains silent. Twenty minutes pass. This isn’t like my kids, and I’m relieved about that. I have just dozed off when it blares again. This time I’m ready for it, expecting a hospital emergency room. Both my wife and I are psychiatrists. We’re not on call this week, but occasionally one of our desperate patients goes to an ER, and sometimes the doctor calls. I grab the phone.

All I hear is the vacuous dial tone. No one there. I put the receiver back, but I’m fully alert now, hypervigilant, listening carefully as if there were a clue in the silence of the bedroom itself.

An ER would have said something. If it was a wrong number—at least a normal wrong number—someone would have said something. Could it be one of my patients who stole my home number even though it’s unlisted, carefully guarded, and my calls are routed through an answering service? Damn caller ID! Now anyone can get my number, any of the scores of patients I have called from the phone at home—like my old friend Debbie, strung-out and catching me at the Sunday paper a week ago, no introduction but straight off, flat-out accusing me, "Why didn’t you put the Xanax on the script?!" As if I was the brother she squabbles with, sitting in her kitchen. With caller ID, I have lost my protective shield. But this wouldn’t be Debbie at 3:00 a.m.—and she’d never hesitate to speak—but her recent call shows it could be anyone.

I’ve just started to relax, 10 minutes later, when it rings again. This time I’m really ready for it, snake my arm to the offending instrument and silently lift it to my ear, determined not to speak or even breathe, facing the intruder directly, but again the earpiece echoes back only the empty dial tone.

I am completely penetrated. Now I’m convinced it’s a patient harassing me, but there’s not a clue and no one to yell at. I begin to assemble a list of my enemies, the ones sneaky enough to pull a trick like this, but if they’re that sleazy I certainly don’t care about them, I have no obligation, and in 5 minutes I’m off to sleep for the rest of the night.

The next day they’re not at the top of my agenda, but the three calls in the night cross my thoughts from time to time. Who would have called three times, and said nothing, and why?

A random wrong number at 20-minute intervals seems unlikely, and besides, that theory has little appeal so someone like me, who looks for a motive in all behavior.

No, it was either harassment, someone determined to keep me awake, or—I have to consider—it was a desperate patient, but which one?

Karen Schultz leaps to mind. For years she has yelled that she wants to die. She has access to guns, her relationships have been going poorly lately, and she canceled her appointment this week without giving a reason. She’s got to be at the top of the list, but would she call and not speak? That part doesn’t fit. I’ve known Karen Schultz for over 10 years, through countless hospitalizations and late-night calls (usually 10:00 p.m. for her), and the pattern of her distress and reaching out to me is grooved in my memory. She usually sobs breathlessly at the beginning of the call and lets me know at the end that she got a small crumb of comfort from my response. Just from hearing a familiar voice. The three calls at 3:00 a.m. don’t match her style, but is it possible, if she were pushed to the edge? I consider the pros and cons of calling her, but there are drawbacks in what that would communicate to her (as well as the extra time for telephone therapy), so I never get around to it.

The day after the three calls, and the next several, there are no contacts from patients that would explain them, and no calls from the medical examiner’s office. I’ve had those calls from the ME on several occasions, and the matter-of-fact voice of the coroner doing his routine investigation of a suicide has been deceptively final and clarifying (the specific method of death), but only the beginning of my self-examination. It’s a relief there are no phone calls or crises over the next few days, but the questions of who and why still tantalize. Some of us love a mystery more than a diagram.

(Karen Schultz is at her appointment the following week, no better or worse than usual.)

I have two other hypotheses about the three calls at 3:00 a.m., neither confirmed (yet), which drift in and out of my thoughts over the next couple of weeks.

It could be a manic patient, a late-night rambler like a hot-rodder gunning down an empty street, and Jackie Carlson comes to mind. In a frenzy of 2:00 a.m. cleaning, pushed by a terror of germs or electrical leakage—she sees it in her condo wiring, but I suspect it’s in her brain—she might phone me, catch herself and hold her tongue, and forget it by the next morning. (If I ask her at her next session, she will barely remember and laugh it off.)

Or even freakier, my 3:00 a.m. calls may have come from a woman who could be a distant cousin of the Addams Family, a Laetitia Addams, a desperate woman who wavers exquisitely between loving me and hating me, presenting only a saccharine facade to my face. (Or like a Richard Cory from the Edwin Arlington Robinson poem.) This is the kind of patient I know little about—by his or her design—till afterward, when disaster has struck, if I hear even then. I may love mystery but must content myself with ambiguity.

One night the phone starts to ring, but before I can move, the sound fades, the phone itself evaporates—it’s a flashback, a fleeting fantasy, not a hallucination but a phantom that’s real in my ear and startle response, then gone. The telephone wires reach only so far, but my patients and I are tied by a bond, a tenacious bondage.

Of course, after a week, the night of those three phone calls has faded from mind, buried by other events and demands. I am relieved, but I can probably never completely give up the watch.

Address reprint requests to Dr. Houghton, 2437 North Terrace Ave., Milwaukee, WI 53211.

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