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Introspections   |    
The Luck Factor
Richard G. Druss, M.D.
Am J Psychiatry 2003;160:238-240. doi:10.1176/appi.ajp.160.2.238
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My friend and classmate Charlie Davidson and I were paired up for our first clinical rotation in medical school—inpatient pediatrics. We were making bedside rounds with Dr. Alfred Millbank (not his real name), one of the world’s experts on pediatric oncology and hematology. The three of us arrived at the empty bed of a 2-year-old girl who had had fatal, rapidly aggressive leukemia. The ward nurse told us that she had died the night before. The nurse also said that the distraught parents wanted to see "the doctor in charge."

The young mother and father of the little girl came in and virtually accosted Dr. Millbank. He sat them down and then sat down himself on the empty bed facing them.

"What happened? Whose fault is this? Did her doctor make a mistake? Did we wait too long to bring Emily in?" the mother said. Both parents’ faces were contorted with rage and guilt.

"It wasn’t the doctor’s fault. It certainly wasn’t your fault. There’s nothing anyone could have done," said Dr. Millbank softly. "It was just bad luck."

I saw their faces instantly relax as the rage and guilt literally melted away, replaced by grief. The father’s eyes welled up, and the mother said, taking Dr. Millbank’s hand, "Thank you for your help, doctor." They got up and walked out, the husband’s arm around his wife’s shoulders.

I didn’t hear the word "luck" much after that. Certainly not during analytic training, when every random and chance occurrence was attributed to some unconscious motivation on somebody’s part.

Mr. Arthur Goodman (his name has also been changed) was a 36-year-old graduate student in physiology. He had been fatherless since age 3 and had been sent to me by his mother, whom I knew slightly—a busy and well-known pediatrician.

When Mr. Goodman appeared for his first visit, I could see that he was a passive and introspective young man. His appearance struck me. He was about 6′3′′ and very thin, especially in his upper body. His overly roomy shirt draped over him loosely, and his enormous Adam’s apple and collar bones stuck out. His skin was pasty and his long blond hair unkempt. Some might have called him odd looking, and some might have called him homely. His nicest feature was his resonant, educated voice.

"Dr. Druss," he began. "I have come for a psychoanalysis. I really like girls, but other than group activities like outings and folk dancing, I have never had a real date. I understand that psychoanalysis takes about 5 years. So after 5 years, when my inhibitions have been analyzed away, I hope I’ll be ready to start dating."

"Mr. Goodman," I replied. "You’ve got the wrong guy. If you come to see me, you will be on the phone trying to call women from day one. Then together, we will look at why you hang up when she answers or why you choke on your words. Secondly, I want you to sit up instead of lying on the couch so we can work on this problem as a joint effort. I have no vitamin B12 shots for you."

He blinked his eyes, looked a bit startled, and said, "That’s a different kind of program than I anticipated. Maybe I ought to get some other opinions."

"Good idea," I suggested. "Shop around as long as you like. Call me if you want to work with me."

He returned after 6 weeks and much shopping and said I made the most sense. We began a once-a-week psychotherapy that was largely cognitive and behavioral and only minimally psychodynamic. His social awkwardness and spaciness became more evident to me as we met. Also, at age 36, he had missed out on learning the dating skills and techniques that one usually discovers in high school and college so that there were large lacunae in experience as well as neurotic inhibition.

He began by telling me that there was no one he really desired in his small social circle, so he would wait until he found a woman worthy of his efforts.

"No. Call anyone," I said. "You shouldn’t be looking for your future wife now. This has to be regarded as batting practice. Get up to the plate, Arthur, and try to hit the ball—no walks: take your cut."

He did make calls and was rejected each time. When he told me this, I said, "Great! That’s six more calls than you ever made in your life. Why don’t you widen the net?"

Some sessions later, he told me he had called a nice woman the previous Saturday at 5:00 p.m. for a date at 7:30 p.m. that evening. She, of course, said no.

"Arthur," I said, "it’s probably not you. No woman would accept a call from Clark Gable at 5:00 p.m. for a date that evening. Perhaps you might try again, but this time give her at least a week’s notice."

Mr. Goodman was never stung by my critique and was always willing to make a new try. I had begun to like this fellow and admired his courage and persistence.

Finally, he began to get a few positive replies and told me about each date in every awkward detail. He described the experience of taking a woman to see Annie Hall. He was so preoccupied with the strategy of putting his arm around his date and reaching down to her left breast that he had to see the movie alone the next night to find out what happened.

Concerns about the sexual aspect of male-female relationships now emerged in therapy, previously hidden by lack of opportunity. We increased the frequency of our sessions from once to twice a week and began to examine this material psychodynamically, with special reference to the absence of his father. He spoke of being mercilessly teased at school all his life and called "Goodie-Goodman" in grade school and "Arthur Goodgirl" in high school, with no father to help him cope with his tormentors.

After about a year, I could see that many changes had occurred in him. He was less spacey, and a new wardrobe and the use of a comb made him look more socially acceptable. But he was getting many more "no’s" than "yes’s" to his calls and was never accepted for a second date. It was time for some good luck.

One day he told me he noticed that a woman in the university cafeteria would often sit down next to him. He quickly added that she was not a "pin-up girl" but seemed very nice. They began to meet regularly for lunch and would take a walk together afterward. Without ever officially having a date, they moved into a friendship. It was the first real friendship of his life with either a man or a woman. Janet, the young woman, seemed to be the more assertive member of the dyad. She did most of the talking and was able to bring him out.

I asked Arthur more about her. He said that Janet was 41 and on the junior faculty in the sciences at his university. She had been in a bad marriage with a physically abusive husband and was now divorced. There had been no children nor did she want any. When pressed about her appearance, he said she looked "comfortable."

They began to see more and more of each other. Although it was not a formal engagement, they had "an agreement" regarding a future marriage.

During one session, Arthur told me that Janet would be meeting him at my office at 6:45 p.m.; they would be going to supper in my neighborhood after the session. The bell rang at 6:40, and I buzzed her into my waiting room. Arthur made a quick introduction and then excused himself to use the rest room, so Janet and I spoke for 3 minutes or so. Arthur was my last patient of the day.

Janet was simply dressed, had an ample—almost plump—figure, a pleasant, well-scrubbed face, and a warm smile. She was indeed "comfortable." After the introductory remarks, she said, "You know I will take good care of Arthur."

"Yes, I can see that," I replied.

At the next session, Arthur confessed that he had set up this meeting. (I had figured that out already.) He asked what I thought of Janet, awaiting my paternal blessing, and I am pleased to say that I didn’t reply with the stock analytic question: What do you think?

"I think she’s lovely," I said.

They were married a few months later. The therapy was terminated on that happy note, and I remember thinking as he left my office for the last time, "Oh, lucky man!"

Address reprint requests to Dr. Druss, 180 East End Ave., New York, NY 10128.

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