Don Quixote, the incomparable, comic, tragic, absurd, possessed by his destiny, dispossessed of his life by his destiny, an explorer who leaves home to find himself but loses himself in trying to find himself, someone perpetually homeless and proud of this homelessness as a quest for the impossible but imaginable.

Sancho Panza, a man like other men, moored in a web of human relationships, not so very grand, but very real, a nobody who is somebody by reason of how he carries being a nobody, being as close to the earth as any other clod, capable of a loyalty that is itself a kind of realization of the imaginary, someone who lives as himself but not so much for his own sake.

A distinguished, tall, thin. extremely learned, very ill elderly man came to see me looking for I didn’t at the time know exactly what and I still don’t know exactly what it was that he was seeking. I find myself thinking he was looking to be made whole. In life as in the law this concept of being made whole is no simple one.

This man yearned to be restored to being who he thought he was. Actually it went far beyond yearning to an insistence that bordered not only on religious faith but on an idiosyncratic religious fanaticism – “I can only be if I am who I take myself to be, even if who I take myself to be is not only complicated but also multiplex, fabulous.”

Ailing had been an integral part of his life, reaching back into childhood. Part of ailing was an unending search for succor and care and healing. He appeared over and over again as a supplicant but as a superior supplicant, one who ought to have been entitled not just to the best of care but to care that was effective.

In fact, the care he received was almost always disappointing, occasionally going well beyond disappointing to disastrous, as serious diagnoses were missed with awful impact on his health. At its very best, the care he received was not quite worthy of him. At its worst the care was contemptuous, injurious, prejudicial, as if something essential about him was a serious threat to doctors and their ilk.

His appearance, how he made himself manifest in my presence, carried at once an appeal that was close to tenderness and an aloofness that expressed a near settled hopelessness about any appeal to another person. “Why bother?” he seemed to be asking himself, “when the results are overwhelmingly likely to be a good bit worse than fair to middling.”

Without being asked, he declared that he was not interested in relationships. They were too much trouble, served only to constrain and limit. Relationships were for those who wanted and needed them, of whom he was not one. Loneliness was not an issue for him. His was the only company he could bear. Anyone else grated on him. He did not miss people and was constitutionally averse to grief.

Strange gambit – to seek out a psychiatrist, going to considerable trouble to do so, in order not have a relationship. He mounted for me formidable displays of his historical and literary erudition. Listening to him I learned a good bit and admired him. He was no fake. His learning was genuine, wide and deep. I became quite fond of him, most of the time enjoying his company. Often I heard the dry rustling of the male peacock’s feathers

I tried to help him with mood, with sleep, even with a host of physical problems. I worked to recruit other doctors in different specialties to help out. I became my patient’s ambassador to the world, even becoming involved in some business difficulties. When I would suggest that he could do some of this, even a majority of it himself, he would retreat into a peevish passive shell, a defiant and unacknowledged insistence on being dependent. He was much too dependent to admit to dependency.

When I found someone who might be of use, he quickly shed them, making short work of their credentials, their capacities, their clinical acumen. Quite regularly he managed to be sufficiently derogatory and dismissive to offend the person in question. In this peculiar way, I became acquainted with a whole circle of clinicians whom I had not previously known and with whom I to this day enjoy cordial and collaborative relations in the care of other patients. My patient helped me reach out and engage, even if he rejected the help proffered. In this regard he was my benefactor.

All the doctors whom my patient shed suffered from a simple invidious comparison. He clung to the notion that, if a doctor simply possessed the requisite clinical and scientific knowledge, that doctor would be able to make a clear and profound diagnosis, placing all his difficulties in an orderly array and so rendering them vulnerable to a virtually surgical strike – neat, unambiguous, effective. My efforts to suggest to him that medicine was almost never like that fell on deaf ears. The ideal of the omniscient omnipotent healer was simply too precious to him. It was the dam that protected him from being drowned in despair.

Measured against the ideal I, too, fell far short. From time to time, my patient would develop intense disgust with me and attack me in the most personal and cutting terms. His tone did as much damage as the content of what he said. It was a long while before I gathered myself to defend myself and repulse his attacks. A number of times he fired me as worse than useless, an insult to him, someone who was complicit in harming him, virtually a criminal. Then there would be rapprochement, more or less gradual, without apology or reflection.

I grasped that, as the messenger bearing news of manifold unacceptable realities, I often seemed terribly toxic to him, as if I were bent on sapping his strength, painting him into one corner or another. I was the attack on the fundamental premise of his existence – his capacity to rise out of and above the ordinary facts of life, but strangely also a nutritive link, someone who listened and responded and tried, even when it seemed quite hopeless. I would have put it that we were in relationship to each other, a characterization he would have rejected.

We were together for years that were often harrowing. He was very skilled at eliciting worry, at making rather extreme demands. I felt helpless a good bit of the time and knew that the situation was fundamentally hopeless, that he was not likely to change in any fundamental way. I could do my very best but my very best would make little difference. My very best was not even close to good enough.

So what held me to it? This is when I began to think of myself as Sancho Panza to my patient’s Don Quixote. He could not help himself and, as a result very much needed my help, not that there was anything much to be achieved or any real reward.. Or perhaps there was a great deal in the way of real reward utterly devoid of glamour. A Sancho is short enough to hug the earth and to feel the earth hugging back. In the long run the earth’s tug takes hold of all of us and we return to it.

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