Regard Everything as a Dream

Ernesto sat across from his wife, Maria, on the balcony of their apartment in Rome, sipping wine. In spite of the beauty that surrounded them, he was lost in thought about his latest writing project, which expanded his thinking about the intensification of paranoid anxieties in times of physical vulnerability. In several of his psychoanalytic cases, he had observed that patients who were struggling with various illnesses described their symptoms not as indifferent failures of their bodily systems but, rather, as persecutory forces seeking to undermine their bodily integrity.

He had analyzed his interest in the topic and knew it stemmed from his own childhood frailty. Several times, his mother had told him, it was thought that he might himself die from various ailments as a child. Why were some people more prone to these paranoid anxieties? The baby, he reasoned, experiences his mother — bejeweled, intoxicating creature — as the source of all goodness. Because of his limited cognitive capacity, in moments of intense distress he experiences his pain as inflicted upon him by the mother. This, Ernesto felt, led to feelings of rage and fear that mother might punish him for that rage. Adults for whom these dynamics had been prominent as children were, thus, more likely to suffer from paranoid anxiety in times of physical illness, to anthropomorphize their ailments, relating to them in the same ways they had related to the maternal figure in infancy. All of this, he knew, was highly inferential, for babies did not formulate their thoughts in language. Yet he felt it captured the essence of the situation.

“Ernesto! Where are you?” Maria said, nearly shouting and rapping her fingers on the table.

“Oh, I’m sorry dear, what were you saying?”

“Dios mio, Ernesto!” Maria said, quietly now though her large, hoop earrings continued to shake. “You are barely here today, sweetheart. What is on your mind?”

Truthfully, Ernesto realized, he was terrified. Only a month earlier, Maria had been diagnosed with Stage 3 ovarian cancer. Although she seemed at peace, committed to doing everything possible to recover, he remained haunted by the diagnosis. When the doctor had informed them, his first thought had been, “Of course. It was all too good to be true.”

Over the coming years, she waged a courageous battle against the disease, pursuing every conventional and alternative medical therapy available to save, and then to prolong, her life. And yet in the end, her spirit, which he had once thought was utterly indomitable, was vanquished by the mindless tenacity of the disease. Their only conflict in those final months had been about this. “You must persist,” he had urged her again and again, tears in his eyes. He could see that his insistence caused her pain and yet he could not cease in his efforts to move her. Even then, a part of him knew that his insistence was egocentric, stemming from fear of the pain that he would suffer were he to lose her and from his irrational anger toward her for falling ill. When she finally died, a part of him felt that he deserved it, that he ought to be punished for his selfishness.


Ernesto realized, startled, that his laptop had been emitting a loud chirp for several moments. He had been drifting off into daydreams again, of a time long ago. Maria had been his wife for nearly a two decades before she had died after a long struggle with cancer — ten years ago.

Yes, theirs had been a whirlwind romance. Meeting at a psychoanalytic conference in San Francisco, he, a young but ambitious psychologist, had been drawn to her passionate intensity which was harnessed to a sharp intelligence. An Italian psychoanalyst and psychiatrist, she had been in the city to present at the conference, where he had first witnessed her mind at work as she spoke insightfully about the psychotic core, the nucleus of madness that lay deep within the minds of those who had suffered early trauma but had been covered over by layers of defensive character formation. He had been inspired by her as he had never been before.

He had, to his surprise, gathered the courage to invite her for a drink that evening. The pair sat across from each other in a dusky, San Francisco bar, night having descended upon the city long ago. As she spoke — what she had spoken about, he could scarcely recall — sipping her Cardinale, the blood-red tonic somehow accentuating her straight, jet black hair as it swirled in her cocktail glass, he reveled in the intensity of her focus upon him, an attention that stemmed from her own need to be understood. He found that he was hungry for it, nearly feral, as if he had lived without something essential for his entire life without even knowing it.

He now understood that as his wife and lover, Maria had provided an important maternal function that he had, as a child, lacked. When he was only five, now so long ago, his own mother had died suddenly. There had been no intimation that her body was turning on her, just the caprice of human frailty: a vessel had burst in her brain and she had expired before his father could even gather her into the car for the ride to the hospital. Ernesto had walked in, home from school, as his father sat on the floor, tears streaming down his face and cradling his now dead-wife. Over the following year, his father had taken on all the responsibilities of parenting, a gentle a competent man. The loss had nevertheless left a absence deep within Ernesto’s soul, though usually covered over by his well-developed intellect and ceaseless ambition.

After that fateful night of cocktails in San Francisco, which ended with Ernesto accompanying Maria back to her room in the Westin Saint Francis hotel, the couple had remained in nearly constant communication, though separated by half the world. And within the year, he had relocated to Rome and, six months later, opened a practice in the same suite as his soon-to-be wife. He behaved with a spontaneity, even impulsiveness, he had never witnessed in himself. The first years of their marriage had been deeply enjoyable and that enjoyment had deepened into a steadfast, committed love. Her death, after a long struggle, had been shattering and he had clung to his work as a drowning man to a life preserver.

He was glad that she had not lived to see the plague. The virus began in China, apparently making the jump from snakes to people, and quickly sweeping throughout the country. The world watched as the Chinese were decimated. The pestilence resisted every measure taken to contain it or ameliorate its assault, from enforced isolation to intensive regimens of antivirals and antibiotics. Inevitably, it made its way around the world. The president of the United States, his breathtaking arrogance on full display, reassured the population that there was “nothing” to worry about, even as scientists said otherwise. Within two months, the States had been torn apart, their medical facilities overwhelmed and millions dead. The situation had been worse in less developed countries: there hadn’t even been enough healthy men to carry away the dead.

Italy, where Ernesto remained, had done better. The population had been ordered to shelter in place early on, forbidden from leaving their dwellings even for food or medical supplies. Government trucks dropped rations of food at street corners, which could be picked up by family members wearing gloves and masks. In spite of these precautions, the hospitals were quickly overwhelmed and most medical personnel were, as far as he could tell, deceased. As these events unfolded, he could feel the cold grip of fear begin to take hold of his spine. He worried, at times, that he was losing his hold on reality as he started at old photographs of Maria or paced back and forth in his apartment, the sounds of sirens and weeping drifting in from the streets. Yet he was committed to carrying on with his patients, both to serve them and to maintain his sanity.


“Regard everything as a dream.”

In this time, he often thought of his supervisor, an esteemed Italian psychoanalyst who had been his still point as he made his way through the rigorous training to become a psychoanalyst in Italy. As a young psychologist, it was impossible to imagine that such a man would have taken him into supervision. Yet Maria, to his eternal gratitude, had interceded on his behalf. The two had formed a generative relationship. Speaking in an accent that always seemed to Ernesto to have an enviable flourish, his supervisor frequently reminded him that everything patients say must be regarded as a dream, as an unconscious communication about what is happening on a deep emotional level between analyst and analysand in the psychoanalytic session.

Even as he moved his sessions to the computer, meeting face-to-face through video chat — a decision that would have been unthinkable for an esteemed psychoanalyst such as himself in times past — he held tightly to his supervisor’s advice. This, he was certain, provided him with enough distance to survive the onslaught of symptoms — bleeding noses, sweating foreheads, and finally vomiting and diarrhea — that had besieged his patients. At times, though, he had been unable to maintain the prescribed analytic stance. Only the night before, waking in bed in the middle of the night, he felt that the world was pressing down upon him, threatening to bury him alive. It was as if the universe was animated by a malevolent force, its cold eyes upon him.

Now he clicked the green “Accept” button and, after a brief delay, Linda, appeared on the screen. Her face was pale and streaked with tears. On her chin, he could see several dark black splotches. Blood, perhaps? Ernesto didn’t speak but, instead, waited for her to begin the session, as was the usual custom. As he waited, the small muscle beneath his right eye twitched repetitively, betraying his tension. When she finally spoke, her voice was rough and quiet.

“I am so tired of fighting, doctor. I simply cannot resist anymore.”

To his surprise, Ernesto deviated from the prescribed parameters of technique. With an avalanche of rage, he yelled at the screen. “You must, Linda! We all must fight this damned affliction. You must survive!” He stopped, shocked at his indiscretion, even as tears began to fill his large, brown eyes and his body shook with emotion that he could not name. There was silence as Linda looked into the screen, her eyes surprised at the display of passion from this man who she had come to know as only steady, reasonable, and reserved. Finally he spoke again.

“I must apologize, Linda. I do not know what came over me.”

Suddenly her hand rose to her mouth as she began to cough, first once and then a second time, her shoulders shaking with the effort. Her body seemed small and frail, a pale imitation of the woman that Ernesto had worked with for nearly eight years. When she drew her hand back from her mouth, it was covered in sticky, black blood. She gasped quietly, her eyes wide.

“I cannot,” Linda said once more, her voice even quieter. With that, her body slid downward in her chair, disappearing below the view of the computer’s video camera. He heard her body land upon the floor with a quiet thump and then there was silence, save for the hum of the kitchen appliances that he could now see, occupying the space where previously Linda had been.

Ernesto sat, stunned. After nearly half an hour had passed, his mind cloaked in numbness, he clicked the red “End Call” button. His eyes were rimmed with tears, though his mind remained empty and cold. He stood and walked to the door of his apartments balcony, a place where he and Maria had shared so many wonderful memories. It was here that they had dined most evenings, sipping wine as they watched the passerby’s in his historic city. It was here, he remembered, that they had last made love, pulling an old futon mattress out onto the balcony, hidden by the covered railing. She had been so frail then, her body assaulted by the drugs intended to save her life. Opening the sliding balcony door for the first time in weeks, he stepped outside, the cool breeze making goosebumps erupt on his pale skin. He listened for the sounds that usually animated the city he had come to love. Yet now there was only silence.

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1 Comment

  1. Kinton Ford

    I really like this. I like “The mindless tenacity of the disease.”

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