The Paris Review

It was Eid al-Adha, the Feast of Sacrifice, so the bazaars in Istanbul were closed. We walked along the silent streets, wondering how thirteen million city dwellers could go so quiet and how we were going to spend our leftover lira before our departing flights in a few hours. Toward the Galata Bridge, we found a commotion of doves and pigeons by the Yeni Cami.

Birds of a feather do flock together: leading from Eminönü Square was an avenue lined with animal stalls. A menagerie of birds—cranes, ducks, fancy chickens, peacocks, and pheasants—called from their cages. In other wire cages, puppies, kittens, and rabbits formed furry masses. Another set of aquatic stalls had turtle hatchlings and goldfish. Bags full of seed, dry food, and wood shavings spilled into one another—supplies for every sort of pet.

We stopped before a collection of three-gallon drums. “Prof. Dr. Sülük,” read placards at the top of all the drums, each of which was two-thirds full of cerulean-tinted water. A man stood beside the drums, resting his weight on one of them, shifting his baseball cap with the other hand, gray hair falling from underneath.

“I saw a Man before me unawares: / The oldest man he seemed that ever wore grey hairs.” This was not the Lake District, but in this busy market I thought of William Wordsworth’s “Resolution and Independence.” Facing these tiny barrels of leeches and their keeper, all I could think of was the Romantic’s leech gatherer.

Several hundred leeches writhed. They gathered like a black belt round the middle of each container, near the water’s surface. A few ambitious leeches left the waistband, inching their way toward the lid; a few fell from those curving heights to the bottom of the barrels. Read More »

According to every epidemiological study of medical-student mental health ever published, a large percentage of us suffer from, well, something. The discussion sections of these research papers generally propose we educate one another in mental hygiene. They suggest we should practice more “mindful medicine.” And, good students, we oblige. A medical student may not come into med school knowing how to handle a “high-functioning” anxious type in clinic, but the diagnosis doesn’t require an office pamphlet. It’s visible right there in the room.

At my school, we first learn to integrate this understanding of acute and chronic anxiety into clinical practice via the required six-week psychiatry clerkship. Six weeks of immersion in “ICU psychiatry,” the psychiatry faculty argues, is not enough time to master the management of anxiety disorders, but at least it is something. Third-year medical students spend six weeks on one inpatient psychiatry ward as well as several night shifts in a CPEP (Comprehensive Psychiatric Evaluation Program), the ER for the ill at ease.

In these settings you learn to triage threat and fear until you know from anxiety. There you learn the difference between anxiety and agitation. Panic-attack patients stay in the ER for a while for cardiac and thyroid workups. Anxiety in the CPEP counts as psychosocial stressors, or Axis IV on the DSM-IV: losing your edge, losing your family’s support, your job your benefits, your place to live. Maybe you will have an adjustment disorder on Axis I, or existential anxiety that keeps you off your axis. Agitation is losing your cool, and sometimes losing your hospital gown if you’re especially feisty. For anxiety there is benzos and SSRIs; for agitation, benzos and antipsychotics and sometimes four point restraints. They call the agitation cocktail a 5+2, for 5 milligrams of Haldol and 2 milligrams of Ativan, though I saw one “frequent flyer” get a 10+4.

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The New Yorker made headlines this month by publishing “new” work by F. Scott Fitzgerald. “Thank You for the Light” had been rejected by the magazine in 1936 when Fitzgerald first submitted it, but editorial judgments—like love, pain, and kitchen knives—have a way of dulling over time.

“We’re afraid that this Fitzgerald story is altogether out of the question,” read the original note spurning the story. “It seems to us so curious and so unlike the kind of thing we associate with him, and really too fantastic.”

Resubmitted by Fitzgerald’s grandchildren, “Thank You for the Light” was, at least by Fitzgerald’s own standards, ready for publication. Its condition differs greatly from his final work, tentatively titled The Love of the Last Tycoon but published as The Last Tycoon in 1941. Fitzgerald died of a heart attack before he could finish the novel, so what went to press was a version of his incomplete draft, notes, and outlines pieced together by the literary critic Edmund Wilson. In his preface to the novel, Wilson wrote, “It has been possible to supplement this unfinished draft with an outline of the rest of the story as Fitzgerald intended to develop it.”

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