them, he supposed, was burning in the office of good Dr. Adler.
The wittier orderlies called the two doctors Hatfield and McCoy and that pretty accurately described their relationship. Still, Kohler had some sympathy for the hospital director. In his five years as head of Marsden, Adler had been fighting a losing political and budgetary battle. Most of the state mental hospitals had been closed, replaced by small, community-based treatment centers. But there remained a need for places to house the criminally insane as well as indigent and homeless patients.
Marsden was such a place.
Adler worked hard for his chunk of the state purse, and he made sure that the poor souls in his care were treated kindly and had the best of a bad situation. It was a thankless job and one that Kohler himself would have quit medicine before taking on.
But beyond that, Kohler’s sympathy for his colleague stopped. Because he also knew that Adler had a $122,000-a-year job, malpractice premiums and state benefits included, and that for his paycheck he worked at most a forty-hour week. Adler didn’t keep up with the current literature, didn’t attend institutes or continuing-education sessions, and rarely spoke with patients except to dispense the insincere greetings of an incumbent politician.
Mostly though Kohler resented Adler’s running Marsden not as a treatment facility but as combination prison and day-care center. Containment, not improvement, was his goal. Adler argued that it wasn’t the state’s job to fix people—merely to keep them from hurting themselves or others.
Kohler would respond, “Then whose job is it, Doctor ?”
Adler would snap back, “You give me the money, sir, and I’ll start curing.”
The two doctors had played oil and water since Kohler first came to Marsden, brandishing court-appointment orders and trying unusual forms of therapy on severely psychotic patients. Then, somehow—no one quite knew how—Kohler had set up the Milieu Program at Marsden. In it, noncriminal patients, mostly schizophrenics, learned to work and socialize with others, with an eye toward moving on to the halfway house outside of Stinson and eventually to apartments or homes of their own.
Adler was just smart enough to recognize that he had a plum deal that he’d have trouble duplicating anywhere in this universe and was accordingly not the least interested in having jive New York doctors rocking his delicate boat with these glitzy forms of treatment. Recently he’d tried to have Kohler removed, claiming that the younger doctor hadn’t gone through proper state civil-service channels to get the job at Marsden. But the allegation was tenuous since Kohler drew no salary and was considered an outside contractor. Besides, the patients themselves rose in rebellion when they heard the rumor that they might lose their Dr. Richard. Adler was forced to back down. Kohler continued to work his way into the hospital, ingratiating himself with the full-time staff and cultivating friends among the practical power centers—the nurses, secretaries and orderlies. The animosity between Kohler and Adler flourished.
Many of the doctors at Marsden wondered why Kohler—who could have had a lucrative private practice—brought all this trouble on himself. Indeed, they were perplexed why he’d spend so much time at Marsden in the first place, where he received a small fee for treating patients and where the practice itself was so demanding and frustrating that it drove many physicians out of psychiatry—and some out of medicine altogether.
But Richard Kohler was a man who’d always tested himself. An honors art-history graduate student, he’d abruptly given up that career path at the ripe age of twenty-three to fight his way into, then through, Duke Medical School. Those grueling years were followed by residencies at Columbia Presbyterian and New Haven General then private practice in Manhattan. He worked with inpatient borderline and
The wittier orderlies called the two doctors Hatfield and McCoy and that pretty accurately described their relationship. Still, Kohler had some sympathy for the hospital director. In his five years as head of Marsden, Adler had been fighting a losing political and budgetary battle. Most of the state mental hospitals had been closed, replaced by small, community-based treatment centers. But there remained a need for places to house the criminally insane as well as indigent and homeless patients.
Marsden was such a place.
Adler worked hard for his chunk of the state purse, and he made sure that the poor souls in his care were treated kindly and had the best of a bad situation. It was a thankless job and one that Kohler himself would have quit medicine before taking on.
But beyond that, Kohler’s sympathy for his colleague stopped. Because he also knew that Adler had a $122,000-a-year job, malpractice premiums and state benefits included, and that for his paycheck he worked at most a forty-hour week. Adler didn’t keep up with the current literature, didn’t attend institutes or continuing-education sessions, and rarely spoke with patients except to dispense the insincere greetings of an incumbent politician.
Mostly though Kohler resented Adler’s running Marsden not as a treatment facility but as combination prison and day-care center. Containment, not improvement, was his goal. Adler argued that it wasn’t the state’s job to fix people—merely to keep them from hurting themselves or others.
Kohler would respond, “Then whose job is it, Doctor ?”
Adler would snap back, “You give me the money, sir, and I’ll start curing.”
The two doctors had played oil and water since Kohler first came to Marsden, brandishing court-appointment orders and trying unusual forms of therapy on severely psychotic patients. Then, somehow—no one quite knew how—Kohler had set up the Milieu Program at Marsden. In it, noncriminal patients, mostly schizophrenics, learned to work and socialize with others, with an eye toward moving on to the halfway house outside of Stinson and eventually to apartments or homes of their own.
Adler was just smart enough to recognize that he had a plum deal that he’d have trouble duplicating anywhere in this universe and was accordingly not the least interested in having jive New York doctors rocking his delicate boat with these glitzy forms of treatment. Recently he’d tried to have Kohler removed, claiming that the younger doctor hadn’t gone through proper state civil-service channels to get the job at Marsden. But the allegation was tenuous since Kohler drew no salary and was considered an outside contractor. Besides, the patients themselves rose in rebellion when they heard the rumor that they might lose their Dr. Richard. Adler was forced to back down. Kohler continued to work his way into the hospital, ingratiating himself with the full-time staff and cultivating friends among the practical power centers—the nurses, secretaries and orderlies. The animosity between Kohler and Adler flourished.
Many of the doctors at Marsden wondered why Kohler—who could have had a lucrative private practice—brought all this trouble on himself. Indeed, they were perplexed why he’d spend so much time at Marsden in the first place, where he received a small fee for treating patients and where the practice itself was so demanding and frustrating that it drove many physicians out of psychiatry—and some out of medicine altogether.
But Richard Kohler was a man who’d always tested himself. An honors art-history graduate student, he’d abruptly given up that career path at the ripe age of twenty-three to fight his way into, then through, Duke Medical School. Those grueling years were followed by residencies at Columbia Presbyterian and New Haven General then private practice in Manhattan. He worked with inpatient borderline and
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