Mood Swings

A psychiatrist surveys the mind and the wider world

A Puerto Rican friendship: Gustavo Corretjer

Lessons from a quiet teacher

When I was a medical student in Richmond Virginia, I did my psychiatric rotations at the Hunter Holmes McGuire Veterans Administration hospital there. Our group of students rotated through different supervisors. One day, four of us found ourselves in one of those nondescript white unadorned windowless VA offices on the psychiatric floor. It was the office of one of the staff psychiatrists. He billowed cigarette smoke at us as we sat on the other side of his desk. My asthma didn’t appreciate it; I suppressed my cough and he surveyed us. We must have looked particularly uninterested or bland, as medical students often are in the whirlwind of rotations they endure. “You all don’t really understand what you see,” he said with an air of disdain. “You don’t even care to understand.” I was a bit shocked; he wasn’t teaching us, he was criticizing us. “You come on these wards just so you can do your time and get off them. You don’t understand the patients.” I looked at one of my friends: he looked straight ahead impassively. No one said a word. Dr. Gustavo Corretjer specialized in substance abuse. “I treat my addicted patients with philosophy.” Now my ears perked up. “There are no drugs for them. We get in groups and talk about Plato and Aristotle. And we listen to them as if for the first time. And they have all kinds of thoughts that make sense to addicts.” I had never heard anyone in three years of medical training mention philosophy or Plato before, topics I read secretly on my own at night. “You need to learn this: There is nothing new under the sun. You don’t know what you need to know; and we’ve all forgotten so much that we need to know.” He kept puffing on his cigarette, looking away from us towards the white walls. I know he felt like he was just talking to himself, that we couldn’t comprehend a word. “There’s nothing new under the sun,” he repeated, and the supervision session was over, never to be repeated, thankfully, thought my friends. They dashed out of there as fast as they could and never looked back. I stopped at the door, and walked back in, and asked more about Plato and Aristotle. 

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Thus began a twenty-five year friendship. I chose Gus to be my faculty mentor in medical school, the person who received all my grades and reviews from all my rotations, and discussed them with me, the person who wrote my primary recommendation later for specialty residency. Most of my grades and reviews were good; I remember that one rotation in pediatrics was not as good; the reviews I received were critical. Gus read them with me, and then remarked, “Well, you can’t make everyone happy.” 

He had this way of making some pithy statement, usually a bit melancholy, and making you feel better as a result.

Of course I chose to specialize in psychiatry; I probably would have anyway, but Gus made it easy. To know that there was someone who thought that Aristotle could be a psychiatric treatment legitimized the profession in my eyes. I don’t think many, if any, other medical students responded to Gus’ in-your-face supervisions sessions as I did. 20 years at the VA hospital yielded few results for him professionally, and a dozen or so years ago, when he was about 60, he officially retired, and finally returned to his native Puerto Rico. His elderly mother was still there and plenty of extended family. He was going to finally get to writing about philosophy and psychiatry, rather than busy himself with the day-to-day practice which, especially in the VA system, produced such limited results.

Gus was as unhappily happy as he could be in Puerto Rico; he disliked much about it, but it was his culture. His name was known on that island because his paternal uncle, Juan Antonio Corretjer, was infamously famous – a leader of the Communist Party, his uncle had led attempts to secede from the US in the mid 20th century, and had been imprisoned in the federal penitentiary in Georgia for his efforts. All Puerto Ricans had an opinion about that Corretjer: a Washington or an Al Capone, depending on your political view. Juan Antonio was also a poet. Those days had long past, but when Gus introduced himself at a dinner party in Puerto Rico, one still saw a flash of recognition in an older eye. Gus had something to live up to – a tradition of rebellion. But its hard to rebel when you’re expected to rebel. 

Gus never got to writing much. Once a doctor, always a doctor, I suppose. Gus had started his medical life in Spain as a surgeon. He once told me he decided to become a psychiatrist because he had begun to think of people as the appendix in room 5. In the end, looking back on it, I suppose was Gus was your classic humanist psychiatrist, leavened by a deep vein of Spanish melancholy in the Cervantes tradition. He was half Don Quixote – wanting to change a world that he knew wouldn’t change – and half Sancho Panza – willing to go along with the status quo even if he didn’t really accept it deep down. He resumed some private practice, and with his VA pension, looked forward to a high quality of life semi-retirement. 

This was his happiest period. I would visit him in Puerto Rico and we’d see each other at conferences. He was relaxed, tanned, still quoting Plato and Aristotle, but complaining about others less. He remained my number one fan in the world of psychiatry, following my articles and reading my books carefully. He made it clear he was proud of me, and I valued his smile and hug. His personal life was good too, as good as it could be for an openly gay man in a macho culture. He had a growing circle of friends, attended medical lectures at the university, saw his patients, loved his dogs, and tended to his mother and family. Then his mother passed away, following his sister who had gone earlier.

 And then trouble came from an old friend from Richmond, a psychiatrist who had gotten heavily involved with pharmaceutical industry research; this friend, who I also had gotten to know well, had run afoul of federal research laws, and, facing jail, killed himself. It was more than a personal shock, it was a major financial blow, since Gus had become involved as a site for that research in Puerto Rico. The government decided to recoup illegal profits from anyone involved with that research group, and Gus was included, his wages and pension being garnished. Now, nearing 70, he would have to return to full-time work, in one of the most difficult places to work, a state mental hospital in Puerto Rico. I went with him once to visit his ward. The hospital was a dilapidated campus dotted with palm trees; as soon as we entered the ward, about twenty men descended upon Gus, asking for a million different favors. He retreated to the nursing station, separated from the ward by a large window, a true fishbowl, where the nurses tried to explain what was happening with whom. I just sat there, bewildered that any psychiatric benefit could be provided in this kind of environment. Gus asked me a few medication questions, then went out to talk to the crowd, then came back a while later. As we left through the decadent campus, I got the sense that he was back to his melancholy ways. He was back to practicing front-line state hospital psychiatry, with which he had started his career, once again at the end of his career. There wasn’t much he could do for those patients. He knew it and I knew it. He was working for himself, for a salary, not for them, and he wasn’t happy about it. 

This was his life the last few years, as his diabetes continued and his glaucoma worsened, and his lungs rebelled against his smoking. I didn’t know it, but for the past year, he entered hospitals with pneumonia and other problems more than once, and the last time, he had a pulmonary embolus, which killed him. 

The call from one of his friends came as a shock. Gus was calling; it was his name on the cell phone, but it was his friend using his cell phone to notify me of his death. I had last spoken to him by phone about 3 months earlier; waiting to pick up my son at his school, I felt an urge to call Gus, not having spoken to him in months. He told me of another friend who had a car accident; he said little about his own health.

I’ve stopped talking to medical students; they know so little, I often think, I feel frustrated trying to talk to them. I’ve given up, and focus on residents. But part of me wonders that even if I did nothing but complain to them, as Gus did, maybe someone might actually follow me out and say: Hey, what is it you want to teach me?

I’m glad Gus complained, and I stayed behind to find out what he wanted to say. I kept learning from him for two decades, and I could have used more.

 

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston. more...

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