Imagine looking at your own left hand with an overwhelming certainty that it is not your own, but some stranger’s. It’s as if overnight someone had snuck into your bedroom, anesthetized you, and sutured a different hand where your wrist ends. And now it’s there, attached to your body, and, miraculously, you have complete control over its movements. You think, become a fist and this foreign object does, the not-your-knuckles tightening. You think, type that email, and the alien fingers do, syncing perfectly with your real right hand and pumping out the words as soon as they pop into your mind. 

This was how my patient, Paul, described his left hand: almost as a tumor that only he could see while all around him people insisted that there was nothing wrong, that this malignancy was as benign as a cup of morning coffee. 

Paul was twenty-one when he came to my office for his intake appointment. My office is decorated to look like a rainforest with tropical plants everywhere and little stuffed lizards, statues of anoles, and a tank with a live axolotl, the filter trickling clean water at a constant, soothing pace. My patients like it. 

“Many lizards possess the power of regeneration,” I tell them when they inevitably ask about the thematic decor. “I come to my practice with the belief that humans actually have regenerative properties too. Not physical regeneration, but emotional.” It’s a corny speech, but it gets the point across. 

I told this to Paul when he first came in. He sat on my green couch hugging a pillow with an iguana stitched on it and listened to my lecture. I wondered if he could tell that I had given this speech many times before. I have a full caseload and it is difficult some days for me to treat my patients as individuals; sometimes the appointments bleed together over the course of the week and I find myself repeating the same tired phrases, the same probing questions (about childhood, about fears, about whether they have coping mechanisms and whether their jobs are fulfilling or at least stable for now). 

While, of course, all my clients have their own unique problems, and they articulate these problems in their own unique ways, the repetition of therapeutic sessions day after day, year after year, begins to make all my patients, no matter how idiosyncratic, become somehow standard. That is, all besides Paul. 

Perhaps Paul stands out not only because of the peculiarity of his disorder, but because of when I took him on as a patient. He first came to me about three months before my wife, Joan, moved out of our apartment. His Friday afternoon appointments would always mark the last of my week’s work before the dreaded weekend, which would inevitably be filled with quarreling and domestic disputes. It was easier to think about Paul and his hand, which was also not-his-hand, than to think about going home. 

When Joan and I at last committed to separating, the quarreling stopped. We did, however, continue to share an apartment until she found a new one, which felt about as good as living with a constant burning fire in the corner of your home, a fire that didn’t spread, and yet maintained its steady, tight heat. This is to say, if I must carry on the metaphor: I was never burned but was always sweating.

Joan moved into our guest bedroom and, after work, we asked each other about our days and even cooked and ate dinners together. Aside from sleeping alone, the only thing that reminded me things had changed was an inarticulable shift in Joan’s demeanor. Was it that she slouched more often, as if ashamed? Could it be that she was mumbling more? Was that a new wrinkle forming, there, between her eyebrows? It was difficult to say. 

Though Joan told me that she was looking for another apartment, her search appeared unfruitful. I never saw her leaving for apartment tours or calling real estate agents, and I didn’t want to prod her. Having her in the apartment allowed me to believe there was still a chance we would stay together. Neither of us had actually called a lawyer yet, and this hesitancy on both our parts added to my reassurance that this was but a temporary, if painful, stretch of time in our marriage. I came to look at the situation from the distance I analyzed my patients’ problems.

I spoke to Joan about Paul’s case in that strange liminal time between the separation and her finally moving out. I started telling Joan more about all my clients than I ever had, as if filling our home with everyone else’s issues might absolve us of ours, or at the very least, make them seem less daunting. 

“He reminds me of someone,” I’d told Joan of Paul. She’d nodded and laughed, “All your patients remind you of someone, Laura.” She was right in the sense that the older I get, the more I am plagued by a constant feeling of déjà vu, everything reminding me of everything else as all my life experiences tumble down and imprint upon each other like the light impressions at the bottom of a stack of carbon paper.

But there was something about Paul. I don’t believe in past lives, but if I let myself daydream, I can almost picture him as my son in an alternate timeline, one in which Joan and I had gone through with having a child. Such musings had to be folded away when I entered my therapy office. At home, it kept my mind off everything deteriorating with Joan.

Paul was nice in a boyish, well-brought-up sort of way, respectful and clever. He had cherubic cheeks and seemed always to be blushing. His family was supportive and his friends were kind. There was nothing out of the ordinary about him aside from this incomprehensible source of suffering emanating from his left hand. I felt a bit overprotective of him. It made it hard to reach out for consultation with other healthcare providers, who might tell me to refer him out to more specialized care. 

He’d first come in not for this hand issue, but for a rather simple case of anxiety. It was his senior year at university and he had some of the expected job-market dread. We talked it through during his first, second, and third session and the anxiety subsided. I felt sure he would quit therapy, seeing as his anxiety appeared to be situational. 

But then he’d brought up the hand, tentatively at first, but once he started going he couldn’t stop. He just went on and on, waving his left hand loosely before me like a dead, rotting fish.

“It’s not my hand. Not really. I’ve known this for many years now and I’ve tried to get used to it, and for a while I’ve been able to live with this not-mine feeling.” (He often used this phrasing to describe it, the not-mine feeling.) “But, I can’t do it anymore. Now when I look at it, I feel something more like disgust. And I was trying to be okay with this, really. I’ve been going online to these forums for other people with this feeling. Because other people do have this feeling. And that helped, but then it got more intense — the feeling of disgust with the hand turned into something…I don’t know…something hateful. I’m not sure how to explain this to someone who doesn’t know how it feels. There isn’t anything quite like it. It’s just, when I close my eyes, I see this version of myself, and it's a version that is me with no left hand. And that feels right. It’s just awful having to open my eyes and see this.” He rested the hand limply in his lap, looking at it as one might a spider crawling ever closer with each passing moment. 

The trickling of the water in the axolotl’s tank filled the room. I did my best to validate his feelings as I tried to recall an article I’d read some time ago in a psych journal about this rare form of body dysmorphia. After he left the session I stayed in the office looking for more information on the subject. Body integrity identity disorder (BIID). 

Extremely rare. Body dysmorphia relating to the limbs. Fantasies of amputation. A sense that one’s able body is not one's own. Apotemnophilia. Much to my dismay, I read that talk therapy rarely helps these clients. The not-mine feeling is as persistent as it is irrational. I continued going through several articles on diagnostics and treatment that night, barely noticing the passing of time until my cell phone buzzed on my desk. There were two messages from Joan. 

Hey Laura! Found an apartment. Will move out at the end of next month. 

Hope your day was good. 

********

When I got home, I shut myself in the bathroom, ran the water, and read. I had been doing this more often since we’d decided to separate, waiting in the bath until I was ready to face Joan and go through the motions of the evening — making dinner, listening to her troubles at the office. 

I was in a book club with some people from my grad-school days. We’d reconnected on a Facebook group for Chicago School Psych Alumni. Someone I hadn’t known back then had the idea to start a book club reading any book with the title “Confession.” We’d read Augustine’s, Rousseau’s, Tolstoy's, and were on to reading The Confessions of an English Opium Eater the week of Paul’s own confession. 

Some days instead of reading, I would get in the bath and set the book on the floor beside me, then stare down at my naked figure in the tub, obscured by the copious bubbles floating on the water’s surface. At forty-seven, I was dismayed to see that I had become what every woman fears: unexceptional. What amazed me about this, was that it seemed I could rediscover this truth about my body an infinite number of times. It was a repeating epiphany, since, throughout the course of my day I would forget I had a body at all, being too absorbed in my work. Then in the mirror at the end of each day, I would see it again. What a lousy surprise to repeat.

Sometimes, I could hear Joan through the bathroom door moving around the kitchen and putting the dishes away or taking out groceries for that night’s meal. She was always so loud in there, and I knew, as much as I denied it, that she was making all that noise so that I might notice her efforts toward normalcy and either reward her for them, or feel guilty for shirking my share of the household duties. I wondered if she would take the dishes when she left for her new apartment and prayed we would not argue over the good knives which had been a wedding gift from my father. But I could already feel my grip loosening on everything we had owned together. In some ways, nothing was really “ours” anymore because there was no us. The question of ownership felt obsolete. 

It was easier to think about logistics and our possessions than everything else. The reality of it. I noted my avoidance of the real issue, but then continued to wonder about the things that had been “ours,” making a mental list of the items we’d collected since our marriage. A complete illustrated encyclopedia of neurology. Too many cheese trays, all useless now on account of Joan going vegan four years ago. Shot glasses from various vacations each bearing a kitschy depiction of some local landmark. The leash we still kept from the old dog we’d adopted together who died only six months after we got him. We never could get rid of that leash. 

The water was becoming cold. My fingers shriveled and I examined them, thinking of Paul.

********

The next morning was a Saturday, and I had a book club meeting. I logged in to the Zoom call where we were to discuss Confessions of an English Opium Eater. 

Attendance had been falling at the book club as the initial excitement of reconnecting with old friends wore off. Our first discussion of Augustine’s Confessions had about twenty people. But people's lives got too busy or else they had other books they wanted to read. We were lucky to have even six people show up these days. 

I wanted to turn off the camera when I saw my face, eyes bloated from bad sleep. I was sitting on the couch, which was overstuffed, and so my body collapsed into it, my chin tucked back and my posture more like a loose pile of mud than a person with a spine. My face was too dark, too far from the camera.

I never said much at these meetings, but it was nice to have something on the calendar. The founder of the club started the meeting off by giving his impressions of the book and some historical background. Then he asked what we thought about drug memoirs in general. I tuned out of the conversation when Joan walked into the living room. I motioned at the laptop and mouthed “on a call.” She nodded in response, then proceeded to drag some of her stuff from our bedroom to the guest room where she was staying. 

Our (no longer shared) bedroom had deep closets that held a seemingly endless supply of old clothes and trinkets that had disappeared after purchase. Now Joan was uncovering them piece by piece, finding treasures of things that we’d forgotten were “ours” all along. 

I watched her from over the laptop screen. She was wearing leggings and a big, moth-eaten t-shirt. She must have just come back from a run, because her hair was pulled in the tight ponytail she wore when she worked out. The hair at her temples had started graying a few years ago, and she’d taken to dying her whole head two shades darker than her natural color. It gave her the look of a raven, especially when pulled back that way, her nose, sharp and Roman, her eyes focused on the task at hand. 

“What do you think, Laura?” I was being called back to attention through my headphones. I hadn’t been listening. 

“I think he makes opium sound like a very nice escape,” I said quickly, and they all laughed.

Marsha cut in then, saving me the effort of having to explain my point further. Marsha was a regular attendee. She was obviously bored with her life and spent most of the Zoom calls monologuing, but almost never talked about the book, steering the conversation instead to issues she was having with her teenage daughter. 

“The author reminded me a lot of my daughter,” she started. “Like, he was so lost and rambling. I kept wondering, couldn’t he just reach out for help? Carina” — that was her daughter — “has been acting so weird lately and I think she’s been smoking weed. Don’t get me wrong, I had a bit of fun back in my day, but never like this. And I mean, I was open with my mother about it. We talked about things. Carina never just talks to me.” 

I admired the way she unloaded so unselfconsciously. We were all psychologists in the book club and so were used to this sort of thing and occasionally guilty of it ourselves. All of us had family and friends and acquaintances who would ask us out to coffee only to spend an hour ranting about their wives or bosses or suspicions that their underperformance at work was probably a result of undiagnosed ADHD. Becoming a therapist was much like owning a truck in this way. Sometimes you just had to help people move. 

Normally, I would let her go on, but today I snapped, “Did you even read the book, Marsha?”

It is odd that you can feel tension even on a Zoom call. My rudeness pierced the virtual room and the book discussion wrapped up quickly that day. I couldn’t go back to the book club after that.

********

The next week, when I left for my office from my half-empty apartment, Paul came into an appointment with more distressing news. 

“I want it amputated.” 

“I see.” My automatic response papered over an eerie drop in my stomach. He and I both knew that I am mandated by the state to report my clients’ intentions to hurt themselves. Failure to do so is unethical and could lead to my license getting revoked. I scrambled in my mind to remember the treatments in those academic journals I had pored over before book club.

“But I need an evaluation from my mental health provider.”

“An evaluation?” I needed more information.

“I’ve already consulted a surgeon to get approval. For the amputation, I mean. I have to get an evaluation from you. You have to declare that I am otherwise of sound mind.” 

I told him I would need to think about it and prepare some paperwork for the evaluation. I did need to think more, but more than that, I needed to be present and I simply wasn’t. Joan was leaving and it was that fact that my mind stubbornly stuck to. 

Paul cried on my couch and nearly begged, squeezing the iguana pillow close to his body. I looked at his left hand as it tightened around the pillow and thought that he wouldn’t be able to hold the pillow the same way if he went through with the amputation. I told him I would evaluate him, but that I would have to speak to some colleagues to be sure I fully grasped the situation. It was what I should have done from the start. I couldn’t get him to speak more after that, just as I’d feared. He was still crying when he left the office. I shouldn’t have let him leave. 

On the way home, I stopped at the bookstore and bought Dirtbag, Massachusetts: A Confessional, the next book in our club’s lineup, to soothe my anxiety. I decided I still wanted to read it, even if I couldn’t show my face again in that virtual room. I stood outside the bookstore for a moment, flipping through the pages of my new book, and thought about going home. Instead, I went to a bar a block away from our apartment. My apartment. 

Since the separation, I’d found a sort of freedom in knowing that I could come home as late as I wanted and Joan couldn’t ask me about it. I was not hers anymore. Sometimes, in my lower moments, I imagined coming home at three in the morning. I pictured the anger vivid on her face. Where the hell have you been? she would say. You’re not in charge of me, I’d return. I hated how I felt like I had when I’d just turned eighteen — that need for a million quotidian rebellions just to assert myself as a person willing, able, and complete. 

These reveries were always followed by a painful realization: Joan would never ask where I’d been. Not out of respect for our fresh separation, but because she simply didn’t care anymore. I was not hers, and she did not want me to be. 

At the bar, I ordered a beer and sat with the book open in front of me, trying to focus on the words. Either the lighting was too dim or my brain was too clouded. I couldn’t make the letters form into coherence. I looked at my hand which was wrapped around the beer bottle. The condensation caused the napkin under it to grow damp and pill and I rubbed at the paper, letting the moist fragments come off on my fingertip. There were so many things a hand could do. It could touch you, hold you, run down your side in the morning. Joan had such beautiful hands. It was one of the first things I noticed about her. Delicate tendons. Near-purple veins running rivers under her skin.

I still wore my wedding ring. The decision not to remove it hadn't been conscious. Rather, it had in some way become part of my body over the twenty years of my marriage. I couldn’t bring myself to remove it any more than I could pull my calf from my knee joint. 

My thoughts returned to Paul, and what course I would take with his treatment. I thought of his fingers, which had not yet grown into the strong digits of a man. There was something still childlike about them. Paul once said that he’d seen a post on one of these forums where a user claimed that they had tried once to physically pull their arm from their body. They’d been drunk with friends and tied their arm to a truck, tied their body to a pole, and had their friend drive the truck off. A modern-day attempt at drawing and quartering. The rope had tightened around their skin, but ultimately slipped, causing bruising and scraping around their forearm, but no limb loss. 

“It’s probably just some weird online bravado,” Paul had said. As he told the story, I noticed a brightness in his eyes that dimmed when he told of the failure.  

“Do people post about that kind of thing a lot in the forum? Trying to remove it themselves?” I asked.

“Oh sure. They call it DIY. Basically if a doctor won’t cut it for you, people will try anything to force an amputation. I saw another guy post about putting his arm in an acid bath. He went to surgery and came out with the exact cut he wanted.”

“Would you ever try anything like that?” I asked. 

“No. Probably not.” 

Alarm bells. It was my job to pry. “Do you have anything at home you’ve thought of using to remove your hand?”

A pause. The sound of the axolotl tank.

“No.”

A band started tuning their guitars in the corner of the bar and only then did I see the signs advertising LIVE MUSIC TONITE. I downed the rest of my beer, paid, and walked home. 

********

Back at the apartment, the lights were off. It was nine o’clock. Joan was in her new apartment. She hadn’t given me the address, but she’d slowly been moving things over there throughout the week — the apartment gradually emptying of her.  

I switched on a few lamps and sat on the couch.  

A couple months before Joan had asked for the separation, I’d painted the walls of our living room a deep maroon. Joan hated it, though she never said as much. She had ways of making it clear, mentioning offhandedly that red symbolizes danger and violence in some cultures, or commenting on our friend’s deep blue-walled apartment, "I'd never go with such a dark color, makes the whole damn place feel like a cave."

I often found myself wondering if things would have ended differently if I had painted the room another color, or if I hadn’t painted it at all. I could dream up a million outcomes to match a million paint swatches. In one world, the room was a mint green, and we would sit drinking coffee together in the mornings. If I’d gone with a light blue, maybe we still would have separated, but later. We could have lasted another month living tensely together between the sky-colored walls. 

********

The next week, Paul came to his appointment late and entered rapidly, bouncing on his toes as he walked. His hair, which was normally neatly combed, stood up straight. He kept fidgeting in his seat. He spoke fast. Something was evidently different. I looked him over and saw his left hand was wrapped in a bandage. 

“I’m sorry I’m late. I got really distracted at home and completely forgot I had our appointment today. Things have been busy at my new job and…” 

“What happened here?” I asked, indicating his wrapped hand, which he covered with his right uninjured one. 

“I had an accident.” 

Sirens. “What kind of accident?”

“I was cooking, and I burned my hand is all.” 

He didn’t look at me when he said it. He was desperate, that much was clear. I pressed him for details, but he stuck to his story. He swore he’d burned it cooking. When I asked him what he’d been cooking he took three minutes to supply an answer. Pasta.

“So Paul, I’ve been thinking about the evaluation you asked for,” I started. 

“Well about that,” he interrupted, “I got news from my insurance and the amputation won’t be covered. Even if I get approval from my mental health provider.”

“I see.” Paul nodded and began fingering the tassels of a blanket patterned with green stripes and eucalyptus leaves, nervous.

I swallowed. “Paul, I hear you when you say you hurt your hand making pasta and that you don’t think about how you would get rid of your ‘not-mine’ feeling.” I could see the blush leave his cheeks. My breath was shallow.

“I want you to know that if you think of hurting yourself, you can reach out to me or go to the emergency room at the closest hospital.” A big exhale. “How about we spend the rest of the session talking about activities that help distract you from the not-mine feeling?”

 I couldn’t get him to talk much at all after that.

********

My work cell rang at two in the morning the following Sunday. Disoriented, I reached for the empty space in the bed beside me. Then I remembered. All Joan’s things were gone, but for a set of armchairs she was supposed to come get sometime next week.

When I realized it was my work cell, my stomach dropped. At such hours, it was always, inevitably, bad news. I answered the phone. 

“Are you okay?” I asked. It was Paul. 

“I’m in the hospital,” he said. His voice sounded so much smaller than it did in person. 

He told me he had coated his left hand in oil and set fire to it. He let it burn a full three minutes before putting it out. By then his hand was useless. The flesh had cooked and charred. He called 911, they brought him to the hospital where the doctor removed what was left. 

I went to the hospital in a daze where Paul was waiting in post-op. He was lying with his head against the pillows as tranquil as a child listening to the final pages of a bedtime story. I sat beside him. 

“How do you feel?” I asked, although the answer was clear on his face.

“Happy. Finally,” he said. 

“Happy you succeeded?”

“It wasn’t mine.”

“It must have hurt.”

He laughed, shaking his head against the pillow. We were quiet for a moment except for the beeping noises from various machines, and the sound of nurses chattering in the hallway.