Week 2.13

“I’d better be a poet or lay down dead”
—Jack Kerouac—


The house on Cedar was a few blocks west of Shattuck, a wide, redwood shingled Arts and Crafts affair with blue trimmed windows.  The front yard, artistically overgrown, was accessed by a winding crushed granite path that led to a decaying akilter redwood trellis valiantly supporting a monstrous psychedelically bright bougainvillea partially concealing the weathered, hand painted sign on one of the broad porch columns.  The practice, Ratchet & Pawl, Psychiatry, belonged to Jerry Pawl and his business partner, Ben Ratchet, pronounced ‘rah-shay’ though Wendt invariably pronounced it ‘rat shit.’  Jerry had married his ex, Sheila. Only afterwards did she officially become known as the artist Sierra North.  But then Jerry’s name had been Pawlowski before he went to medical school.  Can two people who changed their names later in life find true love?  Apparently.

Carl and Sheila had split the sheets twenty years past.  The divorce was nasty and bitter at first, but after a while, mainly through Jerry’s efforts, a pact was declared. The fact that Jerry loved art, collected first editions, was extremely well-read, had a keen appreciation of Wendt, and his writing, helped a lot.  Over the years, they had built up a trust, he and his ex-wife’s husband.  They enjoyed each other’s company, and Sierra rarely entered the picture.

The small plaque by the door above the brass domed doorbell read Please Ring.  Wendt ignored it as he had every time before.  In the foyer a tiny Bauhaus style rug straddled the polished hardwood floor. The white painted staircase with red carpeted tread led to the upstairs living quarters. An ornate oval mirror on one wall above a narrow, spindly-legged art deco table at the entrance reflected the large abstract painting opposite.  It was one of Sierra’s, called I Scream, in homage to Edvard Munch, or maybe a comment on her therapy.  Tutti-frutti, Wendt mused, and walked down the hallway flanking the stairs toward the back of the house.

There was a ringing in his ears, an alarm.  He had set off an alarm.  “Hello?” a voice from the back of the house inquired.  The voice belonged to the man who appeared in the doorway at the end of the hall.  “Hello, can I help . . . oh, hello Carl!”  He was as narrow as a bread stick and just as tan.  Jerry Pawl came forward wiping his hands on the blue striped apron.  “Carl, Carl, how long has it been?”  He wrapped a long arm around Carl’s shoulder and gazed into the bleary unshaven face with genuine affection. “Carl, you don’t look so good.”

“Yeah, I’m not feeling that great.  I must have stepped in some kryptonite.”

Jerry laughed shaking his head. “Come on back to the kitchen, I’m making chocolate chip cookies.”

The kitchen, a large space with white, glass faced cupboards and cabinets, had a marble topped island taking up the center.  On it were cookie sheets, and on them, regimented rows of little flour egg butter sugar and chocolate blobs. Some, by the aroma, were done with their requisite baking.  Jerry was grinning.  “Friday is my day off.”  He turned to the oven opening the door, muttering “these are done,” and louder, “but you know that.”  He returned with the fresh baked batch.  “This is my therapy.”

Wendt looked over the array of comfort food.  “So chocolate chip cookies are the miracle cure.  I better buy stock in Nestlé. Or Hershey.”  Wendt reach for one of the browner sets.

“Careful, they’re still hot.” Jerry was rotating another troop into the oven.

“So it’s what, eat two cookies and call me in the morning?”  A molten chip burned the edge of his lip as he said it. “Sonofabitch!”

Jerry laughed, “I warned you.”

Wendt touched the tender spot with a finger.  “I could sue you.  Defacing a National Literary Treasure.  Now it’s gonna look like I’ve got a herpes sore.”

They both laughed and Wendt nibbled tentatively at the still hot cookie. “Are you going to eat them all?”

Jerry shook his head peeling the cooled brown aureoles from the cookie pan with a spatula and placing them on wire trivets.  “Not a one.  I have them available for my clients when I do consultations.  A chocolate chip cookie is a powerful tool in psychiatry though no one will admit it.  Besides, I don’t do it all the time.”  He had taken the mixing bowl to the sink and rinsed it.  “If I’ve had a stressful week or chaotic session, this helps me take my mind off it even though the problem solving apparatus is still going full blast in the background.  Here, I’m following a recipe, steps, this, then that. It reestablishes order.”

Wendt tipped his chin in agreement, the flavorful efficacy filling his mouth. “Tough one, hunh?”  He scouted another sample among the new arrivals.  Hot chocolate chips cookies, childhood memories.

Jerry nodded.  “Without divulging any of the details, yes.  The insane logic of the crazed. Do you know how impossible it is to convince someone who is crazy that they’re actually crazy?  Not in so many words, of course, and if they’re consulting you, they have some indication that something is out of phase and so the question is not ‘am I crazy?’ but ‘can you make me better?’   There is no cure for insanity because it really is a neuro-chemical imbalance that can be addressed by some more or less effective drugs and therapy, which takes a lot of time.  I’m an advocate of meditation, but that requires will power and a certain self-confidence that a troubled client may not, most often, possess.  My process is to strengthen the will to combat the compulsions, the surges of chemical instruction that enforces negative patterns and lead to neurotic behavior.  Once I’ve accomplished that, and no mean accomplishment that, then we can proceed to meditation and extended periods of self-control.  But there is always the potential for relapse, as in any addiction, where the pleasure centers override caution and the threat of self destruction, that the personality, tenuous as it is, will get out of phase again and require realignment.”

“You make it sound like you’re some kind of AA psyche chiropractor.”

“In so many words.” Jerry cracked the oven door and peeked in at the last batch.  “What brings you over to enemy territory?”

Wendt didn’t answer, balancing a cookie on the tips of his fingers and blowing on it to cool it.

“Running a little short this month, maybe I can help you there.”  Jerry was always an easy touch, a sizable easy touch.

Wendt shook his head and, without looking directly at Jerry, said “More of a medical nature.”

“Carl, you know I’m not an MD.  I’m a psychiatrist.”

“You interned, you can diagnose.”

Jerry pursed his lips, “Ah, you know I was never good with the body.”  This from the guy whose vibrant aura said ‘sunshine nature boy.’  He picked up a large, blue glaze raku fired plate and ladled a pile of cooled cookies on to it.  “Let’s go into my study.  We can at least talk about it.  Are you going to want milk with these?”  And at Wendt’s unenthusiastic expression, “How about coffee then?”

A black robust roast cut with a modicum of dairy product
 in hand, Wendt proclaimed the cookies exquisite and proffered the suggestion that Jerry and his partner get into the boutique chocolate chip cookie business.  “Ben and Jerry’s. . .no, wait, that’s already taken.  How about Pawl and Ratchet’s?  Mmm, no, that won’t work.  People will associate the chips with rodent pellets.”  Wendt broke another one in half and shrugged.  “And you’re probably doing just as well as a head doctor.”

A low table piled with books and academic journals around which were placed some comfortable chairs was set off to one side of the room, away from Jerry’s work desk in the corner by the large leaded sectioned windows letting in a defuse light through the encroaching unkempt foliage.  Jerry drank from a glass of water and ice.  Wendt savored the mouth filling bitter of the roast beans. There was a pause as they both observed a silence that absorbed their breaths until finally Jerry asked, “How have you been?”

Been? This year?  It hadn’t been that long.  Month?  Maybe longer.  Week, day, five minutes ago?  But the answer to which Wendt had to resign himself was much more straightforward.  “I’ve been having these headaches.”

Jerry nodded that he understood and Wendt continued, “They come and they go.  But they are intense when I get them.”

“The worst pain you’ve ever felt in your life?”

Wendt shrugged.  “I don’t know.  I can’t remember.  Pain is like an orgasm.  You know you’re having it when you have it but once you’ve had it you can’t recreate the sensation in your mind, only the emotional reaction.  It fades from memory.”

“For good reason, too.  Imagine if you could re-experience pain somatically, with your nerve endings in full arousal. PTS, post-traumatic stress, flashbacks, recreate those moments, quite viscerally.  Is the pain localized or do you get the overall dome effect?”

“Well, I just happen to be on the tail end of one right now.”  Wendt traced the arc above his left ear.  “Starts in the back on the neck, goes across the side and then underneath the eye.”

“Stabbing pain or. . . .”

“Occupying army.  Like a huge growth squeezing everything else out.”

Jerry nodded, now a serious cast to his demeanor.  “Ok, that would hurt.  Been overdoing the elbow bending of late?”

“No more than usual.  Here’s the crazy thing.  I don’t get hangovers any more.  Besides these aren’t hangover headaches.  I wouldn’t bother you with that.  In fact, I don’t get drunk anymore!  No matter how much I drink!”

“Ah, yes, said the man with the golden liver. So what then, you’ve become immortal and you’re one of the gods?”

Wendt grinned. They’d had this discussion before. Jerry was concerned with Wendt’s habitual tippling and occasional over-imbibing.  It had been Carl’s contention that the gods, as much as they drank, did not get drunk or have hangovers.  And he had countered Jerry’s argument that what the gods drank was ambrosia, a psychotropic concoction, with “Same thing.”

“The headache you’re having now, is there anything that you may have done recently that could be the cause?  High sodium intake?  I know how much you like Chinese food. And your diet’s not the best. Any unusual exertions?  Drugs?”

Wendt waved his hand as if he were brushing the suggestions away.  “None of that.  I don’t do drugs.  That’s kiddy stuff.”

“I understand.  But I’m guessing here.  Do you have an idea what might be the cause?”


“Sex,” Jerry said, trying not to sound questioning, and hid his amusement by sipping from his glass.

“Right, sex.  Can’t men can have sex headaches?”

Jerry leaned back in his chair and rubbed his chin along a forefinger.  “Certainly.  They should.  Why shouldn’t they?  Yes, I would think men could experience sex headaches prior to sex.”  His voice trailed off, reeled back into thought.

“Uh, this would be post-coital, Doc.  I don’t have any anxieties in the performance department.”

“Ok, ok, après la deluge, in a manner of speaking.  Let me check something out.”  He rose and went to his desk and faced the monitor.  The screen brightened after a few shakes of the mouse.

“You’re going to look it up online?  I could have done that at the library!”

“If it makes you feel any better, I’ll pretend that everything I tell you is coming from my vast experience and extensive medical knowledge.  Turn around so you can’t see me conjure this illusion.”

“While you read from an online medical reference.”

“I could go down to the basement and get my medical books but I think they’re supporting part of the foundation. I have this subscription to a professional online medical encyclopedia that is constantly being updated with the latest and I never use it.  Otherwise, I could just fabricate something and that would likely bring up your mother.”

“Just read.”

“Men are three times as likely to develop a sex headache as women.”

“Ah ha! another example of female fakery!”

“These headaches are due to climax or becoming sexually aroused, whether from solo sex or sex with a partner and oral sex.”

“Guilty on all counts.”

“In approximately 70 percent of cases, a severe, throbbing or stabbing headache hits the individual suddenly, sometimes building for several minutes. It can last for hours.”


“In about 25 percent of cases, the headache starts before an orgasm, building in intensity as sexual excitement mounts. This type is known to start in the back or sides of the head and is more of a dull ache.”

“I don’t think so.  And you haven’t explained why.”

“I’m getting to that. The best explanation is that the pain is due to muscle contraction and. . .or blood vessel dilation in the head and neck during intimacy.”

“Should I be worried?”

“If you have a new, severe headache during sex, often described as among the worst ever, it may require immediate attention. These headaches can be due to the rupture of an abnormal blood vessel.”


“Let me finish reading. For example, an aneurysm, causing an acute brain hemorrhage or other serious condition. Since the heart rate and blood pressure are elevated, blah blah blah, weak blood vessels may burst or leak during sex.”


“If you start experiencing sex headaches out of nowhere, you should be evaluated by a physician immediately. While brain bleeds make up only a small fraction of all headaches, this should be handled as an emergency situation. If not treated, they can result in disability or death.”

“Shit, that sounds serious.”

“I’m not done.  There are other factors to consider.”

“Continue.  Please.”

“Well, there’s the most obvious, alcohol intake.”

“As I said, I’ve become immune to its effects.”

“Food or non-alcoholic beverages consumed in the six hours prior to sex. And the size of a pre-coital meal.”

“That sounds rather arbitrary.  Besides the only pre-coital meal I partake in has nothing to do with food.”

“Ok, I get the picture.  How about low blood sugar?  When was the last time you had a blood test?”

“Longer than I care to remember.”

“We can eliminate birth control pills.  How about the little blue pills?”

“I don’t have that problem.”


“Not in more than twenty years. Smoking that stuff only makes me fussy.”

“Possible sinus infection?”

“I like the thought of that.  Certainly better than a brain leak.”

“The timing of the sex.  Does it occur only in the morning or just at night?”

“You forgot noon.”

“I’m trying to be serious here, Carl.  That leaves lack of sleep, glaucoma, and anemia.”

“I think I can eliminate the last two, and I try to sleep whenever I’m not awake.”

“Ok, wise guy.  Here are some solutions you might try. Changing sexual positions may help. Standing up instead of lying down, for example.”

“I’ve done that, pulled a muscle in my lower back.  That wasn’t a headache. That was a pain in the ass.  And if I remember correctly, my partner at the time thought it was very very funny.”

“The person with the headache may also find relief in being the passive sexual partner. And as with most health problems, bringing your overall stress level down can help. For some, abstention from sex for a few days is recommended. Sometimes the problem goes away on its own.  Sometimes the headaches go away, only to come back months later. In any event, consult your doctor, especially if the sex headaches become progressively worse.” Jerry looked up from the monitor.

“That’s it?  I should stop having sex?”

“I know, asking you to give up sex would be like asking you to quit smoking.”

“You’re saying that sex is nothing but a nasty habit.”

“Not in so many words, but sex has its time and place outside of the merely obsessional.”

“I agree. For me that would be any time, any place.”

“You’re hiding your discomfort with the truth of what I’m saying by making light of it.  I’m seeing more and more of that, especially among my younger clients.  Porn and comedy have become national fixations.  Our public image, our cultural identity used to be doctors and cops.  Now it’s pimps and adolescent comedians.  We’ve certainly come down a notch in the world cultural hierarchy.”

“Thanks for the sermon, Pawlowski.  You make a pretty good parish priest for a Jewish guy.”

“Now you’re calling me a Christian.  Should I take that as an insult or. . . .”

“Hey, hey, don’t get off subject.  What’s the diagnosis?”

Jerry pursed his lips and scratched behind his ear.  He shook his head.  “I don’t know, Carl, I honestly don’t know.”

Wendt nodded.  “And my best friend the doctor won’t even tell me what it is I’ve got.”

Next Time: As the week draws to a close, Wendt is stabbed in the heart and kicked in the gut.  Figuratively, of course.  To review what has transpired so far, reference the episodes listed in the sidebar, or click The Complete DAY to read the pdf file.