“I see,” said Dr. Withers. They all needed sick notes. “What seems to be the problem?”

Israel listed his symptoms: exhaustion, vomiting, weight loss, sleeplessness, anxiety.

“Yes,” said Dr. Withers, disappointed, when Israel took a pause for breath. He eyed the Jack B. Yeats print he’d recently rehung on the other side of the room, to give him something interesting to ponder when pretending to listen to his patients. He had an original Paul Henry at home. He’d not had a hiatus hernia for a while.

Withers was a jowly man with a funereal manner who had pure white hair and wore dark suits, and who had his glasses-little half-moon glasses-on a little golden chain around his neck, making him look more like a magistrate or a mayor than a man of medicine. He looked like a hanging judge. With his glasses off you could see clearly his hard, unforgiving eyes, eyes that had all the assurance of a man who was comfortable in his knowledge of his own body, and who was more than happy to point out the faults in others’. At weekends, it was said, Dr. Withers played the bassoon and wore a hat, and cultivated his interest in art and in po etry and in music, and attempted to bully his obstinate and determinedly independent wife, a woman who preferred the Beatles to Beethoven, and who was unimpressed by her husband’s moods and his Wagner. They often visited Dublin, the Witherses, and they had a second home in Donegal; they were perfectly self-satisfied. Dr. Withers was not the kind of man you could imagine either young or happy, and his patients provoked in him only the occasional pity, at best.

“They’re my symptoms,” said Israel.

“Yes,” said Dr. Withers.

“I’ve not been feeling very well.”

“Not very well.” None of them took any responsibility for their lives, that was the problem. Working classes. Middle classes. They were all the same. “I see. And how long have you been off?”

“I was off for a week. My boss says I need a sick note.”

“I see. Any other symptoms. Or is that it?”

“I think that’s it,” said Israel, wishing he had something astonishing up his sleeve. “Actually, no,” he added. “I suffer from migraines.”

“Migraines,” said Dr. Withers, unimpressed. Migraines. Dispensing for migraines was not what you became a doctor for. “And what are your migraine symptoms?”

“Well, just the usual, I suppose. Headache. Nausea. Flashing lights sometimes.”

“And you take medication for these symptoms?”

“Mostly Nurofen.”

“Hm. And anything else? Maxolon, or Migramax?”

“I’ve tried different things. I saw you, about a year ago?”

“I see.”

“But I’m not taking any medication at the moment, no.”

“I see. And how long have you been suffering these other symptoms?”

“I don’t know. A few months.”

“A few months.” If he repeated what the patient said often enough, it appeared as though he were listening. His wife didn’t allow him to do it at home; she’d rumbled the trick years ago. “Can I ask what you do for a living, Mr. Armstrong?” He always wondered what they did for a living, the patients. He was always looking for one of them to surprise him: a concert pianist, perhaps. Or a rodeo rider. Something a little out of the ordinary. But they were always the same. On the social. Or on the sick. Working for the council. Work-shy malingerers, most of them.

“I’m a librarian,” said Israel.

“A librarian,” said Dr. Withers. Better than nothing. “Life of the mind.”

“Well, it’s physical as well as mental,” said Israel. “Because of all the driving.”

“The driving.”

“Yes.”

“You drive to work?”

“No. I drive in work: it’s the mobile library.”

“Ah,” said Dr. Withers, displaying exactly the kind of response that most people had to the mention of the mobile library, as though the fact of its being mobile made it less of a library, as though it were in some way lacking.

“And did you say you’re not sleeping?”

“That’s right,” said Israel. He wasn’t sleeping because of the dreams. Every night, the same vivid, troubling dreams. Often he would wake with a jolt, as though a vast electrical current had passed through him. One dream: he’s in a hotel and has lost everything. The only thing he has is a pair of shoes. His choice is to stay in the hotel room, waiting for someone to come, or leave and walk the streets in only his shoes.

“I see.” Dr. Withers always hated this bit of the consultation. It always came to this: confessions of hopelessness and helplessness. People wallowing in their human weakness. But he had to ask; he was supposed to ask. “And are you feeling depressed at all?”

“Yes,” admitted Israel. “I suppose I am.”

“I see. And are you getting any exercise?”

“I…well, not really, no.”

“I see. And have you ever taken anything for your depression before?”

“No.”

“And have you had counseling”-or rather, counseling, he said, “counseling”-“or therapy?”

“No.”

“No. Well, what I’m going to suggest, Mr. Armstrong, is that we prescribe you a mild antidepressant and refer you to one of the counselors here in the center.”

“Oh. I don’t know if I…”

This is what always happened. They always resisted when you prescribed the cure. Anyone would think they wanted to be depressed. Snivelers.

“What I’m prescribing is known as an SSRI. It’ll treat your symptoms and then the counseling should deal with the underlying causes of your problems.” He typed into his computer, pressed PRINT, and the prescription printed.

“Well, I’m not sure that-”

“There should be no problem with you continuing taking ibuprofen. Some patients, however, can experience a temporary increase in anxiety when using SSRIs,” said Dr. Withers.

“Increase?”

“That’s correct. But often that’s a good sign that the treatment is going to be effective.”

“It gets worse before it gets better?”

“Yes. So.” He handed Israel a prescription. “And there’s nothing else?” The old catch question: you treated the first set of symptoms, and then they revealed the lump in the breast.

Nothing else? Where to begin?

The fact that he was nearly thirty?

Or that his girlfriend had left him and he was alone in Tumdrum, adrift without purpose or destination?

Or that being on the library made him feel sick-all that knowledge, pretend knowledge, looking down on him, mocking him, speaking to him of his wasted opportunities?

The accumulated weight of all the years, and the books, all that acid in them, digesting themselves and him with it?

“No,” said Israel. “Just the sick note. Which is what I really came for.”

“Ah, yes,” said Dr. Withers. “The sick note.” He typed again, pressed PRINT again. The sick note printed.

“There we are. That’s us, then, I think, Mr. Armstrong?”

“Yes. Right.”

“Thank you, good-bye.”

Israel got up and left, with his sick note, and his prescription. Dr. Withers looked at his watch. Only another seven hours to go. He flicked open the latest issue of the British Journal of Psychiatry. That was always good for a laugh.