Out in the hospital’s so-called garden, the air was either too warm or too cold, depending, often, on how we were feeling and, in my case, how recently I had been given meds. Always there were the sirens coming or going and the sound of sledgehammers and saws and earthmovers in the distance where they were removing rubble. Consequently, it was only in the late evening that you could hear birds or the occasional windblown tree. The temperature or noise level notwithstanding, there from time to time we would sit on one of the low concrete benches and puff and watch the sickly pigeons and Mr. Kindt would grin with his bad teeth, rub his forehead, and discourse. It was during one of these speeches that I learned that the herring population in the North Sea had more than once become quite devastated due to overfishing, and that one clear day many years before his misadventures with Fish Lines, before we had watched our program together, when he had read about this devastation over a cup of coffee in his favorite Amsterdam haunt, he had burst into tears.

Sadness builds like sediment with the kind of predictability that still manages to astonish, the kind that often ends by masking its original cause, he said. Years before that cup of coffee, I stood heartbroken in front of a fishmonger’s and watched his knife, guided as much by physical memory as by his blinking green eyes ringed with flecks of blood, destroy the animate integrity of his dead or merely dying charges.

But you like to eat fish, I said. I haven’t seen you cry when you do that.

Oh, I love to eat fish, of course, herring in particular. It is practically a sickness with me. It is perhaps because of this love, which I have had since childhood, that the whole question became so acute. You know the old adage, my boy: touch one part of the web and the whole thing quivers. I can clearly remember as a boy biting the stomach out of a tiny pickled sardine and thinking, but something large and awful will soon do the same to me. Most of us get over these little waking nightmares, but not I. At least not that one.

It was in the garden, likewise, that I learned how to say “you fucking ball-bag” in Dutch, along with other little bits of terminology. It was pretty pleasant, really. When he wasn’t discoursing, Mr. Kindt was endlessly curious about me, and I found myself saying all sorts of things. I talked about my time on the street under the scaffolding on Great Jones and about my two cats that had become one and then none. A lot of what I talked about, of course, was Dr. Tulp. About the short row of silver pens she kept in her breast pocket. And about how her long cold fingers, in the process of going about their ministrations, would occasionally, I imagined, make unexplained movements across my chest. These movements would, later, when the ward had gone quiet and she had returned for a follow-up “consultation,” occasionally be accomplished with the help of one of her pens. The pen she would use would be dry but the marks it left would be wet. She would dig with her pen until there were neat rows of red trenches then she would lean very close and clean me up with large alcohol-soaked swabs.

I don’t know why I imagine that last part, I told Mr. Kindt.

I’m sure I don’t either, Henry, Mr. Kindt said. But we all have our little fantasies, our little gropings in the dark. Who knows what we find there? Who can say? I have groped in the dark and found my fingers around people’s throats and theirs, in turn, around mine. Who knows where it all leads?

Also, I would tell him about my girlfriend, Carine. And about the French poets she loved so much and about her handsome vintage clothing.

Carine was nothing like Dr. Tulp. For one thing she was not tall, for another she was French-ish. I once asked her about this “ish” thing when I was feeling grouchy, and she said she was French by descent and that she had studied French language and literature in school and had lived in France and was a Francophile and was completely and legitimately French-identified. I said that seemed a little stretched and a tad fake, and she, quite legitimately, kicked me hard under the table with her pointy vintage shoe.

I did not study French in school. I did not study much at all in school. A few classics, a little mimicry, a little attitude, that’s about it. This was a sore point, at times, in our relationship.

No, I have not read that, I would say.

Well, do you want to read it? she would say.

I’m not sure, I don’t know what it’s about, I would say.

I just got done telling you, mon amour, I’ve been telling you about it for the past twenty minutes, she would say.

Can you recap? I would say.

No, she would say.

Please, I would say.

It’s about disgust and misogyny and the sexual ramifications of the 1968 student uprisings in France and the current impotence of the contemporary French novel, she would say.

You’re just bragging, I would say.

And she would say, you’re cute, but don’t be a dickhead.

I would like to note again that during our sessions and when she came to see me in the ward, I became very fond of Dr. Tulp. I even took to affecting, both in Dr. Tulp’s presence and out of it, a slight Dutch accent. Even though Dr. Tulp, who had been in the States for some time, did not really have one. Actually, Dr. Tulp’s accent was Boston if it was anything. It wasn’t Boston enough to be comical, if Boston makes you, as it does me, laugh to hear in quantity; but there was something there that made you, when you heard it, think of lips being pulled back to expose a lot of white teeth. I have already mentioned my fantasy about Dr. Tulp carving my chest with her pen so I might as well note that there were moments when it occurred to me to imagine waking up one night with Dr. Tulp’s white teeth sunk deeply but not uncomfortably into my throat. I haven’t told you about my teeth yet. For now, let’s just say they could use a little servicing. As could, as I have said, Mr. Kindt’s. Mr. Kindt wasn’t big on the oral hygiene. Frankly, he was not big on much hygiene at all, but he did love a hot shower. Every day he would have one. I don’t say any soap was involved in the shower, or, rather, that I can confirm that there was soap involved, but it was hot. Once or twice when I was visiting him in his room, he asked me to hand him a towel. Once, he asked me to hand him a towel then sit down outside the shower. When I asked him why he wanted me to do this, he said he just wanted, at that moment, to know that I was near.

I have not felt, he said, entirely myself today. Or rather it would perhaps be more accurate to say that today I have felt too much like myself, that my carefully acquired external layers have sloughed off, leaving my interior exposed.

What does it feel like? I asked.

Not at all good.

Not at all good how?

Quite terrible, you know.

You mean like the big thing eating you.

Well, yes. But also it is as if I had retracted, horribly, as if everything around me had begun to blur.

I didn’t say anything.

It has happened before. It can make me scream.

He was standing, a small yellow form behind the semi-transparent shower curtain.

Do you feel like screaming now? I said.

It is never a question of feeling like it, he said. I just scream.

In the meantime though, Mr. Kindt did not scream — he cried and breathed too heavily and said odd, occasionally corny things — and life in the hospital continued much as it had. I met twice a week with Dr. Tulp, who did not sink her teeth into my throat or carve my chest with her pen, but instead asked me questions about patterns of redundancy and potential or actual seams of discontent within, and the location of, my family, and I received nightly and sometimes daily meds and continued to steal items that I passed on to Job. I also read books suggested by Mr. Kindt, like part of a fat history of the Dutch East India company — basically a chronicle of brilliant greed and unvarnished corruption — which he left on my night table one morning, magazines that Job brought in for me, and things I put my hands on as I made my way around the hospital. Nothing I read though seemed as interesting as The Rings of Saturn, and I often pulled it out of my drawer and flipped through it. After I had read a page or two, I would lie back on my bed or go and lie down if I hadn’t been lying down already and look up at the ceiling and think vague, melodramatic, mostly borrowed thoughts about playing some key part in the Taiping Rebellion in China or helping to end the early-twentieth-century Congolese rubber trade or carrying on a doomed but sort of elegant love affair with the daughter of a vicar. If I was dozy, which I often was, these rarefied thoughts would shift ground, so that before long, instead of carrying the banner for the failing Chinese rebels or riding across the heath to deliver a bundle of roses under cover of dark, or landing at night to join the Irish separatists, I would be patrolling the ramparts of some besieged fortress culled from the fantasy novels of my childhood, brandishing an unbreakable blade, setting my jaw, and waiting for some hideous onslaught. Well, that’s stupid, but the reason I bring it up is that one afternoon just as the huge black arrows had begun to fly, just as the screams and battle cries had begun to take over my skull, I opened my eyes and — in one of the developments that has slowly helped lead me to a better, though still imperfect, understanding of my position here — found myself looking at my aunt.