“At the end, all that’s left of you are your possessions. Perhaps that’s why I’ve never been able to throw anything away…” –Nicole Krauss.
“Don, you have to help me. I’m desperate. Isn’t there some drug I can take, or a therapy?”
Don’s longtime friend, a successful accountant named Avraham “Avi” Goldstein, asked the question of Donald E. Cashdollar, M.D., Ph.D., an eminent physician and researcher at the Brookline Center for Neurological Research. Cashdollar put his hand to his chin as though to reinforce his thinking in response to the question. As he did so, Cashdollar shifted ever so slightly, sinking deeper into Goldstein’s living room easy chair. “Careful, Don—“
Cashdollar’s movements disturbed a stack of newspapers and magazines leaning precariously against the chair leg. This caused the pile to shift and tumble over onto the floor. Except, it did not actually land on the floor. Instead, the printed matter collided with two other large paper stacks consisting of junk advertisements, bills, and assorted political campaign flyers, many of which landed onto some used pizza boxes. Cashdollar looked down at the carnage. He noted that a large portion of a flyer urging the reader to elect Jane Pinkwater as a Councilwoman in the Second Precinct was now tainted with tomato sauce.
Don started to apologize but Avi interrupted him. “Don’t. It’s my fault. It’s out of control. I’m out of control. I asked you here to witness this firsthand so that you can see the severity of my problem.” He continued. “Esther—you remember Esther, right? She’s all but given up on me. She won’t even come into my house anymore. I have to go to her apartment to spend time with her. Those times are fewer and fewer now. It’s been months since she and I… well, you know…”
There was an awkward pause. “Avi, I’m so sorry! We haven’t spoken in—how long has it been? At least three or four years, at my daughter’s bar mitzvah, right? I remember you had these tendencies in college but frankly, I had no idea your illness had…” Cashdollar cast his gaze around Avi’s living room. “Well, that it had progressed this far. You must have seen the articles about my research, yes?”
Cashdollar had recently been featured in the Boston Bugle’s Technology and Medicine Section for his seminal work in mapping the brain using nuclear magnetic resonance. Cashdollar had succeeded in pinpointing, with incredible precision, the various sections of the brain that governed obsessive-compulsive behaviors and addictions. What caught Avi’s attention in particular was the paragraph describing Cashdollar’s work with disposophobia—hoarding.
“Don I… I’ve known for years that I’ve had this problem with… saving things.” Avi became emotional; he wiped his eyes with a Kleenex, and then he stuffed the used tissue in a desk drawer. The drawer was so full it barely closed.
“I feel ashamed! It should be so simple to throw things away! But the indecisiveness is paralyzing. What if I’ll need that ad from last week’s paper? Or that old juice can? Perhaps an appliance breaks and I won’t be able to provide the date of purchase because I threw away the receipt? Or worse yet, a friend might go hungry without the coupons in that stack over there?”
“Avi, you don’t have to feel ashamed around me. I understand — really, I do. Many of my patients have come to me with similar problems. It’s a neurological condition. It truly isn’t your fault. I’ve been having great success with animal subjects and I’m ready for a human trial.”
It was true what Cashdollar had told him—he was on the cusp of a clinical trial—but there was still much paperwork to complete before Cashdollar could secure the proper clearances from the review boards to begin his work. Even so, he couldn’t bear to stand by and watch while his old friend suffered. Besides, there was little doubt that Cashdollar’s animal work had been a resounding success.
Doesn’t my Hippocratic oath command me to treat my patients to the best of my ability? Screw the paperwork!
Cashdollar advised Avi to book an appointment with his secretary the following Monday. He would reserve time on the clinic’s nuclear magnetic resonance imaging machine to help map the anterior cingulate cortex of Avi’s brain that governed this behavior. Afterward, Avi would undergo Gamma Knife radio-surgery to irradiate a very specific area—less than a square millimeter in size—of the cortex. The procedure had worked time and time again in lab animals.
On the appointed morning, Avi was asked to come to the clinic and bring with him a number of his personal ‘hoarded’ paper items. With Avi’s head firmly secured and exposed inside the NMR machine, Cashdollar placed a paper shredder in Avi’s view. He asked him to watch while Cashdollar destroyed random newspaper, junk mail, and other materials collected from the research center. From this test, he recorded normal brain activity. Then, Cashdollar conducted the same procedure; this time, however, he used materials that Avi had brought with him. Avi groaned out loud as he witnessed the doctor shredding a portion of Avi’s personal stash. As expected, Cashdollar observed on the computer screen a portion of the anterior cingulate cortex light up like a Christmas tree.
A technician spent twenty minutes meticulously aligning Avi’s skull, and then the actual Gamma Knife radiation treatment commenced. The treatment took just seconds from start to finish. After he was unstrapped, Avi Goldstein rose from the operating table.
“That’s it? It’s done?”
“Yes, Avi. How do you feel?”
“I feel fine. I think. When should I start feeling a difference with this… this disposophobia?”
“You should begin to notice subtle changes in your behavior almost immediately. Here, let’s go into the next room and try something.”
Avi followed the doctor into another room containing the paper shredder. Avi’s letters and old junk mail sat neatly stacked on the desk. “Avi, I want you to take a deep breath, and then pick up your letters and place them into the paper shredder.”
Avi hesitated. But, what at first seemed like an impossible task was now amazingly trivial! Avi picked up the letters and he fed them willingly into the shredder. Instead of trepidation, he felt elated upon watching the blades transform the paper into thin ribbons of waste. A huge smile appeared on Avi’s face. He turned to his friend and embraced him in a bear hug, lifting Cashdollar several inches into the air.
“I don’t know how to thank you, Don! You’ve saved me!” Avi’s gratitude was more than enough thanks for the doctor. Cashdollar patted him warmly on the back. Tears of joy welled in both men’s eyes.
That evening, Avi was having the time of his life, ridding every room of his house of magazines, shoe boxes, frozen food plates, plastic wrappers, rubber bands, paper clips, packing material, coins, and spent candy wrappers. At first he was cautious as he examined the individual items that he was disposing of. But after a while, his caution evaporated and he felt no hesitation. Avi hummed, he danced, and he sang to himself as he cleaned. Each stuffed bag he transported outside to the dumpster felt like a victory lap. When Avi ran out of garbage bags, he went next-door and borrowed more from his neighbor. Two hours later, when those bags were used up, he took a trip to a nearby supermarket and bought six king-sized containers of garbage bags. The check out person shook her head at Avi in disbelief. Avi didn’t care; he flashed her a huge grin. When he got back home, Avi resumed his cleaning. He kept at it well past midnight.
In the days that ensued, Avi’s house was transformed into a model abode. All of his counter tops and furniture surfaces were spotless, visible for the first time in years. Avi’s fiancée, Esther, stopped by to visit and was dumbfounded upon seeing the changes. She was perplexed, however, when she saw all of Avi’s suits and business attire piled high on the bed.
“Oh, that.” Avi waved his hand in the air dismissively. “I don’t need that stuff anymore. I have far too many clothes. They’re going to Goodwill tomorrow.”
“Are you sure?”
Esther took a peek inside Avi’s closet. It was practically bare. Aside from a pair of blue jeans, only one suit, and two pair of dress pants and two shirts remained. A single tie was hanging on the rack.
In the days that followed, Avi continued in his quest to purge his home of all extraneous belongings. His medicine chest was emptied of shampoos, lotions, and prescription drugs. Avi discarded all toiletries except for a toothbrush, a razor, one cloth towel and a washcloth. A single roll of toilet paper remained in the drawer. Avi emptied his kitchen pantries of all canned and dry goods. He gave away nearly all of his pots and pans. An entire wall of exercise and sports equipment stored in the basement had been placed on the curb for trash pickup. That morning, the free-cycling community thought they’d hit the mother lode when one of their members spotted the curbside “gymnasium” with the “FREE FOR THE TAKING” sign in front of Avi’s home.
Dr. Donald E. Cashdollar perused his messages on a Monday morning after having returned from a well-deserved, two-week Caribbean holiday. Among them was a message from the fiancée of his friend, Avi Goldberg. Cashdollar had made a mental note to contact Goldberg to check on his progress in the wake of the successful disposophobia procedure two weeks previous.
Cashdollar phoned Esther Katz. After exchanging pleasantries, the doctor received shocking news.
“Ms. Katz… Esther… Say that again. Backfired? What do you mean?”
Esther explained that, over the past week Avi had given away every single possession in his home. Then, just this weekend she had received a phone call from a mutual friend of theirs, Sam Hodges. Sam and his then-girlfriend, Alicia, had frequently double-dated with Avi and Esther prior to Alicia and Sam splitting up. Once, after imbibing heavily during a “guy’s night out” Sam had confided to Avi that he found Esther very attractive. “She’s a real keeper, Avi. If you ever decide you don’t want her anymore, you let me know.”
“Dr. Cashdollar… Don… I don’t know what’s gotten into Avi! Sam called and told me that Avi told him he was ‘giving me’ to him as a gift. A gift! What does that mean? I’m his fiancée, for chrissake! He can’t just give me away like I’m a toaster oven.”
“And you think…”
“He’s gone off the deep end! When I called Avi and demanded an explanation, Avi told me that he still loved me, but his life was filled with too many things and I’m one of the things ‘cluttering’ it up. He said ‘it’s better this way’ and that Sam has always loved me.”
Cashdollar took off his glasses and rubbed his bridge of his nose.
This doesn’t make any sense!
Cashdollar promised Esther he would check in with Avi that morning. He hung up with her and called Goldstein’s office. Upon learning that Avi had called in sick, the doctor told his receptionist to cancel all of his appointments. He drove directly to his friend’s house in the suburbs.
Upon arriving at Avi’s house Cashdollar was shocked to see a “For Sale” sign stuck in the front yard. He recalled Esther mentioning this seemingly illogical action during their phone call. Cashdollar went to the front door and rang the buzzer. He couldn’t hear any resulting sound from inside. Then he remembered Esther saying, too, Avi had shut off his telephone along with all of the utilities including the electricity. Cashdollar banged on the door with his fist. Then he noticed Avi peering at him from the living room window.
“Avi, open the door! We need to talk.”
“Go away, Don. I know Esther put you up to this. I’m fine. Just leave me alone. I have no need for friends now.”
Cashdollar stood there for another ten minutes. Then he left in defeat.
The following day, Cashdollar was sitting in the offices an attorney friend. The doctor explained to the lawyer the bizarre case of Avraham Goldstein. The lawyer selected a thick volume off a shelf. It consisted of state statutes. He began thumbing through it.
“Ah. Here it is.” He read it aloud:
‘Commitment by Physicians or Police Officers for Limited Period; Notices; Extension of Term of Commitment: Emergency evaluation of a person permitted upon specified professionals’ reason to believe that failure to hospitalize such person would create a likelihood of serious harm by reason of mental illness…’ Blah blah blah ‘… three day commitment to a facility of a mentally ill person whom the failure to confine would cause a likelihood of serious harm.’
“You sure about this, doc?”
“No, but I’m responsible and I don’t know what else to do. He won’t listen to me or to anyone else. Since I performed this unsanctioned procedure his behavior has changed markedly for the worse.”
The lawyer buzzed his paralegal in and instructed him to begin preparing the proper forms. “Don, we’ll have those commitment papers drawn up, stat.” When the door closed, the lawyer retrieved a business card from his desk drawer and handed it to Cashdollar.
“Don, as you know, I do contracts. I’m not a criminal lawyer. Here, take this card. I think you might need a referral.”
In the weeks and months that followed, Avi Goldstein was in and out of several institutions and hospitals. All those who examined Goldstein — especially Cashdollar — were puzzled by his newly acquired mental illness. In the meantime, the money from the proceeds of the sale of Goldstein’s home, car, and all of his remaining worldly possessions he donated to charity. Goldstein disappeared into the streets.
A medical review board suspended Donald Cashdollar’s medical license and subpoenaed his research facility’s records as well as Cashdollar’s personal laboratory notebooks. Criminal charges were pending against the physician.
Cashdollar attempted to contact Goldstein numerous times, but to no avail. Goldstein severed all contact with his life-long friend, along with his fiancée, and everyone else with which he was acquainted. His eating disorders were taking a terrible toll on the former account-turned homeless man. He purged himself after almost ever meal. Hidden under his pitiful rags, Goldstein’s wasted form resembled that of a holocaust survivor’s.
On a bitterly cold day in November, police found the frozen, lifeless body of Avraham Goldstein under a bridge near the Charles River. Inside his left coat pocket was a hand scribbled note that read, in part:
“This will serve as my last will and testament. I know that I am near the end. That’s okay; I no longer have a need for this body. It’s breathing is depriving others of oxygen and it is taking in precious nutrients that others could be using. I don’t want it to occupy space in the ground, so please cremate it. But before you do, I ask that you donate my brain to Donald E. Cashdollar, M.D., Ph.D. He shall forever be my friend.”