The Conversation at the Sky Bar

A cocktail bar in downtown Milan was the perfect spot for that meeting. Silvia and Elena, colleagues who had worked together for years in the same medical field, hadn’t been able to find a quiet moment to catch up for months. Seated in a quiet corner of the bar, away from the music and the hustle and bustle of the crowd, they had ordered two Espresso Martinis.

Silvia took off her coat and draped it over the back of her chair. She looked at Elena, who had already settled in with her usual impeccable posture and that composed air that never seemed to leave her, not even outside of work.

Around them, the bar was lively but not chaotic: a few groups of friends at the tables, the clinking of glasses behind the bar, and background music quiet enough to allow for a private conversation.

Silvia: So, Elena… we’re finally alone, far from our shifts and the clinic’s hallways. I’ve wanted to ask you this for ages, but the right moment never came.

(Elena looks at her curiously over the rim of her glass.)

Silvia: It’s about Clara. You know, Clara Vismara. That executive who’s always in the business section and at Milanese business events. I’ve gathered from various conversations that she’s one of your patients, but there’s something that doesn’t add up.

Elena: Oh, really? And what is it?

Silvia: I’ve never seen her at the clinic. Never in the waiting room, never in the hallways, never during a follow-up visit. Yet her name often comes up in connection with yours. I’ve always wondered how that’s possible. How did you two actually meet?

Elena: (Smiles in a perfectly enigmatic way, crossing her legs elegantly) Clara. Yes, that’s her. Actually, the story began in a completely conventional way, almost a year ago. She came to see me at the clinic as a regular patient. A career woman, a high-level manager in the financial sector, always impeccably dressed, used to giving orders to everyone, both in her personal life and at work. She was looking for a top-tier specialist to resolve some minor but persistent psychosomatic disorders clearly linked to stress: chronic anxiety, spastic colitis, that typical visceral tension of someone who demands absolute and obsessive control over every single aspect of her existence.

Silvia: (Leaning forward over the marble coffee table, visibly intrigued) And you? I imagine that, as a true professional, you immediately put her at ease… or did you immediately sense some underlying structural weakness hidden beneath the surface?

Elena: I realized instantly that all that institutional rigidity was just a protective armor. During that very first visit—which, mind you, was also the only one we formally conducted at the Sforza Clinic—I maintained an absolutely detached, purely medical tone—cold, clinical—and performed a complete physical examination on her. And you know perfectly well what happens when you suddenly demand that a woman who rules the world undress, strip off her expensive clothes, and lie down on a cold examination table, while speaking to her with the unquestionable authority of a doctor.

Silvia: (Smiles, perfectly grasping the subtle psychological nuance) I imagine she instantly felt… vulnerable, exposed.

Elena: Much more than that. I saw her manicured hands begin to tremble imperceptibly on the exam table’s sheet, and her breathing become short and ragged as I palpated her lower abdomen with latex gloves. My total, ostentatious clinical indifference sent her into a complete emotional meltdown. That’s when I understood the core of the problem: Clara had a desperate, unconscious need to be stripped of every shred of power. To find someone authoritative enough to tell her, without allowing any reply: “For once, let someone else decide.” And so, after that one official visit, my role as a doctor became decidedly more… personalized.

Silvia: Personalized in what sense? (Silvia asks, completely taken aback)

Elena: In the sense that I stopped limiting myself to the symptoms she’d come in for.

Silvia: Sorry… I don’t follow.

Elena: Clara didn’t just need therapy. She needed someone who understood what was really consuming her.

Silvia: And you became that person? (she asks with a hint of skepticism)

Elena: More or less. After that first visit, we kept in touch. At first, it was about medical issues; later, we talked about broader topics. I started to get to know the person behind the manager.

Silvia: And what exactly is going on today? Because the way you talk about it, it sounds like something very different from a normal doctor-patient relationship.

Elena: (Smiles smugly) Because it is. At some point, I realized that the clinic wasn’t the right place to help her. So we found a more private setting where we could work on the dynamics that were wearing her down.

Silvia: Now you’ve really piqued my curiosity. What kind of dynamics?

(The waiter at the bar silently approaches the table to set down a crystal saucer with dark chocolates. Silvia stops mid-sentence, instinctively lowering her voice and waiting for the man to walk away before shooting Elena a look full of mischief and anticipation.)

Elena: (She sets the glass down on the marble coffee table with a sharp, measured tap.) You see, the most stimulating aspect is that Clara is a happily married woman; she has two children and a seemingly perfect life. Her husband adores her and treats her like a queen, tirelessly. And yet, it was precisely that geometric, unruffled perfection that was suffocating her.

Silvia: (Crosses her arms) Wait, so she has a stable family… and she manages to sneak away to see you without raising any suspicion? How does she explain where she’s been?

Elena: There’s no need to run away all the time. We don’t see each other often: once, twice a month at most. It’s the perfect frequency to let the psychological tension build up to the breaking point. After that first time at the clinic, I realized that modern setting was too exposed, public, and impersonal. We needed a safe place, off the beaten path, outside of time. A more private place.

Silvia: And where do you see him now? (she asked, her eyes full of curiosity)

Elena: Do you remember the old apartment I inherited from my father? His historic office was still there. I spruced up the space a bit: I gave the room a fresh coat of paint and tidied it up a little. But I wanted to keep the medical furnishings intact: the dark wooden desk, the glass-fronted medicine cabinet, and, above all, that old vintage steel gynecological exam table with the black leg rests—all mechanical. Let’s just say I adapted that ’70s-era clinic a bit to my needs. I added a series of personal touches to the walls—instruments on display that would send shivers down the spine of an ordinary patient, but which, in that space, instantly redefine the roles of authority and submission. When I moved his appointments there, everything changed radically.

Silvia: (Lowering her voice even further, struck by the details) I can imagine… But what on earth can you possibly be doing to her every single time to justify the frequency of these visits? What does she need so often for a common case of stress-induced colitis?

Elena: (Pleased with her colleague’s growing curiosity) If I saw her every week, it would become a bland therapeutic routine. Instead, by letting three whole weeks pass, all I’m doing is stretching out the mental duration of her submission to the extreme. Clara spends her days at the office counting down the hours until my appointment, because she knows perfectly well that every single visit requires a very high level of physical exertion. Each session lasts nearly two hours and is a genuine coercive intervention on her body.

Silvia: Physical exertion? Specifically, what does the treatment involve?

Elena: Everything has a strict clinical justification in the records, of course. But the point is that I use a rather unique approach. Clara is used to a world of comfort, shortcuts, and immediate solutions. I, on the other hand, make her experience a form of medicine that’s almost from another era: slow, rigorous, often invasive, and decidedly unpleasant procedures. It’s precisely that physical, concrete dimension that forces her to relinquish control.

Silvia: Like what?

Elena: For example, I might give her injections for her much-touted vitamin deficiencies, using larger-gauge needles that leave her with persistent soreness for days—a physical reminder that stays with her even during her business meetings. Or let’s move on to even more old-fashioned practices: therapeutic enemas where I force her to retain large volumes of fluid, and other procedures that many specialists today avoid or delegate to other departments. I prefer to perform them myself, monitoring every reaction and every change in her physical condition.

Silvia: (She stares in disbelief, struck by the harshness of the account) Wow… so you literally put her under the knife every time. But does she just passively endure all this? Doesn’t she ever resist?

Elena: On the contrary, her body initially rebelled. As much as her mind yearned to surrender control, her biological instinct led her to tense up, to try to close her legs to escape the pressure of the water. So, starting with the second visit, I bought some safety straps online to attach to the tables. I completely restrained her on the steel table: her wrists secured to the side rails and two dark leather straps to fasten her thighs into the high thigh straps, preventing even the slightest movement.

Silvia: (Holding her breath, fascinated) The straps—I thought they were just a legend… Did you really tie her up? And how did she react to being restrained like that?

Elena: When she felt the cold hardness of the leather and heard the metallic clink of the buckles tightening, she had a moment of pure, uncontrollable panic. She cried. But as soon as she realized she was truly unable to move, that the biological control of her body had passed entirely into my hands... I saw her features relax. The straps relieved Clara of her last, exhausting burden: that of having to fight against her own will.