Twelve Patients: Life and Death at Bellevue Hospital

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For Diana

The view from my office at Bellevue Hospital looks north up the East River. The south side of the UN building rises like a thin polished band, and it cuts through the arc of the 59th Street Bridge that reaches east over Roosevelt Island and then to Queens. On the southern tip of Roosevelt Island, I can make out the skeleton of the smallpox hospital now in ruins. FDR Drive pulses with white lights heading south as I look out at seven o’clock on a still-dark morning. Red taillights string north in the dark evenings as people head back to the outer suburbs locked in their cars.

The old Bellevue psychiatry building, now a men’s homeless shelter, frames my window on the left. The building is stained with water and neglect. Just to its right is the New York University School of Medicine with its laboratories, classrooms, and hospital beds. Hidden beyond the construction site exactly in the middle of my view is a small white tent. The site had been our northern parking lot until September 11, 2001, when air-conditioned freezer trailers were moved in and surrounded by a chain-link fence. Guards monitored access. The remains of the dead from 9/11 were brought to be identified, their DNA measured against the DNA extracted from toothbrushes and clothes. It reminded me of the ZAKA in Jerusalem (the Hebrew acronym of an Israeli organization that aids disaster victims), who came to the site of a suicide bombing wearing their tzitzis and collecting brain matter and fingers into plastic bags for burial, so that the souls of the dead would be able to join their people when the Messiah came.

The tent is still there as I look out my same window eight years later, though the refrigerated trucks and guards are gone. The view is
being progressively obliterated. The Economic Development Corporation has taken over our north-side parking lot and leased the area to a California company to build a biomedical laboratory building. I figure I have about another three months before the UN disappears completely, and with it the medical school, along with the old psychiatry building
cum
homeless shelter.

When most people hear “Bellevue” today, they picture an old-fashioned insane asylum—but that is just one aspect of this city-within-a-city where I spend my days. For aficionados of
Law & Order
or
Nurse Jackie
, Bellevue is synonymous with psychotic killers perpetrating random acts of violence. But Bellevue is the oldest hospital in the country, 275 years old. It is also arguably the most famous public hospital in the United States. The first maternity ward, first pediatric ward, first C-section—Bellevue is full of firsts. Its public sanitation programs date back to the Civil War. Yellow fever, tuberculosis, typhoid, and polio epidemics were brought under control here. Famous for psychiatry, Bellevue also pioneered child psychiatry with the first inpatient unit complete with a public school for children. Two Bellevue physicians won the Nobel Prize for heart catheterization. The first cardiac pacemaker was developed at Bellevue. So was the early treatment of drug addiction.

Today, the hospital continues to work at the cutting edge of public health issues—HIV, lethal flu, potential terrorist epidemics. Bellevue also has a hundred-bed prison unit to care for prisoners of Rikers Island, the largest prison complex in the country. As part of the city hospital health system, we look after the needs of all New Yorkers—from Park Avenue to the tenement housing of recently arrived Fukienese immigrants, survivors of torture, and everything in between. With thirty thousand discharges and half a million visits in our hundred-plus different outpatient clinics, we see the effects of global problems often before most people know the problems exist: outbreaks, violence, climate change, tobacco, drugs, and the fast-food industry. We are known for many things, in particular our emergency room. If a cop gets shot in Manhattan, his first choice is often Bellevue. If a diplomat gets attacked at the UN, he gets taken to Bellevue. If an investment
banker goes into cardiac arrest, his limo driver knows where to take him. If New York is a microcosm of the world, then the doctors of Bellevue are on the front line. We are a vibrant institution that moves to the same rhythms as the city we serve.

Where in colonial times there was a farm named Belle Vue now stands a vast hospital complex of several thousand beds with seven thousand employees, and several thousand new New Yorkers being born every year. The modern campus sits in Kips Bay, a few blocks south of the United Nations, flanked by First Avenue to the west and the FDR Drive snaking along the East River. The northern boundaries are the aforementioned men’s homeless shelter spun out from the old psychiatric buildings, and an intake center for kids in crisis; both were parts of the original sprawling hospital campus. The southern boundary runs into a nursing school and the Manhattan Veterans Hospital on 23rd Street. For the past 150 years, Bellevue has also been the teaching hospital for the New York University School of Medicine.

I arrived at Bellevue in 1997. After seventeen years as a physician at Dartmouth, I was ready to be back in New York and in public health. As a child growing up in the Bronx, I used to accompany my father, Dr. Robert Manheimer, as he made house calls at night. A rheumatologist and internist at Montefiore for more than fifty years, he took me on night rides in the family’s baby-blue Peugeot with an adjustable spotlight to find house numbers on Gun Hill Road or the little-known alleyways off the Grand Concourse. The sounds, smells, and rhythms of medicine entered my primitive brain’s limbic system. I had no choice. Though I loved everything else—history, languages, archaeology—medicine was my passion.

In the 1970s, when I was a medical student at Downstate, in Brooklyn, the city went bankrupt. Crime rates escalated. The city saw gigantic unemployment, a crack cocaine epidemic, racial tensions, and escalating economic and social disparities. As I made my way to pathology class Monday morning, the Brooklyn morgue was lined with bodies. The late 1970s, when I was a resident at Kings County, a huge public teaching hospital in central Brooklyn, were also crazy times for New Yorkers. The city was homicide capital of the world.
Son of Sam was one of my more infamous patients of the time. There was nothing we had not seen after years working through all of the services, each with its own building on the campus. We had no on-call rooms, so we slept on empty stretchers. There was no air-conditioning, so in the summer we brought several extra shirts to change into. We would meet at midnight in the break room for peanut butter sandwiches and trade a CT scan for a barium enema before going back to battle. After ten years I had seen almost everything.

After a physician was stabbed to death in the parking lot of the hospital by a crack addict trying to rob him of five dollars, I answered an ad in the
New England Journal of Medicine
for a job in New Hampshire.

I met my wife, Diana, at Dartmouth—she was a young professor with Canadian parents and had been raised in Mexico, where her dad worked as a mining engineer. Diana’s work encompassed the world of the arts, theater, performance, literature, and politics, and I was seduced by it from the beginning. From her early childhood in Parral, Chihuahua, a dusty mining town whose only claim to fame was that Pancho Villa had been killed there, her family had moved to Mexico City. In 1997 I followed Diana back to New York City, where she was offered a position at NYU. I, like a true homing pigeon, started working in the city public hospital system again. Bellevue completed my inner circle, which consisted of Diana; my son, Alexei; and our daughter, Marina.

Looking down out my window, I see a corrections van, “New York’s Boldest” stenciled on the side, pull outside the “Blue Room” (holding pen) between the emergency room and the adult psychiatric emergency room, which goes by the acronym
CPEP
—that is, the “Comprehensive Psychiatric Emergency Program.” The occupant of the van must be a high-value prisoner from Rikers Island—seven police and corrections vehicles surround it. The vehicles stop just below my window, and the corrections tactical squad members emerge in full body armor, carrying battlefield-level weaponry. They survey the perimeter, then create a human corridor through which two corrections officers (who must be captains, judging by their starched, formfitting white shirts) escort the shackled prisoner. He is Latino, with dark disheveled hair and a
wispy beard, wearing the standard baggy orange jumpsuit. His skin is tattooed everywhere I can see. Blue, black, green, and red. His neck, arms, and hands.

He looks up toward my window. Las Maras have arrived in New York. They are one of the deadliest gangs. Their signature is extreme violence, no holds barred, unsentimental murder and mayhem. Their initiation rights involve peer beatings and an initiation murder or
asesinato
, as it is called in Spanish. Many of them grew up undocumented in the street gangs of Los Angeles, and were later deported as teenagers and young adults—some to El Salvador, where their parents had fled from the horror of civil war, and some to other countries of origin they had never known. Now they were back, more lethal than ever, with a spiderweb network of drug trade from Colombia and Peru all the way to Los Angeles and Long Island.

This guy’s hands and feet are bound with metal chains; another chain connects the hands and feet, and everything is connected to a strong leather belt around his waist. Is all this security to protect him from a rival gang that wants his territory, or is it to prevent his gang from helping him escape? This transport moment is the vulnerable point—he can’t escape from Rikers, though someone could kill him there. Given the gang’s power and codes, however, that’s unlikely. The guards push him into one of the cells in the Blue Room.

“¡Hola, jefe!”
Patty, my executive assistant, walks in around eight a.m. and startles me out of my thoughts. “You have a full schedule today.”

“As opposed to every other day?” I ask.

“
¿Quién te manda, jefe?
” she rejoins. “You are your own taskmaster. So today, the UN Secret Service folks are coming in to make sure we’re ready for the upcoming General Assembly meeting next week. God forbid they take a shot at one of those world-leader types and he ends up here. The Mexican minister of health will pop in to discuss health care for Mexican migrants.” She goes down the list and finishes with: “By the way, Budd called down from the prison health unit asking if you would run up to say good-bye to Juan Guerra, who is to be discharged on compassionate release.”