Twelve Patients: Life and Death at Bellevue Hospital (19 page)

In fact Arnie did take three full weeks to stabilize from the psychotic symptoms. He was kept under heavy sedation to make sure his heart was protected from an internal hormonal storm.

Evidently when I was stable enough from my heart attack they transferred me off the intensive care unit floor directly to a psychiatric unit. The one they call “double trouble.” It is for patients who both have psychiatric problems and are withdrawing from drugs. You see, I had started to use marijuana along with all of the other medications I was addicted to. I know it sounds ridiculous since I was already taking so many drugs and alcohol, but it relaxed me. I got into the marijuana and had a 1-800 cell phone “delivery service” drop off an assortment of marijuana selections, like Ben & Jerry’s, in sandwich bags when I went to pick up prescriptions from the pharmacy. The deliveryman, a grad student in plasma physics with a ponytail, said he had something special for me and gave me some freebie joints along with my regular supply from his breast pocket. I didn’t know what they were. A few days later I smoked two joints in my bathroom at work. I’d had a long day and too many meetings and was off to another benefit uptown where I am on the board of directors. I got indigestion in my car and some chest tightness and told my driver to take me to the nearest hospital. Bellevue was a few blocks away. I found out a few weeks later when I returned to consciousness that the joints were laced with PCP.

Phencyclidine was legendary in emergency rooms around the country and in psychiatry. It was a bear and invariably left a mess in its wake. Also known as PCP or angel dust, hog, Chuck Norris, Hulk Hogan, and fry sticks, it was originally made by the pharmaceutical company Parke-Davis as an anesthetic fifty years ago. It produced a post-operative psychosis and was abandoned but rediscovered as a drug of abuse, since it’s easy to make with a home chemistry set, and is usually combined with marijuana or LSD. It is sprayed on the leaves of cannabis, oregano, or mint and then smoked. The intoxication phase begins with euphoria, confusion and delirium, psychosis, agitation, rapid heart rate, and high blood pressure with increased salivation. This leads to a stupor with wide-open eyes that beat rhythmically in different directions and is followed with grand mal seizures. The final stage is lethal, with coma, strokes, heart failure, and muscle breakdown causing kidney failure. The stages are mutable and patients move among them. Sedation and isolation in a quiet room with careful observation is the cornerstone of treatment. The psychosis can be transient or prolonged depending on prior psychiatric illness and or exposure to multiple drugs. As Steve Ross, our chief of addictive diseases, always reminded his staff, take a careful, detailed longitudinal history. “The Devil, God, and the Diagnosis is in the details.”

I was locked up, a free pass to psych. That means that two physicians signed an order to lock me in an inpatient psychiatric ward for up to ninety days. There is a buzzer at the door to get in or out unless you have a key. You need privileges to even go for a test off the unit. To exercise on the roof, catch a breeze, or smell the city air in the metal cage has got to be earned. I was so sedated on injections of Seroquel—a medicine for psychosis—plus Ativan, a benzo, that I don’t remember the first couple of weeks on the unit. They said I was zombie-like and better for it since the PCP-induced hallucinations and agitation fluctuate until it fully wears off. There was a one-on-one aide with me all of the time. They call the aides BHTs or behavioral health technicians. The BHTs who looked after me were in their twenties and thirties, young men and women who didn’t let me out of their sight—not to go piss or shit, to the shower, to my Spartan bedroom, or to the dining room or treatment area. They quickly got to know what I liked, my favorite sports teams, skiing in the deep powder snow of Alta, Utah, smoking Cohiba Puros from Cuba, and listening to Mozart operas and old Nat King Cole records. Pretty soon I had
The Marriage of Figaro
on a small tape player and magazines my family brought in of the special things from the parts of my life I had abandoned little by little years earlier. From
Popular Mechanics
to
Forbes
to the
Financial Times.
They would talk to me for hours and ask me questions about my interests. It’s funny, but over a few weeks I came to depend on them and learned about their families, their special interests, places they wanted to visit. It was like a weird Scheherazade. Trading tales from different kingdoms. Each one a foreign language to the other person. I knew more about them and they knew more about me than my own family. I cared more about them than my own family. Just their presence, sitting next to me in a yellow plastic chair, calmed me down. I got weaned off the zombie medications. I was only on methadone for my promiscuous narcotic addiction—if it was a white tablet I swallowed it—and they tapered away everything except for an occasional dose of a tranquilizer and something to help me sleep. Sleep, precious sleep, had been destroyed a year earlier from the marijuana.

We had a unit meeting every day around nine thirty. The staff came on the unit and all of the patients sat in a big circle in the large open day room.

They were a motley crew. Actually, we were a motley crew. I was one of them. I lost all pretensions about who I was. The odd thing was that I felt safe for the first time in years. Safe in a mental hospital.

I was just another patient with a combined psychiatric problem and drug abuse. Period. It was nice to be anonymous. The locked unit, the presence of the staff, the nurses, doctors, psychologists, social workers, activity therapists, peer counselors, yoga teachers, students—it all felt okay. I had tried to pretend and hold myself together for so long, it felt good to be in a place where I was looked after, where there was no more room for lying, deception, cheating, judgments, fears of falling and failure. I could relax talking to my morning BHT, a twenty-eight-year-old Dominicana, Melissa, in charge of my mornings, about her marriage and my failed four marriages plus countless infidelities leaking out to everyone, myself included. Infidelity was my life’s theme. That occurred to me when I was speaking to her. In the middle of a sentence about another interesting thing I had seen or done or visited, I started listening to myself. I shut up and had nothing else to say for a couple of days. I started to listen to the other patients really for the first time.

There was a jumper on the unit when I was there. He had been on drugs and depressed and hanging from a bridge where he had been hauled off by pedestrians and the police. The staff called them jumpers. We had half a dozen admitted when I was on the unit. They jumped in front of trains, from bridges, off apartment houses. They were chased by their demons. There was a young Latino guy who came in with satanic designs on his clothes. He talked to me about Jesus and the planets he had visited. A young black man was beside himself with the idea he might have to go back to prison for a parole violation. He had been abused and re-abused repeatedly in prison. Sexual merchandise was what he was. Small, pretty, and defenseless. He paid for his protection by sucking cocks. He was unpredictable, and we were all afraid of him on the one hand and terrified for him possibly having to go back to jail on the other hand. There was a schizophrenic graduate student from CUNY hearing voices. She looked like my daughter, almost identical. I hadn’t paid attention to my daughter, my own daughter in any meaningful way in years. I had no idea who she was or what she was interested in. I knew more about the BHTs and the other patients on the unit than about my own wife and my children. I could plan a complex hostile takeover and the percentage points on shorting the currency of a sovereign country but I could not have a cup of coffee with my wife and sit still and hear what she had to say about her day, her friends, her fears, her desires.

There was a pause in the room. Arnie sipped some water, wiped his neck and forehead, and the group coughed and rustled in their seats. As I sat in the back row, I felt his wife’s desire for vengeance in the room. She was a full partner and a well-known litigator in a blue-blood New York law firm. She had a career and was more complicated than your average TV-special blond young trophy wife. There was something she said, or rather didn’t say, that made me uneasy—something about how she looked at me. Arnie was looking for redemption and rebirth. Humiliation had a way of being the gift that kept on giving, a lifetime of payback, but of a different kind.

We knew, back in the Bellevue moment, that the hardest part would be post-discharge. It wasn’t clear at first what was alive in Arnie’s life and what wasn’t. It might not be clear for some time. The bridges with ex-wives had been torched and burned to the ground. The current wife, or “merger and acquisition” as one of the counselors murmured, was distant and disconnected. Jean, I remembered. “I want the best treatment for my husband. No expense will be spared,” she declared a
dozen times. “He has to be transferred to the finest institution in the United States for these medical issues.” She never could name them. This was refrain number two in the first forty-eight hours of his transfer upstairs to the locked world of inpatient psychiatry. Her cell phone was glued to her head as she repeatedly called in consultations with his distinguished New York physicians, who all told her the same thing:
Keep him where he is. Leave him alone. He is getting the best care possible.
Mixing economic class is hard for most people to swallow, especially when it comes in so many colors and accents.

Finally Jean acceded to the reality that he’d be treated at Bellevue. She set up a virtual mobile command center and insisted that he be under a John Doe alias; no information could be shared with anyone, under any circumstances, without her express written permission. She made it clear that there would be severe legal and financial repercussions if this demand were not accepted 100 percent. Two of her lawyers arrived in their thousand-dollar Italian suits and met with our senior staff, legal team, and security under her written authorization. Arnie essentially ceased to exist except as incognito patient X with a Latino name. We usually reserved this privilege for mob leaders and drug dealers who had been shot, stabbed, or beaten within an inch of their lives. That kind of alias. But Arnie was not at risk. How would the market factor in a hospitalization on the psych unit at Bellevue? What would the herd do led by computerized algorithms? Hundreds of millions of dollars were at play. For a hospital that defined itself by caring for patients where social risk factors often overshadowed the medical issues, the problem of too much money was not in our differential diagnosis. Too little played a role in most of our patients’ lives. The irony, of course, was that Arnie’s problems with drug addiction and its rippling effects were no different from the problems of any of our regular patients.

I caught up with Jean one day by chance sitting alone in a tiny empty office we offered her. She came every afternoon, was buzzed into the narrow warren of offices with her black leather briefcase, computer, and phone, and waited for visiting hours. I’d heard that Arnie was being evaluated for discharge, so I stopped to talk to her. “So, good
recovery,” I said. “He should be discharged soon.” She looked at me perplexed.

“I want him here for the full ninety days.”

“I don’t understand. Arnie will be here until he is ready to be discharged with a safe follow-up plan. His case is reviewed in detail every day by the entire team. Everyone has input.”

“The transfer was written by two psychiatrists and is legally binding for ninety days.” She spoke to me as if I were a child. Something was different now. There was no emotion. Pure calculation.

“Ninety days is the maximum we can keep anyone here without getting another judge to sign on for an additional period in special circumstances. If people are better and able to leave, the ninety-day issue is moot.” I said it slowly and clearly.

“I don’t agree with your evaluation. He will need the full ninety days and perhaps more time under supervision and evaluation.” I was getting it now.

“He will be declared competent and able to leave at a certain point. It is a physician judgment call.” Why did she want him here longer? She didn’t have to live with him, she could divorce him, move out, have another life, move on. What didn’t I know about human motivation?

“My lawyers will want to review his records and we will appeal any decision this hospital makes to a judge. I know you have a court in the building.”

“What’s going on?” I asked her straight-up.

“I want him to suffer. It’s hard to say, Doctor. I don’t even know what to call it. It’s not hate exactly.” She dropped her force shield just this once; I never saw it again during the entire time I knew her. “He slapped me in front of a roomful of people. Important people in my life, my career, my future. He thought I was some piece-of-shit floozy he could abuse and ignore at his whim, his indulgence? He never even remembered what he did. He was so far gone on the Klonopin, Oxy, and his whiskey. He thinks he can get therapy here or anywhere, then ask for forgiveness and be fucking redeemed. No fucking way, Doctor. He buried himself. He will stay that way. We are not tadpoles, even
though his kids act like them sometimes. He can’t cut off our arms and legs and they just grow back.

“When he was in the ICU there was a family meeting. He was calling everyone names, cursing and being, well, just himself, I guess. I didn’t even hear it, so pathetic really. One of your nurses, a tiny brown woman from India or Bangladesh, I don’t remember, interrupted the meeting. She said loudly and clearly, looking directly at me, ‘No one tells me to get fucked. Not even your husband.’ Then she was quiet again and didn’t say another word. That was the moment for me. I needed to hear it from one of your nurses, who had never used those words in her entire life, who never let herself be humiliated or spoken to like shit. I had eaten it for so long I couldn’t recognize the taste or smell.”