Twelve Patients: Life and Death at Bellevue Hospital (20 page)

There was nothing to say. I heard her loud and clear.

Arnie’s children came by, but there wasn’t much they could add to the conversation. The oldest daughter broke down and sobbed through her tears about the “death of my father.” Martin came in and out of the picture, always alone. He would appear to see his father and then abruptly leave. He had taken time off after his overdose, and Arnie had a trust fund at the ready. The One-Strike Law did not apply in this universe. He wasn’t black. Stop-and-frisk was not ruling his time on the street. He could have as many strikes as he could afford. The youngest daughter, Raquel, lived in the city by herself and came to see her father dutifully. She hardly ever said anything. Hiding in plain sight was her disguise, allowing the rest of the family to speak for her. She volunteered no opinion and offered nothing to the treatment team. She had a secretarial job with an NGO. We wondered where her anger had been hidden.

The discharge process ended in our court on the nineteenth floor, the prison floor. Arnie was sitting next to his lawyer at a small wooden table. The wife sat at the back of the room with her two lawyers. Demetre, the tall, thin, laconic “seen it all” psychiatrist who ran double trouble, was in the dock with a stack of charts piled next to him. “This is highly irregular,” Judge Geffen said to no one in particular.
“The patient has been cleared by his psychiatrists for discharge citing no clear and present danger to himself or anyone else. He has no evidence of cognitive impairment to preclude discharge, and plans have been arranged. I don’t know why you are wasting my time.” He looked up at the Italian suits in the back of the room, apparently unimpressed. The judge’s annual salary was what these guys made every two weeks, not counting end-of-the-year bonuses. He wasn’t going to be moved by any verbal artistry. But I soon realized that the point was not to win this one round. It was a declaration of war by another means.

“Judge Geffen, sir, if I may approach the bench. There are many inconsistencies in the record, days of missing documentation, lack of agreement by the team caring for the patient—”

At that point, Judge Geffen cut him off. He was angry and sat up in his chair. “Just what do you think this is? We are not in criminal court. You are not playing with a jury’s sympathies and manipulating a mistrial for your client.” He turned to the psychiatrist, who watched unblinkingly the show of humanity alternate between farce and tragedy.

“Doctor, in your opinion is the patient of sound enough mind to be discharged?” the judge asked directly to Demetre and then looked at Arnie. The room was silent. The guards had stopped dozing a long time ago.

“Yes, Judge. He is ready to be discharged.”

“Case dismissed.” The judge hammered his gavel with extra force.

They were calling the next case as we filed out of the room. A disheveled Chinese woman, tiny, talking to herself in whispers of Fukienese, was helped into the room by her Americanized teenage daughter in a short skirt and short asymmetric haircut with a hint of purple streaks. The legal team and wife had left by the first elevators. We retreated to the eighteenth floor without much to say. We knew from what we had just seen that there’d be more to come.

The discharge day was difficult. I mean on the one hand I wanted to leave and get back to my life. On the other hand I had destroyed so much of my life that I didn’t know what I was going back to. I knew I couldn’t pick up where I had left off. That part of my life was finished. I had taken care of that. I was a shattered human being. My wife sued for divorce immediately after I was discharged. She had moved out when I was in the hospital. The board of my company made it clear it wanted my resignation, for health reasons. My office was taken over by the acting director. If it had just been alcohol, I might have been able to stay. Alcohol was fashionable. We have presidents who do that, and it almost makes them more fit or electable. Hallucinogenic chemicals and psychotic breakdowns were something else, I guess. As far as my children went, I had to ask them for forgiveness. Then accept their anger, their rage, and endure it as part of who I am and what I had done to them. I hurt them. I put them at risk. What does forgiveness even mean? As someone said, it’s impossible to forgive because even by saying the word we bring back into focus all the harm we’ve done.

He stopped and paused for a few moments in front of the group.

After I was discharged, I had a really good therapist I saw several days a week in Midtown. At first I was on methadone for the narcotic addiction and had to come to Bellevue six days a week to pick up my liquid medicine, swallow it, and come back the next day. After a few months of stabilization, they switched me over to buprenorphine, the pill form—a narcotic substitute you put under your tongue once a day. Now I can go once a month and pick up thirty tablets from my doctor after I pee into a cup for a tox screen.

Methadone had been tried on addict volunteers in Lexington, Kentucky. A synthetic narcotic invented in Germany during World War II when opium and morphine were unavailable, methadone was long acting, and the highs and withdrawals of opiate use were eliminated. The Narco Farm—which took over a prison in the bucolic countryside from the mid-1930s to the mid-1970s—became a treatment center for
thousands of narcotic addicts over four decades. It was shuttered as the country moved into a more confrontational and prohibitionist attitude toward drug usage in the 1970s. There was a fear that large numbers of Vietnam vets were addicted to the heroin widely available in Southeast Asia. The War on Drugs had been declared by Nixon on June 17, 1971, in a calculated attempt to attract Southern white voters to vote Republican. It was part of the pushback from the Lyndon Johnson civil rights era ending Jim Crow segregation. The push to build prisons and incarcerate blacks and Hispanics for small drug offenses was building momentum. The prison population would swell from under a half a million to five times that number plus tens of millions more under state surveillance as ex-felons. The politics of drugs trumped any meaningful treatment approach. Arnie had skittered through a corner of a gulag warehouse for the underclass. I wondered if he knew that the larger story in which he was a bit player was every bit as tragic as his personal story. I wondered.

I was sitting in my therapist’s office a little over four years ago in one of our usual sessions. He was a seventy-five-year-old white-haired frail man who wore frayed white buttondown shirts, no tie, and faded tan chino pants and scuffed black Rockport shoes. He had stacks of books in his office everywhere. Sometimes you had to clear off your chair since he wrote all morning and saw patients in the afternoons in the same office, a ground-floor room in his house on Jane Street in the West Village. We had two chairs in the room sitting ten feet apart looking at each other when he said to me “Arnie, you are an alcoholic and a drug addict.” For a year we had talked psychobabble. I felt good—I had seduced my therapist and he was in my corner, another acquisition and attestation to my getting better. I had continued drinking like nothing had changed, since according to my world I did not have any problem with alcohol—just drugs. My shrink called me on my hypocrisy and made it clear he was neither seduced nor enchanted with my storytelling. The scab hurt when he pulled it off like that. He called one evening a few days later and told me to join him at Sixth Avenue and 12th Street the next day at eleven thirty a.m. I met him and he walked me to an AA meeting at St. Vincent’s hospital. He told me to go inside and keep going every day for at least three months. He agreed to continue to see me on that condition. Non-negotiable. He turned around and walked off.

I went inside and never left. The first year I ended up going to five meetings a day. I couldn’t do anything else and desperately needed the meetings and the phone calls from my sponsor every morning at eight thirty. I am here today to celebrate my fourth year in AA. Really the completion of my fourth step.

Arnie had left out large parts of his “journey” into his heart of darkness. This was an edited version for a semi-public audience. He had started using cocaine years earlier than he let on with a mistress twenty years younger on business trips he took regularly to Europe. We never got to the exact bottom of how much Ecstasy, Viagra, cocaine, benzos, alcohol, and PCP went into the mix to fuel a grueling work and clandestine social schedule. By the time he had gone to his doctor for back pain and received his narcotic prescription, his drug habits had been well established and he was deep into the 1-800 universe of drugs delivered on Vespa scooters like pizza. His kids were a mess—far more than he let on. The oldest daughter had severe eating disorders and had been hospitalized repeatedly (though not at Bellevue). Martin had been arrested for attempted rape, but somehow, miraculously, he got off and the charges were dropped. But hey, the story was close enough. Like all stories, this one was fungible. There are certain things we cannot say, not even to ourselves.

I looked around the room slowly. The overhead fan turned without making any noise. There was the barest hint of a breeze of warm air coming through the windows. The coffee machine hissed and popped. A stack of AA literature was sitting on a windowsill. The 12 Steps and 12 Traditions were curling up in the heat from their perches facing the main room. I looked at individuals and wondered about their stories and their secret lives. The pain in the room was palpable. How many
there were still incapable of speaking out loud to a group of strangers brought together by the same misery and affliction? But they had crossed the doorway and had made some preliminary commitment to doing something. How many had been there for twenty-plus years and had made the meetings their life, a necessary construct around an inner chaos? A person could begin the process of reconstituting a life with the group’s norms and rules and rituals. The serenity prayer was a lifeline—it allowed people to distinguish between the things they could and could not change. It allowed a modicum of hope, of self-acceptance. There was a lot going on in the room that was unsaid, but the very fact that people came back to the same place to hear and talk to one another week after week was something. The room offered a space to try things out without coercion in the privacy of one’s own head.

Arnie thanked the group for their time as they applauded him. The meeting leader in her pink sweater and blue plaid dress, her electric hair now damp and stuck to her neck from the heat and moisture, came up and gave him his four-year coin and shook his hand. They hugged, and he found his seat near the front of the room. Arnie was asked to choose the members present with their hands up to respond for only three minutes to his qualification. He chose a dark-haired Asian woman sitting across from him to start the comments. She thanked him for his qualification and noted how very difficult it is to forgive oneself. I only half listened to the comments as the room rustled and people got up to use the bathroom, stretch, find some water, and readjust themselves. I knew we wouldn’t talk after the meeting or likely see each other again. He was on a journey he had chosen to let me witness out of respect for our dozen conversations and interactions. It was a way of telling me he was now in a different place, on his own and self-sufficient, capable of managing his affairs without intermediaries and special interlocutors. A graduate from our chemical dependency and recovery program both inpatient and outpatient to a private life. The message was received. It was both creation and reinvention.

As people were stacking the chairs against the walls and gathered in clumps to talk, I walked out the front door into the hot West Village
night. Heat rose from the hoods of the cars; air conditioners exhaled heat down Grove Street. I found a French wine bar with a few empty seats by the window. I pulled open the door to escape the heat and sat in a corner with a glass of red wine and a few small plates of tapas facing the bar and the street. The buzz of the conversations of couples hunched over tiny tables, hands clasped, hung over the room, the waiters dressed in black hovering lightly in the background. I opened my black notebook, looked out the window, and pondered the nature of forgiveness.

Sometimes you choose to be involved with patients and sometimes you don’t. It just happens.

Checking my email early on a Wednesday morning, I spotted a message from a cardiology fellow. He wanted to meet with me with—as he put it delicately—“some urgency” about a patient who was on the telemetry, or heart monitoring unit. “Complex medical case, Guatemalteca with end-stage heart disease.” I texted back that I could meet him in an hour in the coffee shop, my de facto second office. My own coffee was better, but I liked the change of scenery.

I found Dr. Lenny Perham in a booth in his white coat, stethoscope dangling around his neck. It was now late afternoon; the place was nearly empty except the take-out lines. Danny, the Greek waiter, wearing a baseball hat and carrying a pad with his hieroglyphic scrawl, saw me and brought me a cup of coffee and a seltzer water. The effervescence soothed my radiation-scarred esophagus and scoured away the remnants of the pasty saliva.

“Dr. Manheimer, we have a tough case and need your help on this one.” I nodded and he kept on going. “She is undocumented.” I knew where this was going.

The story was long and had many inflections and unknowns. Lenny knew the medical issues with great precision and presented the case to me as if he were on visiting professor rounds, not missing a beat. “This thirty-nine-year-old single mother of two children was transferred to Bellevue five years ago. Soraya Molino walked into Woodhull’s emergency room with a complaint of progressive weakness over
six months and a new symptom of breathlessness simply walking a couple of blocks or up the flight of stairs to her first-floor apartment.”

“Lenny, you don’t have to make it so official, just tell me the story. Eat your burned bagel and cream cheese and chill.” He smiled, relaxed, added a thick smear, and ate and talked at the same time.