Twelve Patients: Life and Death at Bellevue Hospital (32 page)

Jeffrey walked into the room in Bellevue garb, cleaner and with his hair combed. He took a seat next to a tiny Chinese woman in her sixties, fully clothed including a black parka with a red scarf wrapped around her neck. He had shed a few years in the transformation from CPEP homeless street person to a middle-aged, out-of-shape, down-on-his luck everyman. Mr. Snickers, or Mr. Duprey to use his real name, was sitting to my left quietly talking to himself between a behavioral health technician and a young white man, good-looking, with a full black beard Taliban-style. The Osama look-alike wore a plaid bathrobe, and his legs jiggled constantly as he carefully appraised everyone in the room.

The translator tried to keep up with the small woman. “My husband was mistressing… with the U.S. military… he stole my children and all of my possessions… I have to leave here and torture him… I have a new husband”—pointing to a black homeless man sitting quietly by himself in a chair, all six feet plus and skinny. He ignored the woman, who went on for a good ten minutes before Rosalinda asked her quietly but firmly to cede the floor to the next person with a hand up. This was a schizophrenic Chinese man who had been a model patient taking medications delivered to the Chinatown kitchen by the Bellevue community outreach team three days a week. A trivial illness forced him to miss two days of work, prompting an automatic layoff. He was sent to Maryland by a Chinese “distributor” to work in another fast-food establishment. He had missed his medications and rapidly become delusional. His wife worked in a laundry in Ohio. She came to Maryland, picked him up, and dropped him in our CPEP before she took the Fung Wa bus from Chinatown back to the Midwest to avoid being laid off from her job.

Half of the Chinese patients were delusional and refused to take their medications. Some had been on the 18 South Asian Unit for over a year waiting for beds at psychiatric state hospitals where turnover is measured in geological time. We hadn’t placed a Chinese patient in a state facility in five years. Discharging patients caused enormous
ethical problems. The staff knew that the risk of suicide was very high—given the number of relapses, the lack of adequate services, the stressed-out and humiliated families where mental illness meant shame and certain social death, and the relentless financial pressure to pay off the Snakeheads. The Chinese embassy was not helpful. The officials required elaborate documentation, though the papers were unobtainable.

Mr. Snickers had his arm in the air halfway through the monologue of the tiny Chinese patient dressed in her overcoat and ready to leave at a moment’s notice. The unit chief called on him. “Mr. Duprey, welcome to 18 South. Would you like to share anything with us?”

Duprey stood up. At six foot four, in civilian clothes he looked like a linebacker for a pro football team. His voice was soft and non-threatening. “I want to learn the secret languages here,” he said, looking around the room.

The psychiatrist said, “These are Chinese dialects, Mr. Duprey, not secret languages.”

“Whatever you call them, I want to learn the languages. I learned a secret language in Crown Heights. Jewish people, dressed in black, spoke in tongues. It took me some time, but I learned to decode what they were saying. I broke the code. I learned their inner secrets.” He looked at the Chinese woman who had finished her comments.

Jeffrey at this point had his hand up and was waving it to be noticed. “Yes, Jeffrey, you can speak if it is okay with Mr. Duprey since he still has the floor.” It was Robert’s Rules of Order on the units to keep a semblance of organization. Duprey nodded that it was okay with him, and Jeffrey stood up.

“I think, Mr. Duprey, you are on to something by decoding these languages.” Jeffrey addressed Duprey respectfully. “I have been studying codes and have worked out the unity of all the forces in the universe back to the Singularity. Life speaks. You have to listen carefully,” he finished and looked at Duprey.

Duprey’s eyes were wide open. “You can break codes?” he asked Jeffrey.

“I have been working on codes for two decades and have made
major breakthroughs. The essence of life is what is being revealed.” He paused for a couple of seconds, collecting his thoughts for Duprey.

“The rabbis have had deep insights into the workings of the world, and Kabbalistic and Midrashic knowledge is part of the entire base of the understanding. Like Planck’s constant—”

Before he finished, Duprey asked him, “Do you know the Kabbalah? I have studied it for some time myself, and the riddles have given up their meaning to me.”

I was briefly teleported to an anthropological book,
The Three Christs of Ypsilanti
, whose author had observed three self-declared Jesus Christ figures sharing their delusions. Fast-forwarding to the present, I was sitting in the common room of a psychiatric unit in the clouds facing south exactly where I had once watched the Twin Towers smoke and collapse in an inverted mushroom cloud of fine white dust on a crystal-clear Tuesday morning.

Jeffrey quickly jumped back in. “The Kabbalah has some of the codes. It is foundational to the knowledge of the origin of all life and the Apocalypse.”

Duprey was enraptured and had his mouth open to continue when Rosalinda interrupted, “We have to let everyone speak, this is a community meeting,” a statement she repeated in Fukienese and then Mandarin. Duprey listened intently, his mouth still a gaping hole. Rosalinda fascinated him as she switched Chinese dialects, chatted with a Filipina nurse in Tagalog, and switched into Spanish with the housekeeper, who was sliding his bucket of water and mop into the room. “I am so glad we have two new patients, Duprey and Jeffrey, who can share a lot together and maybe with the group again tomorrow?”

The staff got up and made noises about moving to group meetings and activities. Duprey took some tentative steps toward Jeffrey, who was looking at him. They slowly closed the ten yards separating them. When I left a few minutes later, they were gesticulating and talking while an aide discretely sat on the piano bench.

During the long community meeting on 18 South, I sat quietly in my metal chair listening with one ear to what was being said and the other
to what was unsaid. I felt overwhelmed by the enormity of the distress I sensed and how complicated the journeys had been to this particular “singularity” on this particular morning. On the path forward, these patients would come into contact with overextended caseworkers, long waiting times, imperfect decisions larded with a big dose of hope. In a society based on instant gratification, instant treatment with a pill, or instant redemption through rebirth, there would need to be another way to measure an inch forward. The relief of suffering was the only pertinent principle in this broth of human misery and fractured lives. One’s frame of reference needed recalibration. Mine did.

After the community meeting I went with Dr. Estrada to talk to Mr. Duprey. She introduced me and apologized profusely as she ran off to a family meeting.

Duprey, or Mr. Snickers, wore an extra-large OR gown since he didn’t fit into hospital-issue pajamas. He looked a lot younger than he was, almost like a teenager. He needed a haircut and a shave. He didn’t look at me and he offered nothing spontaneously. I had asked a tech to sit outside the interview room; I wasn’t Braveheart. A few days had passed since his admission.

We had persuaded Duprey to take his medications in exchange for a steady flow of Snickers and Mars bars. The nickname coined by the tech who discovered the sweet tooth stuck, and the candy modified the raging hair-trigger temper. While the drug companies were developing look-alike drugs, the Mars company seemed to have hit on the magic ingredient for some of our patients: Abilify or Geodon plus a Baby Ruth. Or lithium and Depakote plus Hershey’s Kisses. I was going to try to remember to email the scientist who detailed the emotional maps in brain neuronal circuitry to try dribbling the active ingredients in Mars bars on rat amygdalas to see if it blocked GABA release and allowed a little forebrain electrochemical activity to make a choice to not strike first.

“Duprey, how are things going here?”

He looked up and said, “Okay, but the food sucks.” I asked him what he liked to eat, besides Snickers. “Pizza, Doc, with pepperoni and a Coke and garlic knots.” He was a little more engaged.

“What has it been like for you on the streets?” He had been robbed at men’s shelters numerous times, so even when it got too cold to stay outside he had decided it wasn’t worth the hassle. The rooms were large with bunk beds but no place to secure your possessions. “You get your dinner and breakfast and there is heat, but they kick you out all day, and your stuff is gone. I am not a walkin’ Macy’s, you know. They call me a fucking SPMI.” Pronounced
spemy
, the term was an acronym for “serious and persistent mental illness.” “I told them to go fuck themselves. You fucking satanists, beasts, and I spit at them.”

So he lived off the streets and had hot spots where he could keep his stuff and sleep. He got his meds when he was in the shelter, but he didn’t take them anyway for some time. He mouthed the pills and spit them out or sold them on the street. The pills made him disconnected. Like he had a fog in his head, full of smoke. One of the meds he was given a couple of years ago had given him the creeps. He was jumping out of his skin. Like it was full of ants, worms, and crawling things. He scratched himself so raw that his legs got infected, and he had to go to the hospital. That wasn’t too bad. A friend came in and brought him drugs and cigarettes. He stole some from other patients in the rooms. He got some food, and he was warm. The meds he was taking now were switched and he didn’t feel the restlessness but he didn’t care since he wouldn’t take the meds anyway when he left.

He looked at me, sensed he’d said too much, and pulled back completely into himself. The temperature in the room changed. I got up slowly and moved quietly out of the interview room. The next day I brought him a slice, Coke, and garlic knots and left them with the head nurse.

I went back to the day room and saw Jeffrey sitting near the window. I asked if we could talk for a while, if I could catch up on his life since we had last seen each other. He was insisting everyone use his delusional sobriquet, Jain. I think he agreed to talk with me more to break the hospital rhythm than from any desire to establish a relationship or satisfy my curiosity. He was back on his medication, after the judge had signed the order.

He had been in the courtroom at Bellevue on the nineteenth floor
about ten years earlier. Back then he was just several years into his illness. He refused to let us talk to his family about his care and did not want them to come and visit him in the hospital, though they continued to pay the bills. Jeffrey at this point had been in the hospital three times in a year and qualified for the AOT program—Assisted Outpatient Treatment. His hospital-assigned psychiatrist came in and took the stand surrounded by the volumes of Jeffrey’s medical records. Jeffrey came in with his lawyer, provided by the state department of mental health. The room had wood paneling on one side and plastic maroon chairs with paper signs taped to the backs to “Keep Your Feet Off The Chairs” with speckled brown linoleum flooring. Two armed court security officers dozed against one wall in full battle dress. The judge sipped a large latte from an orange paper cup. There had been three cases earlier, each one lasting fifteen minutes. The hearings involved outlining the “evidence” against the patient—his or her inability to take medication without supervision and stay out of the hospital or avoid behavior that might lead to an arrest.

The murder of Kendra Webdale by a schizophrenic young man, Andrew Goldstein, who pushed her in front of an oncoming subway train, had led to a law in New York State (Kendra’s Law) that created a legal space for outpatient commitment. A novel approach to treating patients whose histories indicated that they could not self-manage their disease, it provided an alternative to hospitalization.

Jeffrey had refused to take his medication following each hospitalization. The psychiatrist was a young Chinese doctor, articulate and precise, who did not need to refer to all of the documents piled in front of him. He knew the case by heart.

The judge asked Jeffrey Torkelson if he had anything to say. His lawyer, a young woman dressed in fashionable Soho black chic, said he did.

“Judge, I have been taking my medications faithfully during the thirty-eight days I have been in the hospital. I have had no problems and fully cooperated with my treatments, community activities, groups, and my therapy. I have a stable apartment, good social supports outside the hospital, and graduate school to return to when I am
released. The intrusiveness and supervision is gratuitous and unnecessary. It provokes anxiety and is infantilizing. I certainly understand why some of your clients require more onerous treatment regimens with teams of providers overseeing their care and well-being. However, I do not qualify in any respect for this type of program.” He took a pause and looked around the room for a few seconds.

Back then, he still could pass for a graduate student. He had curly hair worn a little long, wire-rimmed glasses, a well-trimmed beard, a buttondown shirt in sky blue, and pants that hung well on his six-foot frame. It looked like Kenneth Cole, just like my suit. He wore brown tasseled loafers and no socks. Judge Garland shifted in her chair and started to open her mouth. Jeffrey jumped in, “I am in the middle of a very important project in my doctoral work. The AOT program demands are unacceptable and will interfere with the progress of my breakthrough.” Jeffrey spoke carefully and clearly to the room.

“What breakthrough, Mr. Torkelson?” The judge was straying from her script, but her schedule was repetitive, and she had someone she recognized from her background in front of her now.

“Judge, Einstein failed to create a theory uniting gravity and quantum mechanics. He spent over thirty years trying unsuccessfully to unite the known forces of nature into one unified field theory.” Even the guards were awake at this point. I didn’t know if it was Einstein that got their attention or quantum mechanics. Jeffrey continued, “It is all in the Singularity. The truth of the cosmos and human existence are united in the primordial matter, energy, and massless state that existed before everything else billions of years ago. I am approaching that synthesis in my work.”