Twelve Patients: Life and Death at Bellevue Hospital (42 page)

“Not in mine, either.” He looked up from his fries. “No guarantee, that is.”

“Explains his HIV, though, doesn’t it, though it probably doesn’t need explaining.” Detective Swann kept going, and it was time for me to go.

I wished them a pleasant afternoon and walked to the cash register, paid the check, and headed back to the office. Swann was referring to
Beltrán’s sexual adventure with a new patient on the unit. So much for high security. Next time I saw Beltrán he was being escorted back from a mandated “fresh air” break on the metal cage on the hospital roof. He marched down the hall with his personal police officer in tow.

“
Hola, jefe
. How are you today? What brings you to such a special floor on such a beautiful day? You have so many things to do in such a busy place. You know, I could see New Jersey and the planes landing at LaGuardia, Kennedy, and Newark. Like I was the chief air control
comandante
for all of New York City.” The thought gave me pause. Reagan redux on steroids.

“Hi, Beltrán. Have a few moments to catch up?”

“Sure. Come on in. Let’s have lunch and sit for a while.” A white plastic bag with an orange smiley face filled with Chinese food had just miraculously shown up, brought in by the hospital security guard for the police officer and our patient.

“Aren’t you sick of take-out Chinese by now? There are a few other eating establishments on this narrow island, you know?”

“In Los Kaibiles we had a Indian worker bee who cooked Chinese all the time in a real wok. A change from
Moros y Cristianos
, rice and beans. Your bread-and-water prisoner rations. I got used to it. I like the taste soaked in soy and hot sauce in my
boca
. I guess the salty soy taste brings me back to my youth in
El Infierno
, the hellhole in the Petén,
my cuña
, my cradle.” He grinned at me.

“So I hear you have a new friend here on the unit, Beltrán. He is a kid.”

“Hey,
jefe
, none of your business. And he is not a kid and I am not a fucking
maricón
faggot, either.” He was more than a little exercised. The muscles on his neck stood out.

“Look, I don’t care about your personal sexual habits or interests. None of us gives a flying fuck, to use an expression I know you are familiar with. Except this is a hospital and I am responsible for what goes on here. And number two, we see a lot of patients here who are really damaged goods by the time they make it through the front doors. Many have been trafficked and severely abused physically, emotionally, and sexually as they make their way from Haiti, China,
Africa, Guatemala, to wherever they are dumped. You know damn well what I am talking about. Probably too well. And these are the ones who are not dumped in
narcofosas
, pits filled with the dead bodies of immigrants taken off buses, kidnapped, and killed for no reason whatsoever.”

He stared at me blankly. I had no clue what ideas were brewing behind the flat look, but nothing good, I imagined. Yet he betrayed nothing.

“Look, you eat your pizza and your Chinese takeout while you are here. You don’t pay for sex here with cash or slices of pizza. You don’t prey on the other patients. You don’t get off, jerked off, or anything else by some kid who is totally fucked up. I guarantee you the rest of your time will be under control of the DOC on 19, and then we will see who is fucking whom. You will have hoisin sauce in parts of your body you never thought possible. Do I make myself clear, Beltrán?”

He still looked blank.

Then he smiled. “Okay, okay, chill down,
jefe
. I won’t do it again. Promise.” The smile and promise chilled me more than his stare. He was an unsentimental killer. Smile, listen to merengue, put a bullet in a skull, then finish dinner with a beer.

“Look,” he said, “I’m the victim here. I was a bit player for a few years between the drug cartels and Las Maras. Remember, I got squeezed between the two of them and ended up an immigrant myself. It is something, huh? I came here fleeing violence and certain death, not too different from the woman you told me about from near my hometown who fled the gun-toting
motocicleta
narco-violence and out-of-control machismo in her family eh. So I was part of the military elite who got blamed for everything, every bad fucking thing that happened in Guatemala was put on our head. You live without rules. Except the rules dictated by your commander. Unconditionally. You deviate and you are punished within an inch of your life.” He held out his fingers and indicated a millimeter between thumb and forefinger.

“You learn to kill and put it behind you pretty quickly,” he continued. “You kill one minute and have lunch the next, next to the dead body. On the dead body. After all, who trained the elite killing squads
in Latin America,
jefe
? You invented them in Vietnam and practiced them on us. If you want an advanced degree in black ops or whatever, where do you get it? So let’s not get too crazy about who is doing what to whom without some looking in the mirror.” Again that smile. He pushed both hands through his hair and arched his back. He had a script and had it memorized. He would give up what he had to and not a millimeter more.

“So you come to the United States seeking safety like the rest of the patients at this hospital. Many here have been driven by the violence and kidnapping and mayhem of the cartels and Las Maras and the corruption that has all but taken over their societies.” I almost felt stupid saying the obvious. How could I be playing the
your fault, my fault
game with this killer?

“
Jefe
, you are a smart guy. I am a smart guy. We both know the system is much bigger than we are. It extends over all the borders. The U.S. buys the drugs, sells the weapons, and launders the fucking money, after all. We all know that. It is the foundation, the basic shit 101. I participated in some bad stuff. I never hurt women or children,
jefe
, never. I was raised too good for that. I am a Christian. Like Father Alemán. He was my hero. I had partners that were really bad and did those horrible things. I have seen it firsthand.” At least he didn’t say he was just taking orders. I gave him credit for that. But I wasn’t sure if I could believe him, either.

I stayed a few more minutes and then left. Beltrán completed his TB therapy after several months and was on his HIV-suppressive medication when he was escorted from the hospital by federal officials to an unknown destination. He disappeared one night. Detective Swann was uncommunicative when I saw him a final time a few days before Beltrán’s discharge at the elevator bank on the main floor. I felt uneasy months after he left the hospital.

I swore I would never eat Chinese food again.

It was business as usual as I went on rounds with the trauma team. I did not put a name to the half-visible face lying in the intensive care unit for several days what with the tubes, color monitors, layers of hospital gowns, and black hair plastered to her head.

A clear plastic tube arched from her mouth to a high-tech ventilator, a computer attached to an electric bellows. The machine shushed her chest up and down like a metronome in slow motion. While semi-conscious, she “bucked” the ventilator and her oxygen levels dropped. Insistent alarm beeps and flashing red luminescent warnings up and down the unit brought the trauma team to the bedside. Pancuronium, a curare-like drug, was “pushed” into her IV, and the drug paralyzed every muscle completely. The patient’s oxygen levels normalized. Lunch-box-size computerized pumps clumped on IV poles lined up like the masts on a model sailboat collection controlled blood transfusions, intravenous solutions, and half a dozen medications all titrated to her lab results and instruments that monitored her in real time. An empty plastic bag hung from her left side rail. The shock of her injury damaged her kidneys. A dialysis technician, wearing a navy-blue Bellevue sweatshirt to ward off the proverbial chill of the ICU, hovered over the dials of a white console on wheels. Blood-filled catheters snaked from the patient’s right upper chest and fed the insatiable kidney machine. The insistent hum of the electric pump circulated blood through a filter canister like a liter of blood-red milk.

Erika, the social worker on the intensive care unit floor, came by my office the next day. She had gone through the electronic medical records and seen my outpatient office notes. The patient’s name had
not registered with me during rounds with the surgical team. “Eric, you know Trauma Miami. Her real name is Alicia Rittner. She is an old patient of yours.”

I had gotten the call a few nights earlier to accept a transfer. It had been about three a.m. A small community hospital in Brooklyn called our trauma surgeons about a case they couldn’t manage; they needed an emergency transfer “right now.” Our chief of surgery apologized for waking me up and got to the point. “Eric, look, I know this is unusual. This is a private hospital. But they have a young woman just out of the operating room who is still bleeding from a lacerated liver from an assault by her common-law husband. They are over their heads. She will die if we don’t take her, and she may very well die if we do.”

“Send her over. Do we have staff in the house and a bed in the recovery room after surgery?”

“Yes, we are fine there, no problem. By the way,” he added almost as an afterthought, “she was twenty-nine weeks pregnant. They did a quick C-section and the baby is in their neonatal intensive care unit. I don’t know the status yet; we will find out tomorrow.”

“Jesus, Saul, got it. Let’s get her over. ASAP.” I would call about the baby in the morning. I knew their medical director.

I couldn’t get back to sleep and didn’t even try. I slipped out of the covers trying not to wake Diana and went into the kitchen to look at the lights over Manhattan, Queens, and Brooklyn. There were plates, glasses, and empty wine bottles piled up from a dinner with friends who were Chilean émigrés that ended only a few hours earlier. They had come to New York to escape from the terror unleashed as Pinochet commandeered the government on September 11, 1973. There were other 9/11s; we were not the first. It was strange to think that as I stared at the remnants from a dinner where we had covered the state of the world, life, love, all of our kids and their lives and loves, somewhere an ambulance was threading its way down Ocean Parkway to Flatbush Avenue and over the Manhattan Bridge. There wouldn’t be any traffic. I made myself a quadruple macchiato. As the red light on the machine stopped blinking, I wondered if she would make it or not. Assault or homicide? That was the question.

The next thirty days were rocky for Alicia Rittner. The trauma from direct blows to her internal organs bought her a few trips to the operating room to find and tie off more bleeders. The patient had been discovered after neighbors had heard the screaming in her apartment and called 911. The restraining order was hanging from the refrigerator by a seashell-shaped magnet when the cops and EMT crew arrived and found her semi-conscious. Her husband was picked up by the police at a corner bodega buying cigarettes. Her pregnancy escalated
ordinary
domestic violence into another category. Jealous male rage followed typical patterns, and a pregnancy was a potent trigger. We had seen an uptick in home abuse as unemployment rates went up and the stock market went down.

Meticulous nursing and hypervigilance brought Ms. Rittner around. The turnaround was quick. The bleeding, oozing, and coagulopathy—the inability of her own blood to stanch the wound—stopped. The final signal appeared one day as rust-colored liquid appeared in the catheter bag at her side. Her kidneys, hit hard by the shock of low blood pressure and protein breakdown products from the assault, were coming back. “I told you guys to be patient.” Omar, our trauma surgeon, looked satisfied on rounds as he lifted the bag and showed everyone the good news. Like the ancients looking for signs in the entrails of a slaughtered goat, this was a sign, a save. By putting her body into a kind of stopped time, we had allowed it to revive, rally, and begin to mend.

She now sat up in bed and was moved gingerly to a large lounge-type chair where she could be repositioned to look out the windows toward the blood-orange sunsets courtesy of the oil refineries in northern New Jersey, or toward the glass sliding doors where her doctors and nurses huddled several times a day poring over her medical record and the waveforms on her monitors.

Her baby, a preemie girl, was in stable condition and had been transferred to our NICU. There would be time for them to meet later. I went up early in the mornings just after the team made rounds or late in the afternoons when things were a little less hectic on the unit. I pulled up a plastic chair. “Alicia, I thought you left the city completely.
I have thought about you many times. You sure gave us a run for our money on this one.”

“Sorry about that, Eric. Missed my last appointment, so I decided to take an ambulance to see you.” I hugged her gently.

Alicia and I had met in the Bellevue general medical clinic years earlier when I still treated patients. The electronic printout for the day listed “Rittner, A.” buried in the middle of twelve other patients, with handwritten “add-ons” taking me through lunch hour and early evening. I ran behind before I got started.

Alicia was in her midtwenties, pretty, with long dark hair, an innocently seductive smile, and a self-deprecatory sense of humor. I had a cartoon-like outline of her background despite prompting her for more details. Her middle-class, South American family were originally Jewish émigrés from Europe who had fled during the Nazi
anschluss
or annexation of Austria. They had settled in whatever country would take them, a rapidly shrinking planet lottery. Scarce Argentine visas were purchased, and her grandparents settled in Buenos Aires. At some point in her teens, she became pregnant. She decamped for the United States with the child’s father and ended up in a poor Bronx neighborhood. A couple of one-liners was all I had.

Over the next few years, I saw her frequently. Alicia became an “overbook”—a patient squeezed in between scheduled patients. During her first visit she had complained of migraine-type headaches, with nausea and vomiting and no obvious trigger. We tried a variety of medications, stress reduction techniques, referral to a headache specialist who recommended the newest injectable medications and more sophisticated tests. The headaches that wouldn’t quit prompted a series of “just to be sure” tests to eliminate an incubating brain tumor or pulsating arterial aneurysm from the list of potential medical issues. Alicia went through a battery of scans, from CT, to MRI, PET, and an electroencephalogram or EEG. They were normal. The medications had only a temporary effect, and I started to feel they were making her worse. Alicia became a paragon of alternative treatments and
Googled advice: trips to Chinatown for homeopathic cures, acupuncture, qigong to tai chi. These measures were testimony to the persistence of her symptoms and my utter inability to help her. The feeling that the medical “arsenal” might be part of the problem and not part of the solution nagged at me.