Weekends at Bellevue (13 page)

“That’s perfectly normal after a trauma,” I explain. “It’s called intrusive recollections. It goes away in a few days, usually.” Can I give her any useful advice? “Don’t try to fight the memories. You really can’t. Just let them play out and know it’s your brain’s way of dealing with what happened. It won’t go on forever.”

She sits up, moves her pillow to behind her back, and motions for me to sit on the edge of the bed.

“I have some news for you, sort of,” I begin. “One of the attackers, the one who got hit by the car on FDR?”

“Yeah?”

“He was brought here to Bellevue, to what is called the trauma slot, where critically injured patients are worked on by the ER doctors.” I pause to give her a minute to process what I have just said, and to brace for what’s coming next. “He died.”

“Okay,” she says easily. “But the other one’s still alive?”

“Right. As far as I know, he got taken by the police to central booking, you know, to get fingerprinted, mug shot taken, all that. They’ll keep him there until he gets arraigned. They call it the tombs, where the prisoners wait to see the judge. I guess it’s kind of a creepy place.”

“I hope it is creepy,” she says. “I hope he’s scared, and can’t breathe and has the same tight chest I have. He should spend the rest of his life behind bars.”

I know this won’t happen. Even if he gets convicted, which is always a huge if, they don’t give rapists life in prison as a rule. The pot dealers get longer sentences half the time. Don’t get me started.

“So, you try and rest now, okay? Do you want me to send in a nurse with some more medicine so you can sleep?”

“Could you? I’d really appreciate that. I just want to turn my brain off. Do you have anything that would do that?”

“I’ve got just the thing,” I say convincingly, though I’m not sure exactly what I’m going to order when I get to the nurses’ station. I rise off her bed and the door opens.

“Dr. Holland, can you come to my office for a minute?” It’s Rita, who rarely leaves the clerk’s office, and even more rarely enters the patients’ rooms. “Sorry to interrupt, Ms. Johansen,” she says pleasantly.

I follow Rita to the clerk’s office, curious as all hell. “What’s going on? Why didn’t you just overhead page me?” I look around her desk. Hundreds of pennies, nickels, dimes, and quarters have been segregated and organized. Wads of wrinkled bills are stacked according to denomination. She is vouchering property for a recently admitted patient, a panhandler. Her gloves are black from counting the money.

“I did page you. I guess you didn’t hear me. Too busy having your little heart-to-heart in there.”

“Well, did you hear? One of the rapists died in the slot.”

“I know. Everybody knows. The AES clerk called me and I told Nancy. But you are not going to believe this.”

“What?”

“The cops just brought in a pre-arraignment. I was going through his wallet to look for a health insurance card. You’ll never guess what I found. Are you ready?”

She is milking it a little, adding to the suspense. She is holding a
driver’s license in her hand, but it’s turned around so I can’t see the picture and name. She flips it over and hands it to me.

“Leah Johansen,” I read. Why does this guy have my patient’s driver’s license? Was her wallet stolen? “Wait a minute. You can’t be serious. This is the other rapist?” my voice is loud. Rita shushes me. “You’re kidding me! They brought this guy here? What for? Why?”

“He’s on Prozac and needs to be cleared,” explains Rita.

“This is too much! Jesus, what are the chances?”

“Well, he’s arrested in our borough and he’s on psych meds. So here he is,” she says. “Nancy’s trying to keep him in the nondetainable area so Johansen can’t see him.”

“Oh, shit! I didn’t even think of that! She can’t see him. She’ll go nuts. And he can’t see her either! I mean, who knows what he’ll do if he sees her? Do you think he knows she’s here? I mean, does he know where she is? You think he has any idea?”

“How the hell should I know? Get a load of you! Why are you getting so worked up?”

“I don’t know, Rita. It’s just … this is crazy, don’t you think? I mean, it’s another one of those ‘you can’t make this shit up,’ you know?”

“I know. She gets mauled by two guys. She’s brought to Bellevue, a basket case. Thug number one runs into traffic and is brought to the nearest hospital, us. Criminal number two gets caught by the cops, and needs to be cleared by a shrink. Bring him to Bellevue! Why not? Everyone else is here?!” She’s laughing, but her eyes are wet. It’s sweet. She knows: It’s funny, but it’s not so funny.

I go see the criminal and give him about two minutes of my time. He is shifting his weight from leg to leg, probably in withdrawal from opiates, but his greasy hair and pimpled complexion suggest meth. “Are you hearing voices? Are you suicidal? Do you feel like hurting anyone?”

No, no, and no.

I take the cop aside and explain the situation. I give him the two forms he needs from me, and he is happily out the door. I can fill in the rest of the paperwork later.

I
got the letter two days ago informing me that I have failed my oral exams to become board-certified in psychiatry. I passed the written exam a year earlier, soon after I got to Bellevue, but the oral portion with a live patient, usually taken a year after residency, is notoriously difficult to pass, with nearly a fifty-percent fail rate. This information does nothing to make me feel better. I am devastated and I can’t stop crying for one solid day.
Other people fail exams, not me
, I think to myself.
How could this possibly happen?
Here’s how:

I walk into this small office in an outpatient clinic, and there are two male examiners in the corner behind a desk. The patient to be examined is in a chair in front of the desk, and there’s an empty chair for me. I sit down and introduce myself and right off, I’m transfixed by her appearance. It really throws me off. She’s got very close-cropped jet-black hair, dark eye makeup on the lid above and also circled underneath, and she’s very pale. Maybe it’s her makeup, or maybe she only eats white food, who the hell knows, but she is ashen. With multiple piercings and tattoos and this vicious glare, her whole look is totally goth and dramatic. I should’ve been tipped off right there, but I was laser-focused on doing my job—and not getting thrown—so I didn’t stop and tune in to her, and think,
How should I play this?

I keep to my game plan and start with all my usual background questions, trying to keep it superficial: Do you have any medical problems? Are you allergic to anything? What meds are you taking? I’m not getting
into her symptoms at all. This isn’t the way most people start the interview. It certainly isn’t the recommended way, which is that you let the patient free-float and tell you all their problems for the first five minutes.

No, siree, I had a format I wanted to follow, my way of efficiently building a database, and I wanted her to go along with it.

She interrupts my rapid-fire style. “I’m done answering your questions.” She looks me right in the eye, and says, “I don’t know where I am right now. I don’t really know
what
I am. I mean, I don’t even know if I’m a human being!”

I respond calmly, matching her intimidating gaze, staring her down. “You are in the outpatient clinic, you
are
a human being, and I have a lot more questions to ask you, so let’s just continue.”

It’s the worst thing in the world to say, I know now. She handed me a bunch of symptoms on a silver platter and I tossed the tray, toppling them all. I was just trying to keep her on track, on my schedule. I had only thirty minutes to get her whole story. This was
my
exam. I didn’t feel like this was about her. I figured she volunteered for this because she wanted to be part of the process, she wanted to help me pass.

I’m an idiot.

It just goes downhill from there. I should’ve realized the only way to win the examiners over was to win her over, but I guess I thought I could be a star in their eyes and still afford to be an asshole in hers.

A big part of what you are judged on in the boards is the ability to establish rapport with the patient. You need those points to pass. But somehow, when faced with a bad situation, I just imploded. I tried to out-macho the patient. Bad idea.

I see that I’m going to have to work on all of this with Mary before I take the exam again. We’ve got to soften me up somehow, and fast. This steamroller cowboy thing isn’t getting me anywhere. Except …

After hearing about my failure, Jeremy makes me a card to cheer me up. He has Photoshopped an old picture of me from my rock-and-roll days, onstage with my band in tight jeans and a white tank top, my nipples clearly visible. I am wearing dark sunglasses, microphone in hand, and my mouth is wide open.

Below the picture, he has written a caption:

Julie, you pass your orals with me every time.

W
hen the weather turns frigid, the homeless head indoors, crowding the CPEP beds and perfuming the area with the piercing stench of fungus. People assume the odor would be worse in the summer, but it is always considerably more unbearable in the winter. Patients who live on the street wear multiple layers, sweatshirts and coats that trap the aromas of the body. As they peel each layer off, the smell intensifies, sometimes becoming overpowering enough to make my eyes water, or even to make me gag. When all I want to do is run in the other direction, it gets a lot harder to be therapeutic and caring toward the patients.

Still, when I greet a new patient in the nondetainable area who has matted-down hair, and bugs in his clothing, smelling of urine, sweat, and feces, even if I can’t help but turn my head away, stifling a “PHEW!” I am careful not to say anything. It’s not his fault. There is nowhere to shower in the city but the shelters, and most of the street people avoid the shelter system like a bear avoids a trap. There are too many rules, addicts, alcoholics, scammers, and lunatics. Things get stolen constantly and people get assaulted at random hours, so no one can ever truly relax or sleep.

This weekend at CPEP has been hell, and it has taught me a valuable lesson: Take time off in January. That’s when the census starts to creep up through the twenties, day after day. Tonight, not only are there nearly thirty people in the area, but they are impressively sick. Many of the patients need wrist and ankle restraints. The process of restraining a patient
requires anywhere from four to eight staff members: usually CPEP psych techs and nurses, who are big women, and hospital police, who are smaller men. (Sometimes the sizes and genders are reversed; it depends who’s on shift.) Each staffer takes a limb, and one person stands near the head to oversee the procedure. A doctor is supposed to be present at all restrainings, trying to get the patient to calm down, explaining, “This is only a temporary procedure, until you have better control over yourself. We’re just trying to keep everyone safe.” It’s usually a bit of a mess, with a lot of swearing, grunting, and threatening.

On Sunday, the flurry of aggression that necessitates one man to be restrained sets off another patient who is escalating. Angry that he is being admitted involuntarily, he is screaming at me and kicking the wall. I try to get him to calm down, encouraging him, “Please, try to keep it together so you don’t get tied up,” but he is unable to contain himself. Like a ripple effect in a Rockette line of dancers, five people end up getting restrained over the course of one Sunday afternoon. I wish I were home watching football, instead of at work watching wrestling.

As I fill out the paperwork on the five patients, I am multitasking. Writing and listening, I nod my head to confirm the information is reaching my brain as Nancy tells me about a case that has just come in: a former corrections officer who used to work for D.O.C., who is now a homeless man. He has been arrested for jumping a subway turnstile, which is how we get a good chunk of our homeless patients these days. While in his cell, he defecated on himself and threw his feces at the guards, so NYPD brought him to us.

It becomes clear, once he has been interviewed, that this man is completely out of his mind. He has some sort of psychosis; whether brought on by drugs or mental illness, I can’t yet say, but what
is
said is an oft-spoken line by Nancy. “He ain’t goin’ nowhere but up.” Unquestionably, he needs to be admitted to the prison psychiatric ward upstairs. In order for him to go up he needs to undergo a physical exam, a chest X-ray, and an EKG. He also needs his blood drawn for routine testing. All of these tests require the patient to be cooperative and lie still, or else to be sedated.

Although the former corrections officer acquiesces to the EKG and the chest X-ray, the psych tech informs me that he is refusing to allow his blood to be taken. I leave the relative comfort and safety of the nurses’ station to find the patient.

I give him my usual shtick. “Here’s the deal, sir,” I begin. “You’re
going to have your blood taken. It’s a requirement for the admission. It is up to you whether this happens with you tied up and sedated or freely moving and cooperating.” In psychiatry, this is the oldest trick in the book, the old “choice-no-choice” paradigm. This gives the patient the illusion of control over a situation, offering him a choice that implies freedom, when really there is none. I had used the technique earlier with another man who required a bed upstairs by saying, “You’re going to be admitted to the hospital. Would you like to be a voluntary or an involuntary patient?” You’d be surprised how often this works, especially with toddlers.

The former C.O., no dummy, is not falling for it. He tells me, “There is no fucking way you are taking my blood. Period.”

I have seen patients who are hesitant about blood draws. Sometimes it’s a needle phobia, but other times it’s something more delusional. “Are you afraid of needles?” I ask.

“No.”

“Do you think there’s something special in your blood that you’ll lose if we take a few teaspoons?” I’ve had psychotic patients who are deathly afraid of losing some sort of vital power if their blood is removed.