Weekends at Bellevue (41 page)

I’m looking forward to luxuriating in long-term care instead of triage.
I see now that I need the follow-up. I need my people to get better and stay better. I’ve done enough triaging and crisis intervention to last a lifetime, and I’m done passing the patient along to another doctor once I’ve arrived at a diagnosis. I want to do the whole job now. In my private practice, once I settle on the right medication to manage symptoms, there are still years of sessions, getting to understand the patient’s situation, unique stresses, struggles with weight, libido, and balancing work and family. Their prescription regimen is often tailored to help weather particular storms, and I want to be with them, helping them to navigate through the choppy waters, instead of fishing them out of the stormy sea, letting them sleep on the deck, and then dropping them off at the marina to await another boat.

These past few months, knowing I would be leaving CPEP soon, I was constantly on the lookout for reminders about why I was going. Like waiting until after the holidays to break up with a boyfriend, once I knew I was going to end it, it got harder to stick around and easier to rationalize my impending departure. There are countless things I’ve put up with year after year that I won’t miss: more prisoners, more paperwork, more complicated computer maneuvers. They’ve been snowballing over time, getting worse, conveniently, in the few months leading up to my planned escape.

But here’s the thing that is tipping the scales the most: I’ve transformed significantly, and I’m afraid permanently. It’s not you, Bellevue, it’s me;
I’ve
changed. The combination of motherhood and psychotherapy has brought down a one-two punch that is making me incompatible with emergency psychiatric work. My hormone-fueled maternal instinct blossomed during my stay at the hospital, and I now can’t shrug things off the way I used to.

When I started my job at CPEP, I made a conscious decision to alter my exterior. I inured myself to the tragedy that walked through the doors. That hard-ass persona allowed me to go about my business weekend after weekend. But my three years of psychotherapy with Mary allowed me to see this act for what it was—a defense. And she taught me, through each of my undignified transgressions, that acting this way does not help my patients.

Oscar Wilde says, “Experience is the name everyone gives to their mistakes.” With every mistake, we must surely be learning, right? Maybe I took longer than others, but eventually I did grow from my
experiences, and over time, I softened up my rough edges. But those years of therapy left me with some tender patches that were painfully unprotected. My suit of armor didn’t seem to fit like it did before.

And then motherhood came along, further dilating those soft spots. Something about the physical act of giving birth and nurturing two infants had turbocharged my capacity for empathy. My carefully constructed cynicism and distance started to crack. By 2005, I was simply not the same person I was in 1996. I went from being the prison warden to being the den mother. After two pregnancies and four years of nursing, it was a lot harder to pretend I was one of the guys; being butch just didn’t fly anymore. I couldn’t strut around like I used to, keys jangling, invincible. I had adopted a more caring and approachable bedside manner in my private practice, and I couldn’t shift gears gracefully between my two offices, even if I did have two different bags to take there, accessories to my two different personas.

And then, of course, there was September 11. I remember soon after, sitting in a bathtub with Molly. I pictured a huge jet engine roaring through our high-rise apartment building. I could imagine the cockpit crashing into our bathroom, killing us instantly, or worse, killing only her, and it took my breath away. I sat in that tub, clutching her to my chest, breathless and panicked. I could not bear to lose her.

Motherhood taught me about love, and 9/11 taught me about loss. The terrorists showed us all how quickly life could be taken, and how much it could hurt. After that Tuesday, it seemed, I could no longer look at the lives ruined at Bellevue with my usual casual glance. Every one of those patients had a family somewhere, and a mother, which made it exponentially harder to dampen my heartstrings. I couldn’t deliver my news over the telephone to the concerned parents with the same degree of remove, the clinician’s professional level of indifference. Because I was now a parent too, I couldn’t detach like I needed to. I would hang up from a phone call completely drained, full of sorrow for what they’d have to go through in the years to come.

I hated coming home to my kids emotionally wrung out, trying to blot out the memories of the patients I had treated. We’d be at the playground and my kids would be in the sandbox, but I’d be in the hospital—I couldn’t stop reliving what I had seen or done at work. I was having too much bleed-through between my work and home life, regardless of how organized my closet was. No matter which backpack
I was carrying, insanity intruded into my life, as it impinges on us all, like it or not.

I have to admit, I never quite found that middle ground between hard and hypersensitive. I know there is a compassionate place well beyond sadism, an expanse of territory way past empathic failure and just short of giving till it hurts, but for the life of me, I can’t find that place when I am at CPEP. Despite Mary’s best efforts, it has remained elusive. I have to simply accept that I can’t manage caring for the patients, for myself, and for my family the way I need to.

It’s time to let someone else take over.

And so, using my family as an excuse, I make my gracious exit.

I
try to make my last sign-out memorable, pulling out all the stops, squeezing in jokes wherever I can. When I’m done, there’s an awkward silence. One of the attendings, a woman of course, clears her throat to say a few words.

“As you all know, it’s Doctor Holland’s last day today. She’s been here nine years.”

“Longer than any other CPEP attending,” I chime in. It is an accomplishment I am proud of, and I have joked with the head nurse for months about wanting a plaque to prove it.

“Well, we want to wish you well, of course,” she says, “and also, I feel like someone should say something about Lucy. You’re the last doctor here who actually worked with her, and you were her good friend. You’re our last tie to Lucy, and with you going, it really is the end of an era.”

I did not expect this. No one warned me there would be Lucy talk. I immediately get misty-eyed, which is the last thing I want right now. I want to leave with my head held high, strong, dignified. I swallow hard and think about something, anything, other than my dead friend.

“We’ll really miss your Monday morning sign-outs. It’s not going to be the same around here without you.”

“I’m counting on it,” I choke out.

I leave the nurses’ station and head for the locker room where there are bagels and coffee to celebrate my last day. There are many hugs, and some good stories about my greatest hits, but there is no plaque.

W
e arrive at Cape Cod ahead of the Fourth of July traffic—not that I could see any of the cars behind me. Our station wagon is loaded to the brim with clothes, sand toys, and bicycles; the windsurfer is attached to the roof by a tangle of bungee cords.

We’ve been telling Jojo about the beach for days, and even though he is only fifteen months old, he seems to remember this place, somehow. He makes the sign for water as we get out of the car.

The four of us walk around the house to the porch and say hello to the ocean. There is a strong breeze, and there are plenty of sailboats on the bay.

“How about if you set up the windsurfer and I’ll make up the beds?” I offer to Jeremy.

Molly entertains Jojo on the lawn while Jeremy and I unpack the car and start to set up house.

It is early evening by the time the kids are fed, the bags are unpacked, and the beds are made. Jojo is taking a nap, and Molly and Jeremy are changing into their swimsuits. It is time for me to do the thing that I love most at the Cape.

I lug the board down to the beach and attach the sail. My water shoes and gloves, from the shelf above the washing machine in the garage, just where I left them last Labor Day, are dry and crackly, caked with salt and sand, but they soften immediately as I dunk my hands and feet in the shallow water. I nervously scan the ocean floor for critters as I
walk the sailboard out into the deeper water. With my back to the wind, I climb onto the board and stand there for a minute, savoring the moment before the sail is pulled up. I can see the house with its wraparound porch, the beach peppered with children digging in the sand. All around me is air and water, sea and sky. I remember to breathe.

I squat down to untangle the rope, composing a sea chantey as I prepare to pull up the sail, imagining pirates on a ship singing, “What shall we do with the drunken sailor?” as they hoist the main. Hand over hand I pull on the rope, my weight back, guiding the mast from horizontal to vertical, until I swap the rope for mast and boom. I reposition my feet as I slowly pull the boom toward me, catching the breeze in the sail.

Steering the board with my feet, tilting the mast to assist in the navigation, I snake the windsurfer between the boats still moored in the bay.

As the bay opens up onto the ocean, there are no more sailboats and motorboats to squeeze by. My obstacles are all behind me. It is just the open sea, the breeze, and I.

I tilt my head so my hair blows away from my face. The wind is misty, salty. I inhale the brine deep into my lungs, thinking how the Bellevue AES docs would administer saline intravenously as the first order of business. There is salt in our blood, in our sweat, and in our tears. Even when we are babies inside the womb, we are cushioned in an oceanic haven.

Here, riding on top of the water, harnessing the breeze, the zephyrs stroking my hair, I have found my asylum, my shelter. Whether on a broad reach or a close haul, as long as I stay out at sea, I am alee, safe from the storm. I will not be rained on by debris from explosions; I will not be required to clean up the psychic fallout from the traumas. I have left the land of four-point restraints and medications, of poverty and despair. I am responsible for no one, for none of it. I have no decisions to make that will alter the course of anyone’s life, only the course of my small craft, upwind or down.

I have signed out my private practice for the month of July. My patient load is zero. I have closed one chapter of my life, but I have not yet opened the next. I suppose this is the whole idea of summer vacation: not working. I can focus on caring for myself and for my family. I can get some perspective now that I am away from the hospital. Determining who is sane, who is ill, who needs to be locked up for their
own good, and who may run free, like the wind … this is no longer my bailiwick. Now I decide what to make for dinner, and whether to do laundry today or tomorrow.

Oh, God, will I die of boredom? Sky of blue and sea of green, every one of us has all we need. But will it be enough for me?

The sun hangs fat and low on the horizon as the Technicolor display begins. Wisps of clouds decorate the sky, layered with hints of the vermillion, fuchsia, and tangerine to come. I search for the moon as my board bounces on the rolling waves, carrying me out to sea, farther away.

Actually, too far away.

I have been sailing west for too long. I need to reach the shore before it gets too dark to see and be seen, just as I needed to leave Bellevue before I faded into the background, before we became the same drab color.

I head into the wind and come about clumsily. It’ll take a few days to work the kinks out of my form, but at least I haven’t fallen in yet. My T-shirt is dry as I approach the shore, my forearms aching.

I look behind me once more, to take in the mango-papaya sunset. It is the medical new year, Independence Day weekend, and I am not going back to the hospital. I’m not a cog in the machine anymore, but I still feel my wheels spinning. I remind myself: It will take some time to work those kinks out too. Head for shore, and everything will fall into place.

Jeremy and Molly are frolicking like dolphins in the waves as I glide past them, hooting and crowing. “Yay, Mommy!” Molly shouts.

I grin triumphantly as I release the sail, pushing it away from me as I fall backwards into the water.

I
t’s a snowy Sunday afternoon in January, and I haven’t stepped foot in Bellevue for six months.

My life has slid into a predictable routine. I see patients mid week, take the kids up to the house on Friday, and come back Sunday night to do it again. Monday is my errand day; we have a sitter to watch Jojo, and I’ve started back up with Pilates. My life is simpler, and it feels infinitely safer, but I’m not sure it’s better. And there’s no going back. I will never have a job like CPEP again. Not only do I miss my Bellevue comrades, I miss the rush of being in charge, talking to the cops, feeling decisive, helping the people the rest of the city has avoided and discarded. I miss never knowing what’s going to happen next.

Like a junkie in withdrawal, I find it easy to glorify the good old days spent high on adrenaline with my crew. It will take some more time to adjust to my new life.

CPEP was all about diagnosis not treatment, triaging not fixing. Most of my job was simply determining who’s in and who’s out. My life isn’t like that anymore; it’s not so black-and-white. Now, it’s all about the long view: raising a family, writing books, following my private practice patients month after month. I’m treating people who are no longer lost to follow-up. I am responsible for the outcome, good or bad. Luckily, my patients are getting better and staying well, for the most part. They are grateful to me for my ministrations, and their families are likely
relieved that I’m helping to shoulder the burden of maintaining their mental health.

Still, I know someone else could be doing this type of work, someone more sedate. Not everyone is built for Bellevue like I was. Should I have stayed because I could? Am I really contributing in the same way now? I still find myself talking to the homeless schizophrenics on the street, telling them to head to Bellevue when they look like they’re going south. They’re my people, and I can’t help but do a little community outreach while I’m waiting for the subway.