Weekends at Bellevue (6 page)

The family insisted that she remain on life support. They had heard of people waking up from comas, they’d seen it on television, and so we were unable to convince them of its improbability. She was admitted to the surgical ICU, a girl with a beating heart and nothing more, taking up an intensive-care bed in the hospital for thousands of dollars a day, so the family could have some time to say good-bye. They were angry and confused, and they wouldn’t be rushed into accepting what even I could clearly see: She was gone already.

For reasons I did not yet understand, I ended up displaying the same condescending, remote attitude as my surgical resident when I was asked to go explain her condition again, this time to her high school friends who had gathered in the waiting room: “Right now, your friend is on a machine to keep her alive, and we’re not sure she’s going to pull through.” Short and sweet, and the young girls shrieked and sobbed. They barely stayed to hear my explanation of the shutdown of her various organ systems, turning away to hug each other and cry instead. It was my first time telling anyone their friend was dead, or as good as dead, and my delivery needed work, but doing a surgery rotation in an inner-city hospital would give me plenty of opportunities.

Back at the hospital a few days later, a patient I’d been working with that holiday weekend had tested negative for the AIDS virus. Since I had stuck myself with a needle filled with her blood, I had been anxious, waiting for the results. Unfortunately for the patient, however, the good news about her test results meant very little in the scheme of things. Before the long weekend, she had been hit by a car and had broken her leg. When she left the hospital, with a cast from toes to thigh, she went home to hang out with friends, who, like herself, smoked crack. She must have gone on some sort of a binge; when she eventually started paying attention to her surroundings and her body, she realized that
her leg was bothering her. She felt a tingling, an aching, and returned to the ER to have it examined, where she was told she had gangrene in her toes and foot. The cast was too tight and had cut off her circulation.

I was with her, avoiding her eyes and instead staring at her swollen, black toes, when the surgeons gave her the devastating news: She needed an amputation. I spent time with her, helping her to adjust, and was present in the operating room when the lower part of her leg was removed, the electric saw sparing her knee. (For years after this surgery rotation, it was hard for me to eat chicken, turkey, and especially leg of lamb without thinking about amputations.)

On the day when I got the HIV test results back, I rushed to her room to share with her the good news, but I knew the only news she really wanted to hear was that this had all been a bad dream, and things could go back to the way they were when she had two legs. I left her room and walked down the long, windowed hallway that connected the surgery wards to the ICU. I was thrilled she was HIV negative and I didn’t have to take AZT, getting tested every few months to see if I “sero-converted,” the medical terminology for testing positive. But I couldn’t shake the guilt of being the healthy one.

On my way to the elevator, I heard a sound I couldn’t immediately identify coming from the ICU. It was a screeching, squealing sound, which stopped to take a breath and returned as a wailing, then a moaning.

The dead girl.

She was scheduled to be taken off her life support that day, after three EEGs had confirmed brain death. It was her mother or her grandmother or her sister who was mourning in a way that I could feel in my gut.

I stood in the hallway by the elevators, unable to press the button that would take me home.

F
resh out of medical school, I was finally able to call myself doctor. I left Philly and moved to New York to begin my residency in psychiatry. On my first day on the inpatient wards at Mount Sinai Hospital, I walked into my patient’s room to introduce myself. He was sitting on his bed, cross-legged, his eyes shining.

“Uh, hello, I’m Doctor Holland,” I said awkwardly, not knowing where else to begin.

“Hello, Doctor Holland,” he boomed, smiling beatifically. “I … am … God.” He was perched on his bed like a guru on a mountaintop, in the midst of a manic episode, flying high on his own neurochemicals. He felt so good, he squirmed with pleasure, yet his manner was composed, a king on a throne. I called my mother that evening as soon as I walked into my new apartment. My white coat—stuffed with reflex hammer, penlight, and pocket guides—clunked to the floor. “You’re not going to believe this. It’s the best-case scenario. I am starting my medical career at the very top.” I paused for dramatic effect. “I am God’s doctor!”

“There’s nowhere to go but down,” my mother deadpanned. I hadn’t thought of it that way.

I spent my first two years at Mount Sinai treating all kinds of psychiatric patients. I went to weekly lectures and read journal articles to learn more about schizophrenia, Alzheimer’s disease, delirium, and Huntington’s chorea (a tormenting neurological illness that causes wildly flaying limbs, except in sleep when they mysteriously become
still). My patients listened to their voices, talked to themselves, smoked incessantly, urinated on the floors, twitched, shuffled, threatened suicide, and shouted their demands. I conjured up combinations of pharmaceuticals, prepped them for electroshock therapy, performed lumbar punctures, drew blood, and documented everything that happened in their charts. I made multiple diagnoses, managed a slew of medications, explained symptoms to families, and set up clinic appointments prior to discharge.

Some nights I was on call overnight at Mount Sinai Hospital, a few blocks from my Upper East Side apartment; other nights I was at Sinai’s other training site, the Veteran’s Hospital in the Bronx. There, in the middle of nowhere, I had complete autonomy. I was the only psychiatrist in the house. Frequently, a vet who called himself Morris would call the hospital to speak with the shrink on duty. His calls were legendary—the other residents throughout the city knew about him—and they were a rite of passage for us all. He kept us on the phone as long as he could, asking questions that could not be answered to his satisfaction. “Doc, why do people bless me when I sneeze? What does it mean to fall for someone?” Meanwhile, my pager would go off because someone on the wards had just fallen and cut his head. When I went to examine the patient and order a head CT, there would be a powerful minty-freshness coming from his pores. Mouthwash drunk. Another one. The VA had a store in the lobby that sold toiletries including mouthwash with alcohol, about fifty proof. Vets getting mouthwash-drunk was a rite of passage as inexorable as Morris’s calls.

On the wards at Mount Sinai, there was one demented woman in her seventies with long, curly hair dyed Hollywood-blond. She thought I was her daughter and I let her. It was easier for both of us that way. Most days, she was in a lounge chair in front of the nurse’s station, secured with something like an apron, so she couldn’t slide onto the floor. Her frontal lobes, the parts of the brain that inhibit proscribed behaviors, were shot. She said what was on her mind, which nearly every day, all day, sounded like this: “You look good to me! You look good to me! I want to sex you up, and you, and you!” The more primitive parts of her brain were in charge of her behavior now. Her most elemental desires were gratified with no compunction, no superego to get in the way. On a regular basis, she could be seen masturbating with her free hand, then moaning as she climaxed, and then peeing, her urine pooling on the
floor beneath her chair, after which she fell asleep, sated, with a Mona Lisa smile.

“When I go, I wanna go like that,” I said to the other doctors.

One of the psych residents I got to know was a guy named Daniel. He was a year ahead of me, and charmingly, dashingly handsome. When he flashed his perfectly straight teeth in a sparkling smile, his cheeks practically eclipsed his eyes. We hung out with the same crowd and saw each other socially a bit, but there was one day on the wards that tried our early friendship. I noticed that his patient—slumped over in a chair, drooling and sleeping deeply—seemed excessively sedated. This is a common situation on the wards. I reviewed her medication list and discussed with the nurses which ones to stop, but she wasn’t my patient, she was Daniel’s. I was a first-year and he was a second. I had broken the chain of command, disrupting the hierarchy that is the backbone of a teaching hospital. I just thought,
There’s a patient who’s been overmedicated, what can I do to help?
But it turned out that I stepped on his toes and he did not take it well. As he rebuked me, I saw a side of him I didn’t ever want to see again, and what I had seen informed the rest of my interactions with him as my residency progressed. I had to remember to defer to him, which wasn’t easy for me. I also had to remember that even though I felt like a pro, I was new at this and had to act accordingly.

All the residents were assigned to a supervisor to help us make sense of all we were going through. Mine was an older gentleman with hearing aids and a perpetually benevolent mien. My toughest case was a gal who kept slapping herself and swearing loudly. She had obsessive-compulsive disorder and Tourette’s. She playfully called me Dr. Hollandaise, which my supervisor, an analyst, interpreted for me in a Freudian framework.

“She wants to eat you up. You’re saucy and delectable.”

Okay, then
.

Sarah stayed in her bed most days. She’d wet the bed and not bother to leave it, something that disturbed me inordinately since we were nearly the same age. She was tall, with a humongous head, her face covered in acne. Her big, fleshy lips opened to allow a gruff, insistent voice to escape. She’d bark out swears and racial slurs, then quickly offer her sincere apologies.

I played backgammon with her in the patient lounge when I’d stay late to take call overnight; she had to tap the board and the wall a certain number of times prior to rolling the dice. As the game progressed,
her rituals got more complicated until they included her tapping me. She had to touch my arm before she could take her turn. “It’s my OCD,” she explained.

“I know,” I responded. I tried to ignore it, but after a while I asked her to stop.

“If I could, do you think I’d be in this nuthouse?” she screamed.

After I knew her for a while, I got the feeling she was using her symptoms as a way to manipulate everyone around her. I talked to my supervisor about this and he recommended a game plan for my psychotherapy with her.

I asked Sarah about her earliest memory, a classic screening question in psychoanalysis.

“When I was a baby, I can remember my father yelling at my mother. And slapping her.”

“Hmmm, yelling and slapping. Sound like anyone you know?” It’s an easy interpretation, anyone could’ve seen it, but somehow, it still made an impression on her.

“You’re good, Hollandaise.”

I
was still a resident at Mount Sinai in the spring of 1995, my third year of training, when I had the opportunity to plan an elective rotation. I opted for two months at Bellevue Hospital’s psychiatric emergency room. As a visiting resident, I saw cases and reported directly to the attendings, working alongside the NYU residents. I told the Bellevue CPEP director that my residency schedule only allowed me to work Mondays, Wednesdays, and Fridays. I took off Tuesdays and Thursdays so I could have some time to myself to sleep in, do errands, and go running or Rollerblading. Some days I rode my bike through Central Park, my guitar slung over my shoulder, and played in Sheep’s Meadow, a huge expanse of grass with a view of the midtown skyline. I needed this downtime between my frenetic days at the CPEP. The intensity of my experiences with the patients, crammed in with the other doctors in the tiny nurses’ station, required a counterpoint. The trees rushing by me, the wind in my hair as I sped through the park, helped to recharge me. They were as essential for my mental health as the medications were for the patients, assuring that I remained a pod of sanity in a world of nuttery.

Monday, April 17, 1995. I had been at Bellevue for two weeks, and that night after work I was going to a party. My friend Dan Levy invited me to a gathering for Terence McKenna, the psychedelically inspired writer. I spent the bulk of my day with a new patient, a young man who came in floridly psychotic the night before. Luckily, I was able to
track down his father in the Midwest who reported a history of bipolar disorder. My patient was off his meds and a long way from home. The CPEP was trying something new with these patients: high dose mood-stabilizers in an effort to bring them back to baseline more rapidly. I sat down with the patient to explain the treatment plan. He was funny, cute, and sweet, and we made a strong connection as the day wore on. I felt like he had a little bit of a crush on me, and I didn’t do much to discourage him.

After my day at the ER, I changed into something that I hoped was fabulously sexy and headed downtown to the party. In a city full of numbered streets, I parked my car at the corner of White and Church, in front of the Baby Doll lounge. White and Church. Signs and omens. I wondered if I’d meet someone at the party, someone I would marry.

I walked from the corner to 395 Broadway, watching the litter swirl in the wind. I opened the door to the apartment. Cue the romantic music. Across a room filled with two dozen people, I saw a man who had seen me. I stared at him, thinking to myself, There he is, that’s my guy: long, brown curly hair, beautiful blue-green eyes, full, sexy lips, strong chin. I had a strange feeling that he was The One I was supposed to be with. It felt preordained, inevitable; my only job was to accept it. It was irrational, but I was sure of it. The very definition of delusional.

I got up the courage to say something as I passed him on the way to the bathroom.

“Hi!” I said, in a tone that implied an old friendship, as if we already knew each other and I was glad to see him again.