Marcus Stevens—whose mother had lost first one son to jail and now maybe this one to the G Building—was not quick to leave the psych ER. On his fourth morning there he joined me for group, along with a Mr. Williams and a Mr. Roberts. The former sat and stared eerily. The latter was talkative: “Everyone here is watching me. Why are they watching me?”
“What are you worried about?” I asked.
“They all hate me,” he said. “Please tell them not to hate me.” He was dressed from head to toe in camouflage fabrics: cap, oversized T-shirt, nylon gym shorts. For some reason, maybe because of the lull in professional attention that came along with the skeleton-staffed weekend, non-EOB patients kept wandering in asking if they could be a part of the group. Dr. T. had told me the answer to that question was no, and I tried to enforce it, but sometimes people just sat down to listen, and truly I didn’t mind, because it made me feel sought after.
Marcus said to Mr. Roberts, “Don’t worry so much what other people think of you.”
“Why so quiet, Mr. Williams?” I asked, trying to bring our third member into the discussion.
He tensed up. “I’m trying to control my anger,” he said quietly, concentrating hard. I nodded in response, chilled by his gaze. He went back to staring straight ahead.
After group Mr. Roberts told me he felt much better than earlier in the morning. The contact had apparently done him some good. I told that to Dr. T., adding that it was nice to hear but that I still didn’t feel as if I was doing much in group. “Well, you go back there every morning and try. That’s something,” she said. Her praise was always tepid, but no less than I felt I deserved. “Just remember, you can be therapeutic,” she encouraged. I asked her about the notably intense look on Mr. Williams’s face.
“It’s called the psychotic stare,” she said. Then, “When someone tells you he’s struggling to control his anger, ask him, ‘Do you think it might be hard to control it here today?’ and ‘What can we do to help you?’ You also have to tell the staff. He may need to be assigned an assault level so that we know to keep a close eye on him.
“With Mr. Roberts, probe his paranoia. Why does everyone hate him? Are there reasons people would want to watch him? Is his family connected to this? The CIA? Explain that the staff is looking at him because it is their job to take care of him and make sure he’s doing okay.
“So, now. We have a new admission. I want you to interview him. Remember the telescopic lens. You want to know what brought him here—the presenting problem, and also the history of the presenting problem.” She nodded and went to get this new person. When she returned, she was accompanied by a tall, hefty man in his mid-forties wearing a flannel shirt and pajama shorts. “This is Miss Lockman,” said T. by way of introduction. I winced at the title: unlike my first name alone, it served as an explicit reminder that I was not yet a doctor. I wondered if the patient felt shortchanged. His first chance to tell his story, and all they offer him is a “miss.”
“Henry,” said the man, nodding at me.
He did not look crazy. If colloquially speaking there were more or less two categories of patients here—suicidal/homicidal or totally nuts—it was my guess that he fell into the former. T. sat down in the third chair. I was in charge.
“Can you tell me what brings you here today, Henry?” I asked, disconcerted as always under Dr. T.’s scrutiny. When I was only recounting to my supervisors what I’d said and done in sessions, at least I could leave out the parts I’d deemed most egregious. Here, in situ, my most ridiculous moments—as certain to manifest as the morning dew—were so public.
“I was thinking about killing myself. I brought myself here instead.”
“Did you have a plan?” I asked.
“I’ve been staying with my brother. He’s got a lot of pills in his house.” He waved his hand, et cetera, et cetera.
I nodded, thinking. As a journalist, I’d asked questions for a living, and that suited me—the coaxing of a linear narrative, the culling of the insubstantial details. If only Dr. T. were not sitting there, this would come so much more naturally. I tried to think of the right next question. “What’s been going on in your life that got you to this point?”
“I lost my job. I’m frustrated. I’m tired. My family is at a distance.”
“What were you doing for work?”
“I was in waste management for four years, picking up Dumpsters.”
“Were you laid off?” I asked.
He looked at me, weary. “I got fired. I wasn’t going in all the time. I was stressed-out. I have too much to do. For the past couple of months I was missing work two or three days at a time. I was so tired.”
“Why do you think you’re so tired?”
“I don’t know.”
“Do you have trouble falling asleep or staying asleep?”
“No.”
“Can you say a little more about your family? You mentioned they’re at a distance?”
“Yeah, they say they’ve had enough of me. That’s not how family should be. My brother is better. He took me in three years ago. I’ve been living with him, but I’ve decided to leave. His girlfriend is pregnant, so it’s time to find a place of my own.”
“You’re going to miss living with them?” I asked, trying to glean some sort of cataclysmic loss or injury from his story. He seemed sort of down, but I wasn’t hearing or feeling anything that added up to suicide.
“They’ve been good to me. But I can see it’s time to go,” he said.
“They kicked you out,” announced T. Her statement felt jarring against my gently spoken inquiries.
“If you want to look at it that way,” he said, his back up.
“How many years have you been using?” she asked, and I understood that T.—having had enough of me missing the obvious—was taking over.
“Fifteen or twenty years. What of it?” he asked.
“Alcohol?”
“Heroin, crack, alcohol. Check, check, check.” He was sarcastic now.
“How much?”
“Two hundred dollars a week on heroin. A six-pack a day.”
“When was the last time you used?” T. wanted to know. “Yesterday,” he said.
“How many times have you tried a program?”
“I just left my fourth,” he said.
“Did you finish?”
“I took a break. Went to jail for a while. Disorderly. Possession. I got out, and I went back to the program. Left again.” He was blasé now, not proud of his habits, but maybe of his defiance.
“Do you think that’s why your family is done with you?”
“Probably.” He was nodding now.
“And that’s why you were too tired to make it into work?”
“I suppose so.”
“So what’s your biggest concern right now?”
“Housing,” he said. “I need a place to live.”
“Well, I guess you’ve got that here.” She smiled a thin, tight smile.
“I don’t know what you’re talking about. I’m depressed. I want to kill myself,” he said with no real feeling.
“You’ve alienated everyone in your life,” said T. loudly. “Your family, your employer. The brother who stood by you longer than anyone else doesn’t even want much to do with you anymore, and yet you don’t seem to care.”
He just looked at her. I vaguely remembered learning that this was the hard tack one was supposed to take with an addict, but I’d never worked with any. Conventional wisdom held that therapy did little good with active substance abusers. Drugs and alcohol interfere with the brain changes associated with learning and so progress in psychotherapy. I never quite understood, though, how an active drug user was supposed to get sober without the help of a therapist from the get-go. Was the yelling intended to facilitate that? When he left T.’s office, I asked her.
“With an obvious drug addict, it’s all about straight confrontation. It’s the only way to begin to cut through his denial. He’s full of shit,
and you tell him as much. Suicidal, give me a break. He wants a place to stay. This is better than a shelter.”
“So do we let him stay?” I asked.
“He’s already been admitted to EOB. He’ll spend one night at least. Tomorrow you’ll have another chance with him. You can practice being confrontational.”
The next morning I led three patients into the group room only to find an obese man sitting on a chair against the back wall masturbating. From the doorway I told him that he had to leave, but he was not all ears. I asked a passing nurse for help, and she tried what I’d done, telling him from a distance that it was time to go. He ignored her, too. I wondered what Dr. T. would do. If it was part of my job to tell grown men to wipe crumbs from their faces, was it also my responsibility to let them know that public displays of autoeroticism were frowned upon? If one needed to be told, was it not a moot point? The nurse summoned the security guard nearest to us, a woman who suggested getting the two male guards from the waiting area to deal with our problem patient, who by the by was not on my list. The officers were summoned and led the man out of the room. My charges stood waiting, nonplussed. In what I imagined were gestures of equal parts solidarity and self-preservation, the patients rarely batted an eye at their peers’ most outlandish behaviors. I turned off the television—how much easier that part had gotten—and began group.
Henry was there that morning, along with two other men. I asked each to explain what he was doing in the psychiatric emergency room. Henry said that he’d wanted to kill himself, and also, with a snicker, “It’s going to be cold out soon.” The second man said that he wanted to kill his family, and the third that he wanted to kill his boss.
“So you three have something in common,” I said, growing ever more comfortable with feeling slightly ridiculous. “You all came here in order to stop yourselves from doing something damaging and irreparable.”
After group I invited Henry into T.’s office. She wasn’t in yet, and so I could carry out her order—“practice being confrontational”—with only Henry to bear witness to my folly.
We sat down. “You mentioned in group that it’s going to get cold soon. I took that to mean you plan to use the hospital as your winter home?”
“No,” he said. “I just want to get better.” He grinned. He’d inferred I was a trainee, that I’d been naive about his game yesterday, and that he’d been used to teach me a lesson. Now he was going to have some fun at my expense.
“Are you feeling ready to leave?”
“No,” he said again. “I’m comfortable here.”
“Well, you’re not crazy, and you can’t stay,” I said firmly.
“But if I leave, I might kill myself.”
“You might overdose on heroin,” I said. “But the treatment we do here is not what you need.”
“I need another program?” he asked. He’d dropped out of so many already. I could hardly feign enthusiasm about another.
“I imagine you need to stop using drugs, to go to work every day, to regain your family’s trust.”
“Maybe,” he said. “But right now I’m too busy being in denial.” With this he was smirking, making fun of me and all that I was aspiring toward. I felt ashamed and thought about how that feeling might be related to his own, and then yelling at him just felt beside the point, the continuation of a thousand humiliations he’d experienced over decades.
“You act like this is all a joke, but it doesn’t really seem very funny,” was as confrontational as I could be. Henry gave me a look to let me know I was boring him. I opened the door for him to leave. Rhoda came by. “T. said to tell you she had to go to a meeting. She said there’s an interview for you to do. A Mr. Cook. Young guy. He got here around three a.m. Cops brought him in for making prank 911 calls. One of the residents just evaluated him and admitted him to EOB.”
I found Mr. Cook sitting soberly in the waiting room. He was in his mid-twenties, African American, in expensive pressed jeans, a short-sleeved orange Polo shirt, and flip-flops. He was better groomed than any of the patients I’d seen and also some of the staff. Hope fluttered familiar: maybe there was nothing wrong with this one. Mr. Cook was polite and composed when I brought him in to Dr. T.’s office and shut the door behind us. “Why don’t you start off by telling me how you got here?”
“The police,” he said. “They got angry at me for calling them, so they brought me here. I suppose to punish me.” He looked at the floor, shaking his head.
“Why were you calling them?” I asked.
“I’ve been having a dispute with my across-the-hall neighbor. We used to be friends. She’s old and she can’t work anymore, so she’s always broke, and I used to take her out to dinner sometimes. We leave our doors open when we’re both home so my dog can wander back and forth. I lent her twenty-five dollars a few weeks ago, and ever since she’s been avoiding me. I wanted my money, so I decided to wait for her outside her door. She got home at three a.m., and I was there, so she called the police.”
“She called the police just because you were standing there?”
“Well, I’d been bothering her about the money for the last week or so. I think she kidnapped the cat I was cat-sitting to get back at me. Anyway, I wouldn’t let her get into her apartment. I was insisting she give me the twenty-five dollars.”
“What did the police do?”
“They came, we were both still standing there. I told them what she’d done. They told me to go home, to take it to civil court, and they left. But after they left, she threatened to stab me, so I called 911. The same cops came back, more irritated this time. They were going to arrest me, but instead they brought me here.”
I felt sympathy for the plight of these beleaguered cops, but did they really need to bring this nice fellow to a psychiatric emergency room just to teach him a lesson?
“Have you ever been in the hospital before?” I asked.
“No,” he replied.
“Have you ever been involved with the police?”
“No, never.”
“Have you ever seen a psychologist or a psychiatrist?”
“My wife and I went to couples therapy a few times, before our divorce.”
Couples therapy? Only functional people went to couples therapy. I was sure of it. This guy was fine. The police were only human. Sometimes they retaliated, like with the lady with the squirrel. No harm, no foul.
I did what I’d learned to call a mental status exam. Mr. Cook knew who and where he was. He did not hear things that other people couldn’t hear. He could identify the president, and the one before him. He did not think the television was talking directly to him. He was sleeping regularly and eating heartily. He could count backward from a hundred by sevens. I racked my brain for what to do next and remembered Dr. T.’s lesson about leaning on people, going hard at their judgment to see if it pushed them over the edge.
“You can’t just wait outside a woman’s door at three in the morning and then refuse to leave. You’re going to get yourself in real trouble,” I chastised him. “You can’t act like that in the world.”
“I see that,” he said. I felt relieved. His response was so normal. He would take in my words, and he would stop behaving so ridiculously. I had talked some sense into him. Phew.
I told him he could leave the office. That we would meet again later. I wrote a chart note and prepared to tell Dr. T. that I thought it was true this time, that someone had messed up, that this person really did not belong here.
“It’s not that easy to wind up in the G-ER,” she said with exasperation when she returned and I gave her my take on Mr. Cook. “Did anything in his story not make sense to you?”
“A lot of little things were slightly off,” I admitted.
“Like what?” she asked.
“Well, this is New York. No one lends money to a neighbor, or leaves their apartment door open to let their dog wander in and out. I mean, maybe if he was romantically interested in her, but he said she’s old, and
she must be a bit crazy, too, if she really threatened to stab him. And then there was the thing about the cat kidnapping. I mean, it’s possible …” I trailed off.
“But not likely,” finished T.
I thought aloud: “I’m finding that I work really hard to organize what patients tell me. I push the stuff that’s bizarre to the back of my mind and focus on what does make sense.”
“Why do you think you’re doing that?”
“If I let the stories not make sense, I feel off-kilter. It’s disorienting.”
“So you have a tiny taste of how psychosis might feel,” said T. “That’s good. You’re very empathic, exactly what we all need to be. Pay attention to how hard you’re working with any particular patient to organize their experience. It can be a signal to you of how disorganized their thought process is. Bring Mr. Cook back in.”
This time I found my patient just to the right of T.’s office, standing on his head. He righted himself and followed me back to the small room. When Dr. T. asked, he told us more about his life. He worked as a telemarketer. He had a college degree from an online university, though he’d spent his first two years of undergrad at Cornell. “You know what they say,” he told us, “the easiest Ivy to get into and the hardest to graduate from.” He’d gotten divorced because “we fought about money. Couples often fight about money.” His mother had died one year prior, and he told us calmly, “I went through the stages of grief.”
After he left, Dr. T. asked what I thought once again. I said, “He was behaving bizarrely when I went out to get him, standing on his head in the hall. It’s strange that he started at Cornell and finished at some Internet college. And he seems smart, but he works as a telemarketer.”
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