“Yes, ma’am. The patient states that he kicked her in the leg.”
This seems like a pretty formal inquisition for one kick in the leg. “This has nothing to do with the letter I wrote? Complaining about him sleeping at his post?” I ask. I want his union rep to know that I’m not the best person to call in as a character witness in his case. But it’s too late. Rocky is looking relieved, like they don’t have any proof of whatever it is he did if I don’t condemn him.
I suppose it’s better if Rocky thinks I’ve helped him instead of focusing on my letter. I already got Martin fired; I don’t want to get anyone else pissed off at me. Rocky and I will be working together for years to come, and I need him to watch my back. Fortunately, we will be relocating the CPEP to a new wing of the hospital in a few months. The call-rooms will be across the hall in a separate locked area. I won’t care if Rocky is sleeping while I am, as long as there are two locked doors separating me from the detainable area.
Mama Told Me Not to Come
Sunday night in late fall, it’s Chuck’s birthday, and also the eve of mine. We begin a tradition of celebrating our birthdays together when we work the same weekend. I have made a fudge-marble layer cake with mocha frosting. (The secret ingredient is an extra packet of vanilla pudding added to the cake mix.) We light the candles around midnight, each singing to the other, surrounded by nurses and psych techs. We stand on either side of the cake as we hold the plate, blowing the candles out when our song ends.
Our singing is halfhearted, and we certainly can’t compare with the crooning female patient EMS has just brought in, wrapped in a body bag. The NYC body bags are made of canvas and mesh; they are navy blue, and look like fashionable, oversized totes. These Velcro devices quickly turn an agitated and unmanageable person into a piece of luggage. When the patient is horizontal and wrapped up in the bag, there are sturdy straps that make it easier to heave him onto a stretcher. There is a peroxide-blond woman sitting in the nondetainable area and I assume she is a patient waiting to be seen, but I soon discover that she is one of the EMS workers. Along with two cops and her partner, she parades the new patient over to the triage nurse. The patient in the body bag is a woman in her thirties with long, curly hair and a strident voice. She is singing various songs at the top of her lungs, the best of which is “Mama Told Me Not to Come” by Three Dog Night. She doesn’t want to be here; her mama said there’d be days like this.
She calls everyone “babe,” in a casual, yet demeaning tone. It’s her way of equalizing the power structure, I figure. She is naked and immobilized in the blue canvas restraint, amid a room full of people in uniforms. I’d be calling everybody “babe,” too.
“What’s with the body burrito?” I ask the cop.
His eyes crinkle at my joke as the EMS driver steps in to give me the rundown. “Her landlord called 911 after her tub overfilled and damaged the apartment below hers. He also said she was blasting her music and that she was naked out on the fire escape.” It’s frigid outside, so I have to factor that in. The driver continues, “When the cops came, she started singing the lyrics to the Stevie Nicks album she was listening to, and jumped into and out of the tub. Then she pulled out a pipe and attempted to smoke something in front of the police, offering to share.”
The blond EMS driver jokes with me about how she’s as crazy as the patients, as I nod and smile nervously back at her. She tells me that before she worked for EMS, she used to be a belly dancer who once garnered an offer of a million dollars from some visiting Saudis to dance for them privately. She turned them down.
“Is that the crazy part?” I ask.
Whenever I try to talk to my new patient, explaining where she is and what will happen next, she sings so loudly that I can’t get a word in edgewise. I finally give up and write the medication orders for sedation, filling out the paperwork for a 9.39. There is a lull afterwards, and I start to gather up my belongings to head to my office when two New York City policemen roll in an arrested man, who is yelling, “You got the wrong guy!” repeatedly.
“You guys unloaded?” I ask the cops. It’s practically my standard greeting with NYPD. They have to unload their weapons before entering CPEP. I wonder if they resent the hospital policy. Maybe it’s uncomfortable for them to be carrying useless guns. Maybe it’s even more awkward when I confront them with their impotence; it somehow calls their manhood into question.
“Yes, ma’am,” they both reply.
“What’d you bring me?” I ask the younger-looking one.
“Male black, twenty-nine, arrested for drug possession with intent to distribute.” The cops always talk backwards, Male Black, Female Hispanic. No one else presents cases this way. “When he got arraigned, he started screaming, telling off the judge, and then he went back into his cell and trashed the place. The judge wants him here.” The cop grins. “We shouldn’t get all the fun, right?”
“They sent him to Bellevue as if there’s something psychiatrically wrong with this guy? He’s just acting up, right? Is he saying anything crazy?”
“Not crazy, but he’s pretty threatening.”
The prisoner taunts the police, his chin jutted out while he howls, “I … HAVE … A … RAZOR! It’s hidden on me. You’re never gonna find it. I’ll pull it out later and cut all your faces.”
As he is being searched, his pockets emptied one by one, he shrieks at the police, “It’s not in my pants! Don’t cut my pants! I hid it up my ass! I’m gonna pull it out later and I will fuck you up. I swear on my dead mother that I’ll do it.”
“Chuck, we need to five and four this guy,” I say, meaning 5 mg of Haldol and 4 mg of Ativan. Two fairly large doses, but I’m guessing that’s what we’ll need to put him down. It takes every staff member we have, all the NYPD cops and all the hospital police in the area to hold the patient down while Chuck injects the medication into his gluteus muscle. He could’ve just injected it into his arm, but I’m thinking, Maybe he feels like playing hardball? It’s his birthday, too, so I let it go.
The patient is boiling mad now. “I’m gonna fuck you up with that razor, just like you fucked me up with that needle. I’m gonna cut all o’ you … fuck you up good.”
“Sir, if you keep telling us you have a razor hidden inside you, we’re going to have to search you there as well,” I say, balancing sounding polite with seeming menacing.
“I’m gonna sue the hospital. You can’t Abner Louima me! My family’s gonna sue your asses,” he threatens.
I look to Chuck, who motions with his head toward the guy. “I guess you gotta check him, Doc.”
I’ve done rectal exams aplenty in medical school. If he needs to be checked, I certainly know how to do it. “Okay, you guys, anybody here do yoga? You know the plow position?” The cops look at me quizzically, and I explain what we’re going to do. “Flip his legs up over his head so I can get to his ass.”
The patient becomes silent and passive, for reasons I can’t begin to imagine, as we guide his legs, his pants around his ankles, up over his head. I put on a pair of gloves and opt to do without the Surgilube, which typically would help to lubricate a gloved finger into the rectum on a normal exam. I have no idea if there’s any lube in the CPEP, and I don’t have time to go hunting it down.
But it’s more than that. I’m surrounded by six tough guys, and I’m trying to act like one too, getting caught up in their game. I might as well be grabbing my crotch, swearing, spitting, and talking about sports. The posturing that men do, the armor that they wear … they do it to protect their hearts, and their balls. With their phallic guns, bullets, and missiles, they aim to be the penetrators, not the penetrated. Stupidly, I want to be like them. I slip into my butch mode so I can fit in.
As my finger pushes haltingly inside his warm body, it occurs to me that if he does have a razor up his ass, I could well get my finger sliced.
“No razor,” I tell Chuck, relieved. I turn to the cops and say flippantly, “He’s clean, so to speak.” I strip the g
love off, flipping it inside out with a snap, and walk into the nurses’ station.
“He’s got no psych history, he doesn’t appear psychotic, and he’s not disorganized. We’ll put him on Hold and send him back to NYPD when he calms down a little,” I say to my imaginary audience as I grab his chart off the rack.
I am at home the next day when Lucy calls me. “Hey, Jules. You know that prisoner you put on Hold last night? Right after morning rounds, they found a razor on his stretcher by his head. He was sleeping, so they just tossed it, but he really could’ve cut somebody up.”
“Are you sure?” I ask. “I searched him, Lucy! He was telling everyone how he had a razor hidden up his ass. I personally stuck my finger up that guy’s butt. There was no razor.”
“Are you nuts? What did you do that for? Jesus, Julie, what if he did have a razor up his ass? You could’ve cut your finger to bits!”
I can’t explain it, of course. What came over me? Why stoop to his level? Why be so sadistic? But I expect Lucy, of all people, to understand me. Her immediate reaction lets me know that I’ve stepped over the line. I am shamed, and worst of all, he clearly did have a razor hidden somewhere, and I missed it. Where the hell was it?
“I don’t know what to tell you, Luce. I guess this place is just getting to me or something.”
“Julie,” she says in her charming Southern accent, “I’ll tell you what I’m going to do. I’m going to consult our friendly CPEP Bible on this one. We’ll let the good word of the Lord tell us how you should’ve handled this guy.” She opens the copy of the New Testament which has been hanging around the bookshelf in the nurses’ station for the past few weeks.
“I’ve been using the New Testament like the I Ching recently, and it hasn’t let me down yet. I’m going to pick a random verse from the book, and that will give us holy, divine guidance on what to do with this sort of patient. Okay, here we go.” She reads the verse into the phone:
“Away with such a fellow from the earth, for he is not fit to live.”
Acts 22, Chapter 22, Verse 22
“Well! I guess now we have our answer,” she hoots. I am amazed. The Bible. Yet there’s no “Turn the other cheek,” no “Love thy neighbor as thyself.”
“All right, then,” I say. “I guess that’s that.”
“Yep. That is that.”
“But Luce, seriously. Think about what I did.”
“Don’t worry about it, baby. We all go there at some point. Well, you and I go there, anyway. Remember the time I totally attacked that patient who was being a dick to everybody? And how Chuck had to pull me off him?”
“How can I forget?” I say. “Between you and Chuck, I’ve heard about it enough times.” I’m probably a little jealous: When Chuck tells how Lucy manhandled the guy, his eyes mist over at the memory. Instead of proving our manhood to our fathers, now Lucy and I are unconsciously using Chuck to judge the competition. Lucy is winning. “Anyway, I’m sorry about the razor. I truly have no idea how it got by me.”
“No harm, no foul, right?” says Lucy.
“Right. No one was hurt. You letting that guy go or what?”
“It’s already taken care of,” she chirps. “He is O.T.D.”
Out the door. Good. “Back to the cops?” I ask, though I know the answer. He’s an arrested prisoner. There’s nowhere else he could go.
It’s just that I don’t want to hang up the phone yet. I always love talking to Lucy. Her down-home drawl envelops me, like a mint-julep blanket.
“Hell yeah! You think I’m gonna let the razor man back onto the street?” she crows. “Hey, Julie.”
“Yeah?”
“Happy birthday, girl.”
“Thanks, pal.”
The Wind Cries Mary
After our Thursday morning faculty meeting, I’m hanging out with Lucy in her call-room down the hall from the CPEP. In her cramped office is a small bed beside a chair and desk, a telephone and reading lamp on its edge.
I need to talk with her about what happened with the razor man. I’m worried about my level of sadism, how quickly I can transform from Dorothy to the Wicked Witch.
“I went through the same thing when I first got here. Eventually it settles down, you find your pacing. Talking about it helps. I’ve got a great shrink for you if you want. I know she’s got an opening ‘cause I just wrapped up with her.” She writes the number of her therapist down for me on a rectangular Post-it note, emblazoned with the name of a new antipsychotic drug, courtesy of one of the many visiting drug reps.
My new therapist’s name, written in Lucy’s commanding capital letters, is Mary Shears. Lucy is handing me a savior named Mary. Mother of God. That’s gotta be a good sign, right? From a psychotherapeutic point of view, it will be easier for me to have the corrective emotional experience of a caring and articulate mother if she’s got the ultimate maternal name. The Shears part triggers images of gardening, pruning, weeding—the next best thing to a machete, which might be preferable for hacking through my psychic jungle. And how does her garden grow, I wonder?
“What’s she like?” I ask Lucy. “Typhoid Mary? Is she quite contrary?”
“Ha! Not! You’ll totally dig her. She’s smart, and she’s straightforward. She’s a lot like you and me, only she’s more patient, more thorough. Just as blunt, but not quite as harsh. She gets me. She’ll get you, too, just call her. It’ll really make a difference, you’ll see.”
“I’m all over it,” I assure her. “I promised myself once the dust settled here I’d start psychotherapy.” I’m trying to sound professional so Lucy will think I’m just going to see Dr. Shears because most psychiatrists should be on a couch at some point in their training. It’s pro forma. I’m an attending now, and it’s high time I join the fold. I really don’t have anything wrong with me; I’m perfectly fine, perfectly sane, perfectly happy and well-adjusted. That’s my story and I’m sticking to it.
If I know one thing, it’s this: If I’m going to stay at Bellevue, I’ll need to be in therapy to keep myself mentally healthy. I need something like a mirror to help me see how I’m doing. A self-reflecting doctor is a healthy doctor. I want Lucy to know that I understand that.
It is a Monday afternoon when Mary Shears returns my call. She is chewing something while we speak, crunching away right into the phone. I assume it’s her lunch break and she has limited time to return phone calls before her next patient comes in. I forgive her this transgression, though I think it’s odd that she doesn’t acknowledge it and apologize.
“I got your number from Lucy,” I explain. “I’m a friend of hers at Bellevue. A colleague.”
“Uh-huh,” she states, between swallows. I guess she wants me to go on.
“Well, I’ve never been in therapy before, that is, not any real therapy. I saw a therapist for a few months when I was sixteen. Anyway, I know that every psychiatrist should go through therapy at some point.” I’m yammering nervously. I know she doesn’t need to hear this now. She only needs to set up a time for an appointment. “So … I guess I’m looking for a therapist,” I finally say.
“Okay,” she says slowly. Maybe she is wiping her mouth? Does she have salad dressing on her chin? “I can see you next Monday, would that work for you? How’s four o’clock?”
“Monday at four works great for me,” I say gratefully. This will become my regular therapy slot for the next three years, the perfect time and place to reflect on my weekends at Bellevue. I need a place to unload and process all I have seen, the criminals and the crazies, and I need help understanding my cool, icy response to it all.
When I finally meet Mary at her office, a mere ten blocks from my apartment, she doesn’t seem like the eating-on-the-phone type. She looks more refined, wearing a beige linen suit. She gets up to shake my hand, offers me a seat, and my eyes quickly scan the room to glean more about her. Her office is well-appointed. The predominant colors are earth tones. Like her suit, everything is a neutral shade of tan or brown: leather couch and ch
airs, woven throw rugs and wall-hangings, African sculptures and trinkets. I assume she is a world-traveler, bringing back proof of her adventures to adorn her end tables and walls. Her brown pocketbook is oversized, lying open on the windowsill. I see her car keys with multiple key chains and grocery tags, and guess that she drives to her office from the suburbs. She has the requisite books and journals lining the bookcases, but they do not dominate the room. Also, she has chosen not to display any diplomas or certificates.
Her hair is short and has some gray strands here and there. I’m glad she doesn’t dye her hair. I have a friend in therapy who is wigged out by the frequent changes of her shrink’s hairstyles and colors. How unsettling that must be, prompting the question: How is she supposed to help me when she can’t even get comfortable with her own hair? Mary is wearing earrings that are small, and they are not dangling. Everything about her and her office is classy, tailored, understated. I like that about her immediately. Her voice is assured and low pitched.
“So, how can I help you?” she invites me to unload, and it doesn’t take much more than that to open the floodgates. Just the act of being in a psychotherapist’s office, sitting on the couch, has me feeling vulnerable, shaky, and weepy.
“I hate asking for help. I hate needing help. I don’t need any help, actually. But I know I should undergo therapy because I’m a psychiatrist. I know it will help me to be a better doctor if I can get a handle on what my issues are, so I won’t project my garbage onto the patient.” This is a common understanding in psychiatry. If you are not in touch with your own trigger points, your own hot spots, you will seek them out in your patients, assigning more weight to their issues than may be appropriate. Or you will diagnose all your patients with the same label you have given your sister or your mother or they have given you. Projection is everywhere in human behavior, a common defense, but it is never appropriate for psychiatrists to project their pathology onto their patients.
Weekends at Bellevue Page 8
