Weekends at Bellevue

by Julie Holland

  “Where do you think this comes from, this reluctance to ask for assistance?”

  “Oh, I know where it comes from already: my father,” I answer simply. “His whole shtick is to be strong, capable, self-sufficient. He doesn’t ask for help, and I have always tried to win his attention by being like him. Unconsciously, of course, at least initially.” I hope that Mary will like working with me. I am psychologically minded, forthcoming, chatty. I want her to like me, to see that I will be interesting, yet easy. I don’t want to be any trouble.

  “Although my mother is the one who always reminds me my first sentence when I was a toddler was ‘I do myself!’ I’ve always been independent. Actually, being the youngest of three kids, both my parents encouraged it. It made things easier for them.”

  I’ve only been here twenty minutes, and though it may be only superficial layers of examination, we’ve already discussed my mother and father, starting to blame them for my foibles. Typical shrinkage, I think. And, I’ve already wadded up two Kleenexes. By the end of my first session I’ve gone through six Kleenexes. Over the next three years, I will judge and categorize a session by how many tissues I use. I throw them into the woven wastebasket at the edge of the couch; they amass like empty beer cans in a college dorm. Dead soldiers. In the first few months, I average five a session. Then, as things die down and I get more comfortable being the patient, I plateau at around three. Toward the end of our work together, I will not cry at all.

  When I leave Mary’s office at the end of our first session, I literally feel lighter.

  “You’ve never had a therapist, huh? You’ve gone all this time keeping so much inside you. You’re carrying around an awful lot,” she says near the end.

  Lady, you don’t know the half of it.

  Fixing a Hole

  I’m a whistler, always have been. Every hospital I worked at—Temple, Mount Sinai, Bronx VA, and now here at Bellevue—I’m the doctor walking through the corridors tootling a lively tune. I whistle while I work, just like one of the seven dwarves. Doc. Or maybe Happy.

  When you’re the dad walking through the lobby with your empty car seat to take your new baby home, I’m the one smiling at you knowingly, congratulating you with a nod. And when you’re the dad crouching down in the AES waiting room, trying to explain to your son exactly where his mother has gone, and why she won’t be coming back, I’m the one who stops whistling and remembers where I am. I remind myself I can’t walk around here seeming so happy; it’s rude and unthinking, in front of the worried and the grieving, and they are everywhere.

  It’s a Sunday night in February 1997, and I’m on the inpatient unit, writing notes on the new admissions before I go down to CPEP to run the show. (This chore—how I began my shifts for the first year or two at Bellevue—was eventually reassigned to someone else.) I see familiar handwriting in one of the charts, meticulous capital letters. It’s Daniel from my residency at Mount Sinai. He’s at Bellevue now too, working upstairs on the wards while I’m downstairs in the CPEP. I’d heard he was working here. I haven’t seen him in a year or so, but I can visualize his perfectly parted hair and Hollywood smile. His comments in the patient’s medical record are punctuated by exclamation points. “The patient is now compliant with his medication!” “Patient states he is no longer suicidal!”

  I finish my own charting, sans exclamatory marks, and pop my head into the nurses’ lounge to say good-bye. Three women are listening to the radio; one of them tells me that some people have just been shot at the Empire State Building. We haven’t heard any trauma calls on the overhead PA system (usually the shrill operator instructs the trauma surgeons, the anesthesiologists, and the chaplain to report to the ER) and there have been no disaster bells sounding. It is my first year at Bellevue and I’ve yet to hear them ring. I wonder how many traumas would need to come into the ER before someone considers it a disaster?

  I decide to meander over to the medical ER to see if anyone needs a shrink, and get the usual jokes from the doctors and policemen about who they think needs my expertise, but the bottom line is they’ll call me when they need me. The shooting victims have indeed been brought to Bellevue, but the staff is still trying to sort out who’s who. There’s a gaggle of uniformed police and detectives wandering around, and also a good amount of blood, if you know where to look.

  I head back to the psych ER and get to work. I know I’m going to get called sooner or later to go over to the medical side to hold some hands, so I try to clean up the triage bin as best I can. Just as I’m thinking maybe they won’t need me, the social worker from the AES appears and asks me to come see the family of one of the shooting victims.

  A twenty-seven-year-old rock musician, Simon, has been shot in the head. He is in critical condition, undergoing neurosurgery. He had never been to the Empire State Building before today; he was just doing a favor for some friends visiting the city, taking them up to see the view. His timing coincided with that of a recent Palestinian immigrant equipped with a gun and a vendetta. Simon’s friend from Denmark, whose girlfriend just today told him that she is pregnant, came along with the group to the observation deck. He has been killed.

  The family has been placed in a separate waiting room down the hall from the ER. Some of them are sitting on the floor outside the door, some are pacing the hallway. Most of them are crying and holding each other, their sobs wracking their bodies. Simon’s two brothers with their girlfriends, an aunt and uncle, and his divorced mother and father with their respective new spouses are all waiting to hear word from the neurosurgeon. His roommates are there as well, some of whom were with him at the Empire State Building. One has witnessed the whole thing and is pretty shaken up.

  The most shaken is Simon’s mother.

  I watch her standing in front of a wall, wailing and pounding. “Please, God, just let him live. I’ll do anything.”

  I leave her with her supplicating grief and attempt to let the others know who I am and that I am there to help. “Lousy job you have,” jokes one. I try not to take offense, but end up getting defensive about my many roles at Bellevue including grief counseling. “We’re not here for grief counseling,” says the aunt angrily.

  Outside the room, in the hallway, Simon’s mother is quivering, saying to her younger son, “I’m not strong enough for this. I know you think I am, but I’m not.”

  The family and friends go out of their way to describe Simon to anyone who will listen, and to each other. I notice this eulogy theme as it continues into the night. Everyone wants to talk about how wonderful he is; no one talks about themselves and their pain, their fear. The other recurring theme is the guilt. “I almost went with them. Why wasn’t it me?” as opposed to the unspoken guilty relief, “Thank God it wasn’t me.”

  A father or stepfather wants to go outside for some air, and I show him how to get to the ambulance bay, walking past big drops of blood on the floor. I wonder if he assumes the blood is Simon’s. Perhaps it is the gunman’s, who turned the Beretta on himself after wounding nearly a dozen others. He is pronounced dead in our trauma slot a little after eleven p.m.

  There is a crowd of people gathering as I walk through the hallway to get back to CPEP. A buzz, a humming circles the crowd. It’s the mayor and his disaster squad, coming to lend their support to the victims and their families. Rudy Giuliani is always good about making an appearance wherever the action is. He shakes hands, smiles, offers comforting words to the patients and their loved ones. He vows to make the city safer. One thing I’ll say about Rudy, he may be a loose cannon, but he’s always great in a crisis. He can pull it together better than anyone, looking calm, concerned, and strong. He’s got the kind of personality that thrives when surrounded by chaos, naturally making people feel safer. The rest of America would see this side of him on 9/11.

  There is a rumor being murmured by some of the hospital police that the woman the mayor is having an affair with is here; she is part of his disaster team. I’ve read something about a mistres
s recently in the New York Post, and I crane my neck to see if anyone wearing the blue windbreakers with the yellow block letters looks like someone he might be with.

  Later in the night, I find out that Simon has survived the neurosurgery as well as the shooting. He has been very lucky in terms of the bullet’s trajectory, which missed many of his brain’s crucial structures. The neurosurgeon describes an entrance and exit wound above and anterior to each temple. I had assumed left to right, but the surgeon’s description is “in the right and out the left.” Entrance and exit wounds from bullets have a very different appearance, and I make a point of correcting my personal picture of the patient.

  So now he is going to live, just like his mother begged. When she was pounding against the wall, I remember thinking, Be careful what you wish for. I’ve worked with many brain-damaged patients, people in persistent vegetative states. I worry that she’ll be saddled with a son who requires total care to bathe, feed, and dress.

  The thing about ER work is that it is acute. I get a tiny, traumatic slice of someone’s life, and then that’s it. I rarely see the patient again. Occasionally I will hear updates about a patient’s condition—if it’s a serious case and I’ve made a connection with a doctor upstairs. In Simon’s case, I do hear through the grapevine that his family is visiting him regularly at the hospital, playing his band’s CD for him while he is in his coma. Later, I learn that Simon has regained consciousness. Plans are made to transfer him to a rehabilitation hospital.

  Twelve months later, Jeremy and I are sitting in front of our coffees at his neighborhood diner, when I see Simon’s brother in a booth nearby. I recognize him immediately from our time in the waiting room. We smile and exchange pleasantries, and it isn’t until he points out the bearded guy next to him who’s eating his eggs that I realize it’s the patient who was shot in the head, whom I never met. Simon nods at me nonchalantly and I don’t really get to analyze how good his speech is, or his social graces are, for that matter. I remark to the brother how it’s a miracle Simon’s up and around, and he smiles and nods in reply.

  Jeremy points out to me as we tuck into our own eggs, “The guy probably hears that word constantly. How it’s a miracle he survived.”

  “But taking a bullet to the head and living to tell the tale, that really is a miracle, Jer,” I try to convince him. “The only bigger miracle would be if our government could make it a little harder for a guy to buy a Beretta.”

  Knocking Around the Zoo

  I am up on 18 North again a few weeks later, writing notes on the new patients upstairs when I notice a large bouquet of flowers on the windowsill of the nurses’ station.

  “What’s with these?” I ask the Filipino nurse with the long, straight hair and the beautiful full lips. She is wearing denim overalls and she couldn’t look any sexier if she were posing in a men’s magazine. She’s having an affair with one of the moonlighters, but I don’t let on that I know anything about it, though he’s told nearly everyone.

  “They’re for Daniel. He passed his boards,” she explains. His written boards, I think to myself. His second time. I wonder if he peppered his answers with exclamation points. I know that he failed them on his first try, but I also know that this nurse doesn’t know that. Because he is an attending on an inpatient ward, he hasn’t told many people. I smile smugly to myself, having aced the written exam my first time out. Now I am preparing for the oral exam, which comes next, and is a killer. I guess he’ll take the orals after I do.

  “And you guys got him flowers…. That’s so sweet!” I say, in perfect insincerity. I think about what a killer schmoozer he is, how easily he manipulates women with that grin of his. The nurses must fall all over him up here.

  I finish my notes on the acute ward and head up to 19 West. I always save the prison ward for last. I get a testosterone rush out of standing in front of the prison gate, the bars thick with layers of glossy white paint.

  “On the gate!” I bellow. I have learned this is the way the guards announce that they need the door opened for them. I lift my Bellevue ID card up to where the guard in the booth can see it, and the gate is opened electronically, noisily. I enter a small area where the officers are supposed to unload their weapons into a sand-filled metal chamber. Here I am trapped, as I must wait for the gate behind me to close completely before the one in front of me can open. Once I am through the double-gated chamber, I am in another double-gated chamber, this time longer. At one end is the log book, in front of yet another gate that leads to the forensic psych ward. At the other end of the chamber is the forensic medicine and surgery ward, for the prisoners who need medical attention. The log book is for both wards, and those who sign in reflect the many disciplines of medicine at Bellevue: orthopedic surgery, neurology, infectious disease. I pen my name legibly and print PSYCHIATRY in capital block letters. I want to represent, yo!

  I am on 19 West this evening to speak to a man who has been getting a lot of press lately: a rather famous serial killer in New York City. After his recent arrest, he spent some time at Rikers Island, where it became clear to the prison psychiatrists that he was not right in the head. So they packed him up and shipped him off to us for a more thorough evaluation and one-to-one observation. He is a high profile case, and no one wants a bad outcome, thus a personal babysitter is assigned to keep an eye on him.

  Although the press have not yet caught wind of this, he tried to hang himself at Rikers. Also, I see in his chart that he is reporting hearing voices; the voices told him to kill his cell-mate. Smart move, on his part, to offer up this tidbit to the Rikers shrinks. Few things will make a doctor more nervous than being responsible for a life lost.

  I sit in the nurses’ station of the forensic unit with my feet up on the desk. The patient’s chart rests in my lap, while I munch on some stale cookies the nurses left lying around. One prisoner-patient after another comes over to the nurses’ station, asking if they can have some medicine. “Can I get something to help me sleep?” “Can I get something to calm me down?” “Are you here to see me, Doc? I got this rash.” I can’t stay here too long, I realize, because I’m starting to attract an audience. Once the patients know a doctor is on the unit, they come out of the woodwork, hoping to have their medications changed, or their privilege status upgraded, or just hoping for someone to spend some time listening.

  “I’m not here to see you guys, sorry,” I explain to the gathering group. “If you need a doctor, the nurse can page the moonlighter. I’m just here to write notes on the new patients.”

  The alleged serial killer has already made a full confession. I heard on the news that they found his diary detailing the killings. The press is saying he is suffering from a “degenerative brain disease,” whatever they think that is. If you ask me, if he’s writing it all down, some part of him knows that what he’s doing is terribly wrong. He is compelled to detail the killings because he needs to confess and be punished. Or else he has fetishized the experiences and wants them all meticulously documented. Either way, I’m hoping that between his confession and the diary, what I document in his chart won’t change his fate much.

  After reviewing his records, I muster up my courage to go search for the patient. I walk into the dayroom where there are two of “New York’s Boldest,” NYC Department of Corrections officers. I feel as if I’m walking into a room of caged animals; I can sense the energy level in the room amp up as I enter. Then the noises start, the catcalls, the whistling, and it reminds me of those scenes in movies when the scientist walks into her lab, into the room with the monkeys, and they all start to howl, jump, and rattle their cages.

  The D.O.C. guards create a barrier between me and the other men while I interview the now-famous man at a table in the dayroom. I really just have a couple of quick questions for him and then I am out of there. I’m not easily spooked, but the forensic psych unit at Bellevue pushes even my envelope.

  Wearing hospital pajamas, the prisoner is tall, thin, and bug-eyed. He is surpris
ingly focused, calm, and completely coherent. He is polite with me, and deferential in a way that I wasn’t expecting. Well-groomed, soft-spoken, he is happy to answer my questions. I could easily spend more time with him, take him somewhere more private to do a thorough evaluation, but it isn’t my job right now. I am only here to make sure he isn’t currently suicidal or homicidal, and to find out if he is still hallucinating. Regardless of what I learn, I won’t dare stop his one-to-one observation status. Although he is cooperative, he’s not chatty in the least. Moving to a different interview spot would’ve been a waste of time. He offers one-word answers to most of my questions.

  “Are you still hearing voices?” I ask.

  “No,” he answers.

  “What about the suicidal thoughts? Are you still having them?”

  “No.”

  “Are you thinking about hurting anyone else?” I ask. “Nope,” he answers simply.

  “Well, is there anything on your mind you’d like to talk about?” I inquire sweetly, cocking my head. Toss me a bone here, man. “No. I’m doing okay now,” he assures me, smiling. Great. I’ve got nothing.

  I’m not sure what to make of him. His eye contact is good, and he isn’t spewing a lot of crazy disorganized information, but he still seems a little off to me. It may just be that he isn’t very bright; according to his chart, he’s minimally educated, possibly even mildly retarded. I don’t have a lot to go on from the interview in determining whether he is truly psychotic or not. Denying everything doesn’t tell me much of anything. He could be grossly psychotic on the inside, but sealed-over and acting pretty together on the outside. Maybe that’s the way serial killers usually are.

  I’m just not sure how to describe his mental status in the chart, knowing it’s a legal document that will be pored over by prosecutors and public defenders alike.