Weekends at Bellevue

by Julie Holland

  “I wish I could just rewind my life by a year.”

  I imagine she’s thinking that maybe she should never have had the baby, but I don’t ask that, and she does not offer it up. “What about the father? The baby’s daddy?” I ask. “Where was he when this happened?”

  “He left me to go back to his girlfriend.” She finally starts to cry. She wipes her eyes with the back of her hand. “He already has a baby with her.”

  Now I need to shift gears, hoping if I change the subject, she’ll stop thinking about how her boyfriend left her and the baby to fend for themselves. Her tears began here, so I know this is a hot spot. I’m already convinced that if he had stayed around, the baby would still be alive, but it’s not my place to get into that with her. I don’t want her to fall apart on me now. I’m hoping I can send her out to be arraigned, and I’m worried if we keep talking about her boyfriend, she’s going to crumble.

  “I need to talk to someone who knows you, like a parent or a family member who can tell me a little bit about your medical history.” She gives me her father’s phone number and I call him to verify that she has no history of prior suicide attempts.

  “I am not saying anything to anyone until I speak to a lawyer,” he barks.

  He’s probably already been on the phone with the police, or the DA’s office, or both. Maybe he’s being hounded by reporters already; I’m not sure how quickly the press catches wind of a story like this.

  “Sir, I understand your situation, but I am her doctor right now. I’m not a prosecutor. My purpose here is to make sure she’s not in any danger. Can you at least verify that she has no history of self-harm?”

  “I’m not telling you anything until I talk to a lawyer … but … if you are her doctor, could you maybe give her something to calm her down?” He has no idea how calm she is, relatively speaking.

  Then I hand her the phone so she can talk to her dad. I’m not supposed to let prisoners use the phone, but I don’t stop to think too much about this. There’s some part of me who wants to see the little scared girl talking to her daddy, to see if she’ll be comforted or criticized. She is holding the phone but can no longer get out any words. She listens to her dad and nods her head, her body heaving as she clutches the phone, her voice quivering as she tries to slow down her breathing enough to tell him that she’s okay.

  I take the phone from her hands, and I find her a box of tissues. I ask the nurses to give her some Ativan, an oral sedative, and I quickly complete the paperwork that will allow her to leave with the detectives. She needs to be fingerprinted, photographed, and arraigned. My time with her is over.

  I walk out to the nondetainable area to make sure she has gotten her medication and that the police have their paperwork for the judge. The detectives look sharp; they’re wearing suits and ties. I am used to seeing blue-uniformed officers in the ER, but these guys came from the station where the questioning had been, and not from the street.

  “You boys look pretty dapper this evening,” I comment.

  “Sure,” one of them says, “we’re going to be in the paper tomorrow.”

  The next morning, as I sift through the newspapers at Starbucks, I see a picture of the three of them, the two detectives and my patient, in the New York Post.

  They are all smiling.

  Come Together

  I think of my job as a psychiatrist as being, in many ways, a seduction. Getting the patient to align with me is a major part of what I do in the ER. I use my feminine wiles to have my way with the patients, convincing them that what I have to offer is valid, or at least attractive, and that they can trust me. Sometimes, I can talk a patient down, lulling him enough to avoid getting restrained. Other times, I will sit across from him almost as if on a date, inviting him to open up and tell me about himself. My endgame is for him to divulge what is really going on, where it hurts, and to admit that he needs help.

  My powers of persuasion come in handy out front, too, in the non-detainable area, when the patients are first brought to the CPEP by the NYPD or EMS. I aim to be as enticing to the cops as a doughnut. I feel like I keep Bellevue in business by encouraging these guys to come around again and again. Flirting at my job is my pleasure and my prerogative. Everyone seems happy to join in. Being around ambulance workers and policemen, there’s this heady mix of testosterone and adrenaline, and I feel fine.

  This kind of male-dominated scenario reminds me of med school, my third-year surgery rotation: It was summer in Philadelphia and humid. We were turgid, sweating animals, jockeying for sexual position among ourselves, rubbing up against each other in the OR, the ER, and the call-rooms. The ratio worked in my favor: There was basically a gaggle of good-looking guys in loose-fitting scrubs, and there was me. All of the surgeons were men a little older than I was, some married, some single, but, as far as I could tell, they were all horny. The flirting and sexual innuendos were nonstop.

  We were in the OR; I got to scrub in on an emergency appendectomy. I held the plastic vacuum tube in the body cavity to collect the draining blood. The third-year resident told me, “Suck.” I moved the suction tube to where he pointed, where fresh blood was pooling. “That’s good, now suck here. She’s quite talented at this, isn’t she, doctor?” he joked to the second-year resident. I was humiliated, blushing, but still, I was excited that they found me attractive enough to make sexual jokes. Later, the surgical residents paged me out of a sound sleep to come to the ER, and when I got there, they were telling me how to put a catheter in a man’s penis, laughing while they instructed me to “Hold it like it’s your own. Yeah, grab it like you mean it!”

  They killed me, these guys. Maybe not individually, but as a group, they had it all: smarts, humor, balls, looks. It was mostly a question of which one to pick. I’d made a bet with a girlfriend of mine, another third-year who’d also started off with surgery, to see who could have sex with a resident in a call-room first. It was a competition I intended to win.

  I was in a service elevator, alone with my senior resident, as he explained how to place a central line in a patient. This is a procedure involving sliding a needle under the clavicle, the horizontal bone at the top of the chest. He told me how to puncture the subclavian artery, as he slowly, gently touched my shoulder, sliding his fingers along the length of my clavicle, his palm edging closer to my breast, his face pressed to mine, smiling slyly, not shyly, while his hands were busy working overtime. It was three in the morning and we were wearing scrubs, which pretty much felt like we were staying up all night wearing pajamas. The Temple scrubs were a faded shade of maroon, of blood, worn down by years of industrial-strength laundering, and they felt smooth and soft against our skin. There were only two paper-thin layers of material between our two bodies, making it oh-so-painfully obvious that he was as aroused as I. The urge to grind my pulsing pelvis right up against his was nearly overpowering, but he continued to explain central line placement. Did he think I was paying attention to what he was saying? Did he think there was any blood left in my brain?

  The surgeons and I spent July and August together, sleeping in the call-rooms or working all night and greeting the dawn. That’s one of the things I’ll never forget about that summer. Few surgeons on call ever see the sun going down, but oh, those sunrises! In the early mornings of my overnights, whether I was in the ER, or the surgeon’s lounge finishing up from the OR, or the intensive care units of the hospital, more than once I managed to catch a glimpse out of some east-facing window of a spectacular, honeyed mango and papaya sunrise. No matter what mayhem went on the night before, no matter how many people were shot or stabbed or died in a car crash, and no matter what psychological trauma their families were buried under, the sun would rise gloriously the next day. I remember gazing out those windows, marveling at the impassivity of the universe: The cycle continued, bar nothing.

  The summer went by in a flash, and my own cycle continued: sex, death, sunrise, sex, death, sunrise. I was totally sleep-deprived, buzzing electric. With
the surging adrenaline of the ER traumas, the resulting emergency surgeries, and me encircled by men all summer long, by the end of it I was in a permanent state of arousal. The whole idea of surgery was now so charged with sexual tension, I reflexively lubricated at the sight of surgical scrubs.

  Over the next two years of my clinical rotations, I slept with an orthopedic surgeon who had pierced his own nipples, I bedded two attendings during one ER rotation, and I had a steamy affair with a married neurosurgeon. Scrubs, scrubs, scrubs, scrubs. Just like a trained animal, if I saw a pair, I could not help but become aroused.

  The whole Pavlovian conditioning persists throughout my time at Bellevue as well. Guys I would never look at twice cause me to salivate if they’re in scrubs. The white coat does nothing for me, but put a man in a pair of reversible cotton pants that tie around the waist, and I am all his.

  I am hanging out in the CPEP; it’s not very busy, and Paul, one of the doctors from the medical ER, has come over to do some physicals on our admitted patients so they can go upstairs to the units. It’s about one in the morning and he seems to be in no hurry to return to the AES. He sits down to chat with me and tells me a story about how they got a bunch of cops in the ER after the Million Man March in Harlem. The police were spraying mace into the crowd, but the wind blew it back in their faces and most of them had to seek medical attention. After a bit of back-and-forth banter, he yawns and stretches his arms. As they go over his head, I see his plaid boxers peeking over the edge of his aqua scrubs, the hair from his umbilicus to his pubis exposed.

  “Don’t do that!” I shriek. “What are you trying to do to me?”

  He looks confused, and I attempt to explain. “Those boxers, your scrubs, that happy trail. You’re killing me!”

  A huge grin spreads over his face. He is married; I have a boyfriend. But I have admitted to him that I am turned on by him, and he is pleased as punch.

  He thinks he does it for me, and I’ll have to let his assumption stand unchallenged. I don’t have the heart to tell him it’s his pants.

  You Can’t Do That

  Even though we’ve started to peel away the layers of my sadism like an onion, my behavior is slow to change. Despite Mary’s best efforts, one Monday afternoon in her office, I have a story to tell that suggests I still have a long way to go.

  The previous night a prisoner had come in as a transfer from Columbia Presbyterian, after threatening the medical ER doc there. He’d been arrested for extortion, robbery, and assault, and taken to Columbia because of a large cut on his right hand incurred during the assault. A laceration needs to be sutured within nine hours usually, and since he had refused medical attention at Columbia—hence the threat to the ER doc—he was now working on twelve. I went to talk to him in the locked area, to see if I could schmooze him into having his hand looked at. I was ready for a really nasty, help-rejecting patient, but when he finally rolled in, he was actually calm and pleasant. He had no psychiatric history, denied all the usual symptoms like auditory hallucinations or suicidal ideation, and denied any substance abuse besides alcohol. When I asked how often he got into fights, he said, “Whenever I can,” with a smirk.

  He was initially friendly with me, complimenting me, acting sort of sexy and ultracasual. He let me examine his hand, and he accepted my recommendation to let the hand surgeons take a look. I figured we were good to go. I decided to medicate him with a mild anti-anxiety medicine so he would stay calmer for their exam. I knew the surgeons wouldn’t put up with any attitude or ambivalence; they’d just write in the chart that the guy refused treatment and that’d be the end of it. (The surgeons hate to come down to the CPEP. They’re just like everyone else that way.) After I spoke with the hand surgeon and got him to agree to come down, the patient changed his mind, and decided that he didn’t want anyone to touch his hand.

  I got really pissed off then. I argued with him for a while and got nowhere, and then I called him a pussy.

  “You know what, sister? When I get out of these handcuffs, I’m gonna come back to this hospital and kick the shit out of you. That’s what you need and I know it. I know where to find you, you fucking cunt.”

  “That’s Doctor Cunt to you, you fucking weasel,” I said as I stood in front of his locked wheelchair. “You’re just chickenshit to have the surgeons sew your hand.” I ridiculously believed I could double-dog dare him into having sutures. He was handcuffed to the chair, and as he tried to get out and lunge at me, I flinched and walked quickly into the nurses’ station. As soon as I got in and shut the door, Chuck, the nurse in charge for the night, looked at me and grinned. “Oh, yeah, that was real professional.”

  Mary and I have talked a lot about my need for self-control. I am mortified to have to convey this story to her. It’s a painful but necessary part of my therapy.

  “Look, I know that it’s never okay to talk to a patient like that. There’s no excuse for acting like I did. I know it’s horrible.”

  “Go on,” she encourages.

  I skillfully skirt the whole issue of sadism, but let her know I know it’s there. “It’s not just sadistic, it’s masochistic. I could’ve gotten killed.”

  “I don’t doubt that. But what do you think was going on?” Mary asks.

  “One thing I’ve noticed: All of these guys that I do this with, they’re all in cuffs. Lucy and I have talked about this. Give us a man in shackles and we try to push him around. We sort of get in his face and poke him in the chest—metaphorically, I mean. Or maybe literally. I never taunt anyone who’s in hospital restraints. It’s just the cuffs. Maybe it’s something about his being an acknowledged dangerous person, like sticking my head in a lion’s mouth? Did Lucy ever talk to you about this?”

  “You know I can’t answer that,” Mary says.

  “Oh yeah, of course I do,” I assent. I can never forget that Lucy was Mary’s patient, but I do conveniently omit that she can’t discuss any of their treatment. It’s frustrating to me and probably to her, too. Mary could probably offer me some answers ahead of schedule, tidbits she’s figured out in her work with Lucy, but she can’t. I wonder if she gets bored hearing it all over again, groaning to herself, Oh, please. Here we go again with the butch taunting of the prisoners.

  “Well, one thing that might be related to the cuffs is that these guys are the ones most visibly locked up. I know I have a big issue with having the keys to the unit. I’m the one who has the power and the freedom, and the patients are the ones who’re locked in. I feel horrible about it, but I end up turning that off … doing a one-eighty. I turn my guilt into something else. Something mean.

  “When I first started working in psychiatry, the keys, the patients being locked in, it really got to me. At Sinai, one of the hardest things for me in the beginning was leaving the patients on the ward over the weekends. I would walk out on Friday, locking the door behind me as I left, and all the patients would stay locked up all weekend long. I’d come back on Monday morning, after biking in the park, going to a movie, a concert, whatever, and there they’d be, as if nothing had changed: all of them on the ward just as I left them. Like reading a book, closing it for the night, and when I pick it up to read it later, all the characters would be right there waiting for me.”

  “And how does this translate into you feeling guilty?” she prods.

  “Well, I guess it’s really about freedom. How I have the freedom to run around the city, go Rollerblading, lie in the grass sunbathing in the park, and the patients are locked up all weekend long like caged animals. It doesn’t seem fair.” I pause, thinking about what I said. “So … the keys. Having the keys is a big deal. I have the means of coming and going, of leaving the ward. Oh, you’ll love this: When I was a resident at Sinai, doing a rotation at the Bronx VA, this huge patient, who was kind of simple, but I had a real love for him—I called him Uncle Louie ‘cause he reminded me of my great uncle—he tried to choke me at the door. He was trying to escape and I was trying to shut the door and lock it, and he c
hoked me with my own keys. They were on this long necklace, made out of some heavy string, like a shoelace, along with my hospital ID.”

  “What happened?” she asks, the concern in her voice revealing a maternal, protective tone that I can’t help but savor for a moment.

  “The nurses and psych techs wrestled him off me. They heard me making this kind of choking, gurgling sound, and came running. As they pulled him off me, I remember feeling weakened, broken. I couldn’t understand why nice old Uncle Louie would do that to me. I think I probably sank to the floor, my back against the door, guiltily watching the restraint and sedation that followed. That’s how they did it, you know? There was no discussion or anything.”

  “Wow.”

  “Yeah, so, ever since then I don’t wear keys around my neck, and I encourage the residents and medical students not to also. I keep my keys in my pocket. There are plenty of things a patient can use to hurt you, but the keys around my neck seemed terribly symbolic to me, right? It made me feel like I shouldn’t be dangling them in front of everyone’s faces, like the jailer with his jangling keys to the cells. Or the zookeeper.”

  “Well, the thing that seems interesting to me is that this is a major part of your job in the psych ER, though. Plenty of locked doors, different keys, security guards, prisoners, am I right?”

  “Right. It’s a locked unit. Actually, all the psych units I’ve ever worked on have been locked units. It’s been an issue from the very beginning: who stays in, who’s allowed to leave. I think I’ve always had guilt about being the one with the keys, the one who can leave. I have zookeeper guilt.”

  She’s not laughing.

  “But now, at my new job, it’s more than that. Before, when I was a resident, I could blame it on the doctor in charge. Now, I’m in charge. I’m deciding who can go and who can’t. I am the one locking these people in.”