Weekends at Bellevue

by Julie Holland

  “And?”

  “And … hello? I feel guilty! I hate the responsibility. I don’t want to be the bad guy. You know what else, I never wear the white coat. It’s too authoritative. It just feels wrong to me.”

  “Well, as far as the guilt goes, I think it’s all in the way you frame it, Julie. If you’re helping these people, if they’re getting medicine, and the medical attention they need, doesn’t that help to assuage the guilt?”

  “It should, yes. But … so … why was I such a bitch to this guy? The thing that gets me, that I can’t let go of, is that he said yes at first. I thought I’d won him over and he was going to play ball. Then, when I get everything organized, the surgeon’s coming, the patient’s medicated, he changes his mind. It was infuriating. I thought I had an alliance with the patient. We’re on the same page. But why do I take it so personally when he changes his mind?”

  “Do you think you felt betrayed, on some level?” suggests Mary.

  “But how can I feel so betrayed by a man I don’t even know? Who’s a known criminal, probably a sociopath? There’s a narcissistic element at play here too, don’t you think? Like, I thought I was special, I could tame the lion that no one else could. And him changing his mind makes me look bad to the surgeons, like I can’t control my patient.”

  “I have a feeling if this prisoner was waiting for a consult from an endocrinologist we wouldn’t be having this conversation,” Mary says astutely.

  “You’re all over it, Mary, as usual. I’ll always have a thing for those guys. There’s something about me prepping him for the surgeons, like I’m part of the surgical team. They don’t want their time wasted, and I don’t want to be seen as the one who dropped the ball. But the other important thing is that our interaction started out very casually, and flirty. You know that’s something I do at my job a lot, I flirt. And it usually works. The guy thinks if we were at a bar instead of the ER, I’d probably give him my number, so he agrees to whatever I’m asking. But here, he was going to play it my way, and then he turned on me, somehow. It’s almost like being rejected sexually, too, not just in a doctor-patient framework, y’know? It’s like I got shot down. I think that’s why I exploded so much more than usual.”

  “You think we need to talk more about that? That you flirt at work?” Mary asks.

  “Yeah, we definitely do. I need to understand it better. I know it has something to do with blurring the boundaries, changing the roles of doctor and patient. I guess that’s something else I do to even out the power imbalance. Like when I was a resident, and even when I first started at Bellevue, I used to sit on the floor with the patients and interview them there.”

  “Why on earth would you do that?”

  “Same reason: to even things out. To show the patient I’m down with them, man! I’m on their level. I’m cool.”

  “So, how cool were you last night?”

  “Touché. Not so much.”

  “Right.”

  It’s getting near the end of the session. I can tell by the way her “right” hangs in the air. She’s not starting a new thread for me to take up.

  There is precious little instant gratification going on in this office. Becoming self-aware, making changes in behavior, these things take time. The knots may be loosening, but nothing will be untangled today.

  I leave her office wordlessly.

  The Letter

  I arrive for my shift on Saturday night and check my mailbox, which typically houses junk mail from pharmaceutical companies or medical journals. Tonight a personal letter is in my slot, postmarked May 12 from Philadelphia. The address on the envelope is handwritten to me at Bellevue and includes the correct zip code, my full name, and two different ways to refer to my department: CPEP and Psych ER. Whoever wrote this clearly wanted it to reach me, but there is no return address. I assume it has come from a patient who spent some time here recently. It is a rare event to receive a thank-you note, but it does happen.

  Inside the envelope is a condom wrapped in a blank piece of paper. The condom is enormous, the biggest I’ve ever seen. On another piece of paper, similarly folded into thirds, is a laser-printed note:

  Julie Whore:

  Take a dildo, this divine f.l. and fuck #1 your fucking cunt, #2 your stupid ass, #3 your fucking mouth, #4 your fucking tits & finish off by fucking your stinking pussie.

  The coksman.

  I bring it into the CPEP and show it to some of the residents and medical students, and we deduce the following: The guy’s not much of a speller, and f.l. means French letter, a term I had never heard. One of the doctors mentions that Elvis sang about it once, and it referred to a condom. (Later, Jeremy explains that it was Elvis Costello. I had assumed it was The King.) How this particular condom has been made divine I don’t even want to imagine.

  On Monday morning, I bring the envelope and its enclosures to the NYPD, who give me a case number but don’t want to read the letter or keep it for evidence. Perhaps I am naive to think that anyone would want to try to track down the sender, but I feel like it should be kept somewhere safe in case some sociopath comes after me. I give a Xeroxed copy to the head of hospital security at Bellevue the following Monday morning.

  “If you find me chopped up in little pieces, maybe this will help you solve the puzzle,” I joke. I then remember that, a few years back, a pregnant pathologist was strangled upstairs late at night by a homeless man who was living in the boiler room of the hospital. Maybe the head of security won’t think my joke is that funny.

  The day I got the letter, Jeremy had told me that he was worried about me at the hospital. It was a Saturday afternoon, and we were in Central Park when I ran into a schizophrenic I knew from my years at Mount Sinai. I couldn’t remember his name fast enough, and so I squeezed his arm and said hello. He walked on for a few steps, turned around, and then shouted at me, “Little girl! This is my house! Just you remember that!” referring, I assumed, to the park itself, or maybe simply to the world outside the hospital.

  “He’s not usually so hostile,” I explained to Jeremy. “He’s probably just sick right now, probably off his meds.”

  This triggered a conversation about the hazards of my job. As if to drive the point home, it was when I went to work later that evening that I found the letter in my mailbox. The whole idea of it nauseated me, instructing me what to do to my own body with a phallus, like a sexual assault by proxy. Later that night in my call-room, I kept jumping up, listening and waiting, every time I heard the door to the suite click open down the hall.

  The letter confirmed my suspicions: I had ticked somebody off, big-time. Despite my work with Mary, I continued to be confrontational in dangerous situations. Going up against big, scary guys persisted as one of my favorite pastimes, especially if I thought the patient was lying, pretending to be mentally ill. Discharging malingerers was a routine part of my job, and catching them at lying was easy. “You suck at lying,” I would say derisively. “Why don’t you try Beth Israel down the street. Maybe they’ll fall for it.” Sometimes, I’d even give them a few tips on how to make their story more effective. I’d pull them aside, conspiratorially, “Listen, just because I’m not buying what you’re selling doesn’t mean you can’t find someone who will. Here’s what you gotta do …” But other times, I was just an asshole, kicking them out of a warm place.

  When I first started working at CPEP, the patients I would typically go after were arrested and handcuffed to a chair. I could piss them off as much as I dared, and they were like helpless little kittens: They couldn’t really fight back. Somewhere along the way, though, I had gotten cocky. I forgot that the ones who weren’t shackled could be just as dangerous as the ones who were. They wouldn’t all take my castrating stance so quietly. Sooner or later I was going to take a pounding.

  I had kicked out at least three fakers in the week preceding the letter. After I let a patient know he’s leaving, I usually walk him to the door myself, bringing him back out in front of the hospital pol
ice to wait for his shoelaces. One man got right up in my face out there by the door, calling me a whore, screaming, “Fuck you!” and “Fuck your mother!” Maybe he sent the letter.

  Another man had made up a story about how he had crossed Canal Street in Chinatown, walked into traffic in an effort to kill himself, but then a car stopped and a man got out to “save his life” and brought him to Bellevue. The Good Samaritan scenario in New York City is always a hard sell with me. Over multiple interviews, this man changed the car to a van, and then a city bus. He told the medical student and resident who interviewed him that his brother had committed suicide two weeks ago and he went to the funeral, even though he mentioned he’d just gotten out of jail the day before. (If I had a nickel for every dead person I’ve spoken to on the phone, I’d have a dollar thirty-five by now.) He floundered on dates and locations, telling me he had crossed the street north to south, later telling me south to north. I like to play detective with the lying patients, and when I catch them in their lies, I usually call them on it. I’ve seen one too many episodes of NYPD Blue, I think.

  The weekend before I received the letter, I had kicked out a lying patient who was from Philadelphia, and he swore he would “come back to hunt me down.” The postmark is from Philadelphia. Maybe the letter’s from him.

  I decide to compile a list of likely patients by combing through the discharge records from the past few weekends. I’ll give the list to hospital security and to NYPD. A detective assigned to the case comes by my apartment to speak to me and leaves his card under my door, since I’m not home. When I ask the doorman about it, he has no recollection of letting the man in.

  I explain why he should be extra-cautious about anyone who says he is there to see me.

  Swimming with Sharks

  It begins as a day unlike any other: nine o’clock, Wednesday morning, May 20, 1998, and I’m shot full of drugs. Lying on a stretcher, I am mildly amused at the television show I’m watching: It is my colon, bloodred and slick with mucus.

  “Fabulous,” gushes my doctor. I nod my head in agreement. It is my first colonoscopy, surprisingly painless. Maybe it’s just the Demerol and Valium talking, but I am pleasantly conversant throughout the procedure. Afterwards, it takes several hours to come down from my high. As I walk back to my apartment, I delight at my surroundings. It is a beautiful spring day, unseasonably warm. The trees are flowering on Park Avenue, and there are tulips and daffodils in the gardens in front of the high rises.

  I am working tonight, subbing in for my best pal Lucy, and I decide—as I glide home, stoned—to walk to the hospital, seventy blocks south. After working at Bellevue for two years, it will be my first time walking there. (Over my nine years there, I will never walk to work again.)

  I arrive for rounds a few minutes late, glistening with sweat. Lucy pulls me aside after sign-out and tells me in the hallway that it’s official: She’s been made Director of CPEP. Dr. Lear is leaving, and he has picked her to be his replacement. I am thrilled for her. For us.

  “Are you sure I can’t convince you to work weekdays with me?” Lucy asks. “You could be my assistant director. We’d be a hell of a team.”

  “I know we would, and I would so love to be your right-hand man, dudette. But I’ve gotten very used to my weeks off. I love flying solo on the weekends; you know that. I just can’t give up this schedule. Even for you.”

  “I know you can’t. I probably wouldn’t do it if I were you,” she smiles. She then asks me what I think about Daniel. “You know him from Sinai, right? I’m thinking about pulling him from 18 North to work at CPEP. You think it’s a good idea? Daniel down here to be the assistant director?”

  “Well, he’d certainly be an improvement over the one we have now. He’ll be fine … sure,” I say, trying to convince myself as I sell Lucy. It’s hard to imagine working side by side with Daniel again after Sinai. I’m not sure how I feel about it exactly, but I don’t share my indecision with Lucy. I don’t want to pull the focus away from her promotion. She’s been told to keep it quiet for a while, mostly out of respect for the current A.D. who thought the job would be his, so I spend the first part of my shift feeling like the cat who ate the canary. I know staff morale will skyrocket once everyone hears the news—everyone loves the ballsy and charismatic Lucy.

  The CPEP gets busier as the afternoon wears on. I usually start my shift a bit later when I work the weekends: Working for Lucy on a Wednesday means coming in at four instead of seven. I’m happy to do her this favor, but it occurs to me soon after she leaves that it’s going to be a long night.

  The skies darken early; a hard rain is imminent. The EMS cases start pouring in. I hear Rita, behind her desk, on the phone talking to her son, “No, seriously, it’s hailing now?!”

  The last time I was in a May hailstorm was in a rental car in the middle of wide-open “Color Country” in Utah. The hail pounded on the roof, and Jeremy and I were absolutely panicked that a tornado would come barreling through the prairie and take the car up into its funnel. Rita says “hail,” I think panic.

  The nondetainable area is filling up, and the night has a weird vibe to it. It feels like being on a ship that is taking in water from all sides. Not only is one ambulance case after another coming in, but I am getting a lot of calls from other hospitals. Everyone else is full, the rest of the city is jam-packed with psych cases, but for some reason Bellevue has scads of empty beds—the only beds in the city. So I am accepting transfers from other hospitals, which always pisses off the nurses, adding to everyone’s workload. I am obligated to take the psychotic prisoner referrals, but I also accept a couple of homeless guys with no insurance, knowing full well no other hospital will accept these patients since they can’t pay for services.

  And now, to make matters worse, the ER is dumping wrist slits on me: two in a row, back-to-back transfers, both drunk at the time they cut their wrists, and both sober now. One had lethal intent—he really was hoping the cuts would be deep enough for him to bleed to death, so he gets admitted upstairs to an inpatient psych bed. The other is a drunk “hitting bottom,” as they say, with superficial cuts requiring no sutures. We confirm with him that this is a “cry for help,” and he is admitted to a detox bed.

  There are so many patients on triage that not only the moonlighters—three hired hands to help out with the evening overflow—but also the medical students are having to see cases individually. “Divide and conquer!” I encourage them, even though the medical students typically work in pairs or shadow the moonlighters.

  It’s raining like crazy out there; the lightning strobes against the EOU windows. The resident on-call presents a new case to me, and as we discuss it, I sense that her new patient is malingering. He gave conflicting stories to the triage nurse and the resident, and he’s keeping a very low profile in the ER, slouching down underneath a yellow hooded sweatshirt like he’s hiding out. I ask the resident to reinterview the patient, and now he’s saying anything he can think of to be admitted, upping the ante with each interview, but he’s having trouble keeping his story straight. I go out to speak with him after I notice that he’s given the clerk a home address that’s very near my own, a nice block on the Upper East side. I’m curious about his living in my neighborhood, and when I ask him where the block is, he tells me it’s between Second and Third, though the address he gave the clerk is between Park and Madison. I question him about this, and he then “admits” it is his wife’s address and that they are separated.

  “And you’re confused about what block she lives on since the separation?” I jab. He looks at me quizzically, angrily, and I get up to leave, quitting while I’m ahead.

  When the resident and I rehash the case in the nurses’ station, we decide that the patient is “F.O.S.” (full of shit) and needs to leave. He isn’t mentally ill; he’s clearly faking it in order to gain admission to the hospital. We’re pretty sure he’s a sociopath; we sometimes call them sharks. Guys like this enjoy their time in the hospital, easier th
an the streets or shelters, and certainly more cushy than jail time, which is where most sharks end up. It’s my job to make sure that sociopaths don’t get into Bellevue. Not only do they take up a bed that could be better utilized, but they also make the hospital a more dangerous place. Sharks have a tendency toward violence and they prey on the weak—in this case, the vulnerable psychiatric patients.

  As always, I am eager to kick out a malingerer, excising him like a malignant tumor. As I go out to talk to him, a moonlighting doctor suggests that I take someone with me, that maybe this patient is dangerous. Walking out of the nurses’ station, I say brazenly, “I’ve been here two years and haven’t gotten tagged yet. Maybe I’m due.”

  I walk over to the man in the yellow sweatshirt, and he responds to my inquiries very quietly. So quietly, in fact, that I need to lean in toward him so that I can hear his responses.

  “Mr. Brown, we’re having a little problem regarding your patient information. It’s just not adding up,” I begin.

  “So?”

  “So, some of the doctors here think that you may be feigning your illness.”

  “Feigning?” he asks. “Faking,” I explain.

  And then it comes. A huge fist flies into my face, and as I hear the smack, I see a flash of bright white light. I stagger backwards from the force of the blow. Eleanor, the largest female psych tech we have, is on him in a heartbeat, tackling him to the ground, while I take another step back, and then another, stunned.

  “I got him, Doc,” Eleanor calls to me proudly as I scurry back to the nurses’ station.

  “I want to press charges, Eleanor!” I shout back to her. The hospital police have already come to help out, reminding me that this is an option, and I want them to take him away. Rocky is there, front and center, acting professionally, not making a big deal of the irony that I can’t help but notice. The guy I almost got fired is now the cop who’ll arrest my shark.