I know that Lucy wants to keep her job, and I don’t want to jeopardize that. She feels she has to keep working; she needs her medical benefits. Plus, she’d go crazy at home all day with nothing to do. She’s already dissolved her private practice, referring many of her patients to me.
That was a big deal, Lucy closing down her practice. She was the one who helped me get mine up and running. Back when I was just starting out, she advised me on everything from my rates to malpractice insurance to office policy. The fact that I am now treating her patients sends us all a powerful message that she is ill. Her patients are in love with her; I am a facsimile only. They have this idea that when she gets well again, she’ll reopen her practice and take them back into the fold.
I am playing along with this fantasy, because it’s what feels right to all of us.
How to Save a Life
New Year’s Eve 1998 is on a Thursday night, so I don’t have to work. There are few things more depressing than watching the ball drop with downhearted and delusional patients: We crowd around the television, and when the lighted orb finally touches down in Times Square, there is the painfully awkward moment of deciding whom to kiss. The staff members hug one another, but the patients, all the lonely people, stand or sit, disconnected, forlorn.
The weekend after New Year’s, there’s not much action on Saturday night, but early in my shift on Sunday, we get two cases back-to-back: a man and a woman, related only by a random, horrific event.
A petite blonde in her twenties has been escorted here by MTA police and NYPD. She keeps repeating that she’s missing a party with her family. I tell her she’s lucky she’s still alive to miss the party. The other pretty blond girl, the one standing next to her, waiting for the N train on the Twenty-third Street subway platform, won’t be seeing her family again. My patient has just witnessed thirty-two-year-old Kendra Webdale being pushed into the path of an oncoming train.
Anyone waiting for a subway and seeing a man push a woman onto the tracks would be justifiably upset, but she has the added layer of survivor guilt to deal with. Why wasn’t she chosen as a victim? Why does she get to go on with her life when Kendra cannot? She saw the man ask Kendra a question, get her attention in some way, and then push her with all his might. Did he ask for the time? Did he ask her if she was ready to die? In some way, my patient has been given a small gift, and I think over time she will come to appreciate this. She has been taught that anyone’s life can be taken away in an instant—at least in this city it can—and she’d best make the most of her time here.
She calms down fairly quickly and leaves CPEP after a short interview and a call to her dad. The next patient to be seen is the subway conductor. He is unintentionally but effectively complicit in Kendra’s murder, mowing her down with his oncoming train. The level of guilt he is dealing with is above and beyond my first patient’s. There was absolutely nothing he could’ve done to stop the eighty thousand pounds of subway cars in the split-second before the impact, but it will likely take years for him to get the images out of his head. From his windowed control car, inches away, he has seen everything.
The resident working with me that night sees the conductor, and I sign off on both charts and T & R orders. When I talk to Vera, the head nurse for the night, about our two patients, I can’t help but wonder out loud where the third is. What’s taking so long for the cops to bring him in?
“So where’s the pusher?” I say to the staff in the nurses’ station.
“I don’t know. Do you think he’s one of ours?”
“He must be. I bet you anything he’s a psych patient. Why aren’t they bringing him in for clearance?”
I wait all night for the subway pusher to be brought in, but he never materializes on my shift. He shows up at Bellevue on Monday, when I’m not on shift. (I later find out that he did ask to be brought to the hospital, that he specifically asked to see a doctor while he was still on the subway platform. The cops held him for a day, to get his confession, I suppose.)
And he is one of ours. More than that, he’s one of mine: Jonah Bergman. I remember him well. He was a sweetheart, meek and gentle when I interviewed him a few months before the attack. It’s not that often I get a Jewish schizophrenic, and what’s more, he had the exact same name as a childhood friend of mine. And this is how I am able to remember him immediately, his name, his face, his story. Because when he came in that first time, I took special care of him.
There’s something about schizophrenia, how devastating it is, how relentless its course can be, that draws me to it. Those patients automatically win my sympathy. I spent extra time sitting with Jonah, making sure he felt safe inside the CPEP. I can tell you exactly where he sat, and I remember we talked about music. He was soft-spoken, he seemed very intelligent, and he smiled at me while we spoke. I admitted him to our EOU so we could observe him for a few days before we released him. That was well before the attack, so hopefully no one will be pointing the finger at Bellevue, because obviously, someone dropped the ball in terms of his psychiatric care.
At the time of the assault, he was just a few weeks out from an admission at North General. He was supposed to be transferred to a state hospital, but there were no beds available, so he was discharged to fend for himself at his apartment.
So what happened to him? Did he go off his meds? Or was he so sick that even though he was taking his medication, his symptoms broke through? I wonder how his family will take this terrible turn of events. I learned in the newspapers that Jonah started out so promising, going to Bronx Science, wanting to be a doctor like his father. He made the dean’s list at Stonybrook his freshman year, but it all fell apart when he was a sophomore. That is often the case with schizophrenia. Everything is going along fine, and then it slowly disintegrates: the paranoia, the isolation, the voices. His illness has taken its toll on his family, I’m sure. It’s devastating to have a child who is in and out of hospitals, too sick to finish college or work for a living. And now this. I know the Webdale family is suffering, but my heart goes out to the Bergmans as well.
Jonah is admitted to our forensic unit the day after the attack, and I go to visit him up there the next weekend. When I walk in, he is alone in a room on 19 West, sitting on his bed, staring at the doorway, motionless. He seems to remember me, and so I sit down to chat on his bed. He tells me what happened that Sunday, how he spent the day eating at McDonald’s, hanging out at Virgin Records listening to music and watching the movies playing in the store. I ask him to tell me what happened on the N-R platform, and he says that he was overcome, possessed by a spirit that pushed the girl. He feels like it wasn’t him, that some force came into his body and did this. He looks at me with a blank stare, barely blinking, his mouth slack.
“It wasn’t really me that did it,” he explains.
I let this go, since it is a complicated concept. Is he the same person when his symptoms are in check by the medication? How much responsibility does he have if he is “out of his mind” at the time of the attack?
“And what about now?” I ask him. “Do you know what will happen next?”
He seems to know he’ll stay at Bellevue for a while, and then he’ll be tried in court. If he’s scared, he’s not showing it to me. Actually, he shows very little emotion, which is the way it is for many people with schizophrenia. I can’t tell for sure if some part of him knew what he was doing on that platform and he’s making up the part about the spirit, or if he really was so psychotic that he shouldn’t be blamed. Good thing it isn’t my job to figure that out. I’m not sure anyone could know that with any certainty.
I head back down to CPEP to work my shift, saddened by it all.
Several months later, it’s a Sunday night and I’m working again with my favorite social worker, Julia. She is a wonderfully kooky gal, always wearing bright lipstick and quirky outfits, often involving sequins and headbands, or at least a sequined headband. The nurses from 19 West call down to speak with her, since she is the only soc
ial worker in the hospital assigned to psychiatry. Jonah is going to court tomorrow and he just told the nurses he has nothing to wear.
Julia and I go to the clothes room on the ground floor. There is a bigger clothes room in the basement, but Julia doesn’t have a key to that area. I have heard that it is an enormous space, filled with pants, shirts, coats, and shoes for the homeless patients who need clothing prior to discharge. I’m disappointed I won’t be seeing it. The big clothes room has attained a mythic status over the years, and with Julia not having the proper key, it makes me start to question whether it actually exists at all. Luckily, Julia and I find what we’re looking for in the smaller room. Among the several racks and shelves we find a tan sweater, a plaid button-down shirt, and a pair of pants that should hopefully fit Jonah. We take the outfit up to 19 West and he tries on the clothes. He looks fine, and Julia and I commend ourselves on our makeover, but I don’t think it’s going to help him. I am worried for him, but I can’t tell if he’s worried too, because of that impenetrable blank stare, the flat affect of schizophrenia that makes it so hard to discern what someone is feeling. That’s going to hurt him when he testifies, I just know it.
His first trial for second degree murder results in a hung jury in November of 1999. His second trial in March of 2000 requires only one hour of jury deliberation to deliver a guilty verdict, sentencing him to twenty-five years to life. I am not involved in the trials, but I watch them from afar, in the press like everyone else. At his sentencing, his defense attorney summarizes, “He’s not a monster, Judge. He’s a shell of the man he used to be.” The sentence is overturned later on a technicality involving a psychiatrist’s testimony, and he needs to be tried a third time. It is only in October of 2006, nearly seven years later, that the case is finally settled. He pleads guilty and receives twenty-three years, plus five years of supervised time upon release.
The interesting thing that comes out of this whole ordeal, and which comes quite swiftly compared to Jonah’s sentence, is legislation referred to as Kendra’s Law, 9.60 of the New York State mental hygiene legal code, which provides for court-ordered outpatient treatment. Now, not only can a patient be committed to an inpatient hospital stay, he can be mandated to outpatient treatment and monitoring as well. The civil liberties ramifications are obvious, forcing someone to undergo psychiatric treatment for months on end whether they like it or not. There are people who think this legislation is unjust, but I believe the spirit of the law is right. Jonah fell through the cracks. Everyone seems to agree about this. He was mentally ill and needed more supervision, more continuity of care. He bounced from hospital to hospital, from clinic to clinic, and from one makeshift housing solution to the next.
What was missing was what Jonah needed most: someone who would take responsibility for him and take care of him. Like many people with chronic mental illness, he had a family that went by the wayside. For many reasons, parents and siblings get burnt out. It’s exhausting to care for someone who can’t care for himself, and mental illness lasts a lifetime. It’s difficult for families to stand by and watch one of their own deteriorate, re-compensate, and deteriorate again, repeatedly. People with persistent mental illness that doesn’t respond well to medication often leave their families and end up on the street, in shelters, or perhaps in group homes if they’re lucky. The shelters are a mismatched combination of crowded and lonely. There’s no solitude, no privacy, but there is also very little human connection to be found there. Most chronic patients end up warehoused in the shelters and the state hospitals, which are a lousy solution.
The bottom line is that there are fewer beds than there are patients, mostly due to President Kennedy’s 1963 Community Mental Health Centers Act. This well-intentioned movement helped to spur deinstitutionalization. The decision was made, when effective antipsychotics became readily available, to close down the mammoth state hospitals that were only providing custodial care, not treatment, with the idea that their patients would be transitioned from the state hospitals to community-based care. Many of the state facilities were shuttered, but the community centers never fully materialized, mostly due to a “not in my backyard” mentality in the neighborhoods. Thus, the homeless mentally ill population was spawned. Over the years, many stopgap measures have been put into place, but often, the adult homes and other housing options are ineptly run, overburdened, and sparsely funded.
Jonah needed one treatment team to be responsible for him, to approximate a substitute family that would check up on him, make sure he was taking his medication and seeing his doctor. Kendra’s Law will help to make sure this level of supervised outpatient treatment occurs, through a hearing and a court order. If a patient in the assisted outpatient treatment program fails to comply with the treatment plan, he can be brought into the hospital for an evaluation and potential admission.
If the state of Virginia had a version of Kendra’s Law, then maybe the Virginia Tech shooter would have been receiving much-needed psychiatric treatment, instead of slowly simmering in his psychosis alone in his dorm room.
I appreciate that from a libertarian point of view, Kendra’s Law is a little over-the-top, but from a psychiatric point of view, it’s just what the doctor ordered, to help our patients who are getting substandard, poorly coordinated care. It is meant to keep them healthy, and to keep everyone else safe. Ultimately, it could prevent another young woman like Kendra Webdale from falling prey to the fallout of haphazard mental health care.
We can’t put Pandora back in her box. The homeless mentally ill have been with us since the sixties. The sooner we provide for them, the more fully we address the causes of their problems, the better for us all.
I Will
Seventy-two and sunny, seventy-two and sunny.” I repeat my mantra as I run my laps around the reservoir in Central Park. After months of nagging Jeremy, and then wisely backing off at his insistence, he finally popped the question on my birthday. I am getting married in the park in early May, in the Conservatory Garden, where they don’t allow tents.
“What do people do if it rains?” I ask the woman in charge of booking the venue.
“They bring an umbrella,” she answers in all seriousness.
I have embarked on an ambitious exercise program in order to look my best for the wedding. I was inspired by a patient at Bellevue who managed to get off drugs and alcohol. When I asked him how he did it, he told me his first step was to complete “ninety in ninety.” He went to ninety AA meetings in ninety days. That got me thinking: Do I have that kind of discipline? Is there anything I would do for ninety days in a row? I decide to get in shape for the big day by doing ninety workouts in ninety days. For three months without fail I run, lift, swim laps, do a step class, go Rollerblading or biking. It has paid off: On the morning of my wedding, as I step on the scale, I have magically reached my goal weight. Equally miraculous is the forecast for the day: a high of seventy-two degrees, breezy, with ample sunshine. It’s enough to make a gal thank her lucky stars. Add to that my bliss from finally passing my oral boards, and everything’s coming up roses.
Jeremy and I have decided to make this wedding an intimate group effort. We’ve invited our friends and family to form the wedding band, take the pictures, bake the cake. I am excited about being serenaded by our closest friends, who will strum their guitars and sing Bob Dylan’s “Make You Feel My Love,” as we walk among the flowers to the makeshift altar, three steps underneath a metal archway covered with roses and vines. Our wedding party consists of our two eight-year-old nieces, Zaro and Violet (the “drymaids” in Violet’s words), our two five-year-old nephews, Jake and Jonah (the “ring barriers”), and our three-year-old niece, Ivy, the flower girl.
The garden is at its peak of perfection. The cherry blossoms are floating down like snowflakes in the wind. Hundreds of tulips in purple and pink line the plaza where the ceremony will take place. Ivy has been carrying a single purple tulip tightly in her fist, waiting for her big moment when she will start the pr
ocession. I stand behind the shrubs, hiding from the guests, and taking the occasional peek at them while talking mindlessly with my parents, who will escort me down the aisle.
Lucy has come with Sadie. Other people from Bellevue can come to the reception, but only Lucy is invited to the ceremony. She has warned me that she will be wearing her festive wig today. She owns two wigs, one worse than the other, and on this day, it appears to me she has worn the larger of the two. It is auburn; the long tresses ending in big curls. It is God-awful, and I love her for it, for not caring, for wearing it anyway, for slapping on some makeup and lipstick and dragging her sorry ass to the garden to share this day with me.
After a meltdown about losing her tulip, Ivy walks hand in hand with her mother down the aisle, and so the wedding begins.
It’s a glorious day, the breeze blowing my veil around, and also blowing the words of the rabbi away. The guests wait patiently as the sermon drags on, and eventually, Jeremy stomps on the glass, counts the band off for the recessional (“The Lucky One,” by Freedy Johnston), and kisses me. The crowd cheers and claps as we kiss, and hug, and kiss some more.
I am insanely happy.
All Together Now
Lucy has invited all the CPEP faculty out to her house in the Hamptons for dinner and to see the fireworks for the Fourth of July. It’s the medical new year, and there are fresh faculty members to get to know. Some of the doctors are staying over at Lucy and Sadie’s house along with me and Jeremy, while others are sleeping at nearby hotels. It is the first time that we are all doing something social, as if we were a family, and the gathering has a warm and festive air to it.
Weekends at Bellevue Page 16
