“How’re you doing, buddy?” Daniel asks me as he puts his arm around me in the backyard.
“Pretty good, considering my pally just died,” I choke out.
“I know. But it wasn’t her. At the end. It wasn’t her,” Daniel says.
I have no response to what he’s saying beyond a grunt of acknowledgment. Daniel is trying to comfort me, I suppose, the way he comforts himself, with a shot of denial, but I don’t know where to start in continuing this conversation.
This is the closest we’ll be, arm in arm. Things will disintegrate between us from here on out.
Let Him Eat Steak
Daniel has settled into the work of being the new CPEP director. It’s a lousy position to be in, with the typical managerial dilemma: There’s no pleasing everybody. He needs to meet the demands of the administration, first and foremost, but the CPEP staff assume his sole mission is to make them happy. He’s being pulled in different directions by nearly everyone, and I’m just trying to stay out of his way.
This turns out to be impossible, because he wants more than that from me. As far as I can tell, in his new position as my superior, he wants me to kiss his ass. He pulls me into his office after a Monday morning sign-out, to yell at me for some perceived slight. I did not defer to him enough when he added his two cents on one of my case presentations, or I questioned the relevance of his interruption, as opposed to commending him for his incisive commentary. It’s never going to be enough for him, I’m afraid. He needs a certain amount of public display of admiration to fuel his ego, and I can’t pretend I have the regard for him that I did for Lucy.
“When we are in morning rounds, I expect you to treat me with respect,” he warns, sounding an awful lot like my mom used to when I was thirteen. “Like it or not, I am the director now. And if I bring up a teaching point in rounds, you get behind it, don’t roll your eyes or plow ahead to the next case.”
“And?”
“And, you don’t tell me when you’re taking time off, you ask me to sign your vacation paperwork.”
When Lucy was in charge, we were chums. I handed her my form and she signed it. She wouldn’t have bothered to differentiate between telling and asking, and neither would I. And I did not need to subordinate myself to her. She didn’t require it, first of all, and second, I had the utmost respect for her. I was in awe of her, basically. My feelings for Daniel border on disdain. Feigning adulation isn’t going to be easy, and it seems like a nonnegotiable requirement for him.
“I’m your boss now, Julie. If you don’t like it, you don’t have to stay here.” So there it is. This town ain’t big enough for the both of us. Danny boy, this is a showdown.
“Why don’t you leave?” I challenge, raising my voice. “I like my job. I’m happy here. And the people I work with happen to like me. You, they’re not so crazy about.”
He stares at me for a long time and says nothing. “I have no plans to leave this position anytime soon,” he tells me, glaring.
“Great,” I say. “Fine.” I stall. I’ve got nothing. “Well, if we’re both going to stay, we’re obviously going to have to find a way to get along. I can try to be more subordinate in front of other people, if it’ll help,” I offer. I want him to know I’m on to him, how he likes to feel like the boss, how he seems to get off on the hierarchy. That I need to let the other worker bees know that I am another drone like them, and he is the queen. Otherwise, these private battles and public displays of dominance will likely continue.
“That’s a good place to start,” he accepts. Then he offers me a bone. “There’s something else you should know. I totally covered your ass last week, so it’s not like I don’t look out for my own.”
“What are you talking about?” He’s got my back? Is this possible?
“That woman you kicked out of the nondetainable area last weekend?”
“Yeah …” I answer hesitantly. Who did I kick out last weekend? That hysterical lady?
“She was found in the lobby and brought to AES a little while afterwards. Tylenol overdose.”
“Oh, Jesus. She was a walk-in, and she was crying like mad, saying she didn’t want to be seen, she’d changed her mind. So I told her she could go. She walks in, she can walk out.”
“Not necessarily. This is why you’re never supposed to turn people away. You’ll miss things if you don’t interview them. You know that.” He stares at me accusingly, and I know he is completely right. I can’t possibly rationalize what I did and we both know it. Anyone that distraught should have been ushered through the doors and fully evaluated, but I couldn’t deal with her level of drama, with the noise of it, and when she said she wanted to turn around and walk out the door, I was relieved. I have screwed up royally.
“Anyway, you’re off the hook as far as I can tell. No one really knows what you did. Maybe you owe me one?” Daniel asks.
By now, my eyes are brimming with tears. This is not good. He knows I dropped the ball, to say the least. I hate that he’s seen me being a lousy doctor. And what’s worse, he’s saving my ass. He’s caught me before I’ve fallen. It could’ve gotten ugly for me. The AES attendings could have made it a very big deal, especially if she didn’t pull through. Somehow, whatever has happened with the patient, Daniel has smoothed the whole situation over.
I’m ashamed, but what really sucks is, I should be grateful. It’s just the kind of thing I could easily get hung out to dry for, but he is protecting me.
What am I supposed to do with that?
Daniel and I go back a long way, and our relationship is complicated. There was a time when I really could have called him my friend, back in our residency. But now, there is too much water under the bridge, and I don’t know what to think of him anymore.
I don’t know whether to pity Daniel or despise him. I just know that he always seems to need me to defer to him, to subordinate myself to him, and it’s the need that drives me crazy. But I have to hand it to him: He did have my back this time. I turned away a Tylenol OD. She could’ve died, or needed a new liver, and I would’ve been responsible.
“Thank you, Daniel, really. I do owe you for that.”
“Mmmm-hmmm,” he gloats.
“How are we going to do this?” I ask, blowing my nose as I slump into a chair. “Lucy was our buffer.”
I should have realized a lot of things before. Daniel and I were only united in our love for Lucy; we both knelt at her altar. With her gone, we have no church community anymore. I never appreciated how much she was keeping the peace between me and Daniel until she pulled out of the triangle. I never had to deal with him much until now, thanks to her. He and I are more alike than not, and I think Lucy knew this. I can’t tolerate his faults because they are my own.
“I know, she was our buffer,” he acknowledges, sighs, and sits down at his desk. “I don’t know how we’re going to do this. Go home,” he says kindly.
Lucy’s secretary Loretta loved Lucy, but she was never a fan of Daniel, and she’s not particularly interested in working for him now that he’s the new boss. She is putting out feelers for a different position somewhere else in the hospital. One of Loretta’s main tasks is to maintain the moonlighter scheduling. The bulk of her time is spent calling and emailing various psychiatry residents and attendings for hire, making sure there are enough bodies to staff the CPEP and the up-wards on the evenings, weekends, and holidays.
One Wednesday morning when I’m in the country, at the house that Jeremy and I had bought not long before, I get a call from Dr. MacKenzie asking me if I would be willing to take over the scheduling if Loretta leaves her post.
“Of course I will,” I assure him. I assume this will be a temporary stopgap measure until her replacement is hired, and I’m happy to help out. I want MacKenzie to know that I’m a team player, and I’d do just about anything for Bellevue.
I create a folder of the monthly scheduling templates and compile a mass email list of all the moonlighters, adding their pager and office numbe
rs to my PalmPilot. I assume if I am organized (which I am, bordering on neurotically obsessive), it won’t be too much trouble to keep the moonlighters happily employed.
As the months progress, I realize I have made a horrible mistake. The scheduling not only takes up huge chunks of my time, it’s always on my mind. I obsess over every unplugged hole. I call Daniel at home one night to let him know I cannot continue to do the moonlighting schedule. We have a ten-minute conversation about this and that, and then when I bring up the scheduling, he finally relents. “Just tell me the last date you’re willing to do it so I can find your replacement.”
I give him the most obvious line of demarcation in the medical calendar.
“July first. Fine. Can I go finish my steak now?” he asks, peeved. Steak. July. The screen swirls. I flash back to the Fourth of July, nearly two years ago, when Lucy invited all the CPEP faculty out to her East Hampton house to see the fireworks. It was also the first weekend with Michelle on the scene. I never would have predicted the teddy-bear girl would become the boss’s girlfriend, but that’s just what happened. Shows you what I know. At least he doesn’t have to share his steak tonight.
“I’m sorry, I didn’t know you were eating dinner,” I reply. “You should’ve told me when I called; we could’ve spoken another time.” It’s just like him to play the martyr, not bothering to mention that he has sat down to dinner until the end of our call.
So, July first comes and goes and yet, somehow, I am still doing the scheduling. No one can understand why an M.D. is assigned to take care of a secretary’s job, and I can’t help but feel it’s punitive in some way. Daniel is punishing me, keeping me under his thumb with this assignment. I also assume the reason I am still doing it after our agreed-upon date is passive-aggressive on his part. He wants me to come begging to him again.
At the next faculty meeting, when I mention yet again that I am tired of doing the scheduling, Maxwell, one of the attendings turns to me and says, “That reminds me, I’m going on vacation next month. Can you find someone to work my shifts?”
I explode, first at Maxwell and then at Daniel.
“Well, it’s just that you did volunteer for it. You told Dr. MacKenzie you’d take care of it. And you have more free time than most of us,” explains Daniel.
“You have a new secretary already, why can’t she do it?”
“Dr. MacKenzie feels it needs to be done by a physician.”
I’m going to need to talk to MacKenzie about this. There’s got to be another solution.
I just want things to go back to the way they were. I want Lucy back.
Another Saturday Night
Sometimes the cases I see hit close to home; tonight I decide to buy a man dinner. In all my years at Bellevue, I’ve never once bought a man dinner. I’ll occasionally kick in a few bucks to get someone onto a bus or subway and out of my ER, but I’ve never paid for a meal.
A mild-mannered, anxious man dressed in a suit and tie walks into the CPEP. He is temporarily homeless and afraid of the shelters, and he has lost his medication. After I give him some medicine, rewrite his prescriptions, and discharge him, he asks, “Can I maybe just collect my thoughts in this waiting area for a little while?”
“Of course you can, sir,” I answer kindly. I give the hospital police a knowing look, the kind that says Let him hang out for a bit and then send him on his way, and the cop winks and smiles. A few hours later, on my way to the coffee shop for some dinner, I see that the patient is still sitting in the nondetainable area. Though he is seated, he looks lost, unsure of where to go next.
“Sir, if you don’t want to leave the hospital, you don’t have to, but you really can’t stay here too much longer. Sometimes the police will let you sleep in the waiting room of the medical ER. Do you want to do that?”
He looks up at me and nods nervously. “Would that be okay?”
“Sure, it’s usually fine.” I try to explain where the AES is, but decide to walk him over there instead. On the way over, I ask him, “Are you hungry? Have you eaten?”
“I haven’t eaten in two days, actually, doctor.”
I take him over to the waiting area, schmooze the HP to let him stay, and get him settled. “I’ll be right back.”
I go to the coffee shop and order myself the usual Caesar salad with salmon (try it if you’re ever in town). The guys behind the counter are funny and friendly, as usual, and I am bathed in their warm, loving smiles. I add on a cheeseburger, fries, and a soda. It makes me feel good to bring it to him in his chair. He seems surprised, and sheepish about accepting the bags of food.
I think it’s his suit and tie that did me in, and the fact that he is so genuine. No defenses about him, no lying, no bullshit. Just innocence and fear.
I go back to the CPEP and am greeted with a new EMS case. A manic lady pulled naked off her roof, ranting and raving (you will never see one without the other on the EMS paperwork) in a loud, rhyming stream-of-consciousness that is pure Americana. Bits and pieces of these United Altered States, snippets from ads, sound bites from CNN. “If it doesn’t fit, you must acquit!” “You’re soaking in it! Mild? More than just mild!” “They’re magically delicious!” “Your mission if you choose to accept it … Accept the unacceptable!” She goes on and on, and I am impressed at the catalog of slogans and insights she has at her disposal. I order some medication for her and go inside.
“I got a live one for you,” I say to the resident coming on. “Should be an easy admit.”
Rita comes out of the clerk’s office to tell me that a patient from upstairs has just jumped out of a window onto the pavement outside the hospital. The hospital police brought the patient to the AES, but the man is dead.
A short while later, Desmond, the star resident of his class who was the apple of Lucy’s eye, comes down to the CPEP. He looks pale. He sort of fidgets around, looking like he needs to talk. I ask him what happened with the suicide. I know he’s working upstairs tonight.
“A young Vietnamese guy on the neurology ward. He was in for pseudoseizures,” Desmond begins. This means the patient is having some sort of episodes that look like seizures, but when the neurologists perform an EEG to detect the brain’s electrical activity, the results aren’t consistent with true seizures. Sometimes, people with epilepsy fake some of their seizures. Other times, there is no true seizure activity at all, the pseudoseizure is an elaborate ruse, a well-choreographed plea for help or attention. “He’s got a pretty significant history of physical abuse. His father beats him, it looks like. I think the problem is that he was scheduled for discharge soon, and he was petrified about going back to live with him.”
“Was he on a one-to-one?” I ask. This is the highest level of observation the hospital can provide. If a patient is suicidal, they are assigned a staff member to sit with them twenty-four hours a day to keep them from harming themselves.
“He was for a while. The consult service was following him. The nurses called me because the order was written by a psych resident doing a neuro rotation, not the consulting psychiatrist. I was on the phone with them giving the okay to restart the order.”
“So you restarted it?” I ask.
“Five minutes before the guy jumped.” This lets psychiatry off the hook to some extent, and we both know it, but there is no relief in Desmond’s eyes.
“How did he get out the window?”
“There’s some controversy over whether he smashed the window with an IV pole or whether he just hurled his body against it. But the window looks just like a body went through it.”
“Like a cartoon?” I ask.
Desmond looks at me witheringly, pityingly, and walks away. What the hell is the matter with me?
Desmond is the poster child for Karuna, the Buddhist concept of infinite compassion. We both want others’ suffering to cease, and yet we go about it in completely different ways. Should I be more like Desmond, with his limitless undying love? My patients would be better off if I could stay opened
up and available, giving and understanding, yet my remoteness resurfaces routinely in my work at the hospital. It is my protection, like a hazmat suit, and it’s been effective, so it’s hard for me to move beyond it, even though I’m trying.
When I started out in 1996, I was a single gal with a boyfriend, holding a weekend job with a lot of time to kill during the week. I was confrontational, oppositional—a tomboy. It was as if I was reliving my rebellious adolescence during my first few years at the hospital. Acting as though I was too jaded to be shocked by anything, I challenged the EMS drivers, What else ya got?
As the years went by, I added a private practice to the mix, seeing patients on Fridays in my Greenwich Village office. Then, a few more years in, I got married, bought a house in the country, had a baby. As my life got more complicated, I learned to compartmentalize.
These days, I keep four bags organized in my closet to help keep track of my many personae—harried Upper East Side mom, tony downtown psychopharmacologist, crunchy country Yuppie, boisterous Bellevue doc. I have my private practice briefcase, a brown leather attaché, very thin, neatly packed with selected patient charts, extra prescription pads, my office keys, and a portable memory chip to back up my PalmPilot. On the same hook in my closet is a black diaper backpack, for errands around the city with a kid in tow. Then there is the huge red backpack that I toss everything into for my days off at the country house, my sanctuary. Last is my Bellevue bag: a brown suede cylinder into which I stuff medical journals to catch up on, an extra scrub top in case I get puked on, my Bellevue ID and hospital keys. What also gets packed into that soft suede bag is my suit of armor, the one I’ve had since childhood, a thick shell to protect my soft underparts from being skewered.
But even with the cowboy act, there are still times when I get down off my high horse, when I really connect with a patient, allowing myself to truly, madly, deeply feel what he is feeling, or imagine what his life must be like. I do this tentatively, experimentally, to see how much I can take, peeking into a pained and lonely world. What it teaches me, first and foremost, is to appreciate all that I have in my life. I am a richer person because of Bellevue, having learned the value of what I own. It’s corny, but I swear it’s true. I feel tremendous gratitude when I leave Bellevue on Monday mornings, returning to the outside world—the sort of relief I used to feel when I dismounted my motorcycle after a harrowing ride. I count my blessings, taking nothing for granted—my legs, my sight, my health, my home. More than anything now, I cherish my sanity, knowing full well it can disappear in the wink of an eye, especially in the face of insurmountable stress. I have seen all that can go wrong, how faculties can crumble just as internal organs can betray.
Weekends at Bellevue Page 19
