Weekends at Bellevue

by Julie Holland

  “Ma’am? Are you almost ready to go?” I ask her in a quieter voice, turning on the concerned, therapeutic, caring charm.

  “It’s not safe,” she tells us in a stage whisper. “They don’t understand me.”

  “Sweetheart, I promise you. You are not the first transgender prisoner in NYPD’s history.”

  We assure her that the police will be considerate and she has nothing to fear. Soon, she calms down enough to leave.

  Nancy is pleasantly surprised. It is a magical transformation, and we are both singing the praises of Ativan four, the wonder drug that works wonders.

  The second patient is a guy who was initially brought to the medical ER after he was arrested for shoplifting. He told the cops he had a hernia, but the AES was unimpressed with his bulge, deeming it non-emergent, so they sent him to the corrections holding area to wait for transport to arraignment. While in the blue room, the patient somehow attempted to hang himself using his leg irons. This is a new one on me. He must be awfully flexible and ingenious. The police bring him to CPEP where he is yelling and spitting to beat the band. He is mostly calling the police officers names, screaming how they’re all faggots and they can suck his dick. Once he is tied down and sedated, they begin to search him, emptying his pockets, taking off his shoes. He needs to be searched before he enters the detainable area, and I am nearly positive we’ll have to admit him.

  The cops find two bottles of nitroglycerin sublingual tablets in his pockets, and one bottle of heparin in his shoe. Evidently, he has stolen these from the medical ER. The nitro is a medication that dilates the heart’s blood vessels, meant to be given to a person in the midst of acute chest pain. The heparin is an intravenous medication used to prevent blood clots from forming. If he had swallowed even one bottle of the tablets, it could have been a medical emergency, but I’m not sure he knows the value of what he has filched, and I’m even less sure he had any intention of actually hurting himself. He may have thought he could sell them on the street.

  I can’t get much out of him during the interview, though he’s much calmer with me than he was with the police, and there is no talk of fellatio. He is a flamboyantly gay Filipino male who is quick to report his bipolar diagnosis. He seems entirely believable to me, as he tells me his psychiatrist’s name and number, which he chants rhythmically like a Sousa march. This is the verse: name and number, name and number. When he gets to the chorus, he switches to his lawyer’s name and number. He repeats them both so often and so distinctly that I do not need to write them down. I have the song in my head for the rest of my shift.

  I leave a message with the psychiatrist who calls me back fairly quickly. This sort of thing happens a lot, it sounds like. We have a great conversation, bonding over our love of our jobs, and he fills me in on the patient’s most recent medication regimen. He’s been switching around some of his meds, and we chat until we agree on a pharmacological plan of action. I fill out the admissions paperwork, meticulously ordering all the meds per our discussion, hoping the up-wards docs continue them as written.

  My third prisoner is making his Christmas wish list a little early. It is only mid-September, but he is unabashedly asking for methadone, Clonidine, and Klonipin. Three different sedatives, one of which is a potent opioid narcotic, similar in its effects to heroin. He has seen me give Ativan 4 IM to prisoner number one, and he wants to know why he hasn’t been seen and medicated yet.

  “What do I have to do to get some Ativan around here? Do I gotta bust up this joint?” he shouts.

  His police escorts stand idly by, surveying the scene but opting not to intervene. I stand in front of the prisoner and say, “If this guy acts up, give him twenty-five of Thorazine IM.” I say this to the resident while staring at the patient.

  The prisoner quiets down. This tells me plenty. He knows his drugs. He knows Thorazine will make him feel absolutely horrid. He knows I mean business, and if he’s a good little boy, maybe he’ll get a treat. I may feel charitable and give him one of the sedatives on his wish list. But if he’s bad, he’ll get the charcoal in his stocking.

  The fourth prisoner is an ornery man, rude and irritable. He has tattoos of letters on his fingers and on his neck. The fingers are a tip-off that he’s been in jail, and the neck is typically a warning sign that I’m dealing with a sociopath. He’s giving the police a hard time, but when he gets alone in an interview room with the medical student, he is sweet as pie, subservient, calling her Miss and Ma’am interchangeably. He won’t tell her what he is arrested for, or what he has been in prison for in the past, but he does tell her that he takes Prozac 100 mg and Ativan 50 mg. He says “BID,” which stands for twice a day, so he has done his homework, except that these are outrageously high doses, so even though he’s calm and seemingly cooperative, he’s lying through his teeth.

  He also reports that he gets 130 mg of methadone a day and says he is in withdrawal, because he hasn’t had any in several days. This is a high dose, but not an uncommon one. However, his pupils aren’t dilated and he doesn’t have any goose bumps on his skin. These are two physical manifestations of opiate withdrawal that are difficult to manufacture, so it’s an easy way for me to check his story.

  He denies being suicidal, homicidal, or psychotic, so I get the paperwork together to send him out with the police.

  I walk out into the nondetainable area to talk to the police officer on the case. The cop is a jaded, older guy who tells me he is close to retirement. I always think of Danny Glover in Lethal Weapon when I hear a cop say he’s nearly retiring. Glover’s character ends up getting roped into a dangerous and complicated case just days before he can leave the police force in one piece, which makes me nervous during the whole movie.

  This officer tells me he’s taking a course to become a respiratory therapist. He has a house in upstate New York and is hoping to get a job in a hospital near there. He mentions he has PTSD and asthma from 9/11, so I guess he must’ve been down there and seen some horrible things. He is sharing an awful lot with me, more than the average officer, and it finally occurs to me why. He is trying to butter me up because he wants the guy sedated. Tonight, everyone is trying to get on my good side to get the good drugs.

  The prisoner has been giving him a hard time, and he is in no mood. The cop is at the end of his rope, nearing the end of his time in the force, and he is running out of steam. He also tells me what his prisoner would not, which is that the charge is rape, and he’s been imprisoned in the past for the same.

  “If you’re going to release him to me, can you please medicate the hell out of him?” the cop finally asks me.

  I reply as I often do, “Happy and compliant or dead weight?”

  The cop answers wearily, but without skipping a beat, “If this guy isn’t dead weight, I’m afraid I’m gonna have to kill him.”

  “Sir?” I ask, just to make sure I heard him right. He isn’t saying it like he’s kidding; he’s saying it like he’s exhausted, and it’s the path of least resistance.

  “Dead weight, dead prisoner, what’s the difference? The guy’s a rapist,” the cop moans.

  Wow. Did I say jaded? It’s clearly time for this officer to begin his new career as a respiratory therapist upstate, and head out to pasture. Stick a fork in him; he’s done.

  “Right-O,” I say cheerfully. “I’ll see what I can do for you, sir.” Best to just remain polite and let it go. This cop is not my patient.

  I unlock the door to leave the waiting room and I am hit with a blast of noise in the detainable area. The arrested rapist is now all over me for his methadone, no more mister nice guy. He’s gone from catching flies with honey to spewing vinegar in my face.

  “The hospital limits us to how much methadone we can administer,” I explain. I don’t specify the amount, because I know he’ll blow his top if he hears it’s only twenty milligrams.

  “Call my methadone clinic and they’ll tell you the dose!” he screams at me, his face contorting and reddening.

 
“Sir, it’s eleven o’clock at night on a Sunday. There’s no one at your clinic right now.”

  “Someone is there. Someone is always there,” he insists.

  I go inside to talk to Nancy. “The cop wants dead weight, the prisoner wants methadone. Looks like we should probably just take advantage of the situation.” We agree to do something that everyone knows damn well is completely against the rules. I have never done it before or since: I tell the patient we’re going to give him an injection of methadone, and we give him Thorazine.

  I tell the medical student, “This is the first time in my seven years at Bellevue that I am ever doing this. It’s medically unethical what we are doing, do you understand? You never lie to a patient about what medicine they are getting; it’s against all the rules. Actually, I’m pretty sure it’s against the law. But sometimes down here, the end justifies the means. This way, he calms down, the cop is happy, they both leave and we go on with our night.”

  The medical student nods earnestly. She understands; she doesn’t see any problem with what we are doing. She’ll make a good ER doc someday, and I tell her so. I, on the other hand, am starting to see myself in a new light, beginning to feel that two-shades-beyond-golden-brown, burnt-out feeling creeping up on me. I’m not quite “crispy” yet, but I’m getting there.

  Your Mother Should Know

  Flashback: Saturday afternoon, September 11, 1999. After I go running in the park and shower, Jeremy and I have sex before I leave for work.

  As I walk down the back hallway toward my office, I notice a sharp, twisting pain in my right lower quadrant: I can actually feel myself ovulate. I get very excited, convinced the timing has been perfect and Jeremy and I have successfully conceived our first child. It is our first time trying; we have been married for four months.

  I have a few minutes before my shift starts to go to the coffee shop to get something for dinner. In the line, I run into my friend Gideon, a social worker at CPEP. I decide to let him in on my secret, unable to contain myself, as usual.

  “Guess what?” I ask him.

  “What?” he responds, excitedly. Gideon can get enthused about anything. He’s the perfect person to tell, because he’ll mirror back all my elation and then some.

  “I’m pregnant, I think. And you are the very first to know.”

  “Oh my God! That is so amazing! How far along are you?” he asks.

  “What time is it?” I answer.

  Three weeks later, I pee on a stick and the plus sign appears. We have gone from newlyweds in May to expectant parents in September in the blink of an eye, and we are almost a teensy bit disappointed that we didn’t get to spend a few more months trying.

  Be careful what you wish for.

  Conceiving our second child is a completely different ball game. I am four years older, now thirty-eight, and we are at it for well over a year. I complain constantly about what a pain in the ass it is. (“I know, I know. Then we’re doing it wrong!” I joke with the coffee shop guy.) In all seriousness, I am growing a bit tired of doing it with Jeremy. Baby-making is not sexy. It is like a job you have to show up for, even though you want to sleep in. All the romance has gone out of it; we are slaves to my cycle, my erratic temperature chart, the consistency of my cervical mucus. I take the thermometer to Bellevue on the weekends and lie down impatiently in my office on Sunday and Monday mornings, waiting to get my basal temperature readings before I get out of bed to prepare for sign-out.

  We have sex every other night during my fertile week, whether we want to or not. You again! I think to myself as we try to gear up to get off yet again. Jeez, can I please get someone new over here?

  We try month after month, to no avail.

  There is one day up at the house when we stick Molly in front of the television to watch Snow White as we run upstairs to our bedroom. I try to get “Whistle While You Work” out of my head to better get in the mood. We are giggling as we hear her video playing downstairs, and I have a funny feeling I’m not going to feel the same way about those dwarves in the future.

  After fifteen months of unsuccessful attempts, I finally give in and take Clomid, a medicine that causes more eggs to be released during ovulation. I am deathly afraid of twins, but what I get instead is a few days of industrial-strength premenstrual moodiness.

  On a Monday night up at the house, I insist to Jeremy that tonight’s the night. I’m so tired, having worked two overnights with no sleep in between due to having one child already. The last thing I want to do is get it on, really, but it’s nonnegotiable. I have taken the Clomid and the timing is perfect. It’s now or never.

  When we are done, I have a powerful sense that it has worked—call it women’s intuition, maternal instinct, or magical thinking. Jeremy gets up to go to the bathroom, and I say something softly to the new being cooking in my pelvis. “Stay with us, little man. We want you here with us. You’re in the right place. Stay.”

  The Clomid does work, thankfully, and soon after, my uterus acts like a balloon that’s already been blown up once before. There is no resistance, and I start to show immediately. Nancy tells me one day, “Julie, when you was pregnant with Molly, your butt got really wide. But this time, you gettin’ a bubble butt. It’s going straight out. That’s why we think you having a boy this time.”

  “We?” I ask, bracing myself for what I know is coming.

  “Yeah. The nurses.”

  “So, you all stand around here and discuss the dimensions of my ass?”

  “Only when you’re pregnant!” She grins.

  I have turned into the doctor with a three-year-old at home and another one on the way. “Going another round, eh?” is a popular question around the hospital. There’s no denying it now, no pretending I’m hip anymore. I’ve joined the parenthood club, hook, line, and sinker. At Bellevue, the staff who have kids seem to know everyone else; the status of our children is the currency we use to exchange pleasantries. I discuss toilet training with the hospital police officers, sleep strategies with the radiology technician, and the fertility tricks I’ve learned with the man behind the counter at the coffee shop. It is a level of intimacy atypical for colleagues, but the folks at Bellevue feel like family. Actually, I see them more often than any of my relatives.

  There is one hospital police officer, Pablo, who has a child Molly’s age. He never fails to ask me how Molly’s doing, and he loves to show me the latest photo of his daughter. He’s split up with his wife recently, and I know it must kill him to have limited contact with his girl. I see the way his sunny face clouds over when I ask him about it.

  I come to work one Saturday to learn that Pablo’s daughter has been struck by a van in a hit-and-run accident. She is transferred to Bellevue from another hospital, but it doesn’t look good. She’s on life support, and from what I can gather from the other officers, she may be brain-dead. The entire ground floor of the hospital, where the HP headquarters and most of the security checkpoints are located, is eerily quiet.

  Pablo is friendly and well-liked, and the staff speak in private whispers, gathering in twos and threes in the corners to discuss the latest on the girl’s medical condition. I keep an eye out for him so that I may express my sympathies, to see if there’s anything I can do, but I don’t see him around.

  Later in the weekend, I find out that she has in fact died.

  When I do finally see Pablo, I am too upset to speak to him. The lump in my throat forbids it. Tears sting my eyes at the sight of him, the thought of his anguish. I don’t know how it is that he can pull himself together to be back at the job so soon, but then I realize he’s only come in to do some paperwork so he can take a leave of absence. He is dressed in a suit and tie, as opposed to his usual blue HP uniform, and he seems to have aged a decade since I saw him last. I can’t even imagine the pain he must be feeling. I turn away, feigning absorption in some other task, feeling ashamed at not being man enough to approach him.

  It is the ultimate undoing, the pain of losing a child.
More often than not, it does irreparable damage. I have seen countless patients who pinpoint their psychiatric decline to the date of their son or daughter’s death. Marriages crumble, and individuals disintegrate.

  I should go to him. I should hug him, tell him the same thing everyone else is telling him, “If there’s anything I can do …” But I do nothing. I say nothing. There are multiple opportunities for me to pay my respects and acknowledge his situation, but I escape them all as my avoidance snowballs over time. Somehow, I cannot align my motherhood—our shared parenthood—with my steely Bellevue doctor persona; I cannot tolerate the bleed-through between my two compartmentalized existences.

  I remember the closest I ever got to losing Molly, the twenty-seconds-of-terror vortex that sucked all other reality out of existence. She was nine months old and eating a yogurt-covered pretzel. She liked to suck the vanilla coating off the pretzels, but she didn’t like to eat the pretzels themselves, so I would finish up the job from there.

  I left her sitting in the middle of the living room floor as I was putting away the laundry in the bedroom. And then I realized it was very quiet, and quite still. Too still. I popped my head into the living room and checked on Molly. She was sitting on the floor as before, but she was red in the face. A high-pitched whistle, very faint, was coming from somewhere in the living room.

  It was coming from her.

  She was choking on the pretzel, moving just enough air to create this reedy sound, looking up at me with wide-open eyes.