Weekends at Bellevue (12 page)

Jeremy points out to me as we tuck into our own eggs, “The guy probably hears that word constantly. How it’s a miracle he survived.”

“But taking a bullet to the head and living to tell the tale, that really is a miracle, Jer,” I try to convince him. “The only bigger miracle would be if our government could make it a little harder for a guy to buy a Beretta.”

I
am up on 18 North again a few weeks later, writing notes on the new patients upstairs when I notice a large bouquet of flowers on the windowsill of the nurses’ station.

“What’s with these?” I ask the Filipino nurse with the long, straight hair and the beautiful full lips. She is wearing denim overalls and she couldn’t look any sexier if she were posing in a men’s magazine. She’s having an affair with one of the moonlighters, but I don’t let on that I know anything about it, though he’s told nearly everyone.

“They’re for Daniel. He passed his boards,” she explains.
His written boards
, I think to myself. His second time. I wonder if he peppered his answers with exclamation points. I know that he failed them on his first try, but I also know that this nurse doesn’t know that. Because he is an attending on an inpatient ward, he hasn’t told many people. I smile smugly to myself, having aced the written exam my first time out. Now I am preparing for the oral exam, which comes next, and is a killer. I guess he’ll take the orals after I do.

“And you guys got him flowers…. That’s so sweet!” I say, in perfect insincerity. I think about what a killer schmoozer he is, how easily he manipulates women with that grin of his. The nurses must fall all over him up here.

I finish my notes on the acute ward and head up to 19 West. I always save the prison ward for last. I get a testosterone rush out of standing in front of the prison gate, the bars thick with layers of glossy white paint.

“On the gate!” I bellow. I have learned this is the way the guards announce that they need the door opened for them. I lift my Bellevue ID card up to where the guard in the booth can see it, and the gate is opened electronically, noisily. I enter a small area where the officers are supposed to unload their weapons into a sand-filled metal chamber. Here I am trapped, as I must wait for the gate behind me to close completely before the one in front of me can open. Once I am through the double-gated chamber, I am in another double-gated chamber, this time longer. At one end is the log book, in front of yet another gate that leads to the forensic psych ward. At the other end of the chamber is the forensic medicine and surgery ward, for the prisoners who need medical attention. The log book is for both wards, and those who sign in reflect the many disciplines of medicine at Bellevue: orthopedic surgery, neurology, infectious disease. I pen my name legibly and print
PSYCHIATRY
in capital block letters. I want to represent, yo!

I am on 19 West this evening to speak to a man who has been getting a lot of press lately: a rather famous serial killer in New York City. After his recent arrest, he spent some time at Rikers Island, where it became clear to the prison psychiatrists that he was not right in the head. So they packed him up and shipped him off to us for a more thorough evaluation and one-to-one observation. He is a high profile case, and no one wants a bad outcome, thus a personal babysitter is assigned to keep an eye on him.

Although the press have not yet caught wind of this, he tried to hang himself at Rikers. Also, I see in his chart that he is reporting hearing voices; the voices told him to kill his cell-mate. Smart move, on his part, to offer up this tidbit to the Rikers shrinks. Few things will make a doctor more nervous than being responsible for a life lost.

I sit in the nurses’ station of the forensic unit with my feet up on the desk. The patient’s chart rests in my lap, while I munch on some stale cookies the nurses left lying around. One prisoner-patient after another comes over to the nurses’ station, asking if they can have some medicine. “Can I get something to help me sleep?” “Can I get something to calm me down?” “Are you here to see me, Doc? I got this rash.” I can’t stay here too long, I realize, because I’m starting to attract an audience. Once the patients know a doctor is on the unit, they come out of the woodwork, hoping to have their medications changed, or their privilege status upgraded, or just hoping for someone to spend some time listening.

“I’m not here to see you guys, sorry,” I explain to the gathering group. “If you need a doctor, the nurse can page the moonlighter. I’m just here to write notes on the new patients.”

The alleged serial killer has already made a full confession. I heard on the news that they found his diary detailing the killings. The press is saying he is suffering from a “degenerative brain disease,” whatever they think that is. If you ask me, if he’s writing it all down, some part of him knows that what he’s doing is terribly wrong. He is compelled to detail the killings because he needs to confess and be punished. Or else he has fetishized the experiences and wants them all meticulously documented. Either way, I’m hoping that between his confession and the diary, what I document in his chart won’t change his fate much.

After reviewing his records, I muster up my courage to go search for the patient. I walk into the dayroom where there are two of “New York’s Boldest,” NYC Department of Corrections officers. I feel as if I’m walking into a room of caged animals; I can sense the energy level in the room amp up as I enter. Then the noises start, the catcalls, the whistling, and it reminds me of those scenes in movies when the scientist walks into her lab, into the room with the monkeys, and they all start to howl, jump, and rattle their cages.

The D.O.C. guards create a barrier between me and the other men while I interview the now-famous man at a table in the dayroom. I really just have a couple of quick questions for him and then I am out of there. I’m not easily spooked, but the forensic psych unit at Bellevue pushes even my envelope.

Wearing hospital pajamas, the prisoner is tall, thin, and bug-eyed. He is surprisingly focused, calm, and completely coherent. He is polite with me, and deferential in a way that I wasn’t expecting. Well-groomed, soft-spoken, he is happy to answer my questions. I could easily spend more time with him, take him somewhere more private to do a thorough evaluation, but it isn’t my job right now. I am only here to make sure he isn’t currently suicidal or homicidal, and to find out if he is still hallucinating. Regardless of what I learn, I won’t dare stop his one-to-one observation status. Although he is cooperative, he’s not chatty in the least. Moving to a different interview spot would’ve been a waste of time. He offers one-word answers to most of my questions.

“Are you still hearing voices?” I ask.

“No,” he answers.

“What about the suicidal thoughts? Are you still having them?”

“No.”

“Are you thinking about hurting anyone else?” I ask. “Nope,” he answers simply.

“Well, is there
anything
on your mind you’d like to talk about?” I inquire sweetly, cocking my head.
Toss me a bone here, man
. “No. I’m doing okay now,” he assures me, smiling. Great. I’ve got nothing.

I’m not sure what to make of him. His eye contact is good, and he isn’t spewing a lot of crazy disorganized information, but he still seems a little off to me. It may just be that he isn’t very bright; according to his chart, he’s minimally educated, possibly even mildly retarded. I don’t have a lot to go on from the interview in determining whether he is truly psychotic or not. Denying everything doesn’t tell me much of anything. He could be grossly psychotic on the inside, but sealed-over and acting pretty together on the outside. Maybe that’s the way serial killers usually are.

I’m just not sure how to describe his mental status in the chart, knowing it’s a legal document that will be pored over by prosecutors and public defenders alike.

“Patient denies AH, SI, HI,” I write succinctly, using the standard abbreviations for auditory hallucinations, suicidal ideation, and homicidal ideation. Then I write what I always do when I haven’t gotten anything juicy in a three-minute conversation: “No gross evidence of psychosis currently, though brevity of interview precludes full assessment. Continue current level of care.”

Bor-ing.

Why are the notorious bad guys in the news always so dull when I finally get a crack at them? As the years roll by at Bellevue, this will become a recurring pattern. The more hyped-up they are in the press, the saner they seem when I finally get to sit down with them for an interview. Well, maybe not sane, exactly. They’re deeply troubled, but mostly, when I scratch the surface, there isn’t much underneath. They’re almost always undereducated or borderline retarded, and they’re often quite childlike. Talking to a psychotic killer, I will learn after a few years at the hospital, is a lot like talking to a dumb kid, only it’s more pathetic. With a kid at least you have a sense of optimism about his future.

This prisoner, though he is not one to brag, has left a wake of carnage
that the city won’t easily forgive or forget. I appreciate that I have a chance to speak to him, however briefly. Bellevue will always be kind in affording me these opportunities. It is one of the reasons I came here, and one of the reasons I stay.

I leave the prison gates and head for the relative freedom of CPEP to start my shift.

T
wo nurses and a few psych techs are standing around a stretcher in the shower room. A woman has come in by ambulance from a crack house and is in desperate need of bathing. Her hair is sticky and covered with dirt; she is speckled with mud and feces, and from what we can tell, semen. She has scratches all along her back and buttocks, and bruises on the insides of her thighs.

She is either still high on cocaine or a combination of drugs, or she is out of her mind from trauma—I can’t tell which. While she is being scrubbed clean, she arches her back, and opens her mouth wide toward the head of the stretcher, jutting her chin toward the ceiling. She keeps making these openmouthed sucking motions, and groaning rhythmically. Groaning and gulping, absentmindedly, automatically, as if she’s been doing that for hours already.

“Julie,” says Nancy, in her froggy voice, “I think she been raped.” Nancy is my very favorite nurse. Love Nancy. With her ample bosom and her gap-toothed grin, she is my warm, welcoming, and accepting auntie, and I would do just about anything for her.

“Maybe we shouldn’t be washing the evidence off her?” I wonder aloud. “Should we send her to AES for a rape kit?” It is standard procedure: If someone reports a rape they are sent to the medical ER to be examined. A rape kit is a forensic physical, a way of examining a sexual assault victim with a fine-tooth comb, literally. It can be traumatic for the patient, resonating with the assault itself, but it’s the best way to
collect DNA evidence to assist in prosecution. The vagina and anus are swabbed for semen samples, and the pubic hair is combed for the rapist’s pubic hairs. Also, pictures are taken of the bruises, abrasions, and any other physical signs of the attack.

“I don’t think she was in any shape to identify anyone,” Nancy surmises. “Plus, I imagine she did it for the drugs. You know how these things go. It’s best we clean her up, let her sleep. She looks like she been through enough. I say let it be.”

I suppose she’s right. I watch my coworkers, my friends, tend to this woman, lovingly washing away the dirt, the grime, and the evidence of the crime. I am touched by the scene, the symbolism of the water, the baptism. I hope it washes her clean, inside and out. I hope she can’t remember a blessed thing, unlike our other rape patient in the CPEP.

That woman, who is in the EOU, was attacked just a few blocks from here under the FDR, the highway next to the hospital. She was hit on the back of the head and tackled by two guys. They took her wallet and sexually assaulted her, but then the cops drove up. The two guys ran in two different directions. One of them ran across the highway and was hit by a car. The ambulance brought him to Bellevue, where he was rushed into the trauma slot. The other guy was caught by the cops and taken to central booking.

My friend Jude, one of the AES attendings, calls me with an update. I’m always happy to talk to him. He’s fun to flirt with, and usually flirts back even more insistently than I do, even though he knows about Jeremy.

“Hey, Jude,” I coo.

“Hey, bulldog. You know that rape victim you have over there?” he asks.

“You wanna narrow it down for me, lovey? I got more than one in the area.”

“Yeah, lessee … white woman, mid-thirties? What’s her name, Jackson? Johnson? Something like that …”

“Johansen,” I say, exaggerating a Swedish accent. “Jah, she’s still here. What about her?”

“Maybe you want to let her know her attacker didn’t make it. He died in the slot.”

“Ouch. Well, sorry you lost one, pal, but maybe not so sorry it was this one in particular, huh? Okay, I’ll let her know. I guess you really are
supposed to look both ways before you cross the street. Even if you’re running from the cops.”

“Turns out … so, uh … maybe I’ll come by later to tuck you in, huh?” he teases.

This is a long-standing joke between us: our mutual attraction, and also the fact that I sleep through a good chunk of my overnight shift, while he works every minute of his. Later that night, when my pager goes off with a callback number of 6969696969, I will assume it is him and roll over, settling back to sleep with a smile.

“Tuck me in … I wish,” I sigh dramatically. “Are you wearing those light blue scrubs that drive me wild?”

“I am, indeed!”

And on it goes. I hang up the phone and go to the EOU where Ms. Johansen is lying in bed, curled up in the fetal position with her back to the door.

I enter her room quietly, not sure if she’s sleeping or not, and lean over her to get a look at her eyes. She is staring at the wall, barely blinking, breathing shallowly. “Hi,” I say softly, tentatively. “How are you feeling?”

She rolls over to see who is addressing her. “Mostly numb,” she answers. “My head hurts, still, but the anti-anxiety medicine is working pretty well. I finally stopped shaking. I can’t stop seeing their faces, though. It doesn’t seem to matter if I close my eyes or if they’re open. I keep replaying what happened.”