Weekends at Bellevue (16 page)

Mary and I have talked a lot about my need for self-control. I am mortified to have to convey this story to her. It’s a painful but necessary part of my therapy.

“Look, I know that it’s never okay to talk to a patient like that. There’s no excuse for acting like I did. I know it’s horrible.”

“Go on,” she encourages.

I skillfully skirt the whole issue of sadism, but let her know I know it’s there. “It’s not just sadistic, it’s masochistic. I could’ve gotten killed.”

“I don’t doubt that. But what do you think was going on?” Mary asks.

“One thing I’ve noticed: All of these guys that I do this with, they’re all in cuffs. Lucy and I have talked about this. Give us a man in shackles and we try to push him around. We sort of get in his face and poke him in the chest—metaphorically, I mean. Or maybe literally. I never taunt anyone who’s in hospital restraints. It’s just the cuffs. Maybe it’s something about his being an acknowledged dangerous person, like sticking my head in a lion’s mouth? Did Lucy ever talk to you about this?”

“You know I can’t answer that,” Mary says.

“Oh yeah, of course I do,” I assent. I can never forget that Lucy was
Mary’s patient, but I do conveniently omit that she can’t discuss any of their treatment. It’s frustrating to me and probably to her, too. Mary could probably offer me some answers ahead of schedule, tidbits she’s figured out in her work with Lucy, but she can’t. I wonder if she gets bored hearing it all over again, groaning to herself,
Oh, please. Here we go again with the butch taunting of the prisoners
.

“Well, one thing that might be related to the cuffs is that these guys are the ones most visibly locked up. I know I have a big issue with having the keys to the unit. I’m the one who has the power and the freedom, and the patients are the ones who’re locked in. I feel horrible about it, but I end up turning that off … doing a one-eighty. I turn my guilt into something else. Something mean.

“When I first started working in psychiatry, the keys, the patients being locked in, it really got to me. At Sinai, one of the hardest things for me in the beginning was leaving the patients on the ward over the weekends. I would walk out on Friday, locking the door behind me as I left, and all the patients would stay locked up all weekend long. I’d come back on Monday morning, after biking in the park, going to a movie, a concert, whatever, and there they’d be, as if nothing had changed: all of them on the ward just as I left them. Like reading a book, closing it for the night, and when I pick it up to read it later, all the characters would be right there waiting for me.”

“And how does this translate into you feeling guilty?” she prods.

“Well, I guess it’s really about freedom. How I have the freedom to run around the city, go Rollerblading, lie in the grass sunbathing in the park, and the patients are locked up all weekend long like caged animals. It doesn’t seem fair.” I pause, thinking about what I said. “So … the keys. Having the keys is a big deal. I have the means of coming and going, of leaving the ward. Oh, you’ll love this: When I was a resident at Sinai, doing a rotation at the Bronx VA, this huge patient, who was kind of simple, but I had a real love for him—I called him Uncle Louie ‘cause he reminded me of my great uncle—he tried to choke me at the door. He was trying to escape and I was trying to shut the door and lock it, and he choked me with my own keys. They were on this long necklace, made out of some heavy string, like a shoelace, along with my hospital ID.”

“What happened?” she asks, the concern in her voice revealing a maternal, protective tone that I can’t help but savor for a moment.

“The nurses and psych techs wrestled him off me. They heard me making this kind of choking, gurgling sound, and came running. As they pulled him off me, I remember feeling weakened, broken. I couldn’t understand why nice old Uncle Louie would do that to me. I think I probably sank to the floor, my back against the door, guiltily watching the restraint and sedation that followed. That’s how they did it, you know? There was no discussion or anything.”

“Wow.”

“Yeah, so, ever since then I don’t wear keys around my neck, and I encourage the residents and medical students not to also. I keep my keys in my pocket. There are plenty of things a patient can use to hurt you, but the keys around my neck seemed terribly symbolic to me, right? It made me feel like I shouldn’t be dangling them in front of everyone’s faces, like the jailer with his jangling keys to the cells. Or the zookeeper.”

“Well, the thing that seems interesting to me is that this is a major part of your job in the psych ER, though. Plenty of locked doors, different keys, security guards, prisoners, am I right?”

“Right. It’s a locked unit. Actually, all the psych units I’ve ever worked on have been locked units. It’s been an issue from the very beginning: who stays in, who’s allowed to leave. I think I’ve always had guilt about being the one with the keys, the one who can leave. I have zookeeper guilt.”

She’s not laughing.

“But now, at my new job, it’s more than that. Before, when I was a resident, I could blame it on the doctor in charge. Now, I’m in charge. I’m deciding who can go and who can’t. I am the one locking these people in.”

“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.

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:

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 police 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.