Weekends at Bellevue (26 page)

Daniel is wearing a cast on his arm. He punched the employee refrigerator in the nurses’ station during a particularly dramatic exchange at a staff meeting. One of the psych techs was leaving the CPEP to go work upstairs, primarily, I believe, because of issues having to do with Daniel. Daniel had asked something at the staff meeting along the lines of “Who’s with me?” and this particular tech had made a complaint, or implied that he wasn’t on board and was abandoning ship. So Daniel
growled and popped the fridge with his fist. There was a dent on that fridge for the longest time. Someone had circled it with a pen, as though to outline the evidence of Daniel’s poor impulse control.

“I know, yes,” Dr. MacKenzie utters casually. His first words of our meeting. He knows, but doesn’t seem to care, that Daniel has assaulted an innocent kitchen appliance. A major appliance.

I was hoping for something more conspiratorial. Perhaps I had fantasies of us dishing the dirt about Daniel and his psychopathology, laughing about him, commiserating together. But MacKenzie remains stone-faced, giving me nothing to go on. He is my boss’s boss, after all, and he’s playing it close to the vest, as usual.

I pull myself together and get ready to leave the office. “All right, then … thanks for listening, I guess. I just needed to unload after this faculty meeting. He is really being an ass lately. One thing I can say, I don’t think he’s acting like a director should.”

“Well, as you know, he is the acting director currently, and the administration is discussing whether to make that permanent.”

“Obviously you know my vote,” I stare into his eyes meaningfully as I stand up. “Thank you for your time, Dr. MacKenzie,” I say faux-politely as I turn to head out the door.

“Julie,” he says gently, motioning for me to sit again. “I liked what you had to say at Lucy’s memorial, about how angry she was at having to die. I’m just wondering, how’ve you been feeling lately? I mean, don’t you think it’s possible you and Daniel are just angry that she’s gone? And you’re butting heads in her absence? Because your anger needs to go somewhere.”

Ahh, the psychiatrist in him is emerging
. He’s good, actually. He has a smooth, caring delivery. I bet his patients like that. And he knows Daniel well enough to see what even I can see—that there is good and bad in him, as there is in all of us. Nonetheless, I persevere.

“It’s more than that, I think,” I join in on our new empathic level. “Lucy always said she couldn’t trust him. That was something she spoke to me about a lot, when she first brought him down from upstairs. She thought he was smart, and he’s good with the patients. He remembers cases, I’ll give him that; he remembers people’s stories. But there’s something about Daniel that always bothered me.” Here’s my opening. Maybe we will conspiratorially get to dish and gossip after all. I can only speak my mind and see if he’ll follow suit. “The line I usually use when I describe
him is ‘There’s no
there
there.’ He’s all facade. That’s what Lucy couldn’t trust. She never knew what he was thinking, how he was feeling. There’s something missing when you dig for the real him. You know, when I knew him in residency, he called himself Dan. Then he moves here and changes it to Daniel. Now, he’s got the administration calling him Danny. He says it’s his nom de guerre.” Dr. MacKenzie smiles widely at this.

“You’re smiling,” I say, “but I don’t like that he sees it as a war, that it’s him versus the administration. He spends most of our faculty meetings complaining about how hard it is being the boss, how he has to deal with all of these incompetents upstairs. I don’t think it’s appropriate for the rest of the faculty to hear how he has no respect for his superiors. How are we supposed to respect him, then?”

“Well, I appreciate your candor,” says Dr. MacKenzie, wrapping up our meeting. “I’m not sure there’s going to be any happy resolution here. Part of my job in this hospital is to try to satisfy everyone, address their complaints, and find compromises. What I end up doing, primarily, is spreading the misery evenly, thinly, so no one gets too much or too little. That’s pretty much the best I can do.”

“That sounds like a great job,” I sympathize. I have an image of him as an aproned cake decorator smearing shit-brown frosting over a hospital-sized layer cake.

“I’ll see what I can do,” he promises.

“And that sounds like the parting words of a great administrator,” I say as I leave. “I would appreciate your help on this one, Dr. MacKenzie. I’ve always thought of you as one of the good guys.”

O
n a Monday morning right before I sign out, I spy a man on a stretcher, lying asleep on his side. The word “Pussy” is tattooed on his right cheek. I am not sure who he is since he came in overnight while I was sleeping. During morning report, the resident signs him out as someone on triage who hasn’t been seen by a doctor yet.

About a week later, I see the guy again as I walk by the coffee shop, on my way to have a meeting with Daniel and Dr. MacKenzie. I run into Daniel waiting for the elevator and mention it to him on the ride up, trying to break the uncomfortable silence. “That guy with the ‘Pussy’ face tattoo is back.”

“It’s an unfortunate word to be wearing, isn’t it?” he asks, his manner arch, ironic.
An unfortunate word. Give me a break
. His irony only fuels my rage, but I control myself and join in on his level.

“I wonder if it’s how he perceives himself, or if it’s more a case of advertising what he’s hoping to find,” I offer.

We share the remaining time in the elevator in a stony silence; small talk and attempts at humor are useless. Dr. MacKenzie has asked us to come to his office to see if we can hash things out. I’m doubtful we can do more than hammer out the details of a détente. MacKenzie opens the discussion with a bombshell. “Daniel, Julie has made some serious accusations against you, regarding sexual harassment.”

“No I didn’t! I don’t feel sexually harassed by you!” I squeal. “Hardly,”
I harrumph. “That is not what I said at all. I just told him about how you chewed me out at that faculty meeting. And how you told me I was a lot more fun when I was pregnant with Molly and I should just go home and get knocked up again. And about how you made that gross joke about vagina au jus.” I stick that last bit in with pleasure, knowing it will infuriate him that I have shared his inane joke with his boss.

“Okay, not sexual harassment, per se, more like sexually inappropriate,” Dr. MacKenzie calmly says. “Can we just agree that there will be no sexual comments, innuendos, or jokes in the workplace?”

“Of course,” we both acquiesce. That’s easy enough.

“Now, I understand you and Julie go back quite a ways, isn’t that right, Daniel?”

“Yes, sir. We did our residency together,” Daniel answers pleasantly. “I was, what, a year ahead of you?” He asks me as if he doesn’t know damn well he was a year ahead of me. Like he doesn’t remember doing a rotation together on the inpatient ward at Sinai, when I pissed him off because I stepped in as his patient visibly deteriorated. Hannah. It was over ten years ago and I can still remember her name. I couldn’t stand by and do nothing when she was so obviously overmedicated, but it sure pissed him off that I broke the chain of command.

“That’s right. We do go back a long way,” I say simply. “But now can we please deal with this scheduling situation? With the moonlighters? It needs to go to someone else.”

“Well, now, Daniel and I have been talking about this, Julie, and Daniel feels that it’s appropriate for you to do this extra work because you’re working less hours than the other attendings.”

Fewer
, I think to myself, but I dare not correct him. I also don’t tell him how I’m not working any fewer hours than most of the other doctors. Most of us are logging in less than what is required to be considered full-time. “So why don’t you just demote me to part-time?” I offer. “I’ve been working these hours since way before Daniel became my boss. All of a sudden I’m not working enough, so he thinks he can justify my doing the scheduling? That’s absurd. Can I switch my status to part-time? Would that work?”

“Well, you changing to part-time is potentially a solution. Here’s another suggestion I had, if you really don’t want to do the scheduling anymore,” he says, as he slides over a piece of paper to me. On it is a bunch of numbers, a chart of various hours and salaries. “You can either pick
up some more hours and work another day during the week, or you can take a small cut in salary if you’d like to keep your current schedule.”

“You’ve got to be kidding me.” I can’t believe this is happening. I look at the numbers. “You guys want me to take an eight-thousand-dollar pay cut? I’ve been working the same hours for years! I make one visit to your office to complain about Daniel being a pig and it costs me eight thousand bucks?”

“Now, that’s not what’s going on here, and I think you know that. If you take this new salary, you’d still be the highest-paid doctor at CPEP, based on hourly earnings, which is commensurate with your seniority.”

“But I’d be making less money, doing the same job I’ve always done.”

“This is your choice, Julie. You can keep doing the scheduling, you can pick up another day at CPEP, or you can take the pay cut.”

“How long do I have to think about it?”

“How’s a week? Is that enough time?”

I nod my head and get up to leave. My eyes are stinging with tears, and I have no desire to let Daniel see how upset I am. I’m sure he’s grinning smugly, thinking he’s won this round, which he truly has. He’s got me right in my pocketbook, which hurts me more than anything.

“You understand that I am supporting a new family right now?” I remind Dr. MacKenzie. Emotional blackmail—it’s worth a shot. “This pay cut couldn’t have come at a worse time.”

I leave the administrative suite, ride the elevator down to the lobby, and go to my office to get my things. I feel like I’ve been betrayed. Punched in the stomach. By my dad.

It’s Monday morning, and I can leave for the week. I have a few days to decide what to do, although I’m already pretty sure that I’m willing to part with eight thousand dollars a year if it means extricating myself from this ridiculous scheduling job. That’s what my peace of mind is worth, “eight large,” as they say on
The Sopranos
. I start to fantasize about hiring someone to get these guys whacked. It’s gotta cost less than eight grand.

S
ix days later, Sunday night in CPEP, and who should appear again but the Pussy-face-tattoo-man. He arrives by ambulance, after calling 911 from a pay phone on a street corner.

“Patient reports hearing voices telling him to kill himself, and he has taken two Tylenol number threes and one Vicodin in what he is calling a suicide attempt,” EMS tells me.

“That sounds like a pretty good way to get high, but a lame-ass way to kill yourself,” I say to the ambulance drivers. They laugh, as they always do. They’re the only ones more cynical than we are, I think. Or maybe it’s the cops.

I’ve seen this guy hanging around CPEP and the Bellevue lobby way too often in the past couple of weeks. Plus, now I associate him with Daniel, which is probably why I make the taunting comment right in front of him. He symbolizes all that is wrong with my job at the moment, and he must pay. My malingering radar is up pretty high after hearing a story like that, so there’s no way he’s going to be able to get past me tonight.
I know guys like this
, I think to myself. I already know his pants are on fire. It’ll be tough for him to convince me otherwise. He is destined for the door.

“He’s gotta go; we got way too many patients in the area,” I say to Vera, the tall, thin, blond head nurse on tonight. “I’ve gotta clear the rack. Vera, you wanna join me in here for this guy and we’ll try to bang it out together? I don’t want him to get too comfortable here.”

“The tattooed lady?” she jokes.

“Let’s pretend we just can’t see his face,” I advise her.

We invite him into the triage room for a quick interview.

As he sits down across the table from us, he turns his head to the right, and I finally get to see the left side of his face. Up until now, I had only seen the right side, the “Pussy” side. His left cheek has a tattoo on it as well. “Licker” it says. Aha! Not just Pussy! Pussy Licker! This guy is advertising to all the ladies out there that he is available for their dining and dancing pleasure. Only, I guess it’s not working so well, because here he is looking for a room at hotel Bellevue. I have to take a deep breath and try to maintain my composure before this man, with these words on his face.

Before I can even start the interview, he is already off and running with his laundry list of symptoms.

“I’m hearing voices to kill myself.” He jumps right into the middle, no “Hello, how are you doing this evening?” I can’t even get my fork out for the first question and he is already on his dessert.

“They’re saying ‘Why don’t you just do it already?’ and I haven’t slept more than thirty or forty minutes a night for the past month. Also, I’m
seeing my dead mother in front of me, saying ‘Join me.’” He takes a breath to gather up speed for more, and I am nearly speechless. He is pulling out all the stops, and so early in the game. I’ve never seen anything like this, the impatient approach to convince me of insanity. And this last one, the “Join me,” is a smart move on his part. I don’t know if someone’s been coaching him or if he just happened upon this symptom through trial and error at various ERs, but it’s a doozy.

Identifiable auditory hallucinations are a more potent form of voices, a step above a murmuring mumble, “Kill. Kill.” It is one thing to hear a voice if you don’t know whose it is, or can’t quite make out what it’s saying. It is another thing entirely if the speaker in your mind is God or the Devil, or Jesus or your dead mother. Don’t you usually do what your mother tells you? If you believe in it, you’re more likely to obey it, and that’s when things can get dangerous.

When I’m speaking to someone who is psychotic, I poke around for a delusional framework surrounding the voices. How believable are they to the patient? Has he followed commands in the past? When I was a second-year med student at Temple, there was a patient who chewed off a few of his fingertips when he was in the isolation room on the inpatient ward. He heard a voice saying “Prove your worth. Prove your worth,” over and over. He believed that this was the voice of Buddha, challenging him to demonstrate his devotion. This patient decided that biting off his fingertips would send a powerful message to Buddha, that he was a strong and worthy disciple. Because his auditory hallucinations had delusional content, they carried more weight and were more likely to influence his behavior.