Weekends at Bellevue (35 page)

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.

I picked her up and put her over my knee with my foot on the couch. I hit her back hard, angling her head down. Whap! Whap! Whap!

Nothing.

Oh my God, oh my God. She’s choking to death. She’s not moving any air
. The squeal was dying out. Her face was getting more dusky.
Is she going to die? I can’t get the pretzel out!

What do I do? You’re not supposed to Heimlich a little baby. What else can I do? I have to do something
.

I spun her around and put my fist in her stomach, lifting her up against it. I not only Heimliched her, I did it with all her weight against my fist.

Pop.

The pretzel sailed across the couch.

She began to wail.

I started to breathe again.

I held her tight, squeezing her to me, trying to calm myself down so I could calm her down. No more pretzels.

B
efore Molly was born, as my wedding date neared, Mary had asked me how I would feel if Jeremy died. I don’t remember what brought this up, but I do remember answering that of course I would be heartbroken, but that eventually I would pick up the pieces and get on with my life, and down the road I would probably even fall in love again. She may have been surprised by the coldness of my answer, but I was getting used to my usual defense against any kind of loss or pain.

But now, when I think about how I would handle Molly’s death, I’m not so sure I could go on. It feels more accurate to think that if she died, I would have to die as well. I couldn’t tolerate the pain.

How will Pablo handle his pain? And what can I possibly say or do for him that would offer him any real comfort? To murmur the same lines as everyone else—”My heart goes out to you. I am so sorry for your loss.”—what does that accomplish?

As my years go by at Bellevue, and I clock in more time, the stakes keep getting higher. The threat of loss looms larger now that I have people depending on me. It’s not just my survival, which never was that big a priority. I notice with my second pregnancy that I am thinking more in terms of my family, and how to keep it intact. I must stay healthy and safe so I can take care of them. I begin to feel more at risk,
the way I did after I was punched. It’s the little things now, not just intimidating patients: for instance, the shampoo we use to kill lice. It’s toxic to a fetus, and pregnant women can’t be exposed to it. With new regard, I look at the bottles lying around the nurses’ station and shudder as I put on a pair of gloves and move them to the locked area where we store medications.

Once again, as I start to show with my second pregnancy, the nurses won’t let me go out into the patient area unless it is absolutely necessary. They treat me like a delicate, though bloated, hothouse flower, and I enjoy the pampering that comes with my gestation. I start spending more time in the nurses’ area doing paperwork, and less time going out to meet the patients in the triage area. I especially don’t go onto the unit if a patient is escalating and will likely require restraints, the way I would’ve in the past.

It gets boring, having less patient contact, but it also makes me feel cared for, knowing that the nurses are watching out for me, protecting me and my family as if I were a part of their family. And they’re right; a pregnant doctor does need extra protection.

A few years ago, when I was pregnant with Molly, a new television show called
Wonderland
came on the air. The creator and writers had befriended the Bellevue staff, and had observed how CPEP and the wards were run. In one episode, the female CPEP attending, who also happened to be pregnant, got stabbed in the belly with a hypodermic needle, injuring her fetus. She was doing a consult on a patient in the medical ER. The morning after that show aired, Daniel made a joke about it at rounds, saying how I, the pregnant psychiatrist, could go to the AES to do consults if any got called in. We all laughed, myself included, though I remember thinking he was such an asshole to say that. But I also remember feeling nervous. What if some nut job saw the show and it gave him an idea?

Then there was the nagging memory of the pregnant pathologist who was strangled at Bellevue before I began working there. Six months along and choked to death. I thought of her often while I walked the empty corridors late at night during both my pregnancies.

Besides stabbings and stranglings, there are also infections to worry about. When Molly was about a year old, there were two weekends when CPEP was under quarantine. Some patients had come down with Norovirus, a virulent GI virus that had recently wreaked havoc on a cruise
ship. The good news was that CPEP was shut down. We couldn’t admit any more patients into the area, so EMS diversion was a hard-and-fast rule, not a courtesy; I could actually turn ambulances away. After two weekends, the census got down to zero. Someone took pictures of the empty hallways and stretchers, labeling the Polaroids stuck to the wall “The Perfect CPEP.” I had spent the bulk of my shifts watching DVDs and eating microwave popcorn.

Coming in for work that first night, it was exciting to see the doctors and nurses wearing yellow paper gowns and masks. But then, I realized there was a chance I could carry home the virus, spreading it to my husband and daughter. Norovirus causes so much vomiting and diarrhea that children can die from dehydration. When I got home the next morning, I stood at the doorway, afraid to walk into our apartment, afraid to hug them hello. When Jeremy asked me what was the matter, I wanted him to hold me and comfort me, but I felt contaminated and contagious.

How am I going to keep working at a job that’s potentially life-threatening not just to myself, but to my children? I can’t keep placing us all in harm’s way.

But the next Saturday night, and the ones after that, I drive down to Bellevue, gearing up for another round.

I
have a manila folder full of suicide notes.

For a while at Bellevue, if I came across one at my job, I would Xerox it and add it to my file. Eventually, I stopped doing this. It became overstuffed and sadly redundant and meaningless. There are few things as demoralizing as a stack of suicide notes—all that hopelessness, so much sorrow and regret concentrated in one place. It’s unnatural. Some of the notes are apologetic: “Tell Ilana I’m sorry.”

“I know I’m hurting you by what I’m about to do, but I see no other way out of this.”

“I am so sad and so sorry. Please forgive me.”

But there are plenty of notes full of anger, not apologies.

One note, addressed to an ex-boyfriend, says succinctly, “This is all your fault.”

At least the notes make it easy for me to make a decision about how to handle the case. They are tangible proof that a patient wants to die, which allows me to fill out the paperwork for the admission. The problem is, not everyone leaves a note, and even if they’ve written one, it doesn’t always signify seriousness or intention. Plenty of completed suicides leave no note. And plenty of staged suicidal gestures are accompanied by long letters.

Sometimes a patient will make a veiled or outright threat of suicide on the phone. The person on the other end of the call, not knowing
what else to do, dials 911. Then I get a new angry patient showing up in CPEP, dragged out of his home by EMS, forced against his will to undergo a psychiatric evaluation.

One of the rules of thumb that I’ve developed over the years is to base my treatment plan not on what someone says, but on what he does. People threaten suicide for all sorts of dramatic reasons. I try not to take away their civil liberties and force them into a Bellevue stay unless I have proof of actual harmful intent. Dramatic phone calls don’t count. I’ve had countless situations where the ex-boyfriend calls 911 after the girl he dumped threatens to kill herself. She was hoping he’d come rescue her, but what she gets instead are a couple of ambulance drivers escorting her to a night with me. Now she has to convince me that she has things to live for. Lucky for her, I’m not hard to convince. I let most people leave the CPEP as soon as we’ve had a quick chat, once I get the feeling that they have “future thinking.” I write up a T & R, documenting that a patient has no suicidal intent, is not hopeless, and has future plans and future thinking. These are key components in the decision to release a patient.