Brooklyn Zoo (13 page)

I put my things down in T.’s room and found Rhoda in the office she shared with another of the social workers. I introduced myself and asked for the census. She gave it to me. She was compact, with short hair and a square jaw. She wore jeans and a flannel shirt. She told me that she worked with EOB patients, too, mostly on discharge planning. It seemed no one left CPEP without a post-emergency treatment plan. “I’m sure I’ll be seeing you around,” she said as I left to gather my patients.

There were five patients on the EOB census, including Mr. Bonture and the man from yesterday who’d needed cleaning off. The EOB rooms were empty, so I headed straight back
to the hallway with the nursing station. Patients were lined up in front of a room opposite, from which nurses dispensed pills into tiny paper cups, watching their charges down them with small servings of juice. I called the name of the first woman on my list. “She’s with me,” one of the nurses told me, looking up from taking a patient’s blood pressure. “Right here, but she’s deaf. Do you sign?”

“No,” I told her. My deficiencies were apparently endless.

I called the names of the two other new patients. One young man responded. He was maybe twenty-one and handsome, with taut but not oversized muscles and in a clean T-shirt and jeans. Relieved because he looked like someone I might encounter outside the psych ER, I explained who I was and told him I’d like to take him down to the group room. He was lucid and agreed, and we walked around the corner and down the hall to the dayroom, across from the EOB beds. The dayroom was lined with plastic chairs attached to one another, and there was a round table in the center. The sickly old man, Mr. Younger, sat in the room eating his breakfast. He was clean today, but pieces of muffin fell from between his few teeth as he ate, the crumbs emerging from his too-thin face like maggots from a corpse. The flies buzzed around. The sun shone in too brightly for comfort. I asked Mr. Younger and the handsome man, Mr. Payne, to stay there while I located the other two. A third woman, not on the EOB list, was sitting at the table. “I don’t belong here,” she announced to me. “I’m Jewish!” She was the first white patient I’d seen in the ER in three days.

I left the dayroom and went back into the hallway. Uncertain how long the two men I’d corralled would wait, I made haste to find the other two patients, keeping my eye on the dayroom door in case anyone decided to leave. Mr. Bonture
was outside T.’s office. “Remember me?” I asked. He nodded. “I’d like you to go to the dayroom to participate in a group.” I waved him down the hallway, watching as he headed for his destination while I walked the other way. So close now, I got past my self-consciousness and began calling the name of my fourth and final EOB member, Martina, as I walked. She appeared in front of me groggy and in a hospital gown and rubber-soled socks. Triumphant, I invited her to come with me to the dayroom. When we arrived, the other three were still there, as well as the Jewish woman who didn’t belong. I felt some relief in my accomplishment, but then I realized the television was on, which meant my task was not complete. Dr. T. had said the boxy set needed to be quieted for group and turning it off required unlocking the mounted plastic case in which it sat, which meant getting the key to the case from an office down the hall. “I’ll be right back!” I said.

“Television key?” I asked unceremoniously, poking my head into a room that Dr. T. had pointed out the day before. Someone handed me a key on a long wooden stick. I grabbed it like a relay racer and was back in the group room within seconds, but even standing on a chair, I could not quite reach the lock. The patients sat waiting. It occurred to me to ask the handsome young man for help, but I thought that if he fell off the chair and was hurt, I would be responsible. Instead, I pulled the table over and climbed onto it in my platform heels. The key did not fit easily into the lock, but I jimmied it until it opened, pushing the power button on the set with a flourish. The room went quiet. My patients looked unimpressed. I climbed off the table.

I introduced myself again and explained to my four charges plus the Jewish woman that this morning’s group would be a chance for EOB patients to get oriented and ask any questions
they might have. The Jewish woman got up and left. Martina had fallen asleep, her head nodding to one side, her hospital gown falling half-open to display dark stretch marks on her breasts.

“I’d like everyone to introduce themselves and tell the group why you’re here,” I said. I remembered a truism passed down from a supervisor in grad school: a group is only as strong as its highest-functioning member. I turned to the young, good-looking man and asked him to start.

“I’m Glover Payne. I got upset with my girlfriend and took some pills.” He frowned and then nodded at me.

I turned toward Mr. Younger, who was sitting across the small room from me, masticated food still coming out from between his teeth. He did not respond. “Mr. Younger?” I asked. Nothing. I continued around the room. “Mr. Bonture?” I asked.

“When am I going to go home?” he wanted to know.

“I’m not sure. Yesterday, Dr. T. thought you were doing okay. Maybe today?”

Glover Payne spoke again. “How about me?”

“I’m sorry, but I don’t know. This isn’t a discharge group.” I looked at the woman in the hospital gown, hoping she could introduce herself and change the subject. She dozed. I didn’t have it in me to wake her.

“Well, can you tell me when the discharge group takes place? I’d like to go to that one,” said Glover.

“There is no discharge group,” I said, though I was uncertain. “There’s only this one. You’ll have a chance to talk about discharge later today with Dr. T. Mr. Bonture, Glover told us why he’s here. Can you let him know how you ended up here?”

“My social worker brought me,” he said.

Glover nodded again. They both looked at me. I wanted
to know more about Glover and his girlfriend and the pills but wasn’t sure if this group was too public a setting for such questions. “Are you both getting everything you need?” I asked them. If I couldn’t quite be a psychologist, at least I could be a good hostess.

“The food’s not too good. I’m going to go for a nice meal when I leave,” said Glover.

“I might be leaving today,” Mr. Bonture told him.

“So who was it you said we should talk to about getting discharged?” Glover wanted to know.

“Dr. T. will be here later. She’ll be able to tell you more.” I might as well have been wearing a sign that said “Useless,” but anyway there was nothing to be done about it. “Dr. T. and I will be talking to you all one-on-one later,” I told them, ending our meeting.

When T. arrived, she picked Mr. Younger and his muffin as her first teaching point. “Doing outpatient therapy is passive. Working in the ER is active. Tell him to wipe his mouth. It’s very primitive to have food all over. When adults need to be told to wipe off their faces, they’re infantile, no ego boundaries. It’s not polite to tell a man to wipe his mouth, but we’re providing structure, not politeness. To get along in the world, he needs to know how to take care of his body, so part of our job is to help him be more aware. One of the ways we’ll know he’s getting better is when we don’t have to tell him anymore. Who do you want to see first?”

I told her about Glover and his overdose attempt. “Mood disorder or thought disorder?” she asked. It was the same question she’d been posing to the interns each week in the seminar she taught us. Different from the diagnostic paradigm I’d learned in school (developmental level; character organization), the idea here was that you narrowed it down to mood
or thought disorder based on a patient’s observable behaviors and reported experiences and then tried to isolate which mood or thought disorder it might be per the
DSM
’s checklists of symptoms and their durations. I’d come to understand, in our ER seminars, that a
DSM
mood disorder diagnosis supposed that depression or mania or both were the patient’s primary and debilitating problems, while a thought disorder implied that it was psychosis, schizophrenia being the most serious and organic of these, and with the poorest prognosis.

These were the categories of symptoms most typically addressed in the ER, but there was also a third
DSM
category: personality disorder. Glover had become desperate after a threat of abandonment, which I thought put him in this latter group. Thought disorder, mood disorder, personality disorder: they weren’t mutually exclusive. Most of the patients we saw likely had personality problems (or rigid and unhealthy patterns of thought and behavior) along with their psychoses and bipolar depressions, but these were never quite addressed in CPEP, sort of like how you wouldn’t immediately treat a patient’s osteoporosis if he came to a medical ER with a broken arm.

Dr. T. nodded when I told her my ideas and sent me to the nursing station to get Glover’s chart. On my way, a young, slim guy in a blazer and pompadour motioned me toward him. I went over. He came close enough to whisper. “I’ve got a controlled substance,” he said, flashing a prescription pill bottle in his right hand.

I became giddy with the opportunity to think quickly. “Can I have it?” I asked.

“No,” he replied, dropping the bottle back into his pocket.

I looked around. Kelvin was nearby. I got his attention
and pointed at the patient. “Kelvin,” I said, keeping my voice calm. “He’s got a controlled substance.”

The tech was taller and broader than the patient, who gave the pills to Kelvin without a fuss, muttering something about Adderall. Feeling heroic, I continued toward the nursing station. I retrieved the chart and went back to T.’s office. I wanted to tell her what I’d accomplished, but I couldn’t find the words to give my feat its due. I stayed quiet but must have been swollen with pride. Dr. T. took the chart from me and opened it, reading. ER glory was short-lived.

She shared information about Glover with me as she scanned. “He took fourteen Tylenol and then called his girlfriend and told her what he’d done. She showed up four hours later”—at this she furrowed her brow—“and brought him to the medical ER, where they treated him and discharged him to us. What do we want to know when we bring him in?”

“More detail about what set him off. What exactly happened leading up to the attempt. What did he think was going to happen after the fight? Does arguing always upset him? Has he done this before? Does he have mood symptoms like poor sleep or appetite?”

T. nodded. “What else?”

“Is he still suicidal? Had he been feeling for some time that he wanted to die, or was this impulsive? What made him call for help?”

“Good,” she said. “You’re thinking about mood and personality disorders, and you remembered the telescopic lens. I’ll go get him.”

When Dr. T. returned, she had both Glover and his girlfriend in tow. The girlfriend did not look happy to be there. “Chandra was here to visit, so I thought we’d do a couple’s
session,” Dr. T. explained, introducing me. The office was only big enough for three chairs. I gave mine up and perched on the edge of the old metal desk.

The room fell silent. “This is a difficult time for you two,” said T.

Chandra glanced at Glover angrily and then back at Dr. T. “There is no ‘us two’ anymore. We broke up a week ago.”

“I see,” said T., addressing Glover now. “You did this because you couldn’t bear to have her leave you.” His shoulders slumped.

Chandra continued. “I don’t care what he does. I’ve had enough. We’ve been together a year, and he’s still sleeping with other girls.”

Glover broke in, trying to take her hand. “But, baby …”

Chandra pulled her hand away. “There’s no more ‘But, baby.’ ” She was visibly shaken, teary.

Glover began to speak. “I love her,” he told us. “I don’t care about those other girls. I only want her. I took the pills because I got so scared about being without her. And then I call her and she doesn’t even show up for hours.”

“She was angry,” said T.

“It’s not my job to take care of you!” Chandra replied, starting to cry. “What am I supposed to do now? Be with him or he kills himself?”

“What about trying to understand him better? Why does he fool around with other girls if he loves you? With understanding can sometimes come change—and forgiveness,” T. said.

She turned to address Glover. “Tell me about growing up.”

“It was good.”

“Who raised you?”

“My dad mostly.”

“That’s unusual.”

“My mom was in and out. They were never together. She moved around a lot. When she was in New York, I saw her sometimes.”

“That’s sad.”

Glover shrugged. T. turned to Chandra.

“There’s a little boy in him still longing for Mommy. But once he has her, it’s terrifying to be so invested in one person, one person who’s always abandoning him. So he needs to shore up his resources, find other mommies in case the important one leaves. This is what he’s struggling with. It fuels the cheating. The more he starts to feel dependent on you, the more he needs to do it.”

“And so I’m supposed to put up with that just because he didn’t have a mother?” Chandra seemed angry at the suggestion.

“No,” said T. “But if he’s serious about being with you, he can really commit to therapy and start looking at those old feelings. Eventually, he won’t need the other women in order to quell his anxiety.”

Glover tried to take Chandra’s hand again. She pulled it away, crying. “I don’t know,” she said.

“It’s just a thought,” said Dr. T. “You two need some time alone. We’ll stop for today.”

“Are you letting me go home?” asked Glover.

“No. Maybe tomorrow. You and I have more talking to do.”

Glover and Chandra left T.’s office. She said to me, “What is the real meaning of choice? Does Glover choose to cheat? Yes, sure, but it’s also a behavior that’s overdetermined—a lot of factors influence it. Most of our big decisions are overdetermined. Take my choice to work here. I’ve been here almost
twenty years. I grew up in a traumatized household. My parents were raised on the Russian front. They saw family members killed in front of them. In my home it always felt chaotic, like we were waiting for something dire to happen. So this crazy place feels familiar to me, comfortable.