Living and Dying in Brick City (20 page)

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T
he closest thing to an office I had at the hospital was a tiny shared space we staffers called the “Fish Bowl.” It wasn’t exactly what I had in mind when I finished medical school. Instead of a nice place where I could hang my hard-earned diplomas, certificates, awards, and family photos, my workspace was an overcrowded room I shared with other staff, located in the center of the emergency department. The largest wall was a window that offered a panoramic view of the jam-packed waiting area, examining rooms, and hallway. The patients could look in at us, and we could look out at them—thus, its name, the Fish Bowl.

The Fish Bowl was the E.R.’s nerve center. Three or four staffers could fit comfortably in the room under normal circumstances, but two or three times as many doctors, nurses, technicians, and aides were regularly squeezed in there most days, consulting about a patient, talking on the phone, printing a chart, writing a prescription, or waiting for one of the room’s four computers. (There was always a waiting line at the door for the computers.)

In an effort to deal with the crowding, the department was always undergoing renovation. As soon as one project was completed, the architect was called back to plan the next expansion. Still, our department couldn’t keep up with the demand for more
space. Hospitals throughout the country faced the same challenge. Population growth and increasing numbers of seniors (the group most likely to seek ambulatory care) have caused a surge in emergency room visits nationwide since the mid-1990s. From 1997 to 2007, trips to the E.R. jumped from 95 million to 117 million, an increase of about 23 percent, according to federal records. At the same time, hospitals and emergency departments have been closing in dramatic numbers, particularly in urban areas and suburbs with largely low-income, non-white populations. And the situation threatens to grow even more critical as the Baby Boomers continue to age.

For doctors and nurses, the overcrowded conditions have meant greatly increased nightly caseloads and little time to spend with patients. I often saw Linda, one of my favorite nurses, distributing medications, changing urine Foleys, placing a patient on a monitor, drawing blood, running among as many as ten patients, rarely stopping for even a bathroom break or meal during her entire twelve-hour shift. This behind-the-scenes stress is, of course, mostly invisible to patients, who are often cranky by the time I meet them—and understandably so. It’s bad enough that they have to experience the emergency that landed them in the E.R. in the first place, but then they have to wait an hour or two to see a doctor; and if they happen to arrive when crowding is at its peak, they may end up being treated in a converted hallway with merely a thin curtain separating them and their private business from fellow patients.

At times, when the emergency department and hospital are filled to capacity, we are placed on “divert status,” which means hospitals are not allowed to accept another patient brought in by ambulance, except in life-threatening cases. The rule doesn’t matter, though, because the emergency medical technicians still drive right up to our doors with familiar excuses: “The patient
demanded to come here,” or “Every other hospital is on divert as well.”

There we were one day, crowded in the Fish Bowl on divert status. Operations in the emergency department had come almost to a standstill as we waited for the traffic jam to clear, so my colleagues and I sat around and talked. One of them was planning her wedding and couldn’t decide whether to have the ceremony in Hawaii, Jamaica, Fiji, or New York. A resident sitting at one of the computers chimed in, offering another suggestion: “Turks and Caicos.” He brought up dozens of photos on the computer of him, his new wife, and the wedding they’d had there to show us. The conversation piqued my interest. I’d begun to travel a bit in my free time since med school; whenever I saved up enough money for a vacation, I tried to land on a beach somewhere—in California, Cancún, Jamaica, Saint Martin, Puerto Rico, Belize. I couldn’t take my eyes off the beautiful scenery of the Turks and Caicos Islands in one photo after another. I could hardly believe that this paradise existed just two-and-a-half hours from New York by plane.

From the corner of my eye, I noticed Nurse Linda rush past, leading four patients from the waiting room to the examining rooms. That meant others must have been discharged and the pace was about to pick up again. I moved to the doorway and took one last peek at my colleague’s wedding photos. Just then, I felt a light tap on my shoulder from outside the door. I turned and saw a familiar face.

“Rick?” I said, extending my hand to a friend from my old neighborhood. “What’s up, man? I haven’t seen you in years. How’s everything?”

His appearance told me that the years had not been kind. He responded with a half-crooked smile, revealing more missing teeth than good ones.

“I’m good,” he said.

“What brings you here? Everything all right?”

He pointed to the waiting room. I looked out through the Fish Bowl window and saw a vaguely familiar face. For a moment I tried to remember where I’d met the haggard old guy sitting out there. “Yeah, that’s Tony,” Rick answered, noticing my bewilderment.

I was too stunned even to speak.

“I saw him walking the street,” Rick continued. “I couldn’t believe it myself. He’s homeless. I think he’s using drugs, too. At least that’s what they’re saying in the streets. You know I had to help. I couldn’t leave him out there. Marshall, you know Tony. He was never this way. Ever since we were kids he always had it together.”

“Yeah, I know,” I responded.

Tony and I had grown up on the same block, and our mothers were friends. The two of them often went shopping together or worked outside at the same time, shoveling snow or raking leaves, while Tony and I played in one of our backyards. We were in the same grade, had the same teachers, and spent countless hours playing together after school. We borrowed each other’s video games and played basketball in his backyard until it was so dark we could barely see the ball. It was Tony, not my father, who taught me to ride a bike. I was ten years old, well past the age when most kids learned, and I was embarrassed. I’d even lied about it, telling friends I knew how to ride. It was easy enough to get away with the lie since I didn’t have a bicycle. But the excuses kept getting tougher every time one of the kids in the neighborhood offered to let me borrow his bike to prove my skills.

One July night, Tony handed me his bike, and I just stood there, staring at it. He recognized my shame and said simply, “I’ll show you.” He held the back of the bike and ran alongside as I pedaled. Because it was so hot inside the house during summer, Moms allowed
me to stay outside later than usual, as long as I didn’t stray too far. All night long, I pedaled up and down the block with Tony in tow, at first holding on and then letting go, trotting beside me, cheering me on. I was the happiest boy in Newark when I got a bike for Christmas that year, and I’ve been riding ever since. That night stood out in my mind as a milestone I should have shared with my father, but I’ve always been grateful to Tony, not just for helping me to achieve something that seemed so important to me at the time, but also for the grown-up way that he dealt with my feelings. He didn’t make fun of me or belittle me in that moment when I felt most vulnerable, and his generosity made me a bit less afraid to try new things and even to reach out for help.

I zeroed in on Tony’s tired, leathery face as he sat on the aluminum gray bench adjacent to the emergency department. His eyes looked empty, his face unshaven, his hair matted, and I wondered:
What happened to the eager, fun-loving boy who was just as ambitious and smart as I was?

One time as kids we came up with the brilliant idea of making homemade wine. We found old mayonnaise jars, filled them with grapes, water, and sugar, and then hid them in Tony’s basement. I can’t even remember what prompted our little experiment. We were no more than twelve years old; we had probably read the ingredients for wine somewhere and naïvely thought that was all it took. I can only imagine the bewilderment Tony’s mother must have felt if she ever discovered those jars. I have no idea whether she ever actually did find them, but I was away in college when she suffered a stroke and died. His father died a few years later from complications related to long-term alcohol abuse.

As a kid, Tony swore he’d never be like his old man. When his father staggered into the house once after a day of drinking, Tony whispered to me, “I hate him!” The two of us also mocked the drug addicts who stumbled around the neighborhood, bug-eyed
and begging. We just assumed we would do better. But something began to change around middle school. All of a sudden, it was no longer cool to raise our hands in class and call, “Pick me, pick me, oh, please pick me,” vying for the teacher’s attention. If you liked school, as I did, you pretended you couldn’t stand it, like everybody else. If you got good grades, you hid them. And you’d just about die of embarrassment if you had to go up on stage to collect an award for academic achievement. The only kids who seemed proud of that kind of stuff were the geeky dudes who had no friends. Nobody ever showed us all the places that road could lead—at least nobody that mattered to us.

My friends and I were teenagers when we started experimenting with alcohol, sneaking a sip from our parents’ bottles of Bacardi or pooling our money so somebody’s big brother could buy us beer from the corner store. It seems silly now, but we all just wanted one another’s approval. We wanted to seem cool, like the older guys around us. Tony soon started smoking marijuana; that was his cocktail. I always had an excuse for why I didn’t want to do it. Truth be told, I had a feeling that if I started sliding down that hole, I’d keep falling deeper and deeper. I’d seen it happen to my sister Fellease, and to my older brother Kenny, who was an alcoholic. I was a freshman in college when a fight at a local bar left him paralyzed on his right side and confined to a wheelchair. Though he now lives in a home for the disabled, he hasn’t had a drink in twenty years and is a happier, more peaceful person. My friend Tony had slid down that same dark hole. He dropped out of high school, married at eighteen, had more children than he could afford to raise (five was the last I’d heard), and got hooked on heroin. The drugs probably became his escape, his way of checking out so he wouldn’t have to confront all of his broken dreams. Then he didn’t have a clue how to begin piecing his life back together. He worked sporadically as a truck driver, but the deeper he got
into drugs, the less he was able to hold down a steady job. The pull from the street was greater than his will or his ability to resist it.

Rick, the mutual friend who’d brought Tony to the hospital, explained that he had to leave to take care of some business, and I finally walked over to Tony, who was still sitting in the waiting room. How cool would it have been if he had become a doctor, too, and two old friends who’d once tried to make wine together in their basement as kids could laugh about it now and discuss the latest lifesaving procedure, or stand in the Fish Bowl and check out vacation sites on the computer? When he saw me, Tony stood. He did his best to appear cheerful, like in the old days when he wore a constant smile. We talked about how long it had been since we’d seen each other. Before long, Tony’s eyes fell from mine toward the floor. He was clearly embarrassed. Standing before me in raggedy, oil-stained jeans, a dingy white T-shirt, and well-worn, dirty sneakers, he looked like the desperate, drug-addicted homeless man he had become.

“I need help,” he said finally, still staring at the floor.

I remembered how gingerly he had handled my feelings all those years ago, and that was all I needed to hear. I refused to pry deeper.

“I’ll find a place for you to go, man. I don’t care how far we have to search. The nurse will get you something to eat. Don’t worry. I’m going to take care of you.”

“Thank you, Marshall,” he whispered through dry, chapped lips.

If this wasn’t rock bottom, I couldn’t imagine what was. But there was still hope. Tony wasn’t dead, like Snake. And he wasn’t in jail, like so many other of our boys. He was willing to go to rehab, and I was determined to find someplace for him to go. The chance that I could possibly make such a difference in Tony’s life gave me a huge adrenaline rush, though I knew well the first challenge I faced. After years of trying to help my sister and other family
members, I knew that finding a good residential treatment center would be difficult. The fact that I was a doctor didn’t change the reality that there just aren’t many residential drug rehabilitation centers out there. The few willing to take a patient with no insurance, no job, and no other means to pay were in public hospitals, and like at Beth, crowding at any of those medical centers was sure to be an issue. According to the 2010 National Survey on Drug Use and Health, 23.1 million people ages twelve and older needed treatment for illicit drugs or alcohol use, but only 2.6 million were treated in a specialty facility. Of the 20.5 million who were classified as needing help but didn’t receive it, just 1,024,000 reported that they personally felt they needed treatment. And of those roughly one million people, only 341,000 (33.3 percent) reported that they had made an effort to get treatment; the majority of them, 683,000 (66.7 percent), reported making no effort at all.

I dashed back to the Fish Bowl, waited for the phone to be free, and began calling hospitals that I knew offered drug rehabilitation. I must have called about ten of them, starting with those close to Beth Israel. Finally, I found an open bed at a hospital in New York City. I rushed out to share the news with Tony. He’d gotten lucky, I told him. He’d been given the hospital’s only slot. This was his chance to start anew. He signed the transfer papers, and two hours later an ambulance arrived to take him to the hospital, located about twenty miles away. I stood in the ambulance bay and watched as my old friend was helped inside the vehicle. I felt purposeful and optimistic, even though I’d been through this experience enough with my own family members to know that my intervention didn’t necessarily guarantee a happy ending. I would check on Tony in a week or so, I thought, and maybe even take a trip to New York to offer support.