Twelve Patients: Life and Death at Bellevue Hospital (46 page)

“Doc, I keep asking what if? What if she’d never found out? She would have skied in Bariloche, and gone horseback riding in the countryside, and learned French in Paris?”

“Too many what-ifs, Isaac. Where would you be, by the way? What
if the English had lost the Battle of Britain and there was a Nazi flag on Whitehall?
What if
, Isaac,
what if
…
what
?” He had launched me into an alternative world of what-ifs, a counterfactual universe that did not happen. Once she suspected, she had to know or be poisoned. Already the lie had seeped into her.

“My mom did the research through the different support groups, parents’ groups, children’s groups, Jewish groups, and the international human rights groups that have assisted people in finding their parents, their sisters, brothers, children. The relentless march of the
Madres
, the Mothers, around the Plaza de Mayo with the pictures of their missing children brought her to this central city square. She returned every week to the marches of the mothers, talking to them and piecing together what was really happening in Argentina behind a facade secured with secret police and a city littered with clandestine torture centers. She went to the
Abuelas
, the Grandmothers who tried to identify their lost grandchildren. She found out who she was and heard that her own grandmother was dead.”

The small inconsistencies of daily life multiplied and led her to the disappeared, her parents, whose final moments were blindfolded on a flight over the miles-wide Rio Plate before it disgorged a continent’s effluvia into the Atlantic along with drugged men and women. When Alicia had connected all the dots she left and never looked back. She had moved out of her house some months earlier. She had been living on friends’ couches and in borrowed apartments. She was a fifteen-year-old who had grown up under privilege, with a beloved Bolivian nanny, Carmen, who had been her wet nurse, and a chauffeur, Arturo.

An American grad student met her in a café. They began walking the city together and she moved in with him. She became pregnant with Isaac and they decided to move to New York City, his hometown. He found work with the help of his grandparents, and she took in other children and taught Spanish to high school students. At first it was odd that he never brought her to meet his family, and they never came to visit. There were a million excuses. Given her own flight from her “family” she didn’t ask too many questions, since they had found each other and created a nest and a refuge from the world. The world
gradually constricted for her as he began to monitor her activities and insisted that she stay close to home. The neighborhood was dangerous, the gangs were prolific, the city was in tough times so it all made reasonable sense on one level as a concerned loving partner. Until he hit her the first time.

She had freed herself from one set of monsters, sitting across the dinner table, sharing a meal, watching television, and pretending that normal family life was proceeding calmly. That the banal domestic routines of school, church, clubs, dinners, visiting Iguazú, were supported by caring and love. She had not freed herself from a self-hatred, a self-loathing, that she had been violated so deeply, and contaminated so profoundly by her self-proclaimed parents who loved her to death. Literally it seemed.

Diana had led me through this world step by step fifteen years earlier as she was writing a book on the Dirty War. We had walked with the Mothers of the Plaza de Mayo, visited the torture centers, talked with close friends who had lost their loved ones. The deceptively simple act of mothers meeting weekly and walking in front of the Casa Rosada, the president’s house, year after year never allowed the wound to seal over. They continued to make the disappearances visible as an act of denunciation.

I walked Isaac from my office to First Avenue. We were both depleted and hardly said a word. His searching heart had found a place with people who offered him another mat to scrunch onto as he gradually spread himself out into a cosmopolitan city. All Alicia’s symptoms made sense. A tormented woman looking for help and for care. The inner wounds would not light up on any scan.

A few days later my phone buzzed with a text from Patty during a jammed public meeting in the large open atrium at the main entrance to the hospital. The mayor and governor were announcing support for the public health system. “Better than the private sector” were the last words I heard as I slipped out to make a phone call.

“Lorie, what’s up?” She ran the SS
NICU
like a military vessel.

“Alicia has freaked out. ACS is here about her daughter. We need your assistance on this one.”

She met me at the glass doors to the NICU with Helen from social
work and the attending Suzanne. “Hi, guys, let’s go into the break room.”

“Child protection is here to evaluate her fitness to care for her daughter. She is over the top.” Helen got it out fast and to the point.

“She is breast-feeding her daughter and making a good recovery. All of the bad chemicals, drugs, antibiotics have been replaced by a flood of maternal oxytocin. I don’t get it.” Child protection? Who pulled the alarm?

Helen read me. “We had to file. It is the law. Automatic. They filed from the hospital where they did the C-section. Also Eric, Naomi was almost killed, remember?” Lorie added, “Can you guarantee Naomi will be safe?” My thoughts turned to sliding steel doors and electronic locks. Greg Annas having dinner at Rikers Island before being sentenced to an upstate prison. How many years?

I suddenly realized Alicia could lose her daughter. It had not occurred to me. “Let me go talk to her.” They nodded in agreement, that was the plan. I walked the long corridor of permanent twilight and hushed tones.

“Laura, I need to talk to you about what to do, what is the right thing to do now.” I was sitting with the crime victims social worker in her office.

“Eric, she has no insight into what is happening to her, how she gets involved with these control-freak guys. She emotionally short-circuits. We see this over and over again.”

“So what can be done? She loves her son and he dodged the craziness and is thriving. She obviously loves her daughter. She is not a hopeless basket case on crack selling herself in front of her children.” ACS was frequently in a tough position of when to pull the plug to put kids’ safety first. There was no biopsy for this one.

“There is a lot she can do, and things are not hopeless. Believe me, I understand what is at stake here.” Laura was thinking things through and coming up with a plan.

“Time out from men would be a good thing also.” Laura smiled. “She is a passion junkie and her anxiety goes way down when she is feeling cared for, looked after, the seduction piece.”

“First she needs to commit to treatment, I mean therapy. I can get her a really good person. We don’t need to use the Yellow Pages. Then she needs to join a group of people like her and hear stories and build up some trust with other victims. It works. Like AA and other support groups, it really does work. And she will need additional therapies, like cognitive behavioral therapy or dialectical behavioral therapy, that work in the here and now on practical skills to handle her emotional ups and downs.

“I have seen it firsthand on the child psychiatric unit with Dr. Liu in kids from six to twelve. It does work. ‘Think of pizza with pepperoni when you have those angry feelings.’ ” We were developing a plan to sell to Alicia and to ACS. They both had to buy it.

“Eric, most important for you, before you go into the deep end of the pool on this one, let her tell you in her own words what happened. She has to show you a little trust.” I knew Laura was right and I had no idea what Alicia would say or could say.

Alicia was sitting in a wheelchair, her eyes rimmed in red, her shoulders covered in a hand-embroidered shawl in the unit conference room. The official from protection got up and introduced herself, “Hi, Sarah Caldwell. I have to make a couple of phone calls. Will be in the nursing station when you are done.” She quietly closed the door.

Alicia switched to Spanish. “They want to take my baby away from me. They say she may not be safe in my home.”

“What do you think?” I asked her.

She looked at me and said nothing for a long time. The pause said more than her words. “Eric, I want you to help me keep her. They will listen to you if you support me. You know me well, you know Isaac. I need your help now.” The magic words.

Could I help her? Should I help her? I could imagine her parents. I had walked around the Plaza de Mayo with the Mothers. I had seen the pictures of their missing children. I had known the stories of
hijos
, children, and the rippling effects through families and generations. But I also saw a woman who for reasons she might not be able to control had been cycling in destructive relationships. Could she look after herself? Could she look after her children?

Was there some middle ground? A compromise position where protection’s needs could be met, where the law’s requirements could be satisfied? Could I guarantee that Naomi would be looked after and safe from harm? Naomi Rittner-Annas, I remembered. How many years would the sentence be?

“Alicia, I need to know what happened to you in Argentina, before you left pregnant with Isaac,” I said, then realized it was a bribe, perhaps, or a necessary price she would have to pay. Did she know that I knew? Did Isaac tell her? For years I had talked about Argentina, and not just about Borges. They were finally arresting generals from the time of the dictatorship, now octogenarians, and putting them in prison. The amnesty had been repealed. Maybe her time had come?

She took a long time before she said anything. She wasn’t crying. She sat in her chair and looked at me directly. She knew we weren’t playing a game and there was a lot at stake now.

“My parents were killed, Eric. They were young, just married. Getting started in life. I was the family they were creating. I started to hear stories when I was a young teenager. Murders, kidnappings, children put up for adoption. Little pieces started to come together as I reached out to members of the community created by the Mothers and Grandmothers. The family that raised me and their most intimate friends dismissed the activism and publicity as showmanship and a way to blackmail the Argentine state. One cretinous man, our neighbor, said the military never finished the work it needed to do, that was the problem.”

She looked down at her daughter’s face on her breast. “How many generations, Eric? How many generations have to be lost to this violence?”

“You have to put an end to the cycle, Alicia. You can do it. It will be hard and take time. But you can do it.”

“You think so? I have to think so, too. My daughter’s life depends on it. And Isaac’s. And mine.”

“We’ll talk,” I said as I patted her shoulder good-bye. “Let’s talk tomorrow.”

My office mates left me alone and fielded the phone calls and endless
stream of visitors who made it to Room 30 on the mezzanine floor. I walked down the back stairs and headed for First Avenue through the emergency room, avoiding the long F-Link corridor and a million contacts. I went out the emergency room automatic sliding doors and walked the length of the new asphalted driveway for ambulances to First Avenue, crossed the wide street, made a left, and took a circuitous, aimless walk in the general direction of my home.

The drizzle had us trapped under the parking lot overhang while attendants scrambled to move the cars suspended like larvae from elevated hangers.

“Hey, Eric, what do you think will happen tonight at the legislature?” Julian, the chief of vascular surgery, asked me from under his Red Sox baseball hat and rain gear. He was referring to the proposal for health care cuts.

“Julian, it’s anybody’s guess,” I responded.

“What do you mean?” he asked, looking down at me from his skinny six-foot-plus frame.

“We have been doing it for so long. Patching together a hospital budget year after year.”

“If they vote the cuts on the table, we will be out in the deep blue sea without any oars in the water.” He was right.

That’s how we ran the hospital, making do through unexpected windfalls, overdue Medicaid checks, the Obama economic stimulus funds, onetime fixes, endless cycles of million-dollar cuts, lean reengineering, a wave of Fortune 500 consultants’ recycled “new” ideas in shiny binders, an omnipresent whine of the slow grind of attrition in the background, the privatization of laundry, maintenance, food, and a good dose of witchcraft.

“The deck chairs can be moved around only so many times,” I said. “Let’s just hope the cuts aren’t too deep.”

I knew I hadn’t answered his question and wasn’t sure there was an answer. The structural money issues in health care appeared immutable. The U.S. economy and the medical industry, a full fifth of the
economy, acted like an alternative universe not subject to the laws of gravity. The effects of unaffordable health care were rippling their way through the middle class.

The constant budgetary pressures over many political cycles had left a lot of people inured to the prospects of “real” damage—what I thought of as arterial blood supply blockages causing dead tissue at the core enterprise of health care delivery for our patients.

“Yeah, for sure. It certainly could happen. Other states have taken apart their education systems and health care systems, not to mention infrastructure, pensions, and union busting. How ironic we are finally seeing some shrinkage in the prison industrial complex from state budget deficits! It took the state supreme court, but even California is releasing low-risk offenders.” I wasn’t sure of Julian’s politics on the three-strike and the Rockefeller mandatory sentencing laws, but I put my take out there anyway. Medicine and politics didn’t always mix smoothly. Physicians’ shared concern for patients didn’t always extend beyond a diagnosis or a treatment recommendation.

“I left private practice ten years ago because of the hassles of paperwork and the gimmicks everyone was using to churn patients and squeeze income out of the system. My ophthalmologist and my wife’s gynecologist advertised for Botox injections, and my partner worked in the Emirates for a year to pay for his kids’ college educations. It was a relief to come and work for a salary and take care of patients without gaming the system. I took a salary hit, but my wife says I am more like the guy she married.” An increasingly common story from medicine, law, and the business world as the inflexible laws of market efficiency and the Red Queen rule became the metrics of success, run faster just to stay in the same place.