Brooklyn Zoo Page 21

  There was no place for me at the table. When people began to arrive for the morning meeting, there was no place for them either, and the teacher finally asked her charges to stand up. They did but held on to the charts. Dr. Winkler entered and asked what was going on.

  “Nursing students,” I told him through pursed mouth, hoping he would become outraged and kick them right out, but that was not his way, or he would not have lasted so many years at that hospital, or maybe at any. He just sat down, and we had our usual morning meeting but more crowded.

  The next day I walked onto the unit, and the same students were all over the dayroom talking to patients. There was so much activity you couldn’t hear the television, which was lovely, and the patients seemed to be enjoying the flurry, the closest thing they could expect to a party. I located Domenica, the would-be daughter of Beyoncé, who was proving a difficult case. She was relentless in asserting that she didn’t have anything to talk about. Her distraught mother had become equally resolute about not taking her home, as explosive and potentially dangerous as the family deemed her. Until Domenica and I got somewhere, or she was granted a bed at Kingsboro, she would remain on G-51. I told her I wanted to discuss how she felt about her mother’s decision. It was painful to think about, and so she was ignoring me. This was how it had generally gone between us. One of the students came over. “Can I listen?” she asked.

  “You’ll have to ask her,” I said, nodding toward Domenica, who shrugged at the student and grabbed the word-find book the girl was holding. Domenica flipped through it.

  “She’s having a hard time accepting her situation,” I said to the student, but for Domenica’s benefit. The student wanted to know if she could ask some questions.

  “You’ll have to ask her,” I repeated, my patience so easily thinned. Domenica shrugged again. The student looked at Domenica as if she were an animal at a zoo rather than a relatable human being, which on bad days was not so different from how most of us who worked there looked at her, and my anger intensified still.

  “Were you ever abused?” the student asked, an especially abrasive way to begin. Domenica nodded.

  “Were you ever physically abused?” she went on. Domenica nodded again.

  “Were you ever sexually abused?” This time Domenica shook her head. I knew from previous discussions she was lying, and she looked a little nervous. I cut in, struggling mightily to be nice to this person whose poor judgment and lack of sensitivity I did not think lent themselves to her chosen field.

  “Look, these are deeply personal questions. The answers are important if you’re treating someone, but as long as you’re just here to observe, you should stick with more neutral topics,” I advised her from somewhere on high.

  She looked at me blankly. “But they’re on the list,” she said.

  “The list?” I asked.

  “The list of questions we’re supposed to ask,” she said. I looked over at the schoolteacher, who was watching from a corner, and wondered what kind of sadist she was.

  “Sometimes you have to use your own judgment despite what’s on a list. If your nursing college isn’t teaching you that, you’re not getting your money’s worth.” I was full-blown nasty now.

  “College? I’m not in college. I’m a tenth grader,” she said.

  I was lashing out at a fifteen-year-old. This is what the G Building had reduced me to: thera-pissed. It turned out the students were from one of the city’s vocational high schools, which explained the naïveté of the girl I was speaking with, but certainly not why anyone had let her onto a locked psychiatric ward two days in a row. Patients could be unpredictable. Fights sometimes broke out. And what about privacy? This was no place for teenagers on a field trip.

  “Gimme a dollar,” I heard Domenica demand of the tenth grader as I walked away. I saw Buck sitting with a young man a few tables over and got within earshot.

  “I used to drive a taxicab,” Buck was telling him. “That’s because I was a cer-ti-fied peer coun-se-lor. Write that down!” The openmouthed boy just looked back and forth between Buck and his list of questions and did not manage to get even one in edgewise.

  As a substitute for comprehensive psychological treatment, patients were moved around, from unit to unit, whenever there was any trouble. Mr. Bernard, whom we believed to have dementia, was suddenly transferred from G-51 to another ward after a sexually preoccupied patient accused him of attempted rape when he crawled into his bed one night. Mr. Bernard had been getting into the wrong bed regularly with nothing more on his mind than going to sleep. He was just confused, and putting him on a different unit altogether could only disorient him more, and my book told me that such a decision should always be carefully considered by the treatment team, but that never seemed to happen. I was his therapist, for whatever that was worth, and was certainly not consulted. Transfers took place late into the night, or on the weekends, when there were no meetings, just the decisions of overworked staff who understandably didn’t want any difficulty in their jurisdictions. Dr. Begum and Dr. Winkler were leery of transfers from other units for that reason. To be fair to everyone or maybe to no one, a kind of Yankee Swap developed, and challenging patients were traded back and forth between wards like baseball cards. Sometimes the reason for getting rid of someone was obvious (if counterproductive for the patient himself)—for instance, guys like Marvin Mavin, who scared people. Sometimes it was so illogical that you had to be there to believe it.

  In late January, Zeke came from his rotation in the psych ER to our intern case conference eager to talk about a patient he’d just met there. The man’s wife and two young sons had recently been killed in a car accident, and he had asked to be admitted in order to prevent his own death by suicide. Losing one’s entire family at once was on everyone’s short list of worst nightmares, and I could barely stand to hear about it. But Zeke was interested in hearing more. So even though he wasn’t currently on the inpatient rotation, T. and Scott gave him special permission to continue to work with this grieving man after he left the psych ER and came to G-51. By the time the man was admitted up to the unit, though, shock or denial or both had set in, and he began doing his best to make trouble: selling contraband items like cigarettes, provoking other men into fistfights. Over just a few days he became very unpopular among the staff, who I assumed like me could barely stand to fathom the bottomless pit of his pain. Even though Dr. T. had followed ER protocol and confirmed the man’s story with his remaining extended family, various members of the treatment team began to believe that there was no way anyone who had just buried his wife and kids could be acting like this, and they decided he must have made the whole thing up. It was likely the overwrought man wanted desperately to believe that himself, and the staff’s response to him was a manifestation of this poignant desire. If there had been a functional psychologist on the unit, she might have called a team meeting to communicate as much and to defuse the situation; his behavior might even have gotten addressed therapeutically. Instead, a nursing aide came in one morning claiming to have seen the man on America’s Most Wanted the night before. The staff went on the warpath, trying, in a flurry of Internet searching, to confirm his newly alleged criminal past. Though they failed, the man had to be transferred to another floor, as our team’s hostility toward him had finally reached an untenable pitch. Then Zeke fell on some black ice and tore his ACL and was out for three weeks, so the man lost his therapist, too.

  I was often rushing between the inpatient unit and other commitments, and late one morning Dr. Begum stopped me as I was preparing to go upstairs for back-to-back meetings with Scott, who had begun supervising me on a new outpatient case, and Dr. Wolfe, who had proven the perfect foil to my women’s depression group, encouraging me to enjoy myself and not take it all so seriously, which was good advice because it went against my nature.

  “Go find the new female patient. Vera, she is called. We will be very fast, twenty-five minutes,” Dr. Begum said. He was exacting and focused, and w
hen I conducted interviews under his watch, they were usually brief, unlike with Dr. Winkler, with whom discussions meandered in ways that were as likely to be splendid as tedium filled when there was other work to be gotten to. I found Vera in her room. She was white and past fifty, in a gray T-shirt with a stretched-out collar, exposing her worn chest to her breastbone. Her eyes and lips were lined sloppily, which stood out because we rarely saw patients in makeup. She took all the time in the world getting to the edge of her bed and then rose slowly. She picked up a green mesh laundry bag filled with clothes and put it on a chair. She opened it. She found a cardigan sweater. She took it out. I wanted to encourage her to hurry but held back because her behavior was diagnostic, and I tried to stay patient enough to observe. In slow motion she dragged the cardigan’s sleeves over her wrists and then followed me. Physically unable to make my pace match hers, I was ten steps ahead all the way to the chart room. When Vera finally made it inside, I gave her a chair and introduced Dr. Begum and told her we wanted to know more about her so that we could help her. We hadn’t been able to read the admission note from CPEP, which was par for the course, and did not know why she had come in. I told her she looked unusually sluggish and asked her if she knew why this might be.

  “I got two shots last night,” she said. So much for diagnostic. Her accent was Russian. Her eyelids and chin fell as she spoke. I looked toward Dr. Begum. I had to be upstairs in just five minutes. I hated being late.

  “Maybe we should do this later?” I suggested.

  “Try a few more questions,” Dr. Begum said.

  “How did you get here, Vera?” I asked. Her eyes were now closed, and she didn’t answer. We waited, and then I repeated my question. She managed to mumble this time, something about EMS wanting to take her vitals.

  “What was going on leading up to that?” I asked hopefully. Tick tick tick tick tick. Her neck craned sideways now. A sleeping patient is a poor historian. I looked to Dr. Begum again.

  “Why are you so tired?” he asked.

  “She got two shots last night.” I repeated this information when she failed to answer.

  “They’re fast acting, shouldn’t last more than four hours,” the doctor replied, and I thought that this was the kind of knowledge I was missing for myself and that it challenged my usefulness here. “But okay, you must go, come back later, we will try again,” he said to me.

  When I returned some hours after noon, Vera was more awake. She apologized for earlier, as if she were a student who’d fallen asleep in class. She explained she’d just then gotten her methadone, the safer and legal alternative to the heroin she’d been addicted to off and on for large swaths of her life. Methadone can be sedating, but it had worn off a bit, and now she could talk. She sat back down with Dr. Begum and me in the chart room and offered us a handful of reasons for her admission as if it were a box of chocolates. We should choose whichever ones we liked best. Caramelly suicidal thoughts, cream-filled auditory hallucinations, candied paranoia. But really she mostly seemed desperate.

  “Where were you living before you got here?” I asked her, trying to orient myself to her life in the midst of the red herrings she seemed to feel were required of her.

  “With my husband,” she said, and she started to cry. The tears felt more genuine than the symptoms she’d been reciting from some memorized list in her head. “We just got married last year, right after we met. I’ve been locked in his house for months. He would only let me leave when I needed more methadone, and even then not always. Otherwise I was a prisoner. He was emotionally abusive. He liked to beat me up, too, to hit me with his cane.” Vera’s tears kept coming after she stopped speaking. I passed her some Kleenex, which she took to wipe her nose and eyes. Her makeup did not run, and I saw it was tattooed there. The artist had been one more cruel friend; the shaky line that rimmed her mouth was a millimeter to the right of her actual lips all the way around. She looked like a toned-down version of the cinematic Joker, why so serious. I returned my focus to her story.

  “He beat you with his cane?” This begged more explanation.

  “He’s eighty-six years old,” she said, by the by. She’d tell us later that her father had been high up in the Russian Mafia. He had beaten her, too. This is what happens to the daughters of gangsters, I thought as I listened, Meadow Soprano aside. Dr. Begum diagnosed Vera with major depression and assigned me to her case.

  In inpatient terms, Vera was a real catch: she wasn’t psychotic; she was angry with her parents, and that I knew how to treat. Her relationship with her father became the focus of our talks, which I guessed correctly from the beginning would be many, as Vera had no home to be discharged to and she was happy to stay besides. She liked it on our unit. She made herself at home there. If there was something problematic about that, it also seemed very glass-half-full. There was this resilience in her—in many of our patients really, though sometimes, in the midst of all their challenges, I forgot to take notice of it. Vera held on to the very human notion that life could get better. It hadn’t been beaten out of her. She appreciated the unit more than anyone I’d ever met, and I felt grateful to her, really, for by then I’d come to dread the ward as much as the other residents and the staff seemed to. With my new patient, I’d found work to look forward to, and I saw Vera for forty-five minutes, three times a week. For both of us, it was nice to have some coherent conversation.

  Her recent history we glossed over: cancer, heroin addiction, connubial captivity. Her distant past was more on her mind; she saw that it colored her present. Vera’s father had introduced her to cocaine when she was barely a teenager, and then he called her a junkie and kicked her out of his house soon after they immigrated, and before she turned eighteen. She’d been witness to horrific crimes, she told me, things she couldn’t talk about. Her father and mother had retired to Nevada, and, almost in their eighties themselves, they remained indifferent to her ongoing pleas for money and help. She was still trying madly to get them to parent her. The refusal to give that up stopped her from mourning all she hadn’t gotten way back when and then also kept her stuck there. Our most intense sessions followed phone calls to the couple, and I saw that so much stubborn wishing died hard.

  Vera made friends quickly on the unit because she liked to talk and she was also a good listener, which not all psychiatric patients are. She became particularly close with Ms. Anders, the woman who believed the American Mafia was coming for her. “I don’t think it’s true,” Vera whispered to me from behind her hand for good measure.

  “It seems unlikely,” I agreed.

  Vera got calls on the pay phone from patients who’d moved on, and she’d give me updates, like when a Mr. Archer called from Rikers Island to let her know he’d been arrested just hours after his discharge for stabbing someone on a subway platform. I kept waiting for that news to come back to haunt the G Building, but then I never heard another word. Vera and I had some things in common, personality-wise. My masochistic defenses—superimposed like paper-doll dresses over the depressive ones—had loosened over time in therapy, but I’d gotten to know them well there, to the benefit of my work with people with similar dynamics. My other patients often interrupted our sessions, and I guessed that they were envious of all the attention she got. Most of them could not tolerate a full forty-five minutes of engagement, and even the ones who could often ended up refusing my invitations to talk, like Buck, who’d folded his arms and looked away when I approached, ever since I’d tried convincing him to go back on the Risperdal. “Tell me what’s wrong with me,” he’d insisted, and Dr. Begum had come over and listed his symptoms.

  “You are disorganized, you are grandiose, you are delusional,” he said because this was the way some psychiatrists talked to patients, as if psychosis were diabetes or a gastrointestinal bug or some other disorder that had nothing to do with the unbearable difficulty of acknowledging reality.

  “I’m a certified peer counselor!” Buck protested.

  Like the most ve
hement masochists, Vera evoked sadism in everyone around her. She’d escaped an abusive relationship only to find herself in the middle of several fights in quick succession on the unit: the first left her with stitches above her eyebrow and the third with back pain for which a Saturday doctor prescribed Percocet. (“Is that a good idea for a drug addict?” Dr. Winkler asked when he returned on a Monday. That week’s medical students said that they did not think so.) Despite my understanding of Vera’s dynamics, in flashes of intense feeling I sometimes also wanted to wound her. One day she complained to me that she might have a roommate in the apartment program she was on the waiting list for, and I found myself asking, as though making a joke, if she’d been expecting her very own suite at the Waldorf. It came out meanly, as of course that’s how I’d felt it. I might as well have slapped her across the face. While I watched her react, her placid expression shifting into one of wounded anger, Dr. Begum summoned me from across the room. I excused myself with a thin satisfaction and a thicker slab of guilt, like a repentant alcoholic just off a swig. This was the hardest work with inpatients, the corralling of one’s baser urges. It reminded me of a physical fitness test from grade school—hanging, as they timed you, with your chin above a bar. In those instants, stopping myself felt like that, but sometimes I gave up and fell. These were not my proudest moments. Vera and I would go back to my comment another day (“rupture and repair,” psychologists called it), but in that instant I was glad to be needed elsewhere.

  In mid-February the Justice Department finally arrived. I would not have known but for the abrupt changes on the unit that were aesthetically reminiscent of a kindergarten. Multiple white poster boards adorned with many shapes and colors alerted patients to the myriad scheduled activities available to them. Trips to the seventh-floor gym, community meetings, recreation and therapy groups. Before there’d been only television, which no one had bothered to put on a Technicolor calendar. The group room was suddenly open around the clock with art supplies on its tables and one inmate or another playing its piano. I felt as if we were the von Trapp family putting on the final performance for the Nazis. Even the patients got in on the act, stopping just short of curtsying and exhibiting other best behaviors as the feds toured the building escorted by administrators.