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  We entered the seventeen-year-old’s room. Yanibel was cornrowed and cherubic, holding a denim-clad teddy bear. “What’s its name?” Dr. Jonas asked Yanibel after introducing herself, pointing to the bear.

  “Miranda,” replied Yanibel, smiling and batting her eyelids.

  “If she’s a girl, why is she wearing blue and not pink?” asked Dr. Jonas with her usual conversational flair. Yanibel gave an equally meaningless answer.

  “So your doctors are concerned about you. They asked me to come make sure you’re doing okay,” Dr. Jonas explained. Yanibel nodded.

  “Have you had the condom lecture?” asked Dr. Jonas.

  “Yes.” The girl was solemn.

  “Then I’m not going to give you that lecture. Do you use them?”

  “Yes.”

  “All the time?”

  “Yes,” said the girl, all sweetness and long lashes.

  “Yanibel, I want to explain something to you. Sometimes teenagers have very high sex drives,” she said. “It can be hard to control. But we have medicines that can help, like the birth control pill.”

  The patient was as attentive as I was horrified. Given the neighborhood, ours might be the only conversation this girl would ever have with anyone in the mental health field. If she bought the idea that her sexual acting out was simply the result of hormones gone wild, like soused girls in low-budget Mardi Gras films, she might never get it, the import of dealing with her suffering. I couldn’t let this one go. I might have been only a student—for how much longer was that anyway?—but still I had something to offer. I could condemn myself in my head or fail to stand up for myself in meetings with people like Caitlin and Scott, but I could not let my oldest vulnerabilities get in the way of my actual work. I was not always bad. I was not always wrong. To regress into believing otherwise was to shirk a real responsibility—one it was time to start embracing, as long as I was there.

  I interrupted Dr. Jonas with the indignation of a thousand condescended-to psychologists. “Can I ask a question?”

  She looked at me with exaggerated surprise. “What is it?” I avoided her gaze—finally settled on me—and focused on Yanibel instead.

  “Did you have a lot of sex before the rapes, Yanibel, or not until after?”

  Yanibel giggled as she replied, “After.” She turned back to Dr. Jonas and her imperious authority. “Why is she asking me that?”

  Dr. Jonas swiveled to face Yanibel, carefully enunciating each syllable of her reply. “Why don’t you ask the psychology intern? She’s the one who wants to know.”

  Her hostility threw me, but less than the realization that she did not follow my line of thought. I’d mistaken her arrogance for knowledge. That was so easy for me to do. My heart racing with anger and something else more exciting, I addressed Yanibel. “It’s common for girls who’ve been raped to become very promiscuous afterward. It’s one way of trying to cope with all the frightening feelings that come from being assaulted,” I said slowly, hoping she would get it.

  “Oh,” said Yanibel. She stopped her giggling.

  “Sometimes people go talk to therapists to work out feelings like those,” I told her.

  Dr. Jonas cut in, still dismissive. “We can help you find someone to talk to, if that’s what you want.” Her pager began to beep.

  “Yes, I’d like that,” said Yanibel.

  “I have to take this page. I’ll make a note in the chart for your social worker to find you a therapist, and Dr. Wang will finish up here.” She left, rushing again, as if someone might drop dead if the psychiatrist didn’t get there quickly enough. Alvin took over.

  “So there are several oral contraceptives I can prescribe that may dampen your urge to have sex,” Alvin began.

  “Dr. Wang,” I said pointedly, looking him in the eye.

  “Right,” he said. “That’s not really the issue here?”

  “No,” I said, shaking my head.

  “We’ll be helping to make you a therapy appointment,” he corrected himself.

  “Good luck, Yanibel,” I said. “Feel better.”

  We left the room. Alvin asked me to recommend some basic psychology reading to him, and I told him I’d make a list. We went to wait for Dr. Jonas in the chart room.

  “You’re good with adolescents,” Dr. Jonas said to me when she arrived. “Do you have a lot of experience with them?”

  I did not, and I told her so. “I’ve had course work on trauma,” I added, hoping to communicate that the rudimentary knowledge I’d imparted to this patient had nothing to do with studying teenagers, but rather with my general knowledge of psychological functioning.

  “Well, I think that you should consider specializing in teens,” she said, trying to be generous, I knew, but also missing my point. Dr. Jonas stopped ignoring me after that, and I stopped ignoring myself, too.

  One day as we waited for morning report, a young, blond medical student I’d been traipsing around the hospital with told me he was thinking about going to see a therapist. “A psychoanalyst,” he added. “Psychoanalysis sounds interesting.”

  Dr. Cherkesov chimed from the windowsill and her plants. “You should go for something else,” she said. “Like DBT!” Dialectical behavior therapy was all the rage in psychotherapy research circles, but it was primarily for managing personality disorders, and this medical student was hardly that sick.

  “Nah!” I said, because summer was coming and the mood in the room felt playful. “He’s in the neurotic range. Psychoanalysis seems right.”

  “That’s a horrible word, ‘neurotic,’ ” Dr. Cherkesov responded with her typical fervor.

  “I guess it used to be,” I said. “But not anymore. Now it’s good. Healthy. High functioning.”

  “Well, the public doesn’t see it that way,” she said.

  “I don’t talk to the public that way,” I said, defensive. “Just other people in the field.”

  “Still, if you believe that a patient is neurotic, your negative attitude is communicated.”

  “But I don’t think it’s negative. It’s practically cause for celebration!” It was easy to adopt her exuberant demeanor, and fun.

  Dr. Cherkesov continued: “Your words matter. Someone is not ‘obsessive.’ He is ‘conscientious’!”

  “But I don’t think ‘obsessive’ is negative either. Everyone has a character style. It’s only problematic when it repeatedly gets in someone’s way.”

  “You will communicate your negative feelings about the patient in your face, in your body language,” said Dr. Cherkesov, who saw the world in shades of grave.

  The medical student cut in and changed the subject. Later he told me he did it on purpose. “I couldn’t take the tension anymore,” he said.

  In the meeting that followed, we discussed a man in the hospital after a car accident. He’d been driving and was largely physically unscathed, but his sister, in the passenger seat, had been killed. CL was called late in the night to tell him of her passing. The resident had gone to see him. “Bringing psychiatry in to deliver news makes people think they’re expected to go crazy,” said Dr. Cherkesov, shaking her head. We needed to arrive at a psychiatric diagnosis so that he could be followed up. Somebody took out the DSM to look up “bereavement,” and I felt as if we were a group of aliens investigating the human experience.

  I left the meeting and went to see Nicholas, who’d become a three-times-a-week patient. He was a likable kid, but his self-professed sociopathy kept me wary of each confidence. When I got to his room, he was in his bed as usual, but now there was a slim black wheelchair beside him, and it did things to my stomach, imagining him in it. His nightmares had continued, and he shared them with me on each visit, revision after revision of the afternoon of his shooting. In the most recent iteration, he’d been watching his friends play ball from the sidelines, desperate but unable to get into the game. Did he still belong among them? He told me he’d been a drug kingpin. Those were his words, though I presumed the title an inflate
d one, given his youth. I didn’t know much about street crime, but I’d watched each season of The Wire, and the kids his age were middling players, if always with the bleak promise of ascension. Nicholas was convinced he was bad to the bone. “I’m evil and karma made me get shot, but karma messed up and I didn’t die. I’ve always known I’d die by a shooting, but I never thought I’d wind up like this.” He told me his goal in life had been to be feared, and that he’d achieved it, but now maybe he was rethinking things. No one feared a guy in a chair. His mom had started talking about moving again, to get Nicholas away from this latest bad crowd.

  “But the place doesn’t make the man,” I told him. “Maybe it’s time to start being curious about your attraction to dangerous people.” I wanted to help him recognize that repeating the life of one’s father was a choice. Maybe there were other choices. I asked him if he’d thought of any.

  “This gym teacher came to visit my juvenile detention class once. He’d been in a gang, but he turned his life around. We all really liked him. Ever since then I’ve thought about becoming a gym teacher, influencing kids like that. It’s been in the back of my mind,” he said. Was that where this shooting might eventually land him, in a junior high school gymnasium, not dead at all? We both looked at the wheelchair. He spoke again: “I had another dream, too, about going around to visit a bunch of different people. I told them, ‘I’m walking, but don’t worry, it’s just a dream.’ ”

  After Memorial Day, Dr. Cherkesov went on vacation, and Dr. Singer was overwhelmed with calls. “We’ll have to split up the consults between the residents and Dr. Jonas and me,” he told us at the meeting’s end, unusually harried. Unlike Dr. Kapoor’s, Dr. Singer’s style was to see each consult in advance of the resident, to make sure he had a general handle on it before passing it along.

  “You can give me a few as well,” I said with confidence.

  Dr. Singer thought for a minute. “No, it might just have to be the resident,” he said finally, apologetic.

  I felt the smart of his decision, but only for a flash because then there was this: I had volunteered to go. I had spoken right up. But where is the schoolgirl that used to be me? All year long I’d tiptoed around, revering the idea that I was lacking in some vague way that made me less than useful. Finally I wanted to laugh out loud at that very notion, the wrong answer to the wrong question. My offer to help out, delivered without hesitation, seemed more important than any response it elicited.

  I was still very new to much of this. I still had a lot to learn. But that mattered less in the end than the fact that I’d become willing to participate. It made me a better psychologist.

  I ran into Scott on the sixth floor, and he stopped me. “I have some news I think you’ll like hearing,” he said. “I heard through the grapevine that you’re doing a great job on your family case.” He paused and waited for my appreciation. I’d been refusing to give it to him for so long (so strongly did I resent being asked to pretend that it was there). How much smoother my year might have been had I relented sooner. I smiled.

  “Wow, that’s really nice to hear,” I said. It might’ve been, too, had I actually been seeing a family.

  “I thought you’d want to know,” he said.

  “Yes, thank you,” I said. As I kept smiling, I tried to figure out what might have gone down. Was this my good-humored family supervisor’s winking attempt to help me out with Scott? So separate was he from the G Building in his child and family clinic, would he have even known I needed the boost?

  “How’s the paperwork going?” Scott asked. With just weeks to go, whatever outpatient notes we hadn’t been keeping up with during the year had to be attended to. In our free time the interns were now camped out in our office together, mildly nostalgic for each other and this mess of a place, hands cramping as we wrote vague near-paragraphs about sessions long since past.

  “Good,” I told Scott. “I’m almost done.” I was.

  Alisha would go home soon, or maybe there would be an operation. The former was problematic, as she was having trouble keeping her pain medication down, and without it she was writhing and miserable. As an outpatient, too, it was hard to afford the meds. She’d borrowed from a favorite teacher for them in the past, but they were two hundred dollars a month, and she couldn’t keep asking. Again I felt the heft of reality, this medium I couldn’t alter. Maybe Alisha could use a psychologist, but there was so much else she had to have first. The teacher came to visit and stopped me in the hallway.

  “I feel bad for her, of course, but she’s really difficult,” the woman said in a low voice. “She lies. She’s manipulative.”

  “Think of everything she needs and can’t get,” I said to her. “Manipulation is adaptive in her case. How else would a girl in her shoes get by?”

  The teacher thanked me for the reminder and took a deep breath before entering the room.

  The next time I saw Alisha she told me again about her pain and her doctors’ obfuscations, and I was empathetic and reflected how hard her struggle was. She told me she was glad to have me to talk to. Two days later I returned and she was gone. This was how treatments ended at hospitals, without the thoughtful summations and labored in-office good-byes I’d been taught to call termination. In all of these settings that in school had escaped me, there were rarely neat farewells.

  Nicholas was leaving, too, before me. He was in physical therapy each day by then, not walking yet but making progress and recovered from his surgery. He would be transferred to a long-term rehab facility in uptown Manhattan, his mother housed in an apartment nearby. They were still talking about moving back west, but my patient had become ambivalent, for from his hospital bed with his useless legs he’d managed to fall in love. She was a few years older, a friend of a friend. For a girl longing for a drug kingpin with the loyalty of a schoolboy, an outlaw with a newly acquired heart of gold, I guessed Nicholas was a rare find. At least carousing would be hard from an inpatient rehab, for the months he’d likely be there. The girl had asked Nicholas to be exclusive, and he’d eagerly agreed. “I don’t want to talk about anything dark today,” he told me at the start of our last visit. His face was lit with the elation of new love, more potent than the Seroquel. I wished him well.

  As on inpatient, there was no evaluation at CL. Psychiatrists did not evaluate psychologists. I’d never been technically their student, not on paper, though like Dr. Begum and Dr. Winkler they’d been nice enough to take me in, like wolves might do for a human baby, bereft of its own species’ elders.

  It was the end, and the import of evaluations had fallen away, and also a woman had died while waiting for admission to the psych ER, and everyone in Behavioral Health was wrapped up in it—another in a line of travesties for an already beleaguered staff. The Justice Department had been one thing, and now this was a whole other. The psychiatrist on call in the G Building ER in those early-morning hours had been fired immediately: the security camera had recorded him “kicking” the woman’s still body, though I knew, we all did, that he was only trying to safely rouse her. No matter that she had come in and refused a medical exam (at least I’d overheard that), it looked bad, and nothing was allowed to look bad without people losing their jobs, a cynical and long-standing PR campaign that addressed nothing, until “nothing” was finally all that ever got addressed. “At least it wasn’t a resident on call,” Dr. Singer said in hushed tones to Dr. Cherkesov from his seat in the CL conference room two buildings away.

  It was late June, and we were leaving the hospital in a worse place than even when we got there, and us personally in this better place, so close to being done with all that school.

  On my last day at CL, a week before the official final day as an intern at Kings County Hospital, I thanked Dr. Kapoor and Dr. Singer and Dr. Cherkesov for having me, for all that they had helped me to learn. Dr. Cherkesov asked how my time on CL had gone, and I told her it had been a lot to take in, just like the rest of internship. She nodded with her usual solemn f
ace and then spoke in the voice that always matched it: “You will look back on your experience and discover so much more than you are able to grasp now.”

  CHAPTER ELEVEN

  IT WAS THE END, AND EVERYTHING HAD TO BE COUNTED. How many patients we had seen and how many minutes we had spent with them and in what type of interaction. Psychologists are licensed by the state, and the best way the state could figure out to go about this was to quantify our training experiences, and to the minute. So I returned to CPEP in late June to look over the patient rosters from the month I’d spent there, hoping that I’d recall the names once I saw them so that I could copy them down to prove I’d put my time in. (Of course, we’d been advised at the beginning of the year to record the names and medical record numbers of all our patients, but things moved so quickly on most of the rotations, and none of us had done it. Now it was all over but the scrambling.)

  I let myself into the psych ER with my skeleton key, and like moths to a flame my eyes rose to the familiar sign above its door: “If you don’t have a key, you DON’T belong here.” In October, despite my key, I’d felt a certain kind of not belonging, one buttressed by my presumed shortcomings. Now I grasped the not belonging had origins also less particular to me, rooted in an institutional and ontological confusion and indifference. Both energized and worn down by this place that declared psychic problems medical ones and then sent me to go about some half-derided and under-supervised handling of them, I wouldn’t hesitate to turn in the key, the last vestige of my official business there. But I would do it with a true ambivalence.

  It was early, before 10:00, and the ER was quiet and bruised after the scrutiny it had come under following the death there. Post–Justice Department, the physical space looked altered, too. Doors were clearly marked: “Pediatric Suite,” “Soiled Linens.” It appeared cleaner and better lit, and there were fewer patients aimlessly milling about, though maybe June was just a quieter month. The place felt different now, and I felt different in it. The dread that had gathered in my stomach each time I’d arrived to spend my day inside back in the fall—so strongly I’d tried to overlook it—was gone now. I’d grown more comfortable behind locked doors, only now so close to when I would be rid of them. I went to the nursing station, where a closed-circuit television system had been installed and miniature TV screens let viewers see the goings-on of each remote corner of the place. I looked out from behind the thick glass and saw Mr. Rumbert, whom I’d first met in the psych ER and then followed to G-51. The immaculate pajamas I’d last seen him in on the unit had been replaced by plain jeans and a dark T-shirt. He looked upset, pacing and muttering and holding his arms tightly to his sides. At least he wasn’t selectively mute. I walked out to greet him. “Mr. Rumbert!” It was nice to see him but sad, too, as his very presence there could only mean things were not going well for him. He held still and looked at me.