Brooklyn Zoo (17 page)

I found Mr. Cook sitting soberly in the waiting room. He was in his mid-twenties, African American, in expensive pressed jeans, a short-sleeved orange Polo shirt, and flip-flops. He was better groomed than any of the patients I’d seen and also some of the staff. Hope fluttered familiar: maybe there was nothing wrong with this one. Mr. Cook was polite and composed when I brought him in to Dr. T.’s office and shut the door behind us. “Why don’t you start off by telling me how you got here?”

“The police,” he said. “They got angry at me for calling them, so they brought me here. I suppose to punish me.” He looked at the floor, shaking his head.

“Why were you calling them?” I asked.

“I’ve been having a dispute with my across-the-hall neighbor. We used to be friends. She’s old and she can’t work anymore, so she’s always broke, and I used to take her out to dinner sometimes. We leave our doors open when we’re both home so my dog can wander back and forth. I lent her twenty-five dollars a few weeks ago, and ever since she’s been avoiding me. I wanted my money, so I decided to wait for her outside her door. She got home at three a.m., and I was there, so she called the police.”

“She called the police just because you were standing there?”

“Well, I’d been bothering her about the money for the last week or so. I think she kidnapped the cat I was cat-sitting to get back at me. Anyway, I wouldn’t let her get into her apartment. I was insisting she give me the twenty-five dollars.”

“What did the police do?”

“They came, we were both still standing there. I told them what she’d done. They told me to go home, to take it to civil court, and they left. But after they left, she threatened to stab me, so I called 911. The same cops came back, more irritated this time. They were going to arrest me, but instead they brought me here.”

I felt sympathy for the plight of these beleaguered cops, but did they really need to bring this nice fellow to a psychiatric emergency room just to teach him a lesson?

“Have you ever been in the hospital before?” I asked.

“No,” he replied.

“Have you ever been involved with the police?”

“No, never.”

“Have you ever seen a psychologist or a psychiatrist?”

“My wife and I went to couples therapy a few times, before our divorce.”

Couples therapy? Only functional people went to couples therapy. I was sure of it. This guy was fine. The police were only human. Sometimes they retaliated, like with the lady with the squirrel. No harm, no foul.

I did what I’d learned to call a mental status exam. Mr. Cook knew who and where he was. He did not hear things that other people couldn’t hear. He could identify the president, and the one before him. He did not think the television was talking directly to him. He was sleeping regularly and eating heartily. He could count backward from a hundred by sevens. I racked my brain for what to do next and remembered Dr. T.’s lesson about leaning on people, going hard at their judgment to see if it pushed them over the edge.

“You can’t just wait outside a woman’s door at three in the morning and then refuse to leave. You’re going to get yourself
in real trouble,” I chastised him. “You can’t act like that in the world.”

“I see that,” he said. I felt relieved. His response was so normal. He would take in my words, and he would stop behaving so ridiculously. I had talked some sense into him. Phew.

I told him he could leave the office. That we would meet again later. I wrote a chart note and prepared to tell Dr. T. that I thought it was true this time, that someone had messed up, that this person really did not belong here.

“It’s not that easy to wind up in the G-ER,” she said with exasperation when she returned and I gave her my take on Mr. Cook. “Did anything in his story
not
make sense to you?”

“A lot of little things were slightly off,” I admitted.

“Like what?” she asked.

“Well, this is New York. No one lends money to a neighbor, or leaves their apartment door open to let their dog wander in and out. I mean, maybe if he was romantically interested in her, but he said she’s old, and she must be a bit crazy, too, if she really threatened to stab him. And then there was the thing about the cat kidnapping. I mean, it’s possible …” I trailed off.

“But not likely,” finished T.

I thought aloud: “I’m finding that I work really hard to organize what patients tell me. I push the stuff that’s bizarre to the back of my mind and focus on what does make sense.”

“Why do you think you’re doing that?”

“If I let the stories
not
make sense, I feel off-kilter. It’s disorienting.”

“So you have a tiny taste of how psychosis might feel,” said T. “That’s good. You’re very empathic, exactly what we all need to be. Pay attention to how hard you’re working with any particular patient to organize their experience. It can be
a signal to you of how
dis
organized their thought process is. Bring Mr. Cook back in.”

This time I found my patient just to the right of T.’s office, standing on his head. He righted himself and followed me back to the small room. When Dr. T. asked, he told us more about his life. He worked as a telemarketer. He had a college degree from an online university, though he’d spent his first two years of undergrad at Cornell. “You know what they say,” he told us, “the easiest Ivy to get into and the hardest to graduate from.” He’d gotten divorced because “we fought about money. Couples often fight about money.” His mother had died one year prior, and he told us calmly, “I went through the stages of grief.”

After he left, Dr. T. asked what I thought once again. I said, “He was behaving bizarrely when I went out to get him, standing on his head in the hall. It’s strange that he started at Cornell and finished at some Internet college. And he seems smart, but he works as a telemarketer.”

“He doesn’t have to have any face-to-face contact with people that way,” she said. “His affect was very flat. That’s what stands out to me. He answers questions about emotions with abstractions. I think he’s trying very hard to sound conventional when it comes to talking about feelings.”

“So you think he’s schizoid?” I asked, testing the waters with T. by referring not to a psychiatric disorder but to a character style, a descriptor for someone whose fears about closeness keep him isolated, who doesn’t experience his emotional world the way other people do, who’s interpersonally a bit odd.

“Probably,” she replied. “He generally gets by. Nobody on the street would know anything was off.”

“So what do we do for him?”

“The police thought something was wrong. Taking that
into consideration, we’ll keep him and observe. We’ll make sure that his judgment isn’t a threat to his safety. He is likely schizoid, but he may also be headed toward the more psychotic end of that spectrum. He could be having a first break. There’s no family to call for collateral information, though maybe he’ll agree to let us talk to his ex-wife. With a patient like Mr. Cook, you wait a bit and see.”

The next day I was off. I took an “education day,” as opposed to a vacation day, to meet with my dissertation adviser. We went out to the very end of Long Island, where we courted the social psychologist whose data I was hoping to mine. Over lunch in the food court at SUNY Stony Brook we discussed research measures of adult attachment and their relationship to psycholinguistics, and by the time I returned to the psych ER the next day, Mr. Cook was gone, sent upstairs, and I never saw him again. That was CPEP for you. Blink and you’d miss someone, or maybe a patient would be there four weekdays straight, and you’d feel as if you’d lived out her harrowing course alongside her over many months. On my day away, immersed in the minutiae of academia, I relished the conversations of people unalarmed by the exigencies of the emergency loony bin. Was that the real world? Was this? They were so disparate that going back and forth between the two was viscerally unnerving, like jumping from the hot tub to the cold pool at the Russian baths.

Too soon I was back in my morning group, with a young white drug addict brought in by—“BIB” in chart shorthand—his sister. There was a young, pretty black woman who’d asked her husband to bring her in after watching “upsetting events” on the news; one man who wouldn’t say why he was there at all; a tearful young woman with no front teeth to whom I paid less mind than I might’ve because of her appearance and
the fact that she lived in a group home; and an oddly dressed thirtysomething whose “affect was not appropriate to content” when he reported, with a grin, that he was there for beating his caseworker. After group I called the purportedly clobbered caseworker. She laughed and said that no, he wasn’t violent, just not med compliant, and I guessed that I must’ve been the biggest believer of nonsense who’d ever crossed the CPEP threshold with her very own skeleton key.

The next morning, the same patients were still there, and we felt like old friends, or I felt as if we were old friends for all of us. This helped me relax, and probably not coincidentally they were the most interactive group I’d led. Mr. Fincher—the white drug addict who lived in an affluent Brooklyn neighborhood not usually inhabited by Kings County patients—explained, as if it were no biggie, that he’d disappeared on a crack binge for a week and his mother and sister had flown in from Phoenix to find him on the streets and bring him to the hospital. Mrs. Kendrick—who’d been upset by the television—told us through her tears that she was responsible for some gang killings of teenagers she’d seen on the news. In actuality, she had nothing to do with gangs, but it is common, in psychosis, to believe oneself at the center of events literally—if not psychologically—unrelated to you. Shirley, the toothless woman I’d considered so uninteresting the day before, had found herself an ornamental headband and a denim miniskirt, and her mood was brighter and her attitude more confident, and she strutted around the group room as if she were one of the Supremes; she interrupted the others as they talked, and I had no patience with her. The man who wouldn’t speak the day before was now talking enough to share that he was waiting for a bed upstairs, and the one who’d claimed to have beaten his caseworker said he was going home later that day.
Group lasted twenty-five minutes—a good ten longer than usual—because of Dr. T.’s insistent voice in the back of my head: you can be therapeutic. I waited for something to inspire me, but for all of the interesting content, nothing did, and group ended with its usual whimper.

When I got back to T.’s office, there was a note from her. “Went to meeting. Fincher’s mother and sister will be here at 11:00 to take him home. Talk to him—the hard line—and then to them—limit setting.” The day before, I’d been in T.’s office as she spoke to the young man’s mom on the phone. The mother had asked, “Is he still mad at me for bringing him in?” and T. had almost lost it. I got Fincher from the hallway and brought him into my room. In a Yankees cap and with two days of stubble, he did not look particularly interested in anything I might have to say.

“So your mom and your sister are coming to pick you up.”

“Great,” he said.

“You don’t sound like you mean that.”

“They’re the ones who brought me here. I didn’t belong in the first place. My roommate never should have called them.”

“What do you think would have happened to you?”

“The same thing as always. I wind up back at my apartment, living my life.”

“How long do you think you can go on like this?” I asked. This was not his first crack binge, his first disappearance.

“Until I get tired of it. Then I’ll go back to school. I’m going to be a psychologist.”

“What makes you interested in that?”

“I’m good with people,” he said.

“Psychologists have to spend a lot of time working on themselves. Did you know that?”

“I don’t need any work,” he said.

“You’re in a psychiatric emergency room. As a patient,” I reminded him.

“I didn’t need to be here,” he reiterated.

Dr. T. had instructed me exactly what to say. In a stern voice I managed: “You’ve just lost another semester’s tuition. You’re twenty-six, and you’ve barely finished a year of college. You’re not going anywhere until you stop using drugs. Certainly not into a doctoral program,” I added, sounding harsher than I felt.

He looked at me angrily. “What’s the point of this?”

I cringed. I had asked T. the same thing. She reminded me, “Because someday, when he’s ready, he’ll remember what you said and it may be of use to him.”

I told him, “You’re not ready to truly look at yourself yet. Someday maybe you will be, and you’ll remember what I’ve said.” I was not even convincing myself. I hadn’t said anything particularly profound. He was going to be a burnout, and a corpse waiting to happen, until he stopped using crack: like, duh.

“Are we done here?” he asked.

When I went to get Fincher’s mother and sister from the waiting area at 11:00, they were upper-middle-class and white and so at once felt immediately—wincingly—familiar to me. As we settled into T.’s office, I relaxed in a way that I had not managed in CPEP in all of my days. My unease there was so multifaceted I hadn’t quite connected it to the differences in class and race that were almost constant givens for me in the setting, but now, as I melted into T.’s chair, it was startling in its obviousness.

The room fell silent. Mrs. Fincher looked clueless and out of place. She wore a large diamond ring on her index finger,
and her dark hair was blown straight. She had on a brave face, but it didn’t feel like the right one. The sister was another story. Her eyes were bloodshot, and she looked as if she hadn’t slept, and I thought of my own sibling and how I might feel under similar circumstances. I recited the short speech Dr. T. had prepared for me.

“You need to stop coddling him,” I said. “You need to set limits. Trying to be nice and rescuing him is not going to help him get clean.”

“That’s what everyone has told us,” Mrs. Fincher said.

“Right,” I said.

“I don’t understand,” intoned his sister with intensity. “Am I just supposed to sit back quietly and let my brother kill himself?” She was enraged. Mrs. Fincher put a hand on her daughter’s back. I wished I had an answer that could make it even a little better, and I half believed there was one.