Brooklyn Zoo (21 page)

I spoke to the sortater, who had a long history of psychiatric hospitalizations, for some time and then went to report to Dr. Brink. She seemed distracted, and I felt as if I was bothering her; EOB patients were not her problem, after all, and I didn’t imagine her relationship with T. made her inclined to fill in with her caseload. The hospital police were called to the ER while I sat in Brink’s office, but I paid that little mind. When I got up to go back across the hall, she put her hand out to stop me. “Didn’t you hear that page? You never leave after hearing the hospital police called. You need to pay attention.” It had been a month, and there were many things I had learned there, but others that I had not. I sat to wait while the police broke up a fight in the hallway.

The next day was a Friday, and my last in the psychiatric emergency room; on Monday, I would report to inpatient unit G-51. I gathered the EOB patients for my final group with ease. A moment of interpersonal conflict between two group members got me engaged. The drug addict told another patient he didn’t like being asked about his methadone in the hallway in front of everyone the previous day. The offender replied he’d noticed the drug addict had not eaten breakfast
and was testing a theory that methadone users in general didn’t like to eat. I tried to facilitate further discussion, which would have been the meat of an outpatient group, but neither man was as interested as I was.

After group Rhoda told me there was an EOB patient pending. A psychiatrist I recognized by face but not by name told me I should see him to try to make something of his story. Darren looked like a handful of the others I’d seen that month: early twenties and handsome and robust, nicely dressed in jeans and a sweater. His presence in the G-ER didn’t bode well, but I was still maintaining my manic hope that somehow nothing was seriously wrong this time. T. came in as I was beginning my interview with Darren and quietly sat down to observe. I felt my usual self-consciousness and also a determination to do better this time, to prove to us both that my four weeks of immersion in her EOB had taught me something. Darren made eye contact and answered my questions in the right amount of detail, without hesitation or mistrust. To make matters murkier, his reason for admission puzzled me, and I didn’t know where to go with it. “A week of really bad headaches,” he said. If there was one thing I’d learned, it was that you didn’t get brought to a psychiatric emergency room for a headache.

“Did the headaches start because you’d been drinking too much or using drugs?” I asked.

“No, I’m not into any of that,” he said.

“Did your headache come from voices you were hearing that no one else could hear?”

He shook his head.

“Was it because someone was stealing your thoughts or trying to put ideas into your head?”

He gave me a wry smile. Still no.

“Did the headache make you agitated? Did you get very angry at anyone, maybe yell at them on the street or shove them?”

Negative. We sat there together, equally perplexed.

“Where was the pain?” I asked, grasping at straws. If he told me it was in his face, maybe I could diagnose him with a sinus infection. He said that it was in his entire head. I turned to T., defeated. “Do you have any questions?” I half mumbled.

She took over with her usual omniscience. It was not grandiosity, she just really was all knowing. I tried to calculate the difference between my four weeks and her twenty years. Even allowing for fifteen vacation days annually, it was considerable. “Your thoughts were all jumbled up last week, and it really made your head hurt,” she said to Darren. He nodded, and it was as if a light had turned on in his brain.

“They were mad bundled!” he said.

“And that happened in school, too, right? It got hard to pay attention, hard not to get confused?” Darren had told us that he’d flunked out of college four months earlier.

He nodded, starting to look upset. T. had his chart open in front of her and was looking at the doctor’s orders. “Has the medicine we’ve been giving you helped with the headache?” she asked.

“Yes,” he replied. “It’s gone now.”

“You’re lucky,” she told him. “Years ago we didn’t have these pills, and people who got headaches and confusion like yours had much more trouble going about their lives.”

After Darren had left us for the hallway, T. said, “Most likely schizophreniform, though it could be a psychotic depression.” She explained that schizophreniform disorder was diagnosed in patients with less than six months of symptoms of schizophrenia; only some of them would go on to exhibit the
full-blown disorder. “His prognosis is good. He relates pretty normally, and his affect isn’t flat. If he stays on the medication, he can probably go back to school, next semester even. He should see a therapist, too, of course, to monitor how he’s doing over time, to help him understand his preoccupations better. He’s far from a hopeless case.”

“How about me?” I asked, aware that my minutes there were dwindling, wanting to remind T. that today it was me who was timing out.

“Not hopeless,” she said. “Frankly, I was surprised by how little you knew when you got here. But you’ve been doing a good job trying to take everything in. It’s a lot of information, and it’s a difficult environment. I wasn’t sure you’d come back after what happened the other day with Ophelia.”

This floored me. It never crossed my mind not to return. What kind of wimp did she take me for? “No. I mean, I was shaken, but this is my internship. I signed up for this,” I reminded her. She pulled out the same evaluation sheet that Dr. Young had filled out the month before. T. had not given me high marks, but at least they were scores that actually reflected her own ideas about my work. As she reviewed them with me, I thought again about what Dr. Wolfe had said the month before, and how after so long in the carpeted classrooms of my graduate school it was actually quite hard to pull off, this task of becoming a better psychologist. But also I felt on my way.

ON THE FIRST MORNING OF OUR INPATIENT ROTATION
, Bruce and Tamar and I met in the intern office to go downstairs as a group. The other four adult-track interns had just spent sixteen weeks on inpatient together, and their snowballing collection of inside jokes about medical students we’d never met and patients we’d never seen had highlighted for the rest of us the isolation of our solo rotations—forensics and CPEP for me, neuropsych and consultation liaison for Bruce and Tamar, respectively. I hoped we’d develop our own rollicking camaraderie, but despite our affectionate predispositions toward one another the chemistry felt off. Bruce and I had become friends, almost, but he was private and hard to get to know. Of all the interns, he’d also developed the most immediate and astringent dislike for our shared environs, and his crankiness rubbed up against my own and blistered there. Tamar had two kids at home, and when we all convened in our office, its floor now caked with dirt after a rainy October,
she was the last to arrive and the first to go. She was kind and good-humored, but being around her tended to make me feel repellently frivolous, like a Valley Girl or someone too concerned with celebrity magazines. I couldn’t quite figure out why, though like any good graduate student in clinical psychology I’d tried.

The three of us put down our coats and our bags on six, and then Bruce let us into the dim, concrete stairwell with his skeleton key, unlocking and locking the heavy doors that let us down one flight. We went to the right and through one more locked door to meet Dr. Meyer, our new supervisor, in his small and barren office just outside the unit. Tamar and I took the two seats on either side of Meyer while Bruce stood, chivalrously. Our supervising psychologist was diminutive with a genial smile and a close beard. He was in his forties and didn’t seem enthusiastic about the experience we were about to embark upon. “We’ll spend most of our time initially talking about paperwork,” he told us wearily before going over the admission notes, treatment plans, and discharge summaries we’d be expected to write for our patients. He said we needed to be especially focused on these right now because the Justice Department would be reading them. The paperwork also seemed to be what he expected would most distinguish us on the unit from the other professions. “Before you write a note,” he said, “ask yourself: Could a nurse write it? Could a social worker write it? If they could write it, you are not doing your job. We need to carve out a place for ourselves here.” (But why, I wanted to groan rhetorically, was it not already carved for us?)

When Meyer finished, he told us it was time to go onto the unit. “Morning meeting,” he said. “For the whole staff. Every
day, about 10:00.” The three of us closed our notebooks and followed him through one more locked door and onto G-51.

On the other side of a bolted door we found six or seven morning-crusted patients lounging dispiritedly around the dayroom, a large, stale-smelling space with the now familiar cold white concrete floors and rusty-paned windows that did not open. In one half of the room were wood-framed sofas of cracking pink vinyl and an old color television console locked in a plastic case. In the other half were six or seven rectangular dining tables with black plastic chairs. Some of the patients stared at the TV, its volume loud enough to be noxious as it reverberated off the cream-colored cinder-block walls. A commercial for a calling card blared the last digits of its toll-free number, “Four, four, four, four.” People wandered into and out of the room or sat at tables staring into space or still finishing breakfast. An aisle down the middle of the room led through an open door and into two separate hallways, at the hub of which was a nursing station. The staff bathroom was in the station, and Meyer promised us keys. One hallway housed the women’s rooms—each as institutional and aged as the dayroom, but much smaller and with wooden platform beds built into their floors. All you could say for the vinyl mattresses was that they were probably easy to clean. The men’s hall was almost identical, with its eight rooms and one dormitory-style bathroom and shower, though it also contained the chart room, where the staff met and where new admissions were interviewed. A few patients were scattered outside its door waiting just like in the ER for the promise of a better day.

Dr. Meyer wore his skeleton key fastened to his pants, as did all the interns by now thanks to my former classmate Leora, who had congenially tracked down and purchased seven identical key clips with elastics that extended easily from
waist to shoulder height, where the keyholes in G were set. Meyer used his key now to let our group into the chart room, quickly pushing the door closed with his slight mass and bolting it. Inside and outside might have been separated by a moat. Like every other room in the building, it was dingy, sepia toned. A large, weathered table took up most of the space, and getting past the detritus that surrounded it—stray papers, old computer desks, filing cabinets—took some maneuvering. As we sat down around the table, Dr. Meyer introduced us to the two staff people working quietly there, their backs to the door—Miss Smith, a beautiful older black woman dressed all in red whose fleshy hips were too big for her frame, and Oswald, who was Haitian and in large glasses and also getting on in age. Both were social workers and longtime veterans of the inpatient unit, Meyer told us. They were friendly and welcomed us. We sat down across from them on the far side of the room.

After not very long at all, Dr. Begum, one of the two psychiatrists who ran the unit, entered. A lanky Bangladeshi immigrant, he was middle-aged with dark, thinning hair and a sardonic half smile. Shaking his head, he looked around the small room. “Where is everybody?” he asked with frustration that seemed playful, slamming down his stack of folders, after Meyer had introduced us. Oswald and Miss Smith barely looked up from their work, and my group certainly couldn’t answer. Who was “everybody”? Dr. Begum stomped out of the chart room, returning in little time with five other staff members—nurses and nursing aides, I guessed, and maybe a tech. Dr. Begum took a seat at the head of the table without locking the heavy door behind him, and a patient quickly appeared there. “Oh boy,” said Miss Smith under her breath with a sigh.

“Marvin Mavin, you cannot be in here now!” asserted Dr. Begum, his heavily accented English giving his enunciation a staccato clip. Marvin Mavin was as old as Dr. Begum and taut, with eyes open too wide. He swayed into the room, the door heaving shut behind him. “I’m havva. I’m havva navva havva,” he said, swinging his arms. He looked ready to launch forward, like a rock in a slingshot. I felt the bodies in the room tense along with my own. The man I’d guessed was a tech stood up. So did Dr. Begum.

“Mr. Mavin!” said the psychiatrist. “I promise you that later we will see you! Right now you need to wait outside.” Oswald stood up, too, and as Marvin Mavin lunged at Dr. Begum, he and the tech each grabbed an arm and with some force got Marvin out the door, which one of the nurses locked once they were gone. “He got a shot last night. He’s out of control. You need to adjust his medication,” she said to Dr. Begum. Oswald and the tech came back into the room, unlocking and then locking the door. We could hear Marvin shouting enraged gibberish in the hallway. He pounded on the door.