Brooklyn Zoo (25 page)

Dr. Begum went away on vacation, and Dr. Winkler was left to manage everyone on his own, but having been around forever, he was either less concerned about getting the staff to behave themselves or less self-defeating. Attendance at the morning meeting became sparse—none of the nurses, none of the social workers. Tamar left to do her month with Dr. T. in CPEP, and Bruce—whose already thin patience with the hospital had dissolved completely after a few weeks of morning meetings—avoided the fifth floor as much as possible. So much for my longed-for camaraderie. I sat in the chart room with Jason and Steve, the medical students. The two had settled in comfortably and quickly. Jason was the dentist. Steve was young, skinny, eager—the first medical student I’d met to date who actually wanted to become a psychiatrist. They were likable enough, but I found their self-assurance abrasive, so certain did they seem that completing any kind of medical training somehow qualified them to be working with crazy people. That I’d studied the human mind all those years and still imagined myself grossly unprepared stood out against their contented certitude, and I briefly wondered whose distortion was more problematic.

“Who wants a new patient, a Mr. Bernard?” asked Dr. Winkler, beginning the meeting.

“I do,” I said. “The ones I have are mostly disposition problems at this point.” Which meant that they were only on the unit because they had nowhere else to go, and also that I had given up on them, just like everyone else before me. I was talking about Hong Hanh and Gabriel. Mr. Rumbert—stabilized, I guessed, by an antipsychotic medication—had started talking and eating regularly, and so had gone home with his mother. Mr. Rodgers had taken as much of a break as he could from his miserable family/legal situation and was about to leave as well. The day before, I’d said good-bye to a Mr. Mower, who had emerged from the deepest ebb of his depression nicely with meds or time or conversation and whose departure I’d figured out how to expedite myself when no one else was willing to go downstairs to the pharmacy to fill his prescription in time for him to leave that day.

Steve turned to Jason: “Do you want Mr. Bernard?”

Jason to Steve: “Do you?”

“I’ll take him,” said Steve, making his announcement to Dr. Winkler. It was as if I had not spoken at all.

“Sure, never mind me,” I said with more resentment than I cared to show, but still considerably less than I felt. They seemed to consider me, a mere psychologist, no more than a planet—a moon—to their sun.

Steve and Jason were all apologies, and I had a new patient.

Dr. Winkler went to retrieve Mr. Bernard from the hallway. He was in his seventies, African American with drooping eyelids and age spots, too thin, and barely able to walk in a straight line. Dr. Winkler helped him into a chair. Could he possibly be drunk or high after having spent at least the last twenty-four hours in G-ER?

“Do you know where you are, Mr. Bernard?” asked Dr. Winkler, skimming the chart as he began the interview. If
he couldn’t answer that first crucial question, our assessment would be brief, and I would resort to calling his family to learn about him, if there was any family to call.

“Is this the projects?” guessed Mr. Bernard, his pink tongue and globules of spittle entering the space in his mouth where his bottom teeth were once rooted in better times.

“Do you know how you’ve spent the last couple of days?” Dr. Winkler asked, reframing his first question.

Mr. Bernard paused to reflect. “I’ve been in meetings and consultations with the governor.”

Jason and Steve tried to hide their smirks. Mr. Bernard’s psychosis, whether substance induced or otherwise, did not make him a good therapy case. My indignation had won me no prize.

“Do you have any medical problems?” asked Dr. Winkler.

Mr. Bernard thought and then told us, “I don’t have a heart.”

“What was that?” asked Dr. Winkler. His hearing wasn’t great.

“He doesn’t have a heart,” I said loudly.

“Oh. How is that?” asked Dr. Winkler.

“My old lady ate it!” replied my new patient, outraged.

Steve and Jason could barely hold their laughter until Mr. Bernard was out of the room. “You guys want to thank me for taking this one?” I asked, and they nodded and continued to chuckle.

Dr. Winkler looked at us with a serious face: “ ‘An insane man forsakes reason and often speaks the truth. A sane man holds his tongue.’ Henry Miller. Just because someone’s psychotic doesn’t mean he isn’t telling the truth.” Steve and Jason stopped their laughing.

Dr. Winkler looked back in Mr. Bernard’s chart and found
his daughter’s number. “Call her,” he instructed me. “Find out how many years he’s been drinking. Could be Korsakoff’s dementia. Alcoholics get it from chronic thiamine deficiency. This is a good case. Interesting,” he said, nodding to me on his way out of the chart room. I reached for the chart and the phone.

Mr. Bernard’s daughter was exasperated but helpful. “He’s been a drunk his whole adult life,” she told me. “He finished a two-year inpatient rehab about six months ago and had been sober as far as I could tell since. But a couple of weeks ago he started complaining that one of his neighbors was bothering him, and he had that irritable tone. I figured he’d started with the drinking again. I gave up on trying to save him a long time ago and haven’t talked to him since the complaining started. I’m self-protective at this point. Did his neighbor bring him in?”

Consulting the chart, I affirmed this. She asked with a sigh, “When are visiting hours?”

With so many people from so many different nations both working and residing on the unit, the details of conversations were sometimes lost, and sometimes hard-won. For example, when an obese manic woman spoke, during her initial interview, of the dildo her son had recently purchased for her, Dr. Begum had to stop the proceedings to clarify what that was. The morning meeting was hardly a delicate environment, but still no one rushed to offer an explanation.

Sometimes it was less vocabulary and more pronunciation that was a stumbling block. When Dr. Begum returned to New York from what felt to me like a very long vacation, I sat in as he interviewed an immigrant from Africa. Her
answers to his questions were just vague enough to be bizarre, which was of course diagnostic. “Tell us why you are here?” he began in his Bangladeshi clip.

“I came here to rest,” the young woman, whose name was Mpenzi, said. She wore a colorful turban around her hair. Her Kenyan accent was melodious to my ear.

“How old are you?” he asked.

“Twentysomething,” she replied, smiling beatifically. “You’d have to ask my mother.”

“How is your mother doing?” he inquired, because family history, and especially of mental illness, which runs in families, was always important.

“She’s fine. Doing well,” said Mpenzi.

“Where does she live?” asked Dr. Begum, who would want us to get the woman in, or at least on the phone, ASAP.

“She’s in heaven,” replied the patient.

Dr. Begum turned to me, his de facto American sidekick: “Is that in New Jersey?”

Mpenzi became my patient. It turned out that she was a permanent resident of Kingsboro, sent to us after a manic episode for stabilization, though she must have mostly achieved as much in the ER because she was placid for the week that I knew her, her most pronounced symptom a long-standing and exciting delusion that Kanye West was on his way to New York to marry her. She hoped to be back at Kingsboro before the Christmas holiday for a party that was apparently not to be missed.

I could not avoid doing inpatient interviews in front of the team forever, and finally Dr. Begum instructed me to lead one. Dr. Winkler was sensitive and encouraging. “This is like dentistry,” he said to me as we waited for our new charge to be brought in. “You have to get the patient to open up.”

Her name was Ivory. She was pregnant and addicted to crack. She stared into the distance instead of looking at me and complained that she was not getting any good snacks. I ran through the points of focus I’d written in my notebook—presenting problem, history of the presenting problem, psychiatric history, family history, health problems, drug use, forensic history. She answered me but was so depressed that I quickly began feeling hopeless myself and missed some things. It wasn’t the end of the world. Dr. Begum stepped in to fill in the blanks, and I took in what I’d missed, the information that would help us arrive at the diagnosis. (Substance-induced depression—you couldn’t diagnose anything but substance-induced fill-in-the-blank as long as the patient had recently used.) “Good job,” Dr. Begum said after, smiling as he always did. “Each time you’ll get a little better.”

And if “better” meant “more comfortable,” I did, just a few days later with a patient named Garrett Miller who had checked himself in for homicidal thinking. He was a few years sober, depressed, and hearing voices. Major depressive disorder, severe, with psychotic features. When I told Dr. Meyer about him in supervision, he wasn’t buying it. “In the winter one in four psychiatric patients are malingering,” he told me. It was December.

I liked working with Garrett, though. He was a talker, coherent, and with the typically tragic story. His father had been killed when he was two, shot to death through an apartment door he was pounding on, by an elderly neighbor who’d asked him to bring her some groceries. Garrett’s own homicidal fantasies had been directed toward the wife of his closest cousin. “She was annoying me,” he said, which seemed like a thin motive for murderous thoughts. Garrett’s cousin had just gotten out of jail, and the wife was being possessive of his
time. “I was there for him for four years while he was locked up. Where was she?” he wanted to know.

I said he seemed to have a lot of anger toward women.

“I was raised by women,” he protested, as if that would invalidate my observation. “Everyone here is so fucked up,” he complained to me. “I feel like I have to take care of them all.” That was something to note.

“You’re always taking care of people, but you never feel you get any care in return,” I observed. For the first time he agreed with me, but he did not want to say more. “My life is half over anyway.” He was only thirty-six. “What does it matter?” he asked. Often, on inpatient, there was a certain and predictable shutting down. Even when cognitively capable of it, no one on G-51 wanted to think too closely about himself. This was a large part of the problem.

Garrett was one more patient who couldn’t leave because he didn’t have anywhere else to go. The G Building was not supposed to discharge people to the homeless shelters, as this was either inhumane or a surefire route to a quick readmission. The social workers were kept incredibly busy finding state-sponsored housing programs for those who were functionally homeless, but both Oswald and Miss Smith had disappeared, so no one was working toward Garrett’s departure. He was a voluntary patient and was perfectly happy to stay, which made me think that perhaps Dr. Meyer had been right to suspect that he’d been malingering the voices and the homicidal thoughts. You could choose to see this as sociopathic or incredibly resourceful: once a patient was admitted to G, a team of people went to work on the case, in the end providing a reasonable place to live if nothing more. Most days I admired Garrett’s ingenuity, though I was being at least tacitly lied to in the process, which also made me resentful. Still, in
the wake of the mysterious disappearance of the social workers (why did no one on the unit bother to tell anyone else when they were planning lengthy absences?), I took it upon myself, with a martyr’s attitude, to get a name of a housing program for recovering drug addicts and to start the process of applying to it for him. That wasn’t my job, but I didn’t want him to end up like Gabriel or Hong Hanh or the patient who had been the talk of the building days earlier when she finally left for Kingsboro after an entire decade on the fourth floor of G.

Garrett and I had been working together for a few weeks when I came in one morning to find him enraged. Camara, the deaf and mute patient, had accused a few of the men on the unit of sexually assaulting her late in the night, and Garrett was one of them. He couldn’t tolerate that anyone would think he was capable of such a thing. I took in his indignation and felt apologetic on behalf of the staff. Later I spoke to Dr. Winkler about the whole thing. “She went to one of the night nurses right after,” he told me. “The doctor on call came up and did a sniff test of all the men’s hands. Garrett tested positive.” Camara was transferred to another unit. Maybe her family was going to press charges.