Brooklyn Zoo (37 page)

“Well, thanks for filling me in,” I said to Alvin with forced cheer. He grinned at me behind his instructor’s back.

The three of us arrived at the chart room off the nursing station on the pediatric ward. Dr. Jonas took the girl’s chart and scanned it. “She’s got meningitis,” she said. “Explains the headaches.” So much for the consult question. She kept reading, and when she spoke again, she sounded contemptuous. “She says that she’s had eleven sexual partners in the last month. She’s lying.”

With a history of multiple rapes, eleven men in one month fit. It wasn’t unusual for sexual assault victims to become promiscuous in the aftermath—a valiant attempt to mitigate the trauma, to better understand or control it this time around. This was hardly an esoteric principle. Was Dr. Jonas really so unfamiliar with it?

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 inflated 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.