Twelve Patients: Life and Death at Bellevue Hospital (44 page)

My patients were like persistent afterimages, burned into my retinas. I could channel them into the consultation room. Marilyn, for example, who came in for her monthly blood checks. She was on clozapine injections and needed to have her white cells measured before
her next injection. It worked better than the other anti-psychotics. Her chart was in three volumes and full of visits, hospitalizations, trips to the emergency room, crisis team outreach checks, and a zillion tests and workups. The diagnosis changed over time. I had spent a long entire afternoon reading through it and outlining the case. I was doctor number ten or twelve. The new guy in town, a handoff patient, part of the medical “economy.” She weighed 250 pounds. Medication side effect, I thought.

“You know, Marilyn, this is our anniversary,” I told her when she’d settled in and begun some random chatter.

“What do you mean, anniversary?” She looked at me quizzically.

“Two years now. We have been together for two years. Two years ago today to be precise you came to see me.”

“You are right, Eric, it is two years. I have collected doctors like stamps or buttons. I think you win the award for the longest,” she said and promptly continued.

“All my other doctors got sick of me. I could tell. They would refer me and refer me trying to get rid of me, making up some kind of excuse or other. It was a game. I would tell them a symptom I made up and the predictable referral would appear. Plus I got side effects all the time from the meds they were handing out like candy. A conjuring trick you doctors do, you know.” I knew.

“You have not ordered anything on me in two years. Not one test, nothing. Just my high blood pressure that we play around with. And you never said a word about my weight or my smoking. How come? You don’t play the game, how come?”

“I don’t think you have anything worrisome. I think you are a pretty healthy woman. I am here to listen and offer something when I think I have something to offer you. I think you have suffered a lot at some point in your life. You are talking to me with your body, and listening is my treatment.”

“I never told anyone this. Since it is our anniversary, you should be the first to know. My older brother raped me for ten years. From when I was five years old. Until he went to prison for extra-family sexual abuse of minors. Why do you think I got so fat and ugly?” She said it
out loud, crystal clear, and looked at my reaction. I had first thought of her as the Toad in
The Wind in the Willows
. After a couple of visits, her wit and cutting sarcasm made me look forward to seeing her. She had come in one time for a checkup. I had started her on a new blood pressure medicine and read her the usual side effects and a throwaway “plus it can turn your hair green.” When I looked up from my desk, she was sitting in the chair cool and calm with her hair dyed green. “Doc, great medication. No side effects this time!” She was a safety hatch from the “worried well” auto-monitoring their bodies for the slightest whisper of an infirmity after every news article and morning TV or radio report.

These experiences made me sense that Alicia’s parrying and avoidance pointed to a dark force somewhere. I was aware she had been born in Argentina during the Dirty War or what is called El Proceso—an era that lasted from 1976 to 1983 when the country was run by a military dictatorship. It was global Cold War politics that had gone viral in a South American test tube. I had tried to engage Alicia to talk about her time there, her family, and the experiences she had as a young girl, a teenager before having an affair with an American hippie who was backpacking in South America. She hitchhiked with him to Tierra del Fuego, got pregnant, and left the country precipitously. My wife had written a book about the dictatorship, and Diana and I had spent hours talking about the long-term effects of violence. Many survivors fled Argentina to other safe havens in Mexico or Spain or the United States just as Alicia’s family had once fled fascist Europe for Peronist Argentina. Safe havens that were not safe anymore. Multiple packings and fleeings: You slept with your passports under your pillow and sniffed the political winds continuously.

Years later, I still didn’t know what had happened to Alicia Rittner except that now she had been admitted in a near-fatal condition, and the head nurse was escorting me to newborn Naomi Rittner’s room in the NICU. Baby Naomi had done well despite the emergency C-section. She was on the road to recovery. I stopped and chatted with the nurses
and other mothers nursing their newborns. It was a complete medical universe in miniature. A small baby was being evaluated by a pediatric surgeon wearing blue-green scrubs. His large index finger exerted an ounce of pressure on the tiny abdomen. Black formfitting eyeshades protected the yellow-tinged baby from the light therapy he was receiving for the high bilirubin levels in his blood. Blue light converted the dangerous variety of bilirubin into a benign molecule that could not cause damage to the delicate brain tissue in development.

The preemie’s X-ray showed small black air pockets around the intestinal lining. This was a sign of inflammation of the intestinal wall or NEC, necrotizing enterocolitis, a treacherous complication of prematurity. With luck and patience it resolved on its own with a decrease in feedings and less stimulation of the intestine. Life-threatening infections requiring surgery, decompression with a tube, or removal of part of the intestine was the other trajectory. This was watch-and-wait-and-hope therapy.

Nurses in colorful scrubs padded around softly adjusting their tiny charges, calming them with strokes and caresses while many mothers sat by incubators with their babies strapped to their chests rocking them back and forth. A few volunteer Kangaroo moms had tiny kitten-size preemies squeezed tight between their breasts and chatted quietly to one another. The neonatal intensive care unit deliberately created an environment to soothe the vulnerable, rapidly developing and maturing brain’s neuronal connections for its tiny patients. Overstimulation was toxic for nervous systems making their connections. Low-tech or reverse migration of simple solutions was making its way back to a medical universe high on technology and innovation. A couple of neonatologists in Bogotá in the 1970s, unable to afford the latest incubators, made the mothers surrogate incubators, skin-to-skin. Kangaroo care had arrived, was successful, saved lives, and cost nothing.

Naomi was out of her incubator swaddled to a Kangaroo volunteer mom who had her wrapped tightly against her chest. Naomi’s eyes were wide open. She had a small pink cap on and was receiving protein feedings from an IV pump into an umbilical blood vessel. There was a tiny oxygen tube connected to her nostrils. The first two weeks
had been stormy as she began to adjust to life outside a uterus before her organs had matured. The team was ready to pull the feeding catheter and switch Naomi entirely to breast milk pumped from her mother upstairs in the ICU. Lorie pointed to the oxygen levels on the computer screen above my head and said quietly, “She doesn’t like us talking here.” As our voices had risen, her blood and pulse went up and her oxygen levels dropped slightly. “We should leave.”

A few mornings later I bought a coffee with heavy cream and a couple of croissants at the Au Bon Pain in the lobby of the hospital early in the morning. The day shift was coming on—walking in from Penn Station, the ferry slip on the East River, the express-bus stops at 23rd Street, and the six-train station at Park and 28th. Thousands of people threaded their way to the hospital a few blocks south of the United Nations building. I took the elevator up to the surgical floor, said hello to the nurses coming on, and knocked on the door of Room 28 before walking in. Two distinct Spanish dialects filtered through the open door. Laura, the Mexican from the crime victims unit, sat in a chair with her back to me talking to Alicia.

They invited me to pull up a chair, and I laid out the breakfast I had brought Alicia. I also bought her a copy of the
New York Times
and brought her my faded college copy of
Ficciones
by Borges.

“Sorry to interrupt, ladies,” I said.

“No, join us for a few minutes before the surgical team arrives and I am booted out of here.” Laura pulled over a chair for me. “We were talking about what happened.”

“Okay, Alicia, if I sit in?”

“
Claro que sí
, Eric, of course,” she said clearly.

Laura continued her conversation with Alicia as if I weren’t there. “Your parents fled Europe and by chance ended up in Argentina. Survivors can sometimes feel that it is better to have perished. There is a lot of guilt attached, Alicia. Does this make any sense to you?”

“I deserve the punishment I got,” she said, looking at her hands.

“Nobody deserves what you got. Nobody,” Laura said. “You are not responsible for what happened. The man who did this seduced you and then stole parts of you, little by little. You couldn’t see it coming.”

“He didn’t take anything from me, Laura. Those parts you mention were stolen long before I ever met him.”

The knock on the door was perfunctory as the white lab coats descended on us to check Alicia’s progress. Laura and I beat a quiet retreat. I headed back to my office.

I was preoccupied with a phone call from two days earlier. Alicia’s common-law husband, Gregory Annas, had been transported from his cell at Rikers Island to Bellevue for the standard forensic psychiatric evaluation. He sat in a single cell on suicide prevention watch. It was not rare for us to have the victims in our ICUs as their attackers were being looked after in the prison unit.

The general profile of Gregory Annas was in the public record. His role in a self-perpetuating cycle of violence was familiar fare to our psychiatric teams. He had grown up in a lower-middle-class family on Long Island with six brothers and sisters. They had been homeschooled, and the family had been investigated several times. Neighborhood vigilantes, alarmed by the identical uniforms the kids wore on the rare occasions they went outside accompanied by their father, called 911. One report from a social worker who did several home visits indicated that he brought a soccer ball for the kids one time and they had no idea what to do with it. A sign that read “Order and Progress” hung from a wall.

There was no evidence of corporal punishment or physical abuse, no evidence of malnutrition. There was no television, radio, or Internet access visible. The children were managed by their stay-at-home mother. No visitors came, and no one could leave the apartment or go outside except under the direct supervision of the father when he came home from work. There was a phone that had been rigged to only receive calls. Every child had a typed list of responsibilities, tasks to complete that were recorded in neatly checked-off boxes. The operating family philosophy, summed up by the investigating social worker, was, “Society is toxic and dangerous. It is our responsibility as parents to protect our children from the social influences that will damage them. We accept total responsibility for their growth and development and ask no help from any government or private organization.” There
was no evidence of a cult affiliation. This was merely one man’s control over his family, within the boundaries of the law and the rules of the child welfare agencies.

After several days of questioning, it became clear that Gregory had incorporated his father’s pathological control issues. His father died suddenly. He did not come home one day. The police showed up at the door. His wife showed no emotion and thanked the officer. His maternal grandparents pieced together the family’s ability to function over time with great care and sensitivity and the injection of resources. The grandparents had been shut out of their daughter’s life by edict but not by lack of love. They had considerable means and ensured that all of the children went to private schools close to the grandparents’ Long Island estate, where they built a house for their long-lost daughter and grandchildren. Gregory went off to college and became involved in a drug scene and a variety of religious groups from ultra-Orthodox Judaism to Scientology to evangelical Christianity to Hinduism and back. He experimented relentlessly and kept a live feed of the Western Wall (or “Kotel”) on his computer desktop as a screensaver. The rest of his story was the repetition of control and abuse.

Patty silently entered my office, startling me. A lingering side effect of my platinum chemotherapy was hearing loss and a high-pitched tinnitus or buzzing. My wife strongly suggested hearing aids. I said I would have a Seeing Eye dog first. Great help that will be, she said.

“There is a young man here to see you. Isaac Rittner. His mom is in the hospital.” Patty handed me some important paperwork I’d neglected. She had telepathically completed half and tagged with colored stickies options and question marks without being asked. After more than a dozen years working together, we were in sync. I heard Patty’s teenage daughter laughing outside with Jan, our newest office recruit. I didn’t know how Patty managed with three kids in public schools all on the verge of collapse, the neighborhood a veritable gang training ground, trains that worked half the time making the commute from central Bronx a daily crapshoot, and on it went. When she wasn’t haranguing the board of education, nearly a full-time job, she had started a volunteer program out of our office for kids and
young adults to work in the hospital, from helping in the operating room, to conducting patient interviews, to navigating patients through their appointments. Our office overflowed. As the economy slid into a deeper recession, we had a small army of volunteers whose ranks ran from high school students to a post-retirement FBI agent.

Isaac was Alicia’s teenage son. Pregnant at fifteen in Buenos Aires, she grabbed the first ticket out of Argentina with the North American hippie who’d offered her companionship, caresses, and a twelve-hour overnight flight from a country that was suffocating her. Her descent from upper-middle-class Buenos Aires affluence was relatively swift. She ended up on her own in the Bronx just off the Grand Concourse—an almost genteel Jewish neighborhood where up until the 1960s kids studied hard and went to City College for free.