Weekends at Bellevue (11 page)

If I know one thing, it’s this: If I’m going to stay at Bellevue, I’ll need to be in therapy to keep myself mentally healthy. I need something like a mirror to help me see how I’m doing. A self-reflecting doctor is a healthy doctor. I want Lucy to know that I understand that.

I
t is a Monday afternoon when Mary Shears returns my call. She is chewing something while we speak, crunching away right into the phone. I assume it’s her lunch break and she has limited time to return phone calls before her next patient comes in. I forgive her this transgression, though I think it’s odd that she doesn’t acknowledge it and apologize.

“I got your number from Lucy,” I explain. “I’m a friend of hers at Bellevue. A colleague.”

“Uh-huh,” she states, between swallows. I guess she wants me to go on.

“Well, I’ve never been in therapy before, that is, not any real therapy. I saw a therapist for a few months when I was sixteen. Anyway, I know that every psychiatrist should go through therapy at some point.” I’m yammering nervously. I know she doesn’t need to hear this now. She only needs to set up a time for an appointment. “So … I guess I’m looking for a therapist,” I finally say.

“Okay,” she says slowly. Maybe she is wiping her mouth? Does she have salad dressing on her chin? “I can see you next Monday, would that work for you? How’s four o’clock?”

“Monday at four works great for me,” I say gratefully. This will become
my regular therapy slot for the next three years, the perfect time and place to reflect on my weekends at Bellevue. I need a place to unload and process all I have seen, the criminals and the crazies, and I need help understanding my cool, icy response to it all.

When I finally meet Mary at her office, a mere ten blocks from my apartment, she doesn’t seem like the eating-on-the-phone type. She looks more refined, wearing a beige linen suit. She gets up to shake my hand, offers me a seat, and my eyes quickly scan the room to glean more about her. Her office is well-appointed. The predominant colors are earth tones. Like her suit, everything is a neutral shade of tan or brown: leather couch and chairs, woven throw rugs and wall-hangings, African sculptures and trinkets. I assume she is a world-traveler, bringing back proof of her adventures to adorn her end tables and walls. Her brown pocketbook is oversized, lying open on the windowsill. I see her car keys with multiple key chains and grocery tags, and guess that she drives to her office from the suburbs. She has the requisite books and journals lining the bookcases, but they do not dominate the room. Also, she has chosen not to display any diplomas or certificates.

Her hair is short and has some gray strands here and there. I’m glad she doesn’t dye her hair. I have a friend in therapy who is wigged out by the frequent changes of her shrink’s hairstyles and colors. How unsettling that must be, prompting the question:
How is she supposed to help me when she can’t even get comfortable with her own hair?
Mary is wearing earrings that are small, and they are not dangling. Everything about her and her office is classy, tailored, understated. I like that about her immediately. Her voice is assured and low pitched.

“So, how can I help you?” she invites me to unload, and it doesn’t take much more than that to open the floodgates. Just the act of being in a psychotherapist’s office, sitting on the couch, has me feeling vulnerable, shaky, and weepy.

“I hate asking for help. I hate needing help. I don’t need any help, actually. But I know I should undergo therapy because I’m a psychiatrist. I know it will help me to be a better doctor if I can get a handle on what my issues are, so I won’t project my garbage onto the patient.” This is a common understanding in psychiatry. If you are not in touch with your own trigger points, your own hot spots, you will seek them out in your patients, assigning more weight to their issues than may be appropriate. Or you will diagnose all your patients with the same label you have given
your sister or your mother or they have given you. Projection is everywhere in human behavior, a common defense, but it is never appropriate for psychiatrists to project their pathology onto their patients.

“Where do you think this comes from, this reluctance to ask for assistance?”

“Oh, I know where it comes from already: my father,” I answer simply. “His whole shtick is to be strong, capable, self-sufficient. He doesn’t ask for help, and I have always tried to win his attention by being like him. Unconsciously, of course, at least initially.” I hope that Mary will like working with me. I am psychologically minded, forthcoming, chatty. I want her to like me, to see that I will be interesting, yet easy. I don’t want to be any trouble.

“Although my mother is the one who always reminds me my first sentence when I was a toddler was ‘I do myself!’ I’ve always been independent. Actually, being the youngest of three kids, both my parents encouraged it. It made things easier for them.”

I’ve only been here twenty minutes, and though it may be only superficial layers of examination, we’ve already discussed my mother and father, starting to blame them for my foibles.
Typical shrinkage
, I think. And, I’ve already wadded up two Kleenexes. By the end of my first session I’ve gone through six Kleenexes. Over the next three years, I will judge and categorize a session by how many tissues I use. I throw them into the woven wastebasket at the edge of the couch; they amass like empty beer cans in a college dorm. Dead soldiers. In the first few months, I average five a session. Then, as things die down and I get more comfortable being the patient, I plateau at around three. Toward the end of our work together, I will not cry at all.

When I leave Mary’s office at the end of our first session, I literally feel lighter.

“You’ve never had a therapist, huh? You’ve gone all this time keeping so much inside you. You’re carrying around an awful lot,” she says near the end.

Lady, you don’t know the half of it.

I
’m a whistler, always have been. Every hospital I worked at—Temple, Mount Sinai, Bronx VA, and now here at Bellevue—I’m the doctor walking through the corridors tootling a lively tune. I whistle while I work, just like one of the seven dwarves. Doc. Or maybe Happy.

When you’re the dad walking through the lobby with your empty car seat to take your new baby home, I’m the one smiling at you knowingly, congratulating you with a nod. And when you’re the dad crouching down in the AES waiting room, trying to explain to your son exactly where his mother has gone, and why she won’t be coming back, I’m the one who stops whistling and remembers where I am. I remind myself I can’t walk around here seeming so happy; it’s rude and unthinking, in front of the worried and the grieving, and they are everywhere.

It’s a Sunday night in February 1997, and I’m on the inpatient unit, writing notes on the new admissions before I go down to CPEP to run the show. (This chore—how I began my shifts for the first year or two at Bellevue—was eventually reassigned to someone else.) I see familiar handwriting in one of the charts, meticulous capital letters. It’s Daniel from my residency at Mount Sinai. He’s at Bellevue now too, working upstairs on the wards while I’m downstairs in the CPEP. I’d heard he was working here. I haven’t seen him in a year or so, but I can visualize his perfectly parted hair and Hollywood smile. His comments in the patient’s medical record are punctuated by exclamation points. “The
patient is now compliant with his medication!” “Patient states he is no longer suicidal!”

I finish my own charting, sans exclamatory marks, and pop my head into the nurses’ lounge to say good-bye. Three women are listening to the radio; one of them tells me that some people have just been shot at the Empire State Building. We haven’t heard any trauma calls on the overhead PA system (usually the shrill operator instructs the trauma surgeons, the anesthesiologists, and the chaplain to report to the ER) and there have been no disaster bells sounding. It is my first year at Bellevue and I’ve yet to hear them ring. I wonder how many traumas would need to come into the ER before someone considers it a disaster?

I decide to meander over to the medical ER to see if anyone needs a shrink, and get the usual jokes from the doctors and policemen about who they think needs my expertise, but the bottom line is they’ll call me when they need me. The shooting victims have indeed been brought to Bellevue, but the staff is still trying to sort out who’s who. There’s a gaggle of uniformed police and detectives wandering around, and also a good amount of blood, if you know where to look.

I head back to the psych ER and get to work. I know I’m going to get called sooner or later to go over to the medical side to hold some hands, so I try to clean up the triage bin as best I can. Just as I’m thinking maybe they won’t need me, the social worker from the AES appears and asks me to come see the family of one of the shooting victims.

A twenty-seven-year-old rock musician, Simon, has been shot in the head. He is in critical condition, undergoing neurosurgery. He had never been to the Empire State Building before today; he was just doing a favor for some friends visiting the city, taking them up to see the view. His timing coincided with that of a recent Palestinian immigrant equipped with a gun and a vendetta. Simon’s friend from Denmark, whose girlfriend just today told him that she is pregnant, came along with the group to the observation deck. He has been killed.

The family has been placed in a separate waiting room down the hall from the ER. Some of them are sitting on the floor outside the door, some are pacing the hallway. Most of them are crying and holding each other, their sobs wracking their bodies. Simon’s two brothers with their girlfriends, an aunt and uncle, and his divorced mother and father with their respective new spouses are all waiting to hear word from the neurosurgeon.
His roommates are there as well, some of whom were with him at the Empire State Building. One has witnessed the whole thing and is pretty shaken up.

The most shaken is Simon’s mother.

I watch her standing in front of a wall, wailing and pounding. “Please, God, just let him live. I’ll do anything.”

I leave her with her supplicating grief and attempt to let the others know who I am and that I am there to help. “Lousy job you have,” jokes one. I try not to take offense, but end up getting defensive about my many roles at Bellevue including grief counseling. “We’re not here for grief counseling,” says the aunt angrily.

Outside the room, in the hallway, Simon’s mother is quivering, saying to her younger son, “I’m not strong enough for this. I know you think I am, but I’m not.”

The family and friends go out of their way to describe Simon to anyone who will listen, and to each other. I notice this eulogy theme as it continues into the night. Everyone wants to talk about how wonderful he is; no one talks about themselves and their pain, their fear. The other recurring theme is the guilt. “I almost went with them. Why wasn’t it me?” as opposed to the unspoken guilty relief, “Thank God it wasn’t me.”

A father or stepfather wants to go outside for some air, and I show him how to get to the ambulance bay, walking past big drops of blood on the floor. I wonder if he assumes the blood is Simon’s. Perhaps it is the gunman’s, who turned the Beretta on himself after wounding nearly a dozen others. He is pronounced dead in our trauma slot a little after eleven p.m.

There is a crowd of people gathering as I walk through the hallway to get back to CPEP. A buzz, a humming circles the crowd. It’s the mayor and his disaster squad, coming to lend their support to the victims and their families. Rudy Giuliani is always good about making an appearance wherever the action is. He shakes hands, smiles, offers comforting words to the patients and their loved ones. He vows to make the city safer. One thing I’ll say about Rudy, he may be a loose cannon, but he’s always great in a crisis. He can pull it together better than anyone, looking calm, concerned, and strong. He’s got the kind of personality that thrives when surrounded by chaos, naturally making people feel safer. The rest of America would see this side of him on 9/11.

There is a rumor being murmured by some of the hospital police that the woman the mayor is having an affair with is here; she is part of his disaster team. I’ve read something about a mistress recently in the
New York Post
, and I crane my neck to see if anyone wearing the blue windbreakers with the yellow block letters looks like someone he might be with.

Later in the night, I find out that Simon has survived the neurosurgery as well as the shooting. He has been very lucky in terms of the bullet’s trajectory, which missed many of his brain’s crucial structures. The neurosurgeon describes an entrance and exit wound above and anterior to each temple. I had assumed left to right, but the surgeon’s description is “in the right and out the left.” Entrance and exit wounds from bullets have a very different appearance, and I make a point of correcting my personal picture of the patient.

So now he is going to live, just like his mother begged. When she was pounding against the wall, I remember thinking,
Be careful what you wish for
. I’ve worked with many brain-damaged patients, people in persistent vegetative states. I worry that she’ll be saddled with a son who requires total care to bathe, feed, and dress.

The thing about ER work is that it is acute. I get a tiny, traumatic slice of someone’s life, and then that’s it. I rarely see the patient again. Occasionally I will hear updates about a patient’s condition—if it’s a serious case and I’ve made a connection with a doctor upstairs. In Simon’s case, I do hear through the grapevine that his family is visiting him regularly at the hospital, playing his band’s CD for him while he is in his coma. Later, I learn that Simon has regained consciousness. Plans are made to transfer him to a rehabilitation hospital.

Twelve months later, Jeremy and I are sitting in front of our coffees at his neighborhood diner, when I see Simon’s brother in a booth nearby. I recognize him immediately from our time in the waiting room. We smile and exchange pleasantries, and it isn’t until he points out the bearded guy next to him who’s eating his eggs that I realize it’s the patient who was shot in the head, whom I never met. Simon nods at me nonchalantly and I don’t really get to analyze how good his speech is, or his social graces are, for that matter. I remark to the brother how it’s a miracle Simon’s up and around, and he smiles and nods in reply.