Weekends at Bellevue (21 page)

The bottom line is that there are fewer beds than there are patients, mostly due to President Kennedy’s 1963 Community Mental Health Centers Act. This well-intentioned movement helped to spur deinstitutionalization. The decision was made, when effective antipsychotics became readily available, to close down the mammoth state hospitals that were only providing custodial care, not treatment, with the idea that their patients would be transitioned from the state hospitals to community-based care. Many of the state facilities were shuttered, but the community centers never fully materialized, mostly due to a “not in my backyard” mentality in the neighborhoods. Thus, the homeless mentally ill population was spawned. Over the years, many stopgap measures have been put into place, but often, the adult homes and other housing options are ineptly run, overburdened, and sparsely funded.

Jonah needed one treatment team to be responsible for him, to approximate a substitute family that would check up on him, make sure he was taking his medication and seeing his doctor. Kendra’s Law will help to make sure this level of supervised outpatient treatment occurs, through a hearing and a court order. If a patient in the assisted outpatient treatment program fails to comply with the treatment plan, he can be brought into the hospital for an evaluation and potential admission.

If the state of Virginia had a version of Kendra’s Law, then maybe the Virginia Tech shooter would have been receiving much-needed psychiatric treatment, instead of slowly simmering in his psychosis alone in his dorm room.

I appreciate that from a libertarian point of view, Kendra’s Law is a little over-the-top, but from a psychiatric point of view, it’s just what the doctor ordered, to help our patients who are getting substandard, poorly coordinated care. It is meant to keep them healthy, and to keep everyone else safe. Ultimately, it could prevent another young woman like Kendra Webdale from falling prey to the fallout of haphazard mental health care.

We can’t put Pandora back in her box. The homeless mentally ill have been with us since the sixties. The sooner we provide for them, the more fully we address the causes of their problems, the better for us all.

S
eventy-two and sunny, seventy-two and sunny.” I repeat my mantra as I run my laps around the reservoir in Central Park. After months of nagging Jeremy, and then wisely backing off at his insistence, he finally popped the question on my birthday. I am getting married in the park in early May, in the Conservatory Garden, where they don’t allow tents.

“What do people do if it rains?” I ask the woman in charge of booking the venue.

“They bring an umbrella,” she answers in all seriousness.

I have embarked on an ambitious exercise program in order to look my best for the wedding. I was inspired by a patient at Bellevue who managed to get off drugs and alcohol. When I asked him how he did it, he told me his first step was to complete “ninety in ninety.” He went to ninety AA meetings in ninety days. That got me thinking:
Do I have that kind of discipline? Is there anything I would do for ninety days in a row?
I decide to get in shape for the big day by doing ninety workouts in ninety days. For three months without fail I run, lift, swim laps, do a step class, go Rollerblading or biking. It has paid off: On the morning of my wedding, as I step on the scale, I have magically reached my goal weight. Equally miraculous is the forecast for the day: a high of seventy-two degrees, breezy, with ample sunshine. It’s enough to make a gal thank her lucky stars. Add to that my bliss from finally passing my oral boards, and everything’s coming up roses.

Jeremy and I have decided to make this wedding an intimate group effort. We’ve invited our friends and family to form the wedding band, take the pictures, bake the cake. I am excited about being serenaded by our closest friends, who will strum their guitars and sing Bob Dylan’s “Make You Feel My Love,” as we walk among the flowers to the makeshift altar, three steps underneath a metal archway covered with roses and vines. Our wedding party consists of our two eight-year-old nieces, Zaro and Violet (the “drymaids” in Violet’s words), our two five-year-old nephews, Jake and Jonah (the “ring barriers”), and our three-year-old niece, Ivy, the flower girl.

The garden is at its peak of perfection. The cherry blossoms are floating down like snowflakes in the wind. Hundreds of tulips in purple and pink line the plaza where the ceremony will take place. Ivy has been carrying a single purple tulip tightly in her fist, waiting for her big moment when she will start the procession. I stand behind the shrubs, hiding from the guests, and taking the occasional peek at them while talking mindlessly with my parents, who will escort me down the aisle.

Lucy has come with Sadie. Other people from Bellevue can come to the reception, but only Lucy is invited to the ceremony. She has warned me that she will be wearing her festive wig today. She owns two wigs, one worse than the other, and on this day, it appears to me she has worn the larger of the two. It is auburn; the long tresses ending in big curls. It is God-awful, and I love her for it, for not caring, for wearing it anyway, for slapping on some makeup and lipstick and dragging her sorry ass to the garden to share this day with me.

After a meltdown about losing her tulip, Ivy walks hand in hand with her mother down the aisle, and so the wedding begins.

It’s a glorious day, the breeze blowing my veil around, and also blowing the words of the rabbi away. The guests wait patiently as the sermon drags on, and eventually, Jeremy stomps on the glass, counts the band off for the recessional (“The Lucky One,” by Freedy Johnston), and kisses me. The crowd cheers and claps as we kiss, and hug, and kiss some more.

I am insanely happy.

L
ucy has invited all the CPEP faculty out to her house in the Hamptons for dinner and to see the fireworks for the Fourth of July. It’s the medical new year, and there are fresh faculty members to get to know. Some of the doctors are staying over at Lucy and Sadie’s house along with me and Jeremy, while others are sleeping at nearby hotels. It is the first time that we are all doing something social, as if we were a family, and the gathering has a warm and festive air to it.

When Jeremy and I arrive, Lucy is trying to corral her son Billy into a highchair so she can give him his lunch. I am mesmerized as I watch my pal with her boy, wearing an “I Love My Two Mommies” T-shirt. I can’t look at Billy’s T-shirt without thinking of Lucy’s cancer, and wondering how soon he’ll be down to one mommy.

We are outside in the sunshine as we gape at Billy, who is a beautiful babbling boy. He crawls, he smiles, he is the star of the day, eclipsing all others around him. Lucy feeds Billy with a spoon, making hysterical faces to get him to open his mouth. She is wearing a plaid hat over her bald head instead of her usual scarf or wig. She seems more relaxed and happier than I’ve ever seen her.

A new attending, Michelle, is just meeting us all. She is fresh out of a residency in Massachusetts, and seems very young; she’s wearing thick pancake makeup, and I wonder what she’s trying to cover up. I sneak a peek at her bedroom, downstairs from Lucy and Sadie’s. There is a
stuffed animal on the pillow.
Is this gal for real? She brought her teddy to the sleepover?

Throughout the holiday weekend, we rotate in front of the television; JFK Jr.’s plane has gone down on its way to Martha’s Vineyard. I imagine most of America glued to their televisions instead of outside at their barbecues as the network tantalizingly teases and threatens to broadcast the recovery of the bodies.

On Saturday night (I have asked someone to take my shift at CPEP), we eat outside in the backyard under the stars. Sadie has marinated huge porterhouse steaks in a balsamic vinaigrette.

“You guys, there aren’t enough steaks for everyone to have their own,” says Lucy. “Some of you have to share.”

“Daniel and I can share!” I volunteer. I turn to him. “Do you like it medium rare?”

Daniel is not happy about this, but doesn’t come right out and say it. I’ve announced this, to the table full of physicians, to assert that we are friends, that we have a history together. I want Lucy to know that I am down with her right-hand man. Lucy, though bald and thin, still has a tremendous vitality and presence, but it’s becoming clear to most of us that Daniel will eventually succeed her and become the new director. He is being “groomed” and trained by Lucy as she prepares for her departure. He has already filled in for her whenever she is out sick, which is becoming more frequent. I’m trying to get used to the idea that he will eventually become my boss.

By answering Lucy’s call and volunteering to share with Daniel, I’m trying to let the other doctors know that I’m in the upper echelon of the power structure at CPEP, that Lucy and Daniel, the director and assistant director, are my friends and colleagues, not my superiors. Here’s another thought: I am attempting to bond with Daniel on a masculine level. The steak, a symbol of manhood: We are sharing the kill, predators flush with the thrill of the hunt, putting down our weapons for the feast. Or maybe it has something to do with laying claim to Lucy? Maybe she is the prize, and I am offering to divide it. We are marking our territory over her, snarling animals fighting for our share of the prey, carving her up between us like divided turf.

Whatever it may mean (sometimes being a shrink means you think too much about this stuff) Daniel wants his own steak, of course. What man wouldn’t? And we are not a couple. We are not even good friends,
really. Why do I offer to share with him instead of with Jeremy? My brand-new husband is sitting a few seats down from Lucy, who is at the head of the table. I am sitting next to Daniel at the foot of the table. Daniel, trying to analyze my chumminess, I imagine, is not particularly interested in joining my newly created pecking order, but we share the steak nonetheless.

After dinner we all walk down to the edge of the bay. Sadie and Lucy’s neighbors have graciously offered us the use of their lawn and chairs, and we have a fabulous view.

And then come the fireworks.

I
spend a slew of Mondays with Mary, my dutiful shrink, who, along with me, is getting used to the idea that Lucy will lose her drawn-out war, her body occupied by an unwanted enemy.

I cannot get past how guilty I feel. I’m fine but my friend is sick. And it’s more complicated than that, because I am now four months pregnant. Lucy is dying and I am blooming with life. It is an ironic and painfully awkward juxtaposition. She is wasting away and losing hope, as I enlarge with the promise of the future looking the very picture of health. It makes me feel greedy, as if I’m taking more than my share from the dinner platter, and there really isn’t enough to go around.

Mary points out that this is survivor guilt, plain and simple. She helps me to understand it more fully, how it resonates with my issues from childhood, beating out my sisters to get more than my share from our father. I have a similar discomfort being healthy and wealthy among the sick, poor, and homeless Bellevue patients. I won’t wear my diamond engagement ring to work, and I still feel guilty that I have my freedom while they stay locked up in the hospital.

I hate feeling overstuffed among the hungry. I prefer things to be evenly divided. Gluttonous, I’m relishing eating for two, while Lucy can barely chew her cheese omelet because it hurts her head. We are at the Bellevue coffee shop one Monday morning after sign-out, old friends catching up on this and that. As usual, I cannot bring myself to
discuss any of the really important matters with Lucy, but finally she breaks the ice.

“Julie, you know, you and I are at radically different points in our lives,” she says to me. The imbalance has been impossible to ignore, of course, and I am grateful that she is bringing it up at last, tossing it across the table to me like a beach ball, breezily.

“I’ve noticed it too, dude,” I answer back. “It is nothing if not completely fucked up.” We stare meaningfully at each other for a long moment, and then at last begin to have a real conversation, slowly working our way toward the meat of the matter. We both have a tendency to play up our macho butch angle with each other. It always worked on others, getting their attention and admiration, and we use it on each other to reinforce our bond. But now it feels like it’s time to get more girly. More real.

Instead of talking about her cancer and failing health, how brave she is in the face of death, we begin to talk of children and motherhood. I tell her how I stare at the little girls in pink in their ballet class before I go into my Pilates class, wanting a little girl of my own, but afraid of how hard it will be: The mother-daughter dramas are inevitable, and if there’s anything to karma, my payback will be a bitch, just as I was to my mother in my teens. She tells me that Mary has a daughter, and I admit to Lucy that Mary and I have been spending countless hours talking about the what-ifs of raising a girl, but I do not tell her we spend the rest of the time discussing her cancer and my guilt.

I tell her she’s lucky she has a son, that they are easier to handle, at least emotionally, and Lucy confides in me that lately she has been afraid to bond with Billy. She is pulling back from everyone now, resigning herself to her prognosis. It’s only a matter of time, in her eyes, before she checks out, so she’s starting to pack up early. She knows she’s doing it, and defends her behavior to me. Part of it is protecting herself, and part of it, she feels, is protecting Billy from loving her too much so it won’t hurt him quite as much when she abandons him.

She’s wrong, of course. I want to tell her not to shortchange herself, or him, and that she should maximize whatever time she has left, to love and be loved. That’s all that life can really give us: time, joy, love. Being fully present is the best gift she can give him. But I don’t want to
turn into that naive little Kansan Pollyanna with her again; I want to stay strong for her, to mirror her bravery, and so I mostly remain silent. The thing that binds us, the persona we share, is our macho exterior. If I shed it, I fear, we will have no special connection anymore, and even less common ground on which to rest.