Weekends at Bellevue (25 page)

“Was he on a one-to-one?” I ask. This is the highest level of observation the hospital can provide. If a patient is suicidal, they are assigned a staff member to sit with them twenty-four hours a day to keep them from harming themselves.

“He was for a while. The consult service was following him. The nurses called me because the order was written by a psych resident doing a neuro rotation, not the consulting psychiatrist. I was on the phone with them giving the okay to restart the order.”

“So you restarted it?” I ask.

“Five minutes before the guy jumped.” This lets psychiatry off the hook to some extent, and we both know it, but there is no relief in Desmond’s eyes.

“How did he get out the window?”

“There’s some controversy over whether he smashed the window with an IV pole or whether he just hurled his body against it. But the window looks just like a body went through it.”

“Like a cartoon?” I ask.

Desmond looks at me witheringly, pityingly, and walks away.
What the hell is the matter with me?

Desmond is the poster child for Karuna, the Buddhist concept of infinite compassion. We both want others’ suffering to cease, and yet we go about it in completely different ways. Should I be more like Desmond, with his limitless undying love? My patients would be better off if I could stay opened up and available, giving and understanding, yet my remoteness resurfaces routinely in my work at the hospital. It is my protection, like a hazmat suit, and it’s been effective, so it’s hard for me to move beyond it, even though I’m trying.

When I started out in 1996, I was a single gal with a boyfriend, holding a weekend job with a lot of time to kill during the week. I was confrontational, oppositional—a tomboy. It was as if I was reliving my rebellious adolescence during my first few years at the hospital. Acting as though I was too jaded to be shocked by anything, I challenged the EMS drivers,
What else ya got?

As the years went by, I added a private practice to the mix, seeing patients on Fridays in my Greenwich Village office. Then, a few more years in, I got married, bought a house in the country, had a baby. As my life got more complicated, I learned to compartmentalize.

These days, I keep four bags organized in my closet to help keep track of my many personae—harried Upper East Side mom, tony downtown psychopharmacologist, crunchy country Yuppie, boisterous Bellevue doc. I have my private practice briefcase, a brown leather attaché, very thin, neatly packed with selected patient charts, extra prescription pads, my office keys, and a portable memory chip to back up my PalmPilot. On the same hook in my closet is a black diaper backpack, for errands around the city with a kid in tow. Then there is the huge red backpack that I toss everything into for my days off at the country house, my sanctuary. Last is my Bellevue bag: a brown suede cylinder into which I stuff medical journals to catch up on, an extra scrub top in case I get puked on, my Bellevue ID and hospital keys. What also gets packed into that soft suede bag is my suit of armor, the one I’ve had since childhood, a thick shell to protect my soft underparts from being skewered.

But even with the cowboy act, there are still times when I get down off my high horse, when I really connect with a patient, allowing myself to truly, madly, deeply feel what he is feeling, or imagine what his life must be like. I do this tentatively, experimentally, to see how much I can take, peeking into a pained and lonely world. What it teaches me, first and foremost, is to appreciate all that I have in my life. I am a richer person because of Bellevue, having learned the value of what I own. It’s corny, but I swear it’s true. I feel tremendous gratitude when I leave Bellevue on Monday mornings, returning to the outside world—the sort of relief I used to feel when I dismounted my motorcycle after a harrowing ride. I count my blessings, taking nothing for granted—my legs, my sight, my health, my home. More than anything now, I cherish my sanity, knowing full well it can disappear in the wink of an eye, especially in the face of insurmountable stress. I have seen all that can go wrong, how faculties can crumble just as internal organs can betray.

I have seen other doctors “turn off” when they feel they can’t help, or they’re getting it wrong. When a clinician misses a diagnosis, or the patient is “failing their treatment,” the unsuccessful doctor’s disgrace turns quickly to derision and dismissiveness.
You don’t have anything I can fix
turns into
You don’t have anything wrong
. Or worse, if the patient is a
woman and the doctor is a man:
It’s all in your head; you’re hysterical
. The clinician is afraid, plain and simple. Afraid of his impotence, of the enormity of his failure and what it means to all involved.

Heinz Kohut, a well-known psychoanalyst, writes about empathic failure, that the psychiatrist can’t always succeed at knowing the patient’s pain and helping to ease it. It is best to admit fallibility and apologize for the failure, but most physicians aren’t schooled in the ways of humility. They want to help and heal, to cut, sew, and fix things, and they often get mean and angry if they can’t, like a petulant child. At least I do.

The problem with CPEP is that it is no place for infinitely compassionate clinicians. It’s just not set up for the bleeding hearts. Being malicious is never appropriate—Lord knows I’ve learned that from Mary—but it is crucial to maintain some distance. I’ve known that all along, and Desmond will figure that out too, soon enough. When he eventually gets a job as a CPEP attending, he will last only one year. He will be reluctant to T & R many patients, wanting to admit them and treat them all aggressively, preemptively, no matter how full we are upstairs. Desmond will learn over time that he cannot save everyone, he cannot fix everything, and he will leave CPEP early in the game, telling me he is “crispy,” his term for burnout.

But not me. I will work for a few more years after Desmond comes and goes, my longevity a direct result of my hardened persona, my blessing and my curse.

P
lease don’t wake me.”

Four words that have never come out of my mouth at Bellevue. When it is time for me to leave the CPEP and escape to my office and bed, around one or two in the morning, I always give the same spiel: “I wake up easy; I fall back asleep easy. You should have a low threshold for calling me. If you have a question, pick up the phone; that’s what I get paid for. Just remember, there are no stupid questions … only stupid people.” I pause here for a smile or a laugh, though I’m not always rewarded with one. “And also, this is very important, you CANNOT discharge anyone without my hearing the case.”

When I was a resident, I felt it was important to let my attendings sleep. It was a matter of pride. I wanted to show them I was competent, capable of working all night on my own without their guidance. As an attending, I know that many of my residents likely feel the same way. However, as I am quick to remind them, it is
my
ass on the line if there is a problem with a discharged patient. I’ll be the one named in a lawsuit if there is what we euphemistically call in medicine “a bad outcome,” so it is not okay for them to fly solo on my watch.

“So,” I conclude, “at some point during the night, call me and give me an update on the area, even if you’re not discharging anyone. If I don’t hear from you, I assume you’re sleeping like I am.”

I always let the residents know that I am available to them all night
long, and this is why I take great offense at the faculty meeting when Daniel accuses me of telling the residents not to wake me up.

I immediately deny it and challenge him, “You find one person I said that to.”

“The residents were complaining about you at their last meeting,” he replies.

I know what he’s talking about. A week before, one of the residents had called me to present a case and was giving me a long-winded, meandering case presentation. Since she had woken me up and I was trying not to fully engage, so I could get back to sleep more easily, I asked her to get to the point. She was offended that I had requested the
“Reader’s Digest
version” of her presentation and processed it as a narcissistic injury, a blow to the ego. She complained at a residents’ meeting where Daniel happened to be. (The irony is, she, too, eventually became a CPEP attending after her residency, and developed a reputation as one of the doctors who makes it clear she does not want to be woken during the night.)

Along with the accusation that I shut out the residents overnight, Daniel adds a few more complaints about me in front of my colleagues. I am working fewer hours than everyone else, and I am whining about doing the moonlighting schedule at every faculty meeting. He singles me out and pummels me verbally. I am defensive and angry as I loudly refute his accusations, and it is not pretty. One of the new attendings sits next to me, her mouth agape. As Daniel and I run out of steam, and the faculty meeting winds down, I notice an interesting coincidence. At this particular meeting when Daniel has chosen to chew me out, his adoring girlfriend, Michelle, and his henchman, Dave, are nowhere in sight. There are many subordinates, but no senior faculty aside from Daniel and me. He has picked a good time to get on my case, making sure his compatriots aren’t there to see the carnage, lest it sully their image of him.

After the meeting, I go straight to Dr. MacKenzie’s office to complain about Daniel, his treatment of me, and all of his recent behavior. I may as well be running to my father to complain that my brother is teasing me:
Danny’s picking on me! He started it!
I am fuming, rehearsing in my head the litany as I march through the bustling hallways to the other side of the hospital, dodging women wearing saris, men
in dashikis, other men in heavy black suits and yarmulkes, their hair curled in front of their ears. I swim upstream toward the entrance as hundreds of Bellevue staffers work their way into the building.

The hallway that leads from the outside world to the inner workings of the hospital has the same brisk, bustling feeling as Grand Central Station, but the mix of nationalities is reminiscent of Ellis Island. (The welcome sign for the pediatric emergency room is written in seventeen languages, painted above and alongside the double doors.) Families come in to visit their loved ones; patients arrive for their clinic appointments; concerned mothers, their sick children wrapped in blankets, search for a doctor. I walk in silence, scanning each face, passing the wheelchairs stacked and chained in the corner. (The panhandlers steal them so that they can sit in them and appear crippled, to make their time spent on the corners more lucrative.)

Dodging the bodies, I am lost in thought. It’s not just that Daniel likes to tear me a new one, he likes to do it in front of an audience. Anal sadist exhibitionist. This is how I have described him to Mary.

I stop mid-stride as I stumble upon a startling revelation: I wonder if that’s how Mary thinks of
me?
Maybe she thinks I’m the sadistic one and I project all my demons onto Daniel. Is it possible that he’s not really the problem, that it’s all just projected self-hatred?

Jesus.

I resume walking, my hand on my forehead.
I can’t waver like this when I present my case to MacKenzie
, I say to myself. I have to acknowledge to myself that Lucy’s death has further complicated my perceptions of Daniel. I know he was a better friend to Lucy in the end than I was. He sat by her bedside in that hospital, not me; he was fiercely loyal to her, and he loved her as I did. He worked by her side five days a week while I only schmoozed with her on Monday mornings before I went home for the week. In truth, Daniel got a bigger piece of her than I did, and I was jealous. He’s a good doctor, hardworking and generous to a fault. He is charcoal gray, not black,
but I can’t paint him as such when I complain to MacKenzie, who can smell ambivalence, who’s a shrink like you, don’t forget
, I ramble on in my interior monologue. And don’t cry. You have to learn that it’s okay to be angry. Women at work are always letting their anger make them cry, especially in front of a supervisor. Bosses at work are usually processed as father figures. Don’t make this about your father.

I take a deep breath outside of MacKenzie’s office.
He is not my father
, I say to myself emphatically, knocking on his door.

“Daniel is totally out of control,” I hit the ground running, barely letting my ass hit the seat before I begin my screed. “He is being a complete pig. First of all, at the faculty meeting two weeks ago, he makes a disgusting joke about ordering ‘vagina au jus’ at a restaurant.” I make a face, to show I am repulsed by this ribaldry.

MacKenzie is impassive, silent. His fixed gaze and upturned face imply I should continue.

“I have as dirty a mind as the next guy, I’m sure you know, sir, and I can appreciate a good joke, but that was disgusting, misogynistic, and also—honestly—not particularly funny. Then, one Monday morning he says to me, in front of his secretary, ‘You were much more fun to be around when you were pregnant with Molly. You should go home and get yourself knocked up again.’ Do you believe that?”

I stop to see his reaction. Dr. MacKenzie cocks an eyebrow slightly, but doesn’t look too taken aback.
Come on, man, at what point will you join me in my outrage?

“And now this morning … he totally humiliates me in front of my colleagues, accusing me of being a slacker and telling the residents not to wake me up, which is completely bogus! I would never say that.” I am steaming mad, lobster-red in the face, fighting back tears while I try to convey to Dr. MacKenzie what an impossible child Daniel is being, without sounding like one myself. I start to imagine a little girl running to her dad for support and coming up empty. This thought makes it infinitely harder to control the tightening in my throat.

Say something, Daddy!

I fill the silence with more whining, “Honestly, I really can’t stand working for him. Under him is more like it. He insists on my subordination, and I have no respect for him anymore. And you know what happened to his hand, right?”