Weekends at Bellevue (34 page)

After the Ativan starts to kick in, the patient quiets down, looking around the nondetainable area like a little kid, lost in Wonderland. I assign her to the resident after all, who goes out to get the full story.

“So, what’s her deal?” I ask, putting my feet up on the desk, waiting for the resident to present the case to me.

“Okay, so she was on this bus, right? A ninety-minute bus ride from Rockland down to the city.”

“State hospital Rockland?” I ask, my eyebrows at attention.

“Yeah, but she says she doesn’t go there for treatment. I asked.”

“Good thinking, asking.”

“So, she’s on this long bus ride and she needs to go to the bathroom. But there is no bathroom on the bus, so she asks the bus driver to let her off somewhere, but he won’t. So she went to the back of the bus and urinated into some sort of plastic bottle and then threw it at him ‘cause she was mad at him for not stopping.”

“Okay, well, our job is just to make sure she’s not psychotic, suicidal, or homicidal. So far she’s just assaultive and showing poor judgment, poor impulse control, et cetera.”

“Right. But now, her main concern is that the police are going to abuse her, and she’s afraid of the other prisoners doing the same. The cops are going to take her to central booking, right?”

“I guess so. But they must have a separate area for the transgender prisoners. I know they do at Rikers.” I throw my feet down, and get up from my chair. “Let’s go ask the cops.”

I am amazed at how calm the patient is now. “You see this? This is great!” I open my arms wide toward the becalmed Babe in Toyland. I am trying to teach the resident something. “Ativan four is my favorite first-line med for sedating a triage. The more I use it, the more I like it better than Haldol five and Ativan two. Look at how calm she is! You give five and two, you incapacitate the patient and it makes further interviews and interactions impossible for at least eight hours. I thought
for sure we’d have to eat this admission because the cops wouldn’t be able to deal with the screaming and the drama. And I was afraid it’d take a mess of meds to get her quiet, and then she’d sleep for days. The Ativan four really allows her to calm down and get herself together, but not turn her into a zombie. So now, she can leave!” I say this last part excitedly as we are getting closer to the patient’s stretcher.

“Ma’am? Are you almost ready to go?” I ask her in a quieter voice, turning on the concerned, therapeutic, caring charm.

“It’s not safe,” she tells us in a stage whisper. “They don’t understand me.”

“Sweetheart, I promise you. You are not the first transgender prisoner in NYPD’s history.”

We assure her that the police will be considerate and she has nothing to fear. Soon, she calms down enough to leave.

Nancy is pleasantly surprised. It is a magical transformation, and we are both singing the praises of Ativan four, the wonder drug that works wonders.

The second patient is a guy who was initially brought to the medical ER after he was arrested for shoplifting. He told the cops he had a hernia, but the AES was unimpressed with his bulge, deeming it non-emergent, so they sent him to the corrections holding area to wait for transport to arraignment. While in the blue room, the patient somehow attempted to hang himself using his leg irons. This is a new one on me. He must be awfully flexible and ingenious. The police bring him to CPEP where he is yelling and spitting to beat the band. He is mostly calling the police officers names, screaming how they’re all faggots and they can suck his dick. Once he is tied down and sedated, they begin to search him, emptying his pockets, taking off his shoes. He needs to be searched before he enters the detainable area, and I am nearly positive we’ll have to admit him.

The cops find two bottles of nitroglycerin sublingual tablets in his pockets, and one bottle of heparin in his shoe. Evidently, he has stolen these from the medical ER. The nitro is a medication that dilates the heart’s blood vessels, meant to be given to a person in the midst of acute chest pain. The heparin is an intravenous medication used to prevent blood clots from forming. If he had swallowed even one bottle of the tablets, it could have been a medical emergency, but I’m not sure he knows the value of what he has filched, and I’m even less sure he
had any intention of actually hurting himself. He may have thought he could sell them on the street.

I can’t get much out of him during the interview, though he’s much calmer with me than he was with the police, and there is no talk of fellatio. He is a flamboyantly gay Filipino male who is quick to report his bipolar diagnosis. He seems entirely believable to me, as he tells me his psychiatrist’s name and number, which he chants rhythmically like a Sousa march. This is the verse: name and number, name and number. When he gets to the chorus, he switches to his lawyer’s name and number. He repeats them both so often and so distinctly that I do not need to write them down. I have the song in my head for the rest of my shift.

I leave a message with the psychiatrist who calls me back fairly quickly. This sort of thing happens a lot, it sounds like. We have a great conversation, bonding over our love of our jobs, and he fills me in on the patient’s most recent medication regimen. He’s been switching around some of his meds, and we chat until we agree on a pharmacological plan of action. I fill out the admissions paperwork, meticulously ordering all the meds per our discussion, hoping the up-wards docs continue them as written.

My third prisoner is making his Christmas wish list a little early. It is only mid-September, but he is unabashedly asking for methadone, Clonidine, and Klonipin. Three different sedatives, one of which is a potent opioid narcotic, similar in its effects to heroin. He has seen me give Ativan 4 IM to prisoner number one, and he wants to know why he hasn’t been seen and medicated yet.

“What do I have to do to get some Ativan around here? Do I gotta bust up this joint?” he shouts.

His police escorts stand idly by, surveying the scene but opting not to intervene. I stand in front of the prisoner and say, “If this guy acts up, give him twenty-five of Thorazine IM.” I say this to the resident while staring at the patient.

The prisoner quiets down. This tells me plenty. He knows his drugs. He knows Thorazine will make him feel absolutely horrid. He knows I mean business, and if he’s a good little boy, maybe he’ll get a treat. I may feel charitable and give him one of the sedatives on his wish list. But if he’s bad, he’ll get the charcoal in his stocking.

The fourth prisoner is an ornery man, rude and irritable. He has tattoos
of letters on his fingers and on his neck. The fingers are a tip-off that he’s been in jail, and the neck is typically a warning sign that I’m dealing with a sociopath. He’s giving the police a hard time, but when he gets alone in an interview room with the medical student, he is sweet as pie, subservient, calling her Miss and Ma’am interchangeably. He won’t tell her what he is arrested for, or what he has been in prison for in the past, but he does tell her that he takes Prozac 100 mg and Ativan 50 mg. He says “BID,” which stands for twice a day, so he has done his homework, except that these are outrageously high doses, so even though he’s calm and seemingly cooperative, he’s lying through his teeth.

He also reports that he gets 130 mg of methadone a day and says he is in withdrawal, because he hasn’t had any in several days. This is a high dose, but not an uncommon one. However, his pupils aren’t dilated and he doesn’t have any goose bumps on his skin. These are two physical manifestations of opiate withdrawal that are difficult to manufacture, so it’s an easy way for me to check his story.

He denies being suicidal, homicidal, or psychotic, so I get the paperwork together to send him out with the police.

I walk out into the nondetainable area to talk to the police officer on the case. The cop is a jaded, older guy who tells me he is close to retirement. I always think of Danny Glover in
Lethal Weapon
when I hear a cop say he’s nearly retiring. Glover’s character ends up getting roped into a dangerous and complicated case just days before he can leave the police force in one piece, which makes me nervous during the whole movie.

This officer tells me he’s taking a course to become a respiratory therapist. He has a house in upstate New York and is hoping to get a job in a hospital near there. He mentions he has PTSD and asthma from 9/11, so I guess he must’ve been down there and seen some horrible things. He is sharing an awful lot with me, more than the average officer, and it finally occurs to me why. He is trying to butter me up because he wants the guy sedated. Tonight, everyone is trying to get on my good side to get the good drugs.

The prisoner has been giving him a hard time, and he is in no mood. The cop is at the end of his rope, nearing the end of his time in the force, and he is running out of steam. He also tells me what his prisoner would not, which is that the charge is rape, and he’s been imprisoned in the past for the same.

“If you’re going to release him to me, can you please medicate the hell out of him?” the cop finally asks me.

I reply as I often do, “Happy and compliant or dead weight?”

The cop answers wearily, but without skipping a beat, “If this guy isn’t dead weight, I’m afraid I’m gonna have to kill him.”

“Sir?” I ask, just to make sure I heard him right. He isn’t saying it like he’s kidding; he’s saying it like he’s exhausted, and it’s the path of least resistance.

“Dead weight, dead prisoner, what’s the difference? The guy’s a rapist,” the cop moans.

Wow. Did I say jaded? It’s clearly time for this officer to begin his new career as a respiratory therapist upstate, and head out to pasture. Stick a fork in him; he’s done.

“Right-O,” I say cheerfully. “I’ll see what I can do for you, sir.” Best to just remain polite and let it go. This cop is not my patient.

I unlock the door to leave the waiting room and I am hit with a blast of noise in the detainable area. The arrested rapist is now all over me for his methadone, no more mister nice guy. He’s gone from catching flies with honey to spewing vinegar in my face.

“The hospital limits us to how much methadone we can administer,” I explain. I don’t specify the amount, because I know he’ll blow his top if he hears it’s only twenty milligrams.

“Call my methadone clinic and they’ll tell you the dose!” he screams at me, his face contorting and reddening.

“Sir, it’s eleven o’clock at night on a Sunday. There’s no one at your clinic right now.”

“Someone is there. Someone is always there,” he insists.

I go inside to talk to Nancy. “The cop wants dead weight, the prisoner wants methadone. Looks like we should probably just take advantage of the situation.” We agree to do something that everyone knows damn well is completely against the rules. I have never done it before or since: I tell the patient we’re going to give him an injection of methadone, and we give him Thorazine.

I tell the medical student, “This is the first time in my seven years at Bellevue that I am ever doing this. It’s medically unethical what we are doing, do you understand? You never lie to a patient about what medicine they are getting; it’s against all the rules. Actually, I’m pretty sure it’s against the law. But sometimes down here, the end justifies the
means. This way, he calms down, the cop is happy, they both leave and we go on with our night.”

The medical student nods earnestly. She understands; she doesn’t see any problem with what we are doing. She’ll make a good ER doc someday, and I tell her so. I, on the other hand, am starting to see myself in a new light, beginning to feel that two-shades-beyond-golden-brown, burnt-out feeling creeping up on me. I’m not quite “crispy” yet, but I’m getting there.

F
lashback: Saturday afternoon, September 11, 1999. After I go running in the park and shower, Jeremy and I have sex before I leave for work.

As I walk down the back hallway toward my office, I notice a sharp, twisting pain in my right lower quadrant: I can actually feel myself ovulate. I get very excited, convinced the timing has been perfect and Jeremy and I have successfully conceived our first child. It is our first time trying; we have been married for four months.

I have a few minutes before my shift starts to go to the coffee shop to get something for dinner. In the line, I run into my friend Gideon, a social worker at CPEP. I decide to let him in on my secret, unable to contain myself, as usual.

“Guess what?” I ask him.

“What?” he responds, excitedly. Gideon can get enthused about anything. He’s the perfect person to tell, because he’ll mirror back all my elation and then some.

“I’m pregnant, I think. And you are the very first to know.”

“Oh my God! That is so amazing! How far along are you?” he asks.

“What time is it?” I answer.

Three weeks later, I pee on a stick and the plus sign appears. We have gone from newlyweds in May to expectant parents in September in the blink of an eye, and we are almost a teensy bit disappointed that we didn’t get to spend a few more months trying.

Be careful what you wish for.

Conceiving our second child is a completely different ball game. I am four years older, now thirty-eight, and we are at it for well over a year. I complain constantly about what a pain in the ass it is. (“I know, I know. Then we’re doing it wrong!” I joke with the coffee shop guy.) In all seriousness, I am growing a bit tired of doing it with Jeremy. Baby-making is not sexy. It is like a job you have to show up for, even though you want to sleep in. All the romance has gone out of it; we are slaves to my cycle, my erratic temperature chart, the consistency of my cervical mucus. I take the thermometer to Bellevue on the weekends and lie down impatiently in my office on Sunday and Monday mornings, waiting to get my basal temperature readings before I get out of bed to prepare for sign-out.

We have sex every other night during my fertile week, whether we want to or not.
You again!
I think to myself as we try to gear up to get off yet again.
Jeez, can I please get someone new over here?