When Meyer finished, he told us it was time to go onto the unit. “Morning meeting,” he said. “For the whole staff. Every day, about 10:00.” The three of us closed our notebooks and followed him through one more locked door and onto G-51.
On the other side of a bolted door we found six or seven morning-crusted patients lounging dispiritedly around the dayroom, a large, stale-smelling space with the now familiar cold white concrete floors and rusty-paned windows that did not open. In one half of the room were wood-framed sofas of cracking pink vinyl and an old color television console locked in a plastic case. In the other half were six or seven rectangular dining tables with black plastic chairs. Some of the patients stared at the TV, its volume loud enough to be noxious as it reverberated off the cream-colored cinder-block walls. A commercial for a calling card blared the last digits of its toll-free number, “Four, four, four, four.” People wandered into and out of the room or sat at tables staring into space or still finishing breakfast. An aisle down the middle of the room led through an open door and into two separate hallways, at the hub of which was a nursing station. The staff bathroom was in the station, and Meyer promised us keys. One hallway housed the women’s rooms—each as institutional and aged as the dayroom, but much smaller and with wooden platform beds built into their floors. All you could say for the vinyl mattresses was that they were probably easy to clean. The men’s hall was almost identical, with its eight rooms and one dormitory-style bathroom and shower, though it also contained the chart room, where the staff met and where new admissions were interviewed. A few patients were scattered outside its door waiting just like in the ER for the promise of a better day.
Dr. Meyer wore his skeleton key fastened to his pants, as did all the interns by now thanks to my former classmate Leora, who had congenially tracked down and purchased seven identical key clips with elastics that extended easily from waist to shoulder height, where the keyholes in G were set. Meyer used his key now to let our group into the chart room, quickly pushing the door closed with his slight mass and bolting it. Inside and outside might have been separated by a moat. Like every other room in the building, it was dingy, sepia toned. A large, weathered table took up most of the space, and getting past the detritus that surrounded it—stray papers, old computer desks, filing cabinets—took some maneuvering. As we sat down around the table, Dr. Meyer introduced us to the two staff people working quietly there, their backs to the door—Miss Smith, a beautiful older black woman dressed all in red whose fleshy hips were too big for her frame, and Oswald, who was Haitian and in large glasses and also getting on in age. Both were social workers and longtime veterans of the inpatient unit, Meyer told us. They were friendly and welcomed us. We sat down across from them on the far side of the room.
After not very long at all, Dr. Begum, one of the two psychiatrists who ran the unit, entered. A lanky Bangladeshi immigrant, he was middle-aged with dark, thinning hair and a sardonic half smile. Shaking his head, he looked around the small room. “Where is everybody?” he asked with frustration that seemed playful, slamming down his stack of folders, after Meyer had introduced us. Oswald and Miss Smith barely looked up from their work, and my group certainly couldn’t answer. Who was “everybody”? Dr. Begum stomped out of the chart room, returning in little time with five other staff members—nurses and nursing aides, I guessed, and maybe a tech. Dr. Begum took a seat at the head of the table without locking the heavy door behind him, and a patient quickly appeared there. “Oh boy,” said Miss Smith under her breath with a sigh.
“Marvin Mavin, you cannot be in here now!” asserted Dr. Begum, his heavily accented English giving his enunciation a staccato clip. Marvin Mavin was as old as Dr. Begum and taut, with eyes open too wide. He swayed into the room, the door heaving shut behind him. “I’m havva. I’m havva navva havva,” he said, swinging his arms. He looked ready to launch forward, like a rock in a slingshot. I felt the bodies in the room tense along with my own. The man I’d guessed was a tech stood up. So did Dr. Begum.
“Mr. Mavin!” said the psychiatrist. “I promise you that later we will see you! Right now you need to wait outside.” Oswald stood up, too, and as Marvin Mavin lunged at Dr. Begum, he and the tech each grabbed an arm and with some force got Marvin out the door, which one of the nurses locked once they were gone. “He got a shot last night. He’s out of control. You need to adjust his medication,” she said to Dr. Begum. Oswald and the tech came back into the room, unlocking and then locking the door. We could hear Marvin shouting enraged gibberish in the hallway. He pounded on the door.
“I will take care of it,” said Dr. Begum, scribbling a note to himself on his stack of papers. He continued speaking over the clamor. “Where was everybody this morning? Every day we meet! This is not optional. I will not take responsibility for this unit—I will ask for a transfer!—if I cannot get you people into shape!” The staff looked bored. He turned to us, the interns. “I have been at Kings County only as long as you. We were at hospital orientation together—I remember you. I came over from Maimonides. I could not believe how badly this unit was being run, and now I am asking new things from the staff. My requests are not being met with enthusiasm.” He paused and looked around the room. “I will leave if things continue as they are!” he repeated, waving a finger in the air. No one reacted. He seemed to be enjoying himself, and I enjoyed him in return. He smiled and shrugged and sat down. He turned to Bruce and Tamar and me again and said: “The morning team meeting is very important. We review all patients’ progress. We talk about what is happening on the unit. We assign you therapists to the patients; each will carry about five cases. Then we interview any new admissions.”
George had started on inpatient at Columbia the month before. On his unit, “community meetings” preceded the treatment team ones. The patients and staff all convened to address problems the former were having with their stays. It gave the patients a chance to be heard, to work things out by relating to others. George was being taught to lead the meetings, as they were apparently standard operating procedure on locked wards. But Dr. Begum didn’t mention these, and I guessed they were not among our offerings.
“Nurse Hector, please begin,” Dr. Begum said.
The nurse began reading names from a list that resembled the CPEP census, in the same boldfaced font I’d only ever seen at Kings County. It looked mimeographed. Meyer took copies from the middle of the table and handed them to us. With each name someone on the staff chimed in: how had the patient’s night been, was he improving, was he almost ready for discharge. Several patients had only recently arrived, including Mr. Rumbert, my selectively mute friend from the ER. The staff did not know him well yet, so I offered what information I had, despite my ever-needling fear that to offer anything might be to overstep some boundary. Was it a student’s job to keep her mouth shut? I wasn’t sure. “I worked with him in CPEP. He came in not speaking, but he talked after a few days. He’s psychotic—confused and suspicious, frightened but cooperative,” I said.
“You will take this patient?” asked Dr. Begum. I was happy to. Mr. Rumbert made three. I’d already been assigned two patients—transferred from Leora—before I’d even arrived for my first day. Each of these women had been living in the decrepitude of the unit for upwards of six months. “Not good therapy cases” was all Leora had to say about them. That was psychology intern shorthand for people who had trouble engaging in what felt to us like meaningful work. I had no experience treating psychotic patients, but I was determined to surmount this: I had just finished reading I Never Promised You a Rose Garden—in which a talented psychoanalyst patiently cures a young schizophrenic woman—and had high hopes (Dr. Aronoff might have called them grandiose) for what I would accomplish with patients who weren’t “good therapy cases.” When the meeting ended, I went out to meet my new charges and to find Mr. Rumbert. I walked into the dayroom looking for any of the three. I knew that one was Vietnamese and the other was an older black woman. Asian people were rare in the
G Building, and so were old women. I glimpsed the elderly woman first. She had cropped gray hair and bright eyes. She was wearing an overcoat and sitting on a plastic dining room chair that she’d moved next to the unit’s only exit, a shopping bag at her feet. It overflowed like a cornucopia with her things—clothing, toiletries, several striped woolen caps. I approached her. “Are you Gabriel?” I asked, thinking that her name was evidence of her earliest experience with careless parenting. Was she once a girl who should have been, among other things, Gabrielle?
“Yes, I am,” she said loudly, raising her eyebrows. “Who are you?”
“I’m Darcy,” I said. “I’m your new therapist.”
“Well, as you can see, I’m on my way out, leaving. So I won’t be needing a new therapist.” She pronounced the last word as if it were hyphenated. “Thera-pissed.”
“Where are you going?” I asked her. Of course I was unsure if she was actually leaving. Was she delusional? Optimistic? Was there any difference, on this locked ward, between the two?
“To Kingsboro!” she said. “That’s where I’m going. Going and gone-ing. They’re coming to get me. I’m out of this dump.” I didn’t know what Kingsboro was, or if it was anything at all.
“Can we talk a little before you go?”
“No,” she said. Her tone did not invite argument, and I didn’t want to disrespect her wishes, to get us off on the wrong foot were she really staying. But I didn’t want to seem rejecting either.
“Okay, well, I’ll make sure to come say hello if you’re still here tomorrow.”
“Okay,” she agreed noncommittally, still watching the door. I walked away, in search of Hong Hanh. There were no Vietnamese women in the dayroom, so I headed for the women’s hallway. In the second room on the left, I found a tiny, middle-aged woman in red sweatpants and a hospital gown with shoulder-length black-and-gray hair sitting on the room’s only bed.
“Miss Hanh?” I asked. Some patients made me want to use their last names. She looked up from her writing. I continued. “I’m Darcy. I’m your new therapist.”
“You tell Dr. Win-kler I no need be here,” she said with some urgency. Dr. Winkler was the other psychiatrist on the unit. He had not been at the morning meeting, so I hadn’t met him yet. The interns who’d just finished up on the unit had described him as old and doddering.
“I thought we could talk a little, start to get to know each other,” I said. She looked at me blankly. Good grief. “Do you speak English, Miss Hanh?” I asked.
“No English,” she said. “Little English,” she corrected herself and stood up, coming very close to me. “You tell Dr. Win-kler?”
“I’ll make sure to talk to him,” I said, trying to make my voice reassuring because I didn’t know if she could understand my words. She sat back down cross-legged on the bed, and I left. What was one more inauspicious beginning among so many? I went to the men’s hall to look for Mr. Rumbert. My dejection peaked when I found him lying on a bed wrapped from head to toe in a white sheet. I recognized him only from the shape of his haircut. “Mr. Rumbert!” I was still happy to see him, even if his half recovery in CPEP had been short-lived. “It’s Miss Lockman, from the ER!” I hoped he would respond to my joy at our reunion with at least some interest, but he did not move. Who put the catatonia in catatonic schizophrenia? “I’ll be working with you while you’re here,” I told him. “Maybe tomorrow you’ll feel more like talking.” I returned to the chart room to note my interactions with my patients in language I hoped would carve out a place for my field. As Dr. Meyer had implicitly predicted, my work that day had not.
The next morning I walked onto the unit to find Gabriel waiting by the door again, in her coat and with her bag. “I’m leaving today,” she told me when I greeted her. I thought that she recognized me, but she didn’t seem to remember that she’d given me the same (mis)information the day before. Was she psychotic or demented or both, and without psychological testing—which would have been done months ago had anyone deemed it important—how would I ever make that determination? Hong Hanh was in the dayroom, too, in the same red sweatpants and with the same old song: “I no need be here. You tell Dr. Win-kler.” I clearly needed to know more about these women than they were able to tell me, so I went to the chart room to wait for the meeting and read whatever was legible among their paperwork.
When I unlocked the door, the chart room was empty except for a slim man in his seventies wearing a three-piece brown suit. He had a white beard and a full head of white hair. He was small and handsome. “Dr. Winkler?” I asked. He looked up, and I thought I could hear his neck creak.
“That’s right,” he said.
“I’m Darcy,” I said. “One of the new psychology interns.”
“Ah,” he said. “Welcome.” He emanated a calm I had not felt on the inpatient ward, and at once I realized that the rest of the staff looked on alert—as if afraid they were being followed—all of the time. Zeke and Jen and Alisa and Leora had dismissed Dr. Winkler because of his age and probably something else that I wasn’t picking up on yet, but I preferred older psychiatrists, trained in a time when medicine was still interested in the mind as opposed to just the brain.
“Thank you,” I said. “I think I’m working with one of your patients. A Vietnamese woman. She’s asked me a couple times to tell you that she doesn’t need to be here.”
He nodded. “Yes, Miss Hanh.” He sighed. “She’s a difficult case. I’d like for her not to be here, either. She’s been declared mentally incompetent by the courts, and her family won’t take her in. It’s not uncommon for some immigrant families to cast out members who are mentally ill; they can’t earn money, so they’re a real strain on a family struggling just to survive. She’s had a legal guardian appointed who makes decisions for her, and the guardian says she can’t go home, even though she owns an apartment. She’s been in and out of hospitals. When she got here six or seven months ago, it was after her super saw her place and called EMS. She’d basically turned her apartment into a hovel, took out all the plumbing. I think she was in a refugee camp in Vietnam at some point, probably traumatized during the war, looked like she was trying to re-create that environment. There are pictures in the chart. You should take a look.”
“I will,” I said. “So does she just stay here indefinitely?”
“We’ve got her application for Kingsboro in, but a bed hasn’t come up for her yet.”
“Yes, Kingsboro. What is that place?”
“State hospital. For long-term care. We’re an acute care unit, not for long-term stays. We’re supposed to be stabilizing patients, preparing them for reentry into the community. When patients aren’t going to be ready for discharge within a couple weeks, we’re supposed to send them on, but it doesn’t always work that way. There aren’t enough places for them to go. So we have people like Miss Hanh who get stuck here. It’s tragic really.”
“So what’s my role as her therapist, given that we can’t really even communicate particularly?”
“Read her chart. Touch base with her guardian,” said Dr. Winkler. “You could try calling her mother or her brother if she’ll let you. They’re in the Bronx. Last time we called her mother she hung up on us. Her English wasn’t good, but I don’t think that was why.”
“Are you working with Gabriel Nolten, too?” I asked. In addition to having a therapist, each patient on the unit was assigned to a psychiatrist for medication management. Dr. Winkler and Dr. Begum split the floor, twenty-plus patients in each man’s caseload. He nodded.
“She’s another one waiting for Kingsboro.”
“By the door each morning,” I said.
“Yes. The waiting isn’t completely nuts. She was supposed to leave last week. After five months on the waiting list, they finally had a bed for her. But she’d turned sixty-two in the time between when we put the application in and when she got accepted. That’s the age cap for the adult beds. At sixty-two you need a senior bed. Someone there caught her birth date,
and she went straight to the bottom of a different list. No telling when she’ll leave now. Her hopes were up. She’s not ready to accept it yet.”
“What’s going on with her?” I asked.
“Long history of schizophrenia, we think,” he said. “Lots of psychiatric patients are poor historians. When there’s no family to talk to, we’re left to do a bit of guesswork. She was brought in by the police after they found her wandering in traffic. She was able to tell us that she’d been in psychiatric hospitals off and on for a long time, and you’ll talk to her, you’ll see her symptoms.”
“She didn’t seem to remember that she told me yesterday she was leaving. Could she have dementia?”
“That could be going on, too,” he agreed. Others were settling around the table now. Tamar and Bruce had come in and sat down to the right of me. I thanked Dr. Winkler for all the information, and in a flurry of good mornings Dr. Begum called the meeting to order. There was a new patient sent up fresh from CPEP, and after we reviewed the census, one of the nurses went out to fetch him. Dr. Begum turned to the interns. “I will do the interview. I want to know why he’s here and also about his history: substance abuse, previous hospitalizations, family, et cetera. I will do a mental status exam, find out about health problems. Many things. Today I will do the interview, but usually I want the students to do it, so pay attention. Tomorrow we will have new patients, and it will be your turn.” Dr. Meyer signaled to us that we should take notes, and the three of us opened our notebooks and uncapped our pens. In that much at least we were practiced. The nurse returned with Mr. Rodgers, a burly, light-skinned black man around forty. He moved slowly, and his face was tearstained. He took a seat at the table as the nurse locked the chart room door behind him.
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