(“Tell me more,” I’d learned to say.)
“You’re just tired,” Dr. Long said.
“I’m afraid that I won’t be able to take care of this baby,” the woman tried again.
(“Tell me more,” I’d learned to say.)
“You’re just tired right now. Everything will be fine,” Dr. Long said, and the woman stopped her talking.
Yes, a resident, I thought, let us all have therapy with a resident.
There were often suicide attempters in the medical buildings. Dr. Cherkesov insisted on sending them to CPEP after and especially when there was a note. “If a person took the time to write, it’s not impulsive. They’re going to G, and I’m not changing my mind.” Not all the CL psychiatrists shared her view. I went with Dr. Jonas—whose contemptuous attitude, I had learned, had made her the trainees’ least favorite attending—and a resident named Alvin Wang to see a would-be suicide. She’d written a note. She’d taken some pills. She was sorry she’d done it. Dr. Jonas thought she was better and cleared her psychiatrically for discharge, and after the consult I asked the doctor, though she had still yet to officially acknowledge me, about her thinking.
“If they seem okay, I don’t send them to G. I see what happens when people have psych histories,” she said gravely. But what was it exactly that happened? They would feel embarrassed? For someone who’d elected to become a psychiatrist, Dr. Jonas certainly seemed to find emotional problems repellent.
Our next stop was obstetrics. We went to see a woman who’d miscarried at five months. “She’s been quiet,” her obstetrician told us. Dr. Wang would do the consult. We went to her bedside, and he asked her what had happened.
“My cervix couldn’t hold the baby,” she told us. “I didn’t have health insurance, so I hadn’t been to the doctor. They told me if I’d gone, they probably could have prevented this.” She began to sob, and the three of us stayed quiet and let her. She went on. “Her face looked just like mine, but miniature.”
“What are the disposal plans?” asked Dr. Jonas.
“The hospital will take care of it,” said the woman, who was thirty and bird boned and still crying. “Burying her would make it too real.”
Dr. Jonas nodded at Dr. Wang, and he took over. He listed the symptoms of this disease they called depression. Trouble sleeping. Changes in appetite. Loss of interest in activities typically found pleasurable. Thoughts of suicide. If she had any of these, she should contact her doctor. The woman told us she planned to get back into shape, to focus on work. She stopped crying. We left. When we got to the nursing station, Dr. Jonas was livid. She turned to Alvin: “First you have to tell her you have no reason to believe she will develop these symptoms! She has no psych history. You shouldn’t scare her.” But what was so frightening about the idea of feeling down after a profound loss? Whose apprehension were we talking about anyway?
Dr. Wang located the patient’s chart and began to write in it while his supervisor continued to lambaste him. His notes were too long and so on. A snapshot of the delivered fetus—she had her mother’s face, her bird bones, but in miniature—stared up at us from the page in the chart where it had been stapled, but we all ignored it and focused on the yelling instead.
Dr. Kapoor told me he had an interesting manic patient for us to see. After so many months at the hospital, I wasn’t sure that such a thing still existed for me. The patient’s name was Carol. She was forty and thought she was the Statue of Liberty; she was black, and she had HIV. We’d talked a lot about HIV at morning report. CL was often called for HIV patients, as the condition was sometimes accompanied by psychiatric symptoms, and there was also AIDS dementia, which came with global deficits that made it hard to diagnose, Dr. Cherkesov said. It was a complicated virus with seemingly boundless sequelae. Dr. Kapoor called Carol bipolar, though she’d been diagnosed with schizophrenia at seventeen. “I’m skeptical about diagnoses from that era,” he told me. “Back then, blacks with psychotic symptoms were diagnosed with schizophrenia, whites with manic depression.”
We arrived with the medical students at Carol’s room to find she’d just disappeared. This was especially curious because she was on one-to-one, which meant a nursing aide had been assigned to remain by her side, a cautionary measure taken with patients who were likely to hurt themselves or run away. Dr. Kapoor looked at the one-to-one aide questioningly, and she made a face like what was he asking her for. We all went back into the hallway, where the hospital police were already walking toward us flanking our patient. In moon boots, a hospital gown, and a light green foam crown—the kind they sell to tourists on Liberty Island—she was a self-defeating fugitive. She took off her boots but not her headpiece and climbed back into bed. Dr. Kapoor introduced our group and asked, “How long have you thought you were the Statue of Liberty?”
“Since October,” she said. It was April.
“How did you learn this?” he asked.
“God informed me,” she said.
She told us some other things. Her brother was president of the Wall Street Journal. She’d been born in France. We listened, and her sister showed up. I imagined the sister didn’t want us around, gawking at her crazy statue sibling.
It was a Friday, and on Monday we went back to follow up. The Abilify had kicked in, and the crown had migrated from Carol’s head to her bedside table. “As the delusion gets weaker, you see gradations of its disappearance,” explained Dr. Kapoor.
I told George about the patient that night, half chuckling that Dr. Kapoor had called her interesting. “But she sounds it,” George said. “A beacon of freedom. Give me your tired, your poor, your huddled masses yearning to breathe free.” He was emphasizing the possibility of personal significance, of metaphor, in this patient’s chosen delusion. I had stopped at “bipolar.” After so many months at the hospital I was dipping into becoming what I disparaged. I was forgetting to make meaning, and I needed to remember again. I went to Dr. Singer and asked to be assigned some talking cases.
I had come to CL eager for simplicity, but having it was not so comfortable. It was like a compulsion, this wanting to know people and their meanings, but at least I’d turned it into something upstanding, something I would earn a living at, in a future growing ever less distant.
After Scott rebutted my request for a letter of recommendation (“Ask Dr. Wolfe to write it,” he’d suggested, adding, “He really seems to like you,” looking puzzled by the thought), and after it became clear that I was not being granted an interview for a job that had opened up at forensics (Tamar had also applied and been called, which stung hard), it occurred to me that though we were more than nine months into our twelve-month endeavor, Scott had yet to conduct my midyear evaluation. I went to the other interns and learned that all of them except for Zeke had sat for theirs many weeks back. It was no secret that Scott liked Zeke even less than me, and our coupling suggested no sunshine or cupcakes were headed my way. I knocked on Scott’s door to inform him of his oversight. He said he had almost completed the review, which of course involved paperwork, and that I should come back in twenty-four hours, which I did, to the minute.
“You’ve been the topic of much conversation in the supervisors’ meetings,” Scott said breezily once I sat down in his office. I guessed that must’ve been the junior supervisors’ meeting that Caitlin had mentioned back when she reviewed me, the one she said she’d regularly complained about me in. I’d hoped then, in the moment’s thought I’d given it, that she’d been exaggerating.
“Oh?” I could only reply, the air going out of me.
“Your work is fine, not much to say there, but we really don’t like you as a person,” Scott announced in his pissy manner, and then listed the general complaints that Caitlin had shuffled at me a few months back. (Hearing these, I felt almost betrayed because I’d thought she and I had roughly worked things out. Our relationship had remained unsatisfying, but I’d been trying quite hard to be nice, if sometimes through Cheshire cat smiles.)
“At first they did,” he admitted grudgingly. “Eventually, though, everybody else got on board as well.” As if there had been a campaign.
But who was everybody else? There was no way Dr. Wolfe attended any junior meeting, or Dr. T. or Dr. Matthews, my weathered and ill-attendant supervisor on a family case that had anyway dropped off the map before Thanksgiving. Dr. Meyer from inpatient was long gone. That left my oncology supervisor, who’d not said much when we’d had our review, and Dr. Young, with whom I’d barely interacted all those months ago on forensics. I pressed Scott. He didn’t want to name names.
“Dr. Blanchard?” I asked. (Oncology.)
“Yes,” he said.
“But she never mentioned anything to me.”
“When I questioned her, she admitted something was a little off.”
“Dr. Young?” I asked, and he nodded again, not exactly looking me in the eye.
I couldn’t help it, I started to cry. They were tears of fury, but not at Dr. Scott Brent. I was angry with myself. How could I have knowingly inflamed Caitlin that way? Why hadn’t I been trying harder to hide my general feelings of cranky deprivation? Dr. Blanchard had noted them apparently, as I imagined had Dr. Young. I deserved what I was getting now. I’d set it up myself, like a table primped for tea.
Scott handed me his typed-up form. On paper his assessment was more measured, and just for a moment I took that in before this idea of being disliked took me over. I left his office tearstained and walked to J Building for our weekly intern support group. The review, though much overdue, had been perfectly timed. With the other interns and our group leader—a former Kings County intern herself—I cried as I blamed myself. I was the bad one. Scott was only doing his job. (Could I not hear the vicissitudes of my character style through those tears? That I would identify depressive defenses so readily in my patients only to miss them gone full bore in myself is a testament to how seamlessly they operate.) The others were sympathetic and tried to remind me that Scott was at least half a horse’s ass. It had only been a few weeks back that the child-track interns, more incensed than usual by one or another of our Scott stories, had wanted to go to their own director of training, whom they adored, to complain about him on our behalf. We’d politely declined, touched by their concern for us. No good could come of publicly crossing him.
After group, still unconsoled (“not taking the milk,” went the Kleinian metaphor), I called Dr. Aronoff, who called back soon. My usually staid analyst was apoplectic. “That is so inappropriate! How could you let him talk to you that way?!” She rarely, and by rarely I mean all but never, spoke like that. The nice thing about someone who is professionally measured is that a break from form has all the power of a macroburst. Her words cut through my concentrated self-loathing. I had provoked Caitlin, but our dance had taken two to consummate. I’d been grouchy and unenthusiastic, but not without some reason. Maybe I could consider my own responsibility without absorbing all of it. For a change I could be outraged, but on my own behalf.
Dr. Aronoff’s words lifted my bad feeling fleetingly. Warding it off felt like holding my chin above that bar. Still, the next night I got a high fever, and over the days that followed, I became sicker than maybe I’d ever been, ruminating with abandon whenever I woke up about my bad behavior and all those near strangers who reportedly disliked me as a person. Bad, bad, I was so bad. The stress of the year had finally toppled me, and also I’d been working in the medical hospital with a less than adequate appreciation for a frequent washing of hands. Two weeks before my wedding I was out sick an entire four days, my nose chafed beyond makeup’s repair. It was almost better by our blue-sky marriage day, and as George and I danced and toasted with our families and friends, we forgot about our training for the first time in many months. The next morning we left for Palm Springs, and a ten-day honeymoon all but vanished the rest of the chap from my skin.
CHAPTER TEN
WE TOOK THE RED-EYE BACK FROM LAX, AND OUT OF VACATION time I caught the airport shuttle straight to the subway, hospital-bound. After morning report Dr. Singer sent me to follow up with a Mrs. Guzman. She was in her sixties, admitted after a stroke. Her doctors thought she seemed depressed, and my supervisor was honoring my request for a talking case. Her speech was slowed, and she couldn’t easily move her left side, but she told me she was mostly worried about her twenty-year-old son, who she said couldn’t take seeing her like this. I wondered if she was projecting. I encouraged her to talk about her son’s difficulty, and for a while she cried. Mostly I listened and asked her to elaborate. When it was time for me to leave, she asked if I could return the next day and I did. We talked some more.
In some ways it was easy, this work with the medically, as opposed to the mentally, ill. The bar was set so low. I only had to be willing to hear about their experiences. Across the general hospital—and I’d been all around it now—support staff and doctors were telling patients not to have their feelings. “Don’t be sad.” These words fell on the wards as regularly as April rain. It made my blood pressure spike each time I heard it in passing. “I can’t tolerate your sadness,” I wanted to teach them to say instead, because it was more to the point and would also quickly give its speaker pause. Sometimes there were just things to be unhappy about. The DSM had a category for patients who were blue because of new and troubling medical problems: adjustment disorder (DSM code 309.0). Dr. Kapoor told me he preferred “adjustment reaction,” which is what the international disease manual, the ICD-9, called it. “Someone who has just had a stroke and goes around like nothing’s happened, that’s a disorder,” said Dr. Kapoor. Yet being not sad was often presented to patients offhandedly as the only acceptable course.
Dr. Singer soon had two more talking cases lined up for me, each eighteen years old. One had sickle-cell anemia. The other had been paralyzed by a gunshot. I went to Dr. Cherkesov to ask for some pre-session supervision because I wondered if there was something more active than listening I should be doing with these medical patients and also because she’d fascinated me in our meetings. Every time she opened her mouth a gripping certitude came out. It might be a dubious fact: “Horror writers get their most interesting ideas from suffering delirium tremens!” It could be inspirational: “Turn all negative experiences in your life into learning experiences and you will stop being scared!” And sometimes she intimated an almost magical intellectual prowess: “I know things I don’t know how I know them. I was born in U.S.S.R. I came here and someone asked me what is the tallest mountain in the U.S. and I knew it!”
She was a Russian Jew who’d gotten into medical school in pre-glasnost Moscow against all odds. “They had quotas, only take 2 percent Jews in their class of five hundred. I got in by telling myself a tale that I would. The minute you make a decision, everything changes!” She told us that she and her husband spent weekends walking the streets of Brooklyn, six or seven hours at a stretch, to oxygenate their brains and fend off dementia. George and I spent our Saturdays the same way but in order to revel in the scenery—the Brooklyn Bridge, the incense plumes as they rose above the Atlantic Avenue storefronts. When I asked her for some general wisdom about working with sick people, Dr. Cherkesov declared, “If you don’t believe your patient has anything to live for, they won’t either!” which was the inverse of what I’d learned in graduate school and felt like a lot of pressure. She also gave me an article about demoralization, which it distinguished from depression in that the former cleared once its medical precursor did and was unlikely to respond to antidepressants (still, everybody was prescribed them).
I asked Dr. Cherkesov to explain sickle-cell anemia, which she said was an inherited disease of the red blood cells that caused pain and infection and organ and joint damage. She told me that the sickle-cell trait evolved in climates where malaria was common, and that while having two sickle-cel
l alleles meant trouble, being born with just one offered protection against that tropical disease. I went to see Alisha, herself with two alleles. The consult question was “eating disorder?” as her doctors could find no cause for her self-reported vomiting. But Dr. Singer said the real problem was that she was infuriating the staff with her angry outbursts and grandiosity. She’d refused to speak to Dr. Singer, but he hoped she might benefit from talk therapy and thought she might relent if speaking to a woman.
“I’m not crazy,” Alisha said when I reached her bedside and identified myself. She was a pretty West Indian girl in a skimpy tank top. She was skinny after losing twenty pounds in the past year, about which she seemed neither pleased nor concerned. She wanted to be a model and showed me an album with old pictures of herself, posing. She was fuller-bodied in the photos and said she liked herself better fleshy, as per the preferences of her culture. She told me she vomited from her pain, caused by the necrosis in her hip. “My doctors won’t do a hip replacement, because I don’t have insurance,” she said. Who knew if this was accurate—there was, after all, emergency Medicaid—but she believed it and was in a rage. She was an undocumented immigrant and near homeless, she and her mother having recently been evicted. They’d moved in with an uncle, who Alisha said was clearly unhappy with the arrangement. It was impossibly warm out again, and Alisha’d been left to sleep on his couch in the heat and her discomfort. Walking pained her, and she’d wet herself and her makeshift bed in the middle of the night when it hurt too much to get up, which made her uncle want them even less. Hospitalization had been a relief, though she would’ve preferred to be on pediatrics, where she’d spent long swaths of time since she was twelve. She was eighteen now, old enough that they could refuse to take her back. The nurses there felt she treated them poorly, though she swore to me that wasn’t true. She stopped talking and gave me a deep pout. Could I be of any help?
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