“Well, now, Daniel and I have been talking about this, Julie, and Daniel feels that it’s appropriate for you to do this extra work because you’re working less hours than the other attendings.”
Fewer, I think to myself, but I dare not correct him. I also don’t tell him how I’m not working any fewer hours than most of the other doctors. Most of us are logging in less than what is required to be considered full-time. “So why don’t you just demote me to part-time?” I offer. “I’ve been working these hours since way before Daniel became my boss. All of a sudden I’m not working enough, so he thinks he can justify my doing the scheduling? That’s absurd. Can I switch my status to part-time? Would that work?”
“Well, you changing to part-time is potentially a solution. Here’s another suggestion I had, if you really don’t want to do the scheduling anymore,” he says, as he slides over a piece of paper to me. On it is a bunch of numbers, a chart of various hours and salaries. “You can either pick up some more hours and work another day during the week, or you can take a small cut in salary if you’d like to keep your current schedule.”
“You’ve got to be kidding me.” I can’t believe this is happening. I look at the numbers. “You guys want me to take an eight-thousand-dollar pay cut? I’ve been working the same hours for years! I make one visit to your office to complain about Daniel being a pig and it costs me eight thousand bucks?”
“Now, that’s not what’s going on here, and I think you know that. If you take this new salary, you’d still be the highest-paid doctor at CPEP, based on hourly earnings, which is commensurate with your seniority.”
“But I’d be making less money, doing the same job I’ve always done.”
“This is your choice, Julie. You can keep doing the scheduling, you can pick up another day at CPEP, or you can take the pay cut.”
“How long do I have to think about it?”
“How’s a week? Is that enough time?”
I nod my head and get up to leave. My eyes are stinging with tears, and I have no desire to let Daniel see how upset I am. I’m sure he’s grinning smugly, thinking he’s won this round, which he truly has. He’s got me right in my pocketbook, which hurts me more than anything.
“You understand that I am supporting a new family right now?” I remind Dr. MacKenzie. Emotional blackmail—it’s worth a shot. “This pay cut couldn’t have come at a worse time.”
I leave the administrative suite, ride the elevator down to the lobby, and go to my office to get my things. I feel like I’ve been betrayed. Punched in the stomach. By my dad.
It’s Monday morning, and I can leave for the week. I have a few days to decide what to do, although I’m already pretty sure that I’m willing to part with eight thousand dollars a year if it means extricating myself from this ridiculous scheduling job. That’s what my peace of mind is worth, “eight large,” as they say on The Sopranos. I start to fantasize about hiring someone to get these guys whacked. It’s gotta cost less than eight grand.
Six days later, Sunday night in CPEP, and who should appear again but the Pussy-face-tattoo-man. He arrives by ambulance, after calling 911 from a pay phone on a street corner.
“Patient reports hearing voices telling him to kill himself, and he has taken two Tylenol number threes and one Vicodin in what he is calling a suicide attempt,” EMS tells me.
“That sounds like a pretty good way to get high, but a lame-ass way to kill yourself,” I say to the ambulance drivers. They laugh, as they always do. They’re the only ones more cynical than we are, I think. Or maybe it’s the cops.
I’ve seen this guy hanging around CPEP and the Bellevue lobby way too often in the past couple of weeks. Plus, now I associate him with Daniel, which is probably why I make the taunting comment right in front of him. He symbolizes all that is wrong with my job at the moment, and he must pay. My malingering radar is up pretty high after hearing a story like that, so there’s no way he’s going to be able to get past me tonight. I know guys like this, I think to myself. I already know his pants are on fire. It’ll be tough for him to convince me otherwise. He is destined for the door.
“He’s gotta go; we got way too many patients in the area,” I say to Vera, the tall, thin, blond head nurse on tonight. “I’ve gotta clear the rack. Vera, you wanna join me in here for this guy and we’ll try to bang it out together? I don’t want him to get too comfortable here.”
“The tattooed lady?” she jokes.
“Let’s pretend we just can’t see his face,” I advise her.
We invite him into the triage room for a quick interview.
As he sits down across the table from us, he turns his head to the right, and I finally get to see the left side of his face. Up until now, I had only seen the right side, the “Pussy” side. His left cheek has a tattoo on it as well. “Licker” it says. Aha! Not just Pussy! Pussy Licker! This guy is advertising to all the ladies out there that he is available for their dining and dancing pleasure. Only, I guess it’s not working so well, because here he is looking for a room at hotel Bellevue. I have to take a deep breath and try to maintain my composure before this man, with these words on his face.
Before I can even start the interview, he is already off and running with his laundry list of symptoms.
“I’m hearing voices to kill myself.” He jumps right into the middle, no “Hello, how are you doing this evening?” I can’t even get my fork out for the first question and he is already on his dessert.
“They’re saying ‘Why don’t you just do it already?’ and I haven’t slept more than thirty or forty minutes a night for the past month. Also, I’m seeing my dead mother in front of me, saying ‘Join me.’” He takes a breath to gather up speed for more, and I am nearly speechless. He is pulling out all the stops, and so early in the game. I’ve never seen anything like this, the impatient approach to convince me of insanity. And this last one, the “Join me,” is a smart move on his part. I don’t know if someone’s been coaching him or if he just happened upon this symptom through trial and error at various ERs, but it’s a doozy.
Identifiable auditory hallucinations are a more potent form of voices, a step above a murmuring mumble, “Kill. Kill.” It is one thing to hear a voice if you don’t know whose it is, or can’t quite make out what it’s saying. It is another thing entirely if the speaker in your mind is God or the Devil, or Jesus or your dead mother. Don’t you usually do what your mother tells you? If you believe in it, you’re more likely to obey it, and that’s when things can get dangerous.
When I’m speaking to someone who is psychotic, I poke around for a delusional framework surrounding the voices. How believable are they to the patient? Has he followed commands in the past? When I was a second-year med student at Temple, there was a patient who chewed off a few of his fingertips when he was in the isolation room on the inpatient ward. He heard a voice saying “Prove your worth. Prove your worth,” over and over. He believed that this was the voice of Buddha, challenging him to demonstrate his devotion. This patient decided that biting off his fingertips would send a powerful message to Buddha, that he was a strong and worthy disciple. Because his auditory hallucinations had delusional content, they carried more weight and were more likely to influence his behavior.
So, this guy with his tattooed face is giving me the line about his dead mother saying “Join me.” It’s a sneaky, calculated move. I’ve only met one other malingerer who used this tactic. A Vietnam vet I got to know while I was working at the Bronx VA Hospital. That guy followed me down to Bellevue for a while after I left the VA, but he gave up because I wouldn’t admit him once I got settled in my new digs. More important, he came into a lot of government money when he won some back-owed cash for a disability claim. The last time I saw him at Bellevue, we were talking investments—stocks and bonds versus real estate—so I knew I wouldn’t be seeing him for a while. But before the money came through, he used to go from ER to ER, where he would report hearing his dead father’s voice saying “Jo
in me.”
“Works like a charm,” he told me. “I get admitted almost every time with that line. That, and I put an unloaded shell in my mouth and try to light a match to it. Freaks everybody right the fuck out,” he beamed proudly.
I try a different line of questioning with Pussy Licker: “Why is it that I see you around the hospital so much?”
“I come to the clinic here to get my AIDS medicine,” he tells me.
“So, I’m just curious. Why are you so rigorous about taking care of your health if you actually want to die?”
“Huh?” he asks. He does this a lot whenever I ask him a tough question. Any question, actually.
As the interview progresses, it sounds like this:
“Do you take any medications?”
“Huh?”
“Have you ever seen a psychiatrist before?”
“Huh?”
This starts to drive me insane, as it does Vera, who’s sitting to my left in the triage room. We look at each other with raised eyebrows, lips pursed, sharing a moment as the “Huh”s start to amass in a pile on the table in front of us. Obviously, he’s stalling while he tries to come up with a line, and his “Huh” is a way to buy him some time. It is an obvious “tell” that indicates that he doesn’t have an honest answer for us. There’s practically no point conducting the interview if all we’re going to get is bullshit. Also, here’s a man who claims he hasn’t been sleeping for a month, hears voices, and sees visions (which he says are happening all day, every day, including right now), yet he doesn’t look the least bit disheveled, distracted, internally stimulated, or preoccupied.
I know he is lying, Vera knows he is lying, and on some level, I do hope the Pussy Licker man himself knows he is lying. It’s time to let him know that we aren’t going to be able to gratify him tonight.
I break the news to him in a way that I hope will spare me too much hassle. “Sir, while you do have an excellent story, which many psychiatrists in the city would completely buy, you are unfortunate this evening for several reasons. One, I have been at this a long time and so I am not having any of it, and two, we have no beds to offer you tonight because we are full.” I play this up. “If it were slower here tonight, I’d give you a place to sleep, but we just have no place to put you. Maybe you should try another hospital?” I cock my head coyly.
“You’re not going to admit me?” he asks, incredulous.
“No, sir, I am not,” I say as politely and deferentially as I can muster.
“Can I get a Xerox of my chart, then? And a copy of the ambulance call report sheet too? The dispatch lady from 911 said with that complaint, about hearing voices to kill myself and taking those pills, that I should be admitted anywhere in the city. She said to call her if I didn’t get admitted.”
In all my years, this is the first time a patient has asked me for a copy of the EMS sheet. I’m impressed. “That’s a new one on me, man! A copy of the ACR? You are a piece of work!”
Then he tells me that while he was waiting to be seen in the nondetainable area, he was looking for a piece of metal to cut himself with. When that goes nowhere, he ups the ante. “You know, Doc, on top of the pay phone when I called 911, there was a razor. I shoulda just used that to cut myself.”
The guy is starting to get desperate, laying on one veiled, and not-so-veiled, threat after another: He’ll sue me and the hospital, he’ll hurt himself as soon as he leaves here.
He finally asks me, “What happens to doctors like you who kick out patients and then they come back on a gurney?”
I tell him calmly, “It’s never happened to me, so I don’t know.”
He stops talking then, and looks down at his lap. He has pulled his wallet out of his back pocket and placed it on his lap underneath the table. He reaches into his wallet, slowly. I am a bit panicky now, because he has mentioned a razor, so I don’t know if he has one in the Velcro part of his wallet that he is peeling back. We are alone in the triage room with him, with no hospital police in sight, just Vera and I, and I’ve been pissing this guy off, as usual, though I was actually trying not to.
Live and don’t learn, that’s my motto.
I never do see what he takes out of his wallet, if anything, because he closes it back up, looks at me, and sighs heavily, angrily. He’s got nothing. It was a ruse, just to scare me, which it did.
The last guy to open his Velcro wallet in front of me had a shard of mirror in it, and Mr. K, one of our more proactive psych techs, was on him in a heartbeat, swooping in from the side, wrapping his arms around the guy’s torso. They both crashed to the floor. I remember thinking how chivalrous it was of Mr. K to take a fall for me, literally.
“Listen, do you want me to fill out the paperwork so you can get into a shelter?” I ask, as nicely as I can muster. It is a lousy consolation prize, and he knows it. He declines.
Vera escorts him out of the triage room, and he says to her, “I bet you would’ve admitted me if I punched that doctor.”
“No, actually, we would’ve pressed charges and sent you to Rikers,” she says with a saccharine smile.
Like the last guy who punched me, I want to add. But I keep that part to myself. No need to give him any encouragement. I go back into the nurses’ station to fill out his paperwork, relieved that I have escaped another attack.
For now.
On Monday morning, I go to Dr. MacKenzie’s office and tell him I’ll take the pay cut. Life is short, and I need less bullshit in mine.
Here, There, and Everywhere
Tuesday morning, quarter of nine, and Jeremy and I are loading up the car to head to the house. I get Molly into her car seat and then put the AM radio on to hear a traffic update. A woman has called into the station claiming that a small plane’s just hit one of the World Trade Center towers. She’s looking out her window describing the smoke coming out of the tower, and now some other man is also calling in who’s seen the plane hit. Their stories differ in terms of how big the plane is, but my assumption is that it’s only a little twin-engine Cessna or something. Jeremy slams the trunk and gets into the passenger side.
“Some pilot just crashed into the World Trade Center,” I tell Jeremy. We listen to the radio for the next hour and twenty minutes, as the story continues to unfold, more and more unbelievable. “I should be at Bellevue,” I say repeatedly as we drive away from the city. “Whenever there’s a disaster like this, I’m pretty sure we’re all supposed to just report for work immediately.”
“We’re not turning around,” he says.
Okay, I think. We need to get Molly somewhere safe. She’ll be safer outside of the city. Maybe I’ll just take the train back in, once she and Jeremy are settled at the house. They probably need me at CPEP. With the Pentagon attacked too, people must be losing it. The psychic fallout on the periphery of the explosions must be immense—people panicking, paranoid, in shock, traumatized.
When we finally get to the house, we’re in time to see the second building collapse on CNN.
The phone rings, and I assume it is someone trying to track me down from the hospital, telling me I have to report for duty, but it is Spalding Gray. Being on the phone with Spalding is like having a front-row seat for a workshop of his next monologue. This time, however, he isn’t regaling me with fascinating anecdotes, peppered with his neuroses. Now, there is something different, feverish in his delivery. He’s unloading his mania onto me, his speech revealing the layers of his obsessions and delusions. It’s still a monologue of sorts, but it’s heaving with pain and pathology. He and Kathie have sold their house in Sag Harbor and they’re moving a mile away to North Haven. Spalding has become obsessed with the move, convinced it is a cataclysmically bad decision. He regrets selling “the green house” and is wary of relocating. He rambles on about how unfit the new house is for habitation and how perfect the green house was for him and his children, and mostly about how he wants to turn around time, to undo the sale, the closing, all the things that can’t be undone.
> I try to sympathize with him. He’s been through so much. A car accident in June has left him in a very bad state, physically and emotionally. He’s been intensely depressed and has required multiple surgeries. He still can’t walk very well. Maybe he’s fixating on the house sale needing to be undone because it is more feasible than undoing the car accident. He’s clearly connected them in his mind. He repeatedly reminds me about the coincidence of the names: The driver of the car that crashed into his in Ireland and the real estate broker who has sold his beloved green house share the same common Irish name, which he weaves into the tapestry of his obsession. It’s all been too much for him to handle, and he seems to be unraveling.
I can barely get a word in edgewise until I ask him, “Spalding, have you turned on your TV today? Do you know what’s going on?”
“What? What are you talking about?” he asks.
I hear Kathie in the background yelling at him that the World Trade towers have fallen.
“There are other things going on in the world, Spalding. Big things. Bigger even than your house, maybe. Go see what Kathie is talking about. Call me later, okay?”
I hang up and think for a moment about my compartmentalized life, the four bags in my closet that segregate Bellevue and Manhattan from my country house, my work days from my days off. My little plan is not exactly working today as Spalding’s mania crashes through my barriers, as I putter around my house feeling like I should be at CPEP. And Spalding has breached some boundary too, crossing over the line from neurosis to outright mental illness. I need to call Kathie later to create a treatment plan. He needs more help than I’m comfortable providing.
I try to get Daniel on the phone to see if he wants me to come in, assuming it’s total chaos at Bellevue by now. I spend the next thirty hours trying to phone in to work. All circuits are down. A fast busy signal with every number and every pager I try. We also can’t email anyone; the dial-up keeps getting stuck at “authenticating.”
Weekends at Bellevue Page 21