Weekends at Bellevue

by Julie Holland

  Doctors are supposed to alleviate pain. Psychiatrists are meant not only to soothe the despair and hopelessness that a depressed person experiences, but also, I have come to realize, to prevent the pain of the ones who would be left behind. This means I must do all I can to prevent the leaving.

  Hole in the River

  January 2004. Kathie Russo calls me in the morning on my cell phone, just before I’m leaving the hospital. She should sound frantic, yet her voice is somehow friendly, as always.

  “Spalding’s missing again.”

  “Oh, no …” I say.

  “Can you find out if he’s in the ER there, or …” she trails off.

  The morgue, I think. “Sure. I can ask them if they have any John Does. You want me to call the medical examiner, too?” I ask as casually as I can.

  “Yeah. I guess so. I think he’s really done it this time. He left on Saturday night, saying he was meeting a friend for dinner, but when he didn’t come home I called his friend. He didn’t have any plans with him. And Spalding called Theo to say good night around ten o’clock, but he never came back. He left his wallet here.”

  “Boy, that doesn’t sound so good, Kathie, leaving his wallet.” I don’t say the word: suicide. Spalding has been talking about it for years, and he’s made several attempts since I’ve known him. There was that time on the bridge in Sag Harbor in September of 2002. He didn’t jump. That’s what EMS calls a “bridge up,” as opposed to “bridge down.” (There’s also a “hang up” and a “cut up,” more ways to trivialize the event, surgically removing its gravity.) Then there was another time when he actually did jump off the bridge in October of 2003. And the time he walked into the ocean fully clothed. He’s left suicide notes in the past, or a message on the answering machine saying he was going to jump off the Staten Island Ferry. But Kathie says this time there’s no note.

  “I don’t know what to think. All I know is, if he did it, or if he’s just pretending he did it … I don’t think I can do this anymore.”

  “I know, Kathie. It’s horrible, what he’s putting you through. And the kids. It’s not fair. He’s been miserable for such a long time. But I thought he was getting better.” Again, I don’t say what I’m thinking, which is that it’s when depressed people get a little bit better that they finally have the energy and the wherewithal to complete the suicide they’ve been contemplating. “I’ll call the ER and the ME’s office and call you back if I find out anything.”

  I call the AES and ask if they have any unidentified white males in their sixties. They don’t, and I dial the city morgue next. They’re on the next block, just north of Bellevue, and I’m tempted to walk over there. It’s probably easier than getting someone to pick up the phone, if it’s anything like Bellevue. I’m placed on hold, and I really have to pee. I dance around my office with the phone cradled in my neck. I’m six months pregnant now, so I have to use the bathroom every few hours at least. It’s hard not to think about Spalding’s kids while I’m waiting. I imagine they’re all sitting around, watching the door, hoping he’s going to walk in so everything can go back to the way it was before.

  Only it hasn’t been the way it was for years. Kathie has been through hell dealing with Spalding’s depressions, and there have been a handful of phone calls to me along the way, especially since his car accident in Ireland the summer before 9/11. He had two psychiatric hospitalizations in 2002, the first at Silver Hill in June and then at Cornell in September. The Cornell admission lasted for months and months. I remember Kathie calling me to complain how she couldn’t get them to release him, because Spalding wouldn’t tell them he wasn’t suicidal anymore. Basically, he was, and he didn’t know enough to lie. I bet his Cornell psychiatrist knew what a lot of us pushed to the back of our minds: He was absolutely going to kill himself eventually.

  For the next few weeks, I drive home on Sunday and Monday mornings, my car covered with snow, heading north on the FDR, the East River on my right. Spalding’s out there somewhere, I think as I glance at the ice. If he did jump off the Staten Island Ferry, then his body is most likely in the East River because of the currents. And all the evidence is pointing to the Staten Island Ferry. The call to Theo came from the terminal there. Someone who works on the ferry reported that they saw him the night before, on Friday night, when he placed his wallet on the bench and walked over to the boat’s railing. Maybe it was a dry run, or maybe he just wasn’t quite ready, but I’m afraid he did jump into the river the next night. The police tell Kathie that his body will probably turn up in the spring, when the ice thaws. I think about that every time I drive home.

  It’s odd to think of him drowning. He’d have to purposely try not to swim. All of his suicide attempts involved water, jumping off of bridges, walking into the ocean, letting his sailboat drag him while he hung onto the rudder. I don’t know why it had to be in the water, but it seemed like it was crucial to him. I know he can swim; I’ve gone swimming with him up at our lake house. Right after I got married in the summer of 1999, Spalding and his two sons came by for the afternoon. Theo, who was probably four back then, jumped off the dock over and over again, wearing a swimsuit with built-in Styrofoam floaters. I picked up Kathie at the train and we all had dinner. I remember that we talked about JFK Jr. That was the day they found his body.

  A few summers later, we went to visit them at their lake house. Molly was three. I had taken her to three lakes in three days, but Spalding’s lake was by far the best. I remember how crystal clear the water was, and how the fish swam right up to us, unafraid. We sat with Spalding on the shore, but it didn’t seem like him anymore. He had changed so much since the car accident. He was silent, morose, horribly depressed. The neighbors came by to say hello and Kathie did most of the talking. I remember wondering if he was aware of how elderly and frail he appeared. When he went out on the deck to start the fire for dinner, he tripped on the bag of charcoal. He was having a harder time walking because of his foot drop, a result of the accident. None of us said anything, but my heart lurched as his body did. He had aged so much in two years.

  I should’ve thought that there was a connection between the car accident and his depression, but it never occurred to me. Spalding had such a complicated picture: a lifetime of obsessive neurosis and existential angst, which blossomed over time into something that looked more like bipolar disorder. After the car accident, his symptoms became much more intense, and I should have realized that he had a head injury in his frontal lobe, and that this was the likely culprit causing his psychiatric symptoms. Maybe if he had come to me as a patient in my office instead of talking to me as a friend, I would’ve been able to pull back and see the big picture. But I had been reluctant to treat him, referring him to a colleague instead. It was only when Spalding saw Oliver Sacks later in the fall and gave him his whole history that the decision was made to put him on Lamictal, a mood stabilizer that is more appropriate for head injuries than many of the other medications that had failed to bring him back around.

  And then for a while it seemed that he was doing much better. He was working on a new monologue about the accident and its resultant depression. But somehow it just wasn’t enough. He was still hell-bent on drowning. That Saturday, before he jumped off the ferry, he saw the movie Big Fish with his sons at the theater right around the corner from my office. At the end of the movie, the father goes into the ocean, turns into a fish, and swims away. Maybe Spalding decided that film had finally given him permission, or he wanted the boys to see it to understand what he was planning.

  In early March, when the ice thaws, Spalding’s body turns up on the shoreline in Brooklyn, and it is as if he has died a fourth time, after the car accident, the debilitating depression, and the presumed suicide.

  Jeremy and I go to the memorial at Lincoln Center; it is standing room only. Kathie has done a great job organizing a dazzling turnout of eulogizers. Spalding was, above all else, an amazing storyteller, and it is a fitting tribute to him that the evening i
s full of entertaining tales of his talent as well as his titanic struggle with depression. There is just the right balance of laughter and tears.

  It is nine days before Jojo is born, April 13, 2004. I am ungainly, as I was when I danced with Spalding at the Harper’s party the night before I gave birth to Molly. I am glad I get to see Kathie again, before the delivery, and to feel Spalding’s presence again for a moment before my second child is born. It feels like a blessing, somehow.

  God Put a Smile Upon Your Face

  Monday morning and I have twenty minutes until sign-out. I waddle to the coffee shop to pick up my breakfast, walking through the ambulance bay. It’s a busy morning in the AES and there are three stretchers waiting to be triaged, each with two EMS workers in attendance. A drunken, gray-haired man with a bloody nose, his face red and raw from the sun, is telling his female ambulance driver, “I don’t usually look this bad, you know,” as if he’s hoping there’s a chance he can ask her out. “I know you don’t, sweetie,” she soothes.

  There is a large woman on a stretcher, her shirt open, the dark hairs leading to her pelvis exposed. She is talking loudly, rapidly into her cell phone, “I was up all night working on my screenplay. You know the one Spielberg’s directing?” With a short wave, I get the triage nurse’s attention as I am walking by. “This one’s ours,” I mouth, and smile. She smiles back and nods vigorously. Evidently, she’s figured that out too.

  As I return to the CPEP with my brown paper bags full of breakfast, the screenwriter has already made her way to our area. She is sitting on one of the green interconnected bucket seats, still talking on her phone, which she won’t hand over to the hospital police officer. He asks her again, and she states imperiously, “Do you mind? I’m talking to my agent!” and then hisses into the phone, “I said, I’m at Bellevue. Come down and get me out of here, now!”

  The HP tries to explain the no cell phone policy, and so she turns to leave, saying, “Okay, then. I’ll use my phone outside.”

  I interrupt, and explain to her that she needs to stay to be evaluated. “Since you were brought here by ambulance, you can’t leave this area until you’re seen by a psychiatrist.” I have lain down the gauntlet.

  “Are you from West Virginia?” she asks me, out of nowhere.

  “No,” I reply. “Why?”

  “They do a lot of inbreeding down there.”

  I stare at her dumbly.

  Zing.

  I break into a wide grin, score one for her in the air with my finger, and spin around on my clogs. She’s not going to be my problem today. I’m getting ready to sign out, saving her for the day staff. Ahhh, shift work.

  I take my breakfast into the nurses’ station, and set up my food before we do sign-out rounds. The phone rings. It is my pal Dr. Robert, an attending from the inpatient wards who occasionally moonlights in the CPEP. He calls everyone “baby.” (I have another Bellevue friend who calls everyone “lovey.”) I think it’s cute. Moreover, I think he’s cute. Before I met Jeremy, he was my number-one Bellevue crush. Especially when he would come into work on his Rollerblades. He actually skated through the hospital to get to the CPEP. I loved that.

  “Julie, baby, how are you?” he says, sounding like a Hollywood agent.

  “Great, I’m as big as a house and I pee every two seconds. I’m going out on maternity leave any day now, taking four months off, not that it pays. You’ll think of me while you’re working, I hope? All summer, I mean?”

  He takes it in stride, barely skipping a beat. “Oh, you … Of course, of course. Listen, can you sign out something for me this morning? Make sure Maxwell hears it, okay? We’ve been having a lot of problems up here the past few weeks, and I keep forgetting to tell you guys.”

  “What is it?” I ask.

  “You gotta only send us ‘bloods,’ or ‘crips,’ not both.”

  “Come on, really?”

  “No, I’m totally serious! We’re having like mini gang-wars up here.”

  “You think we should designate your ward as a ‘crip’ ward and we can do 18 North as a ‘blood’ ward?”

  “Whatever it takes, but I’m telling you, it’s for real. Only bloods or crips. Not both. Sign it out.”

  “Okay, boss,” I say, getting ready to hang up. I have no idea how true those words will become. After I leave Bellevue, he’ll become the next director of CPEP, the third replacement since Lucy died.

  When I Get Home

  I deliver Jojo even more rapidly than Molly. He is pushed out just twenty minutes after arriving at Mount Sinai. He has an old-soul look in his eyes, and his face resembles nothing as much as a squished-up elderly man, more from Jeremy’s side of the family than mine. I spend the first few days feeling like I’m nursing my father-in-law.

  I take the summer off from work, and the four of us spend most of it on Cape Cod. By the end of August, I am dying to return to the hospital.

  “I can’t wait ‘til I can get back to Bellevue and have a little peace and quiet,” I say to my friends. The irony of deeming CPEP a calm oasis is not lost on me or anyone else. “At least there, I’m the boss,” I explain. “When I ask someone to do something, it gets done. They don’t whine or throw a tantrum. Or, if they do, at least I can medicate and restrain them,” I joke.

  I find I’m losing my patience easily with Molly these days. She is reacting to a new baby in the house by testing limits, defying my authority (such as it is), and being oppositional on a daily basis. I remember one of my patients in my private practice warning me when I mentioned her age, “You know, everyone talks about the terrible twos, but no one warns you about the fucking fours!” I take solace as I hear from mother after mother that four is a particularly difficult age, a miniature adolescence full of rebellion and drama. At one point, we are wrestling on the sand in front of the beach house as I whisper harshly into her ear, “I am in charge. You are not in charge.” I am eager to go somewhere where I can have more control over my environment.

  It is September of 2004 when I return to CPEP. As I walk through the ambulance bay doors, I’m so overwhelmed by a sense of homecoming that I can practically smell the turkey. I bring pictures of the kids, and the nurses are appropriately appreciative of their good looks, and they make sure to tell me how thin I look, God bless them.

  And then there’s Chuck, who has always made fun of how big my butt is, whether I was eating for two or not. When I was pregnant the first time around, he would measure the width of it and then record it on the wall under the clock. Using a long envelope typically used to store chest X-rays, he would hold it up behind me when I wasn’t looking and then mark off my dimensions, making two little blue pen marks on the glossy beige surface of the wall. When I get back from maternity leave, despite the nurses’ compliments, he remeasures and compares the width to show me it actually isn’t any smaller. Thanks, pal. Maybe we can paint these walls sometime soon?

  “Julie, we are so glad you are back here with us.” Nancy’s beefy arms open warmly to greet me.

  “I don’t know, Nance. It’s been a while. It may take me a bit to get back up to speed.” I am particularly worried about the computer, entering orders and retrieving data. Do I remember my password, or the cumbersome twenty steps necessary to enter an order for a chest X-ray?

  “Oh, it’s just like riding a bicycle. You never forget. You’ll be T-and-R-ing like the best of ‘em in no time,” she assures me.

  I look out the triage window and see some neatly groomed men, all dressed alike.

  “Looks like an FBI case is coming in. See those blue jackets? And those haircuts! These guys are like clones!” I walk out to investigate.

  “Good evening,” I say, welcoming the men to my home away from home. “I’m Doctor Holland. What’d you bring me?”

  “Mr. Rocket Scientist here thought he’d build himself a pipe bomb. He was barricaded up inside a makeshift structure with the bomb. We’re not sure if he was trying to kill himself or take a lot of people out with him.”

&
nbsp; “Oh, and I didn’t get you anything!” I joke with the G-man. It’s my oldest bit, well-worn from years of triage banter, and it feels good to slip back into it like a favorite sweatshirt. The federal agent, against his better judgment, cracks a smile.

  Rita registers the patient and asks for the old chart. When it arrives, I see he’s got a history of a few prior suicide attempts. Once, he overdosed on drugs and was in a coma for several weeks. Another time he shot himself in the chest with a nail gun, requiring surgery. The second one is the red flag. I spend the next ten minutes lecturing the medical student on what sorts of things should make you think of psychosis instead of garden-variety depression when you evaluate suicide attempts.

  “People who stab themselves or create elaborate devices to kill themselves are more likely to be psychotic than those who overdose on pills, slit their wrists, or hang themselves,” I explain. “In general, the crazier they are, the more bizarre and unreliable their suicide plans.”

  Our suicidal bomber needs to be evaluated, per the FBI, to make sure he isn’t homicidal. I spend some time with him, allowing the medical student to ask most of the questions. After he details how he spent three months constructing the barricade to assure that no one else would be hurt in the explosion, I know the FBI can go.

  Once I’ve tucked away the bomber, I meet my next patient, a Trump Tower trust-fund guy who’s staying at the Plaza while they work on some water damage in his apartment. I don’t know what it is about the Plaza Hotel, but they sure end up sending us a lot of business. They might as well have a CPEP shuttle for their guests. People in a manic phase of bipolar illness will go there and hole up for weeks on end, burning through tens of thousands of dollars as they get more out of control. Other folks will check in there prior to suicide attempts. The Plaza is a classy joint, and I guess some people prefer opulent surroundings just before they end up at Bellevue. Most important, it turns out rich people can go crazy too. Being loaded doesn’t insulate you from mental illness. You can come from the Port Authority bus terminal, or you can come from Trump Tower. Bellevue, like insanity itself, is the great equalizer.