One Friday in April

by One Friday in April (retail) (epub)

  I stumbled downstairs and out of the building. I stuffed keys, cash, and my meds in my pockets, and called a car. The subway was too risky. I would press myself against the platform wall and hyperventilate.

  I gave the driver the address, an orthopedic clinic on the Upper East Side, not far from the apartment where I lived in my twenties, back in the time when my mother was getting sober. There’s a hospital not far from my apartment in Brooklyn, but it didn’t occur to me to go there. On the ride into Manhattan, I lowered the window and felt the air.

  When I was a boy, I got carsick. The time that I remember most clearly was in the Smoky Mountains, on hairpin turns outside Asheville, North Carolina. My grandfather was driving, and my grandmother sat beside him, my mother’s parents. My sister and I were in the back seat. I must have been seven, going on eight, and Terry six, going on seven. Maybe it was 1965. I looked out the window at trees and valleys, and I could feel the motion of the car. The car was white, with red upholstery, and we were on a trip, and my grandfather liked to speed; and then my grandmother turned and reached back to hand me an apple. It was a yellow apple. The apple was mushy and dry, and the road wound left, right, up, down through the hills. Now, as I write this, I wonder where we were going, where we’d been; and it seems to me that this was a time when our grandparents took my sister and me from our mother and father. We were heading across the mountains, then south to Sarasota, to the house on Wisteria Street. We’d visited Tennessee relatives. Our parents’ marriage was ending. I threw up on the seat, and my grandfather stopped the car. He and my grandmother put down towels, and my grandfather told me that if I got sick again I could stick my head out the window and breathe, and I’d feel better.

  The clinic was busy. It was a big modern place. I barged up to the desk. The receptionist asked if I had an appointment. I said that I needed a doctor, and she asked me the problem.

  “My shoulders.”

  “Your shoulders?”

  People behind the reception desk turned and whispered. I was shaking. I hadn’t shaved. I’d got skinnier since my weekend at the hospital, and my clothes were big on me, like clown clothes.

  I remember the receptionist telling me that there were no free appointments, but that I could make one for another time. I pleaded, “It’s important! Can I talk to a doctor? Isn’t there a way?” My throat was tight, and my mouth dry. Did I look decent? Was I shouting?

  She told me to wait.

  I sat in the waiting room. Was I holding a clipboard, a pen? The waiting room was quiet.

  A doctor appeared. He was young, and wore a white coat. Would I please accompany him down the hall?

  We went into a room. I didn’t climb onto the examination table, and the doctor didn’t sit on his rolling stool. We faced each other. He seemed wary. He asked me the problem, and I said, “It’s hard to describe. It feels like my arms are falling out of the sockets.”

  “Both arms?”

  I was breathing fast. My heart was beating fast. “It’s more on the left.”

  “Can you rotate?”

  I swung my arms in the air. I told the doctor that if I raised and brought my arms too far back the shoulders might dislocate.

  He briefly poked and manipulated, going through the motions, and said, “I’m not finding anything out of the ordinary.”

  “There is!”

  He took a step back and said, “You’re welcome to make a regular appointment. But I don’t think there’s anything wrong with your shoulders.”

  He told me that he had other patients to see. “Let’s go,” he said, and then led me back along the hall, past the reception desk, and across the waiting room. People watched. The doctor held the door, and then quietly shut it behind me. I rode the elevator to the lobby. On the street, I called my friend David, who lives in Nyack, twenty miles up the Hudson. David had stayed on the phone with me through the winter and the spring, listening patiently to my jagged talking. I raged to David about my physical condition, and he screamed, “Why aren’t you in a hospital? You need to be in a hospital!”

  I thought of Anne. We’d been friends in college. She was a year behind me. She’d gone to medical school and become a psychiatrist, and I recalled hearing that she practiced at Columbia Presbyterian, at Broadway and 168th, near the George Washington Bridge and the top of Manhattan. I didn’t phone her that day after leaving the clinic, but the next day, or maybe the day after, I got in touch with Anne, and she told me that she was an inpatient doctor, and that she worked in Columbia’s psychiatric emergency room.

  I was on the little sofa in my living room. I told Anne about the Klonopin and the Ativan, Regan and the roof, the infantilizing doctor and the Brooklyn ward; and I promised her that I was not thinking of hurting myself, though dying was my only thought. I did not need a hospital, I told Anne. What would happen if I told the truth?

  She said that I sounded sick. She told me to come to Columbia Presbyterian. They’d take care of me, she said; they’d help me get better. She told me that it was dangerous for me to stay out on my own, that I’d be safe in the hospital, and that I needed treatment. What did she mean, treatment? I told her that I would consider what she was saying. She then gave me the phone number of a colleague in private practice. The colleague’s name was Dr. T.

  “Everyone respects her,” Anne told me.

  Dr. T’s office was on the Upper West Side, in the nineties, near Central Park. Diplomas hung on the wall above a desk. Freud’s works, the Hogarth Press Standard Edition, sat in faded blue jackets behind glass doors in an antique bookcase, and there was a fainting couch for patients in analysis, a touch taken from Freud’s Vienna consulting room. The doctor sat in the corner, near the window, writing notes in a pad. I sat in the middle of the room, in an armchair. The upholstery was frayed. The doctor warned me that I was in danger, and that damage and harm would accrue and intensify. She meant brain trauma. She told me that if I stayed out of the hospital I would die.

  Later that week, on a Friday, I called a car and asked the driver to take me to 168th Street and Broadway. On the drive, I phoned Regan, my father, and my friends, and told them where I was going. Like many active alcoholics, my father had an undeveloped concept of psychology. He told me, though, that he had called a psychiatrist in Fort Worth, and that the doctor had assured him that I would be in good hands. I told my father that I hoped that the doctors had all the king’s horses and all the king’s men.

  I felt calmer in the car than I had at home. I breathed more easily. It was a clear day. The Hudson River was on the left, and I could see the George Washington Bridge ahead in the distance. The trees in Riverside Park were green. Cyclists rode on the bike path beside the highway. I hadn’t planned; I’d taken some things, my keys, some cash, but not much. I’d stopped writing and reading long before, and hadn’t bothered with a book.

  The car stopped in front of a building made of stone. I saw doctors, nurses, and ambulances. There was the emergency room. I paid the driver, got out of the car, and walked toward the entrance. Five weeks before, an eternity before, coming down the stairs in my socks, down from the roof, I had had the feeling—it was a sense of my future, perhaps—that there was more to come, more and worse, and that I would be put away, always and forever.

  I remember waiting in the emergency room. I sat bowed over, my head in my hands and my elbows on my knees. Eventually a nurse came and took me to a door that had a policeman standing outside. It was a wooden door. This was the psychiatric emergency room. The policeman knocked on the door, and a second policeman, waiting inside, opened it.

  The psych ER wasn’t a big space. There was a reception desk, an area with five or six cots, and a few small, private rooms. One was mine. It had a small, hard bed. Anne was on duty. She told me that she was glad that I was there, but that it might take a few days to get a room. Then Regan arrived. She sat with me while I signed the papers granting the hospital the right to hold and keep me, even against my wishes, were it necessary for my safety o
r the safety of others. Then it was time for her to go. I curled up on the bed. There was always a policeman nearby. I wore a hospital gown. I ate the food, swallowed the pills, slept, and waited for a bed on the ward.

  That first night, people came. It was the middle of the night. I was deep asleep. Hands and arms lifted my body from the bed. Then I was going somewhere, moving through hallways. Was I in a wheelchair? Sometimes my eyes were open. I heard voices and machine noises. A voice said, “He can go back now.” I learned in the morning that I’d had a CAT scan.

  I remember a woman. She looked like she was my age, in her mid-forties. She had long red hair. Her husband had driven her to the hospital from their home in the Catskills. She had dark rings around her eyes. She’d nearly died of suicide. We talked, and I told her that I hoped she’d stay in the hospital. Should she commit to treatment? What would happen? How long would she have to stay? She wanted to go home. Might she be all right at home? I suggested that she stay and be safe. It’s possible that I was trying to believe that I was safe. Maybe, had she made the choice that I made, the choice to submit to life as a patient—maybe then we both would have felt less forsaken. We could be allies. But her husband came to get her, and they left.

  The next morning, Monday morning, Anne told me that a room had come free, and a while later a man arrived with a wheelchair. I sat in the wheelchair, and a policeman opened the door to the general emergency room. The man behind the wheelchair pushed me through the hospital. We went up in an elevator, and then across a skywalk to another building, and from that building across another skywalk to the New York State Psychiatric Institute, a place I’d never heard of. We went into an elevator, and got off on the fifth floor. At the end of the hallway was a door. The door was made of steel, like the one in the Brooklyn hospital, and had a small window. A nurse inside unlocked the door, and the man rolled me onto the ward. He held out papers for the nurse. I recall that the nurse was Nurse D. She was head nurse.

  I stood up from the chair, and Nurse D showed me around. She showed me the nurses’ station; the medication dispensary; the activity rooms; the dining room; the little gym with a stationary bike; the telephones; the quiet room, empty except for a mattress on the floor, where patients can cry or rest undisturbed; and the medical examination room; and the patients’ common room—everything except our bedrooms, down a hallway that was locked in the morning, and kept locked until after dinner. We were not allowed to linger in our beds. The common room was furnished with sofas and chairs, and a television that blared, and a computer for patients’ use. I spent many days lying on a sofa. I had a canvas bag, and every day I carried personal items, a sweater for when the air conditioning got cold, a toothbrush and toothpaste for when my mouth got dry. The bag was black. I used it as my pillow. I wasn’t reading. I took my glasses off and put them on a table, and then stretched out on a sofa and tried to sleep. Every twenty minutes, throughout the day and night, a nurse counted us, all the patients, noting our locations, checking on us. Were we safe? Anything sharp was forbidden. Sharp objects were known as sharps. Patients who cut themselves on a sharp, or who showed, as it were, active engagement in dying, who somehow managed what the hospital called an attempt, were shadowed, everywhere they went, and at all times, by an attendant. The attendant will not leave the patient’s side, even when the patient is sleeping. The practice is known as constant observation. We called it CO. I have heard of nurses tying themselves to their patients with pieces of string, just as a precaution.

  Twice a day, a nurse called out, “Fresh air!” This was when we left the ward and went downstairs to sit or smoke or walk around in a yard. The yard was circled with tall chain-link fencing, and had a patio with a picnic table. You could see the George Washington Bridge to the north. It was a struggle for me to go outside, just as it had been a struggle to leave my apartment, and I often stayed upstairs. I could look out the windows.

  The hospital itself, at 1051 Riverside Drive, is a modern building, clad in green-tinted glass. It has the shape of a boat. It is not a tall building, but you can glimpse it, right behind the trees lining the West Side Highway, if you look closely as you drive past. There were several wards at the Institute, one dedicated to schizophrenia and other strong psychotic illnesses, another for residents of the surrounding neighborhood, another for children and adolescents. The ward that I was on was called the General Clinical Research Unit, or GCRU. The mission of the Institute is research, and many of the patients in the GCRU were volunteers for clinical trials of new treatments. We were a broad mix of people with chronic or acute psychotic symptoms, eating disorders, and heroin addictions. The addicts had come to get clean, and to perform cognitive testing. We all had blood pressure tests, blood draws, weight checks, physical checkups, medications, counseling with our doctors, conversations and walks through the corridors with nurses, and visits from family and friends. I think that there might have been about twenty-five of us in the GCRU. I was not on a research protocol. I was a clinical patient, admitted because I was in need. There were a handful of us with clinical status, and we became a circle within the larger group, wishing each other well, consoling, checking up, hoping for happy outcomes, saying good luck when it was time for one of us to discharge, good luck, good luck out in the world.

  I recall a woman in her twenties called Sarah. She seemed listless and enervated, and often sat without moving. She spoke in a monotone whisper. She confided that she had survived suicide several times, and been in and out of hospitals since she was twelve, when her parents divorced. I don’t recall anyone visiting but her father. Was her mother alive? Sarah and her father sat at board games, hunched over the table.

  Thomas was young too. He’d come from a southern state, and was taking Prozac. He was anxious, agitated. Shortly before he was to leave the hospital and return to his family, he was placed on CO. Nurses sat beside him on sofas, and in the dining room while he ate. A nurse sat beside his bed at night.

  And there was Kathy. Kathy was my age and single. She lived on disability assistance, and did not hold a job. Like Sarah, and like Thomas, she had few visitors. She and I sat together. Her conversation was limited to illness and its consequences. She frightened me; they all did, with their stories of past admissions, drug loads and side effects, their perilous lives. Would I become one of them? Did I belong among them? Had I always belonged among the sick—ever since the night I was born, when my grandmother took me from my mother, wasn’t fed her milk, wasn’t given touch? What happens to children who are neglected? We don’t understand, as children, that our loneliness and lack of care will become a fate—a loneliness that we will feel all our lives.

  My doctor’s name was Dr. A. He was in his mid-thirties. He wore a tie and a white coat, and was always harried. He told me that a whole team would take up my care, doctors, nurses, residents in psychiatry, and social workers. He promised that they would get me better, that they wouldn’t give up, and that I would be safe. I sat in the common room and gazed out over the Hudson. The sun was setting over New Jersey, and the river shone in the light. It was evening. Regan had come for visiting hours. She’d brought toiletries and clothes, pants and shirts, underwear and socks. Nurse D sorted the things that I could keep in my room from the things that I couldn’t. What I couldn’t keep, she locked away. She kept my razor.

  I wouldn’t have used it, I might have told you, not for suicide; and I might not have, not in those first days. I felt relief, after finally arriving on the ward, and even anticipation. I think that I felt these things because I was out of immediate danger. I was out of harm’s way, as we put it—my own harm to myself. The ER had been scary and difficult, but the ward was open and light, and people were about. I could not relax my muscles, or walk a straight path down the hall, and I believed that my life was ruined and that I would be locked away, but I nonetheless could not easily die in the hospital. Maybe you’ve spent some time trying every day not to die, out on your own somewhere. Maybe that effort became, or has become,
your work in life. Perhaps there is help from family and friends, all the people who don’t quite understand that when you tell them that they will be better off with you dead, you are speaking a truth. Maybe you’re alone in a room, lying on a bed, and your chest is tight and your breathing shallow; you feel afraid to move, and sleep two or three hours each night, and then wake up in fear. Maybe you pace. Maybe you keep pills in a jar or a drawer, or hidden behind a box in the closet. When I was on the roof, I was terrified of the hospital. Who isn’t scared of the hospital? We know, or think we know, its histories of lobotomy, shock therapy, and mind control experiments. We know to avoid the hospital.

  Most days on the ward are pretty much the same. Shortly after admitting to the Institute, after my team of doctors had looked, listened, consoled, questioned, and taken notes on me, I began an eight-week drug trial. The drug was nortriptyline, an older-generation medication that affects norepinephrine and serotonin levels, though not as dramatically or as effectively as the newer SSRIs and NSRIs, Prozac and Effexor, for instance.