Black Man in a White Coat (25 page)

Hearing someone scream, I jogged to the rear area where the psychiatry patients were held. This space, like virtually all hospital psychiatric areas, was a locked wing, this one modernized in requiring a bar-coded ID badge rather than a clunky key to come and go. I pressed my badge against the sensor, turning the light from red to green. This allowed me five seconds to open the heavy wooden door before it automatically locked again.

Inside, there were two small seclusion rooms to the left, where the most ill and dangerous patients were housed while recreational drugs cleared their systems or our tranquilizing ones took effect. To my right, a large open area was divided into several small cubicles, each consisting of a lounge chair bolted to the floor and a television secured to the adjacent wall.

Lonnie was in the first seclusion room, screaming. He paced back and forth in the confined area with the urgency of a drug addict in need of a fix, but if his records were any indication, his problem had nothing to do with drugs. Over his thin frame he wore a T-shirt and sweatpants that had several holes of varying sizes and were blotched with paint stains. His thick hair and scraggly beard both looked uncombed and unwashed.

“This is racist shit,” he yelled at the two police officers who stood outside the partially opened metal door. “That motherfucker tries to infect me with Ebola and I get locked up? You gonna let him kill all the niggers in Durham, ain't ya?”

The older police officer, a gray-templed New York transplant with broad shoulders and thick biceps, stared at Lonnie blankly. His younger colleague shook his head in disgust. Everyone Lonnie had encountered thus far, from the police officers who'd brought him in to the nurses and emergency room doctor who'd seen him, was white. Even the on-duty nurse's aide (most of whom were black) that day happened to be white. Like Chester, the racist white patient who encountered one black staff member after another, Lonnie picked the wrong day to get sick.

“I'm gonna sue all you crackers for this,” he screamed, as spittle sprayed in several directions. “You just wait. I'm gonna get Johnnie Cochran and Al Sharpton and Jessie Jackson to come down here and put your white asses out of business.”

“I can't wait,” the older officer said sarcastically. “I need a new job anyway.”

Medication is the staple treatment for acutely psychotic behavior. In the emergency room and psychiatric hospital, it often comes in the form of a needle in the rear end. The psych nurse, Suzanne, a brunette in her mid-forties, had already drawn up the tranquilizers—a mixture of Haldol and Ativan—into a syringe. In these settings, this combination was to agitated psychotic patients what insulin was to diabetic patients. Even the proportions were standard. Haldol was given in a dose of 5 milligrams, while Ativan was given in 2-milligram doses. So common was this cocktail at the places I worked that doctors and nurses simply referred to it as “five and two”—shorthand that communicates as quickly in a hospital as “I'll have a Number two” does at the fast-food restaurant drive-thru window when a customer orders a burger and fries.

Unless patients were trying to escape, or presented an active threat to hurt someone (including themselves) or to destroy hospital property, I liked to at least make an attempt to talk to them before they were held down by police and stabbed with a needle. Despite all of his paranoia and aggressive words, my instincts told me that Lonnie understood he had no chance of getting past the burly officers. Whether that meant he would agree to take medications on his own, however, was another story. But I thought it was at least worth a try.

When I came into his line of sight, Lonnie, who'd been cursing at Suzanne about how she was trying to poison him, stopped talking. His eyes lit up. He smiled the ragged smile of someone with several missing teeth. “Michael Jordan,” he said.

Lots of people had said that I resembled Jordan through the years. A dollar for every time I heard this comparison would have financed a short trip to Jamaica, dining and hotel included. But maybe Lonnie, with his delusional mind, thought I
was
Michael Jordan.

I stood hesitantly at the entrance to the seclusion room. “My name is actually Damon.”

He studied my face closely. I wondered what sort of bizarre and disconnected thoughts were dashing around in his fragmented mind. Should I have just played along?

“But you related to him, right, man?” he asked.

“Not that I know. But a lot of people have said that I favor him.”

“You play ball too,” he said, more a statement than a question, while excitedly mimicking the motion of a jump shot. He stuck out his tongue like Jordan did so many times, only Lonnie's was covered with a scaly, thick white film that looked like part of an ongoing infection.

I would have much preferred people to think that I looked like Jordan on the basketball court rather than in street clothes, but that never happened. Not even once. “I used to play a bit,” I said. “But I don't have much time anymore.”

Lonnie's jagged smile faded. I had dampened his fantasy. He glanced over at the two police officers who stood behind me.

“So, can you tell me why they brought you here, to the hospital?” I asked.

Lonnie looked at the officers again. I turned around. Both had their arms folded, which accentuated their biceps. Both wore latex gloves, something police often did around psychiatric patients in the emergency room, on the chance that they might have to grab and restrain the patient at a moment's notice. The psychiatrists and nurses usually didn't get their hands dirty.

“Can you give us a little bit of privacy?” I asked.

The older cop gave me an “Are you sure about this?” look. When I nodded, he shrugged and motioned to his partner. Both of them stepped back about twenty feet toward the center of the room. Suzanne went with them. It was more symbolic privacy than anything real.

Lonnie started a loud, rambling story about his neighbor trying to infect him with Ebola. Apparently this neighbor was in cahoots with the property manager to make all of the black people at the apartment complex deathly ill, as if a virus like Ebola could somehow be confined in such a way that it would only make the black residents sick. There had been news reports at the time about poorer blacks in the area getting displaced by affluent whites through urban renewal projects, or gentrification. So there was a kernel of truth to Lonnie's paranoia. However, his schizophrenic brain had distorted that reality into a delusion.

Although I'd been training in psychiatry for just a few months, this was sufficient time for me to know that there was no point in trying to use reason to convince him of what was real. That approach usually made things worse. He couldn't go back home, so I had to figure out how to get him calm while we processed his transfer to the state hospital, where the severely ill and aggressive patients went. The only other option would have been to have the police take him to jail for setting fires and throwing knives at people. But once he got there, from what I'd seen done before, they would simply have sent him back to us. He needed medication.

I glanced back at the police officers and Suzanne, who awaited my direction. I told them that I needed a few more minutes, then turned again to Lonnie. Leaning down slightly to minimize our height difference, I spoke slowly and softly, hoping my voice and mannerisms might help calm him. I tried to put myself in his place and imagine where his mind might be traveling. The first feeling that came to me, surprisingly, was power: “It sounds like these white people around here are a bit scared of you,” I ventured.

“Yeah,” he said, smiling again. “I want to make them all shit on themselves like babies.”

I laughed—because of the absurdity of his words, but also because Lonnie was tapping into a familiar sentiment I'd heard so often. I used that familiarity to dig into what I'd long thought was a source of that attitude: “You also seem a little scared too. I get it, man.”

Lonnie broke eye contact, bowing his head so that his chin almost touched his clavicle. His hands quivered slightly. For a second or two, I worried that I might have said the wrong thing, something that could make me the target of his racial delusions. I took a step back. But he had no more fight left. He looked defeated, embarrassed, and ashamed.

“Yeah,” he said. “I need to get some sleep, man. I'll take those pills. They ain't so bad. You don't need to give me no shot.”

I spun around to see if Suzanne had heard Lonnie, as he'd never lowered his voice enough to keep her and the officers out of earshot. Her jaw dropped ever so slightly. She looked at the capped needle and syringe in her right hand before her eyes darted back up to meet mine. “So, you don't want to give him the shot?”

“It sounds like he'll take the pills,” I said, turning back to Lonnie. “Is that right, sir?”

Lonnie nodded. Suzanne scurried toward the locked door and used her ID badge to get back to the nurse's area where the medications were stocked. She returned moments later with two small individually sealed tablets in one hand and a tiny cup of water in the other. She popped the foil and plunked them into his hand. Lonnie swallowed the pills. He even allowed Suzanne to observe him for “cheeking,” where patients pretend to take a medication only to spit it out moments later. Lonnie then stretched out on the slab that functioned as a bed. Within half an hour, he had fallen asleep.

“Good work,” the senior officer said to me. “The last thing I wanted was to throw my back out wrestling with him.”

“Same here,” his younger colleague chimed in. “It looks like you're in the right field.”

Suzanne smiled. She asked me if I'd thought about working in the psych ED as a career. By meeting Lonnie on his level, I'd saved everyone a lot of trouble. The police and Suzanne didn't have to deal with the inherent risks of an uncapped needle and an agitated psychotic patient. More important, I'd helped Lonnie. The senior doctor—in charge of the entire ED—had already ordered Haldol and Ativan; Lonnie was going to get the “five and two” cocktail regardless of what I did. What I'd done was save him the discomfort and humiliation of being forcibly restrained like an animal.

During medical internship, I'd drawn blood from veins and arteries all over the body, inserted needles into abdominal and chest cavities to drain away excess fluid, placed central catheter lines, and performed CPR. I conducted hundreds and hundreds of physical exams. Rarely did anyone compliment me, even as I became increasingly proficient with these various procedures. With Lonnie, I hadn't raised a hand. Nor had I suggested a drug that worked better than the standard ones any ED doctor could order. All I had done was talk to him. Yet this had made a clear difference in his willingness to accept treatment. Never had I felt like I'd done so little while those around me thought I'd accomplished so much.

“I think it's great for the patients here to see a black male like yourself,” Suzanne said. “You know, someone they can look up to. It would have been a mess here otherwise. Thanks.”

I wasn't sure if she was thanking me for being black, for being calm, or for both. In the short time I'd worked in the psych ED, two-thirds of the patients who came through had been black. On the inpatient psychiatric unit, about half of the patients were black. During medical school and my internship year, I'd certainly had black patients respond favorably to me, but no scenario had ever been quite this dramatic.

*   *   *

While race had been an important issue for me throughout medical school and my internship year, I wasn't sure what to expect as I began my psychiatric training. I soon discovered that, there too, race was often a factor in the hospital and clinic. Psychiatry, like other areas of medicine, operates on a two-tiered system of public versus private care
.
In many ways, however, the distinctions are more blatant. Those with private health insurance, or who have the ability to pay out-of-pocket, have access to private facilities and providers, whereas those who don't or can't are relegated to a public system that has come under ever-deepening budget cuts.

As a resident, I worked in both settings and saw the disparities play out on a daily basis. A typical case might involve a young woman who'd come to the emergency room following an overdose on prescription pills. After doing the initial medical and psychiatric evaluation, the next and most important detail was to determine her insurance status. This single factor would determine whether she went to our inpatient unit or one of several private hospitals in the area where there would be other depressed and anxious patients like her and she could get individualized treatment, or whether she was shipped to a state hospital, where she would be surrounded by aggressively psychotic, manic, and antisocial personality disorder patients. Invariably, it seemed, the private patient would be white, the public one black.

The contrast was most overt with substance abuse treatment. Much of our inpatient psychiatry work during the first two years of residency training involved people with alcohol and drug problems. In Durham and its surrounding areas, cocaine and its cheaper derivative, crack, remained the street drug of choice well into the 2000s. In local public settings, the usual protocol was to admit a patient for four to seven days for alcohol detox and two to three days for cocaine withdrawal (if accompanied by suicidal thoughts). The patient would then be discharged to outpatient treatment. Occasionally, a person might be accepted to an off-site residential program (fourteen to twenty-eight days), but that typically required them to have established outpatient care first and to have remained alcohol- and drug-free before they could be enrolled.

All too often, patients struggled under this system. While rotating at the state hospital, I saw Steve, a mechanic in his early forties who'd been abusing cocaine for almost two years, having started shortly after his wife and young daughter were killed in a car accident. His supervisor had recently confronted him about his drug use and threatened to fire him if he didn't seek treatment. Without health insurance to cover the costs of private office care and a three-month wait to be seen at the county clinic, Steve came directly to our hospital. Because the alcohol and drug detox unit was full, he was sent to the general admissions wing, where he was surrounded by patients like Lonnie who had severe mental problems.