Twelve Patients: Life and Death at Bellevue Hospital (29 page)

“So why are things so tight, Mahendra? What’s the deal?” My tone was neutral and matter-of-fact, though I thought I knew the reasons.

He looked into the waiting room behind my shoulder and said, “Just take a quick look around the waiting room and you have your answer. This is not magic, really. You can see there is not a chair available and we have three sets of cops here with new drop-offs.” I could see the cops slouching against the walls, talking on their cell phones or to one another, sipping their bottomless paper coffee cups. The box of Dunkin’ Donuts smeared with jelly and chocolate was sitting on the one empty chair in the room.

I swiveled around in my chair while he narrated, “The two patients across from us are old St. Vincent’s regulars. We hired many of their nurses when they imploded into Chapter 11 bankruptcy and were picked up for multimillion-dollar condos. Or vice versa.” Mahendra loved the total absurdity of the city, the madness, the dark matter and dark energy of the contact sport of politics, and the sheer—his favorite Yiddish word—chutzpah. He always had questions to ask in return when someone asked him to explain why Pakistan was so corrupt and
how its intelligence agencies could be so inept. He knew everything contained its opposite. Contradictions were not what they appeared to be, and desire was not a four-letter word.

He continued without breaking a sweat, “So this was like a homecoming for everyone. We should put up a sign stolen from the landmark Catholic hospital where you couldn’t get a prescription for birth control pills but where there was top medical care for the gay and lesbian community of the West Village. ‘Welcome to St. Vincent’s. Welcome to Reis Pavilion,’ though I imagine it is part of the new condo deal, they get some of the memorabilia to add historical value so they don’t have to pay taxes for ninety-nine years, or something like that.

“Some of the patients are here all the time. In fact one of them has been here over a hundred times in the last two months. His personality disorder, addiction to medications, and maybe a touch of something new from the street pushed him to come in, be discharged, and return in a few hours. We even started a special group to deal with ‘frequent fliers.’ Steve, our chief of addiction services, put together a new program with the emergency room and the Outreach Crisis Team to see if we can stem the tide. We get a thousand dollars a day for an admission and seventy dollars per outpatient visit and only a pittance of that if the patient has insurance. Go figure. I am just an ignorant guy from the city of Lahore in the Punjab. What do I know that the guys in Albany do not?” He was on a roll. Most people who worked in the medical system did not know how the system worked. He clearly did.

The simple explanation is that it is not a system. In no way shape or form. It is a congeries of interest groups that has carved up and distorted how health care is paid for and delivered into balkanized protected feudal states enlarged and serviced by armies of lawyers and K Street lobbyists and ready-willing-and-able politicians. “Where I come from, people don’t want to get vaccinated; it is a CIA plot. Here politicians warn people not to get vaccinated because it causes autism with the implication that it may be a CIA plot. Like the Rapture, Eric, the time hasn’t come. We have to be patient.” Mahendra smiled his enigmatic smile.

We spent the next forty minutes going through each of the fifteen cases in the waiting room that, because of the overcrowding, had
become an extension of the CPEP proper. You could feel the body heat, the emotional intensity. At that moment an aide in a beige uniform wheeled in stacks of plastic food trays. Everyone looked up, and the temperature dropped a few degrees. Food always had a soothing effect regardless of the source. We had halal chicken for the Muslim patient in the corner, Chinese food for the young woman with the police, and plain ordinary cold greasy American grilled cheese sandwiches, iceberg salad, and solid bricks of apple brown Betty for everyone else. The cops were take-out specialists and used their smartphones to GPS local menus and order out. A couple of detectives went down to the Greek coffee shop to chill out on their break.

“Jeffrey, or Mr. Jain as he prefers to be called now, was brought in after midnight by the Port Authority police.” Mahendra turned around to look into the unit sitting area, now converted into over-census sleeping quarters using the
Titanic
-like deck chairs. The middle-aged prophet was gesticulating to the wall and talking to a fellow male patient who was oblivious to his entreaties and fixated on a verbal altercation going on across the room being smoothed over by two tag-team behavioral health aides, one male and one female. I had seen them in action when an out-of-control psychotic patient was brought in handcuffed and bound to a stretcher. Bolshoi or James Bond, pure and simple. The patient would be stripped and searched, re-dressed, and put in the unit to chill out in a few minutes. Hardly a word would be spoken. Tie in place, not a wrinkle in the putty-colored Gap buttondown. Shaken, not stirred.

“You probably know him better than we do,” Mahendra declared out loud to no one in particular. Just a statement. “Where are his parents now?” he asked me finally. He knew I had followed Mr. Jain, aka Jeffrey, for a long time. We all had patients we knew better than others, a few that got to us in some personal way. Most of the time we didn’t take the time to figure out why. The why could ramify in deepening and widening circles. If you stayed on the surface all the time, dealing with the “facts” of the cases, you did not know very much at all. The treatment plan was a caricature, copy and paste. A game of what is the right dose of which medication.

“Back in Michigan,” I said in answer to his question. “I haven’t heard from them in several years. His father is a well-known sociology professor and his mother worked for a national kidney dialysis company as regional manager. She traveled a lot. Really knowledgeable people. Smart, engaged… they tried everything they could think of for Jeffrey. I think his drug use finally wore them out. Cocaine specifically. Who knows for sure. That is how I put it together. In fact, I saw an article his father wrote in a medical journal on his personal journey as a parent with his son’s mental illness. The article took me by surprise since they appeared to want to keep things under wraps for so long. Maybe they wanted to protect Jeffrey and just finally realized how serious his illness was. Maybe they decided the best protection was going public?” This was a complicated business, and there were both public and private narratives for family affairs that spilled into our front doors. The narratives morphed out from the cocoon of family secrets into semi-public, awkward, embarrassing, financially devastating, humiliating, destructive, demanding, and lifelong family sagas. Rarely were the two narratives the same—nor should they be.

Mahendra sat quietly in his chair and turned his full attention to me. From where we sat in a glass-enclosed room, we could see 360 degrees from the waiting room into the interstices of the psychiatric emergency space. He had a gift of making you feel you were the only thing of importance in the room and on the planet when his gaze switched onto yours. I knew he had a big private practice and worked late into the evening every night. I was surprised he hadn’t left Bellevue some years earlier for the siren call of a lucrative private Manhattan psychiatric practice. This was concierge or boutique medicine, the opposite of what we were doing every day. When I asked him why he’d stayed, he said it was because of his father.

“My father was a successful businessman in Pakistan, in retail clothing, and came to the United States and washed dishes. When he was in Pakistan he had unlimited offers to participate in widespread corruption and make a small fortune. He never once participated.” He continued, “He told me, ‘Son, if you go down that path even once you
are doomed. What do you care about and what do you want to be? Just answer those questions and you will always make the right decisions.’

“I bought my parents a house a few years ago, and he lives a few blocks from my apartment. My kids hang out with him all the time. It is the best I can give to him and to them. That is why I’ve worked here now for over twenty years. The line between health and illness is a thin line, very thin. You never know which side of the line you will be on and when or who will be there to look after you. Everything else is myth.”

“You know, I met Jeffrey over twelve years ago when he first got admitted to Bellevue,” I said. “At that time he was a Princeton graduate student. He had just completed his doctoral exams and was on track for his thesis, in religious studies in fact.” Mahendra fell silent. It was now my turn to fill him in on the patient under his watch.

“I got a call from the mayor’s office, the Giuliani era. ‘Call Jeffrey Torkelson’s father. His son is in CPEP and call ASAP.’ The deputy mayor and Torkelson had been in college together. He was gracious on the phone and asked, ‘One, can you assure me he will get the best care you can provide? Two, can you keep an eye on him?’ I think some of it was the public hospital thing. Private must be better. The more you spent, the better it was. Like single-malt Scotch. You know,
Law & Order
crap.
Take them to Bellevue.
Like who do they think is sitting in the Hartford Retreat or McLean, the Bobbsey Twins? And if it is the Bobbsey Twins, then they’re fratricidal meth-snorting pederast twins!” My riff was over.

“I came here and sat talking to your predecessor, Harold, now long gone into an academic psychoanalytic practice in Upper Manhattan. Jeffrey had taken a bus to New York City from Princeton. He went to a local Midtown hotel to check in. The clerk asked to see a credit card. He said he didn’t need one. They pressed him a bit and called the manager. Jeffrey lowered his voice and confessed that he was ‘God and God doesn’t need a credit card.’ He was on a journey to find Scarlett Johansson, who was Mary, the mother of Jesus. It was his mission to protect her from evil forces that were going to kidnap her into a
parallel
Matrix
world until the end-of-time apocalypse when everything would be exterminated in a Singularity, the Big Bang in reverse. There was no Rapture for the holy in Jeffrey’s delusion. A white powder would be all that remained of the universe.”

“Sounds like 9/11 to me…,” muttered Mahendra.

I finished, “He was clear that the world would end as it had begun in a Big Bang, a Singularity, that created all matter and over billions of years the earth condensed out of elements forged from primal hydrogen atoms. Scarlett Johansson, aka Mary, alone had the power to prevent the Apocalypse, and the rain of white powder that would be all that was left of an eon of creation. The hotel manager said he would get him a room and picked up a phone in the next room and called hotel security and the police.

“It had been Jeffrey Torkelson’s first psychiatric hospitalization. His parents were on the next flight from the Midwest to LaGuardia Airport and showed up on the inpatient psych unit shortly after I did. They were your ideal couple. Everyone was thanked numerous times for our caring and considerate work. They were here during every visiting hour. They rented an apartment a few blocks from the hospital and embedded themselves in their son’s new ten-thousand-square-foot locked universe. It was around this time that Jeffrey started calling himself ‘Jain’ after the Indian religion that extolled all life, insect to human. The Jains placed their dead on wooden platforms reaching to the sky. The cadavers were eaten by vultures feasting on human flesh. They circled the Towers of Silence, riding the warm air currents, while waiting for their next meal.

“ ‘Jeffrey switched from physics to religion in college,’ ” his father told me when we were sitting in a small conference room off the 18 North psychiatric unit where his son was hospitalized for sixty-two days. ‘We didn’t think that much about it at the time. You know, they’re related in many ways. Thinking about ultimate causes, trying to unite everything into one grand unifying theory. That is the stuff of physics. The idea of a unifying theory drove Einstein to distraction, and he didn’t accomplish much after his
annus mirabilis
except to try to disprove quantum mechanics.’

“At the time, I remember appreciating the father’s intellectual approach to his son’s case. But I also wondered where the emotional side to this tale lay, the rawness, the sadness, guilt, pain, anything. His son was an inpatient on our psychiatric unit for an acute schizophrenic break and I was sitting in a room high in the air, in my Tower of Silence, overlooking Gotham in all directions, discussing particle physics, Brownian motion, string theory, and how many dimensions are required to satisfy a totalizing explanation of all of reality. Jeffrey’s father and I were pretty much in a ‘real’ reality now, weren’t we? Or maybe not? That was the question.

“Mr. Torkelson and I sat in that small room filled with pegboards, schedules, phone numbers for different community agencies, and Manhattan’s best take-out restaurants, given gold stars by the staff. He took me through his son’s medical history. ‘Jeffrey was always sort of a math prodigy since grade school and he got interested in optics in middle school. The speed of light fascinated him. Why it was a constant and how it fit into Einstein’s equation about mass. The relation between mass and the speed of light squared inspired his imagination and he got stuck on it. Our other son was always fascinated by sports. He collected things, memorized things, and obsessed about sports teams, ice hockey in particular. It was totally normal stuff. Not Jeffrey. By the time he was in middle school, he was reading Richard Feynman, the quirky Nobel laureate whose taped CalTech lectures about QED or quantum electrodynamics are cult classics. We talked to the school counselors, and they said he had a special talent and not to stress over it.
Like a kid who has great musical skills. Support it and let it go where it goes.
The school itself didn’t have enough to offer him so I took him to my university where colleagues let him sit in on classes as a personal favor. I had no idea what this stuff was about and still don’t. The math is beyond my capacity. He was a high-maintenance kid. We wrote it off as pre-adolescence, then as puberty, then post-adolescence. I guess we were fooling ourselves.’ He was very matter-of-fact and presented a police dossier about his son. Like Inspector Maigret. I was not clinically involved and decided to leave those conversations to his doctors, social workers, psychologists, and nurses.