Twelve Patients: Life and Death at Bellevue Hospital (33 page)

I realized when his delusional system escaped into the open air that the judge would sign the order. Whether or not he was a danger to anyone, whether or not he would take his medications and follow the directions of his team, was irrelevant. Hidden behind this yuppie facade was a ramifying delusional system that made up his private world. And the branches of it protruded like an extra eye or arm when he was on his medications and fully flowed unedited and unadulterated when he went off them.

“Mr. Torkelson, you are a wonderful, brilliant young man. Your whole life is in front of you with such promise and hopefulness, and I applaud the great progress you have made here. However, you have been hospitalized three times within the last year and each time you stopped your medication.”

Jeffrey stood up and started, “Judge—”

She raised her voice and said curtly, “I am the judge and you are not to interrupt me. Sit down and be quiet please. I am signing the order for AOT for six months. You will have another opportunity to meet here to review the order. Think about your decisions and the implications. It is not safe for you to be unsupervised at this point. Dismissed.” She picked up her latte, turned toward the clerk, and started chatting. Jeffrey got up slowly, his lawyer patted his back, and they turned and walked down the aisle and out the back door.

I remember breathing a sigh of deep relief, though looking at the Prophet now I knew how momentary that relief would prove. But one of the core aspects of schizophrenia is the lack of insight the patients have about their illness and their lack of volition or forward movement to do anything about it or to take charge of their life. Some experts have even defined the illness as a volitional absence. Was it as elemental as a lack of desire?

“How are you doing here, Mr. Jain?” I wanted to know where he was coming from, thinking back on that crystallizing moment years earlier.

“Doing? You know how I’m doing. I am locked up and under observation. Look, I am an adult and know my rights. I can make my own decisions and do not want to be supervised and checked on like a prisoner or a child.” He was emphatic.

“What about the ‘relapses’ your doctors went through in some considerable detail?” I didn’t mean to play verbal chess with him. Just get his take on the ups and now more downs of his emotional life.

“A relapse for you is not a relapse for me. What you find problematic is not a problem for me. It is a matter of definition and power. At the end of the day, I am here because the state has the power to keep me here. Let’s get real. You have the power to lock me up. I get it.” The psychiatric
diagnostic bible was pathologizing everyday life from shyness to menstruation. He had a point, and I could feel his tension and anger.

Despite existing as long as humanity, mental illness has not escaped strong public and private censure, stigma, and shame. Psychiatry as a profession was and is seen as something less than a hard science built on biopsies, CAT scans, and blood tests. Its bible of diagnostic categories, the
DSM
(now going into its fifth iteration in committee), is a phenomenology of signs and symptoms bundled into disease states. It is used by insurance companies for billing purposes and as a justification for disability claims, insanity defenses, access to Social Security, longer time for SAT exams, early retirement, and World Trade Center compensation. If you don’t fit a category, then you don’t exist as an entity. Thus the “fight” to be legitimized as an illness continues in the back rooms of lobbying groups and in the psychiatrists’ committees themselves: Legitimization follows funding, and powerful players in the field control funding. It is a work in progress very much embedded in politics and payment systems. Thus a solipsistic system with complex eddies and histories that reflect the times as much as scientific discovery.

Mr. Jain and I talked for an hour on 18 South. As we spoke, the steps of his decompensation over the fourteen years I had known him flickered through my consciousness like an old black-and-white movie on celluloid. Despite the wear and tear, glimpses of his younger self would punch through and stir up an old memory.

“Mr. Jain, have you spoken with your parents?”

“They have interfered with my life from before I was born. You are not allowed to talk to them under any circumstances whatsoever. I have written commands not to allow them access to any of my health information. My lawyers have all of the information.” He looked at me in the eyes for the first time.

“I understand and respect your wishes. Do you have anyone you want us to contact?” I knew the social worker had been down this road with little success.

“I have fired all of my so-called friends,” he said with ferocity and a little spittle forming on his lower lip.

“I remember Dr. Fountain and you had a long relationship for almost fifteen years.” I brought up the name of his longtime psychiatrist. I wanted to know why Jeffrey destroyed this long-term connection with the man who had hung in with him through more detoxes and bailed him out of jail half a dozen times. Dr. Fountain had gone well beyond the limits of the doctor-patient relationship for his generation of traditional Freudian analysts.

“He fooled me for a long time. I mean he didn’t really fool me. He deceived me into believing that he could be trusted. I made a big mistake in pretending to myself that you can trust someone else. The bastard was going to take my ideas and steal them for himself. The son-of-a-bitch had been taking notes, filling notebooks with things I had told him in confidence over a decade. He put them in code and was going to use the information to decipher the last ultimate steps of the Singularity. There was no fucking way I was going to let that happen once I found out his dirty little secret.” The spittle flew in my face and onto my black suit.

So that was why he’d ripped Fountain’s office apart. He had been high, flying in fact on crystal meth. His brain had been rewired again, paranoid on top of the unmedicated paranoid delusional baseline. I had seen enough of these patients in our emergency room to know the power of these drugs. I had told families enough times that their kid was in orbit and might not land safely.

“I want to get out of here and be left alone. No shelter, no apartment, no home. Just leave me alone and let me get out of here. You pretend to be well intentioned, but you’re jailers. Really that’s what you are. I have my work to do and this is bullshit. All of it.”

After an hour and a half of chatting with Mr. Jain on 18 South, I said good-bye, I knew for the last time. He would be released in a few days or weeks and disappear under an overpass or into the tunnels that riddled the palimpsest that lay under the skyscrapers, subways, water mains, and sewage gutters. He would join the sandhogs scraping and blasting the rock. Maybe he would find his Singularity once and for all.

The call to the emergency room had come in from the fire department dispatch just after midnight. The ambulance was four minutes out with a young woman hemorrhaging badly from a gunshot to the left groin. A passerby had called 911. He was coming out of a liquor store in the Lower East Side, just south of Houston Street, and saw a woman screaming, going down clutching her left side. Blood spurted like a fountain into the air. Her male companion was frantically pressing his hand to her side and pleading with her, too stunned to call for help. A couple of hoodies were running south down the street and cut left at the corner toward the Baruch housing projects.

The EMT driver and his partner had been getting a coffee and falafel when their radios went off. They ditched their food in a trash can, sprinted to the ambulance, engine idling in front of a fire hydrant, made a U-turn with their lights and siren on full throttle, and headed to Houston Street. They could see the woman on the sidewalk with a man clutching her as they pulled down the street. A cop car was pulling in from another direction and blocked the street just as they pulled up with their sirens screaming. A crowd had already gathered around the pair lying on the sidewalk. The techs ran up with their bags as the cops came out and cleared away the crowd and two other cop cars and a fire truck pulled into the area. The streets are narrow in this part of Manhattan, and even after midnight the traffic congeals, barely moving.

The Lower East Side is a funky area in transition. It had the reputation of being a beat-up no-man’s-land when I was growing up. Everyone avoided it except junkies and the Puertorriqueños and Dominicanos
who lived there.
Loisaida
, they called it. That had been changing rapidly as New York City morphed over the last dozen years. Very little was left in Manhattan that had not been colonized by wealthy young couples and their children in Ben-Hur strollers. The rents had skyrocketed, pushing out the mixed generations of locals. Hipster restaurants, pubs, bars, and single-outlet specialty clothes shops lined the streets. After dark, and particularly after midnight, it was nearly impossible to walk down a sidewalk. Legions of twenty-somethings took over the streets and stood smoking unfiltered Camels in tight new pants outside the clubs. Squads of out-of-town young men and women cruised by in late-model black BMWs and Mercedes with New Jersey license plates looking for the right place to score and chill. To see and be seen.

The edges were still a little rough. Avenues C and D in Alphabet City had some dark areas that could be tricky late at night. Toward the projects near the FDR Drive below Houston there were plenty of drugs going down, plenty of dealers. The suburban middle class came to buy cocaine, heroin, and crystal meth. There was a squadron of undercover cops who looked scarier than the pimps and real drug dealers. The only things differentiating them were the gold detective badges dangling from their necks and the Glocks strapped under their baggy jackets. They would bring in their busts, wilted yuppies in withdrawal looking a lot less glamorous than when they’d left Short Hills or Great Neck.

It only took a few seconds for the EMT crew to realize they were dealing with a traumatic injury to a major artery with a massive hemorrhage in progress. The woman was covered in her blood. She was no longer screaming. She was very quiet and lying still, though conscious and responsive. Her companion moved to the side and allowed the EMT guys access. They asked him to keep pressure on her left groin as they put an intravenous into her right arm with a bag of saline, or saltwater solution, running flat out. They checked her pulse and blood pressure, listened to her lungs, and—with the help of her companion and one of the cops—quickly raised her onto the narrow stretcher they had retrieved from the ambulance. They had her in the ambulance within a couple of minutes, and one tech looked at the man
covered in blood. “I’m her husband,” he said in answer to the nonverbal question. The tech pulled him inside and slammed the doors shut. A cop car started to clear a pathway as they circled the block with their sirens on full tilt to get the stopped cars to move across a red light. It all seemed to take too much time. The teams were frustrated at their inability to make it to First Avenue and ride the long wave of yellow cabs up the twenty-seven blocks to Bellevue. There were a couple of other hospitals in the vicinity, some too small, some limping along on support from the Catholic Church or Albany handouts, but none with the capacity to handle this kind of trauma. Finally, after what seemed like much too long, they made it to First Avenue, a cop car still leading the way. The driver called into the FDNY call system and got patched through to the Bellevue emergency room.

“Woman down, around thirty, massive bleeding left groin, gunshot, tachycardic pulse 150, blood pressure now sixty over palp, thready and a respiratory rate twenty-five and shallow. We will lose her soon.” His last words hung in the ear of the emergency room attending.

She was becoming less conscious and less responsive as they sped up the wide avenue with Alphabet City on the right and Greenwich Village on the left, into Kips Bay/Murray Hill and Stuyvesant Town. There were a dozen cabs lining the east side of First Avenue both north and south of 10th Street outside the Islamic Council of America Madina Masjid Mosque. The drivers congregated outside on the street in multicolored salwar kameezes and white skullcaps. They all looked up in unison, as if in a Broadway play minus the Lion, as the FDNY ambulance headed north. The traffic was finally moving, and they blasted through the red lights on 23rd Street. Just at the corner of the old medical examiner’s office on 30th Street they turned right and drove down a long block.

The ambulance turned right at the East River and swung into the bay outside the Bellevue emergency room. Doctors were waiting outside the automatic sliding doors for the patient. The back doors popped open and a dozen hands reached in to help the stretcher out. The EMTs popped down the wheels and ran holding the IV bags over their heads, making a sharp left down two doors and into the slot in
the second bay. The entire trauma team had been activated through their pager system and was waiting for “Trauma Detroit,” as she had been named. A pre-numbered medical chart had been activated, one of the hundreds we have for emergency admits when there is no time to ID the patient. Standard operating procedure for trauma centers, using alphabetical code names for unknown arrivals when time to treatment often equaled survival.

There is a small intensive care unit of twelve beds, the emergency ward or EW, adjacent to the slot. The nurses in this area are critical and trauma care experts and enter the slot through a side door to titrate as much nursing care as needed for each situation. They have a window into their other work area so other staff can be activated directly.

The husband followed his wife as she was being rushed into the slot. The night nursing supervisor coaxed him toward the visitors’ waiting room a few doors down. “You’ll only slow things down in there,” she convinced him. “I’ll keep you informed. I promise,” she had to add to ensure he would stay put in the small room. He looked for a chair, but it was standing room only. There were thirteen traumas that weekend, mostly broken bones, bicyclists hit by cars or pedestrians hit by bicyclists, and two jumpers in very serious condition. The administrator rounded up a few more chairs and brought some coffee for Trauma Detroit’s partner.