Twelve Patients: Life and Death at Bellevue Hospital (4 page)

Many if not the vast majority of the individuals in the psych unit were subjected to extremities of violence themselves as children. If there is a laboratory experiment in how to create people at the margin of functionality by eliminating all resources and social supports, education, medical care, and community involvement, these are the guinea pigs who have been dumped out of their cages and turned loose on the streets. The prosecuting attorneys lock them up in the city’s penitentiaries, and we treat them for the medical and psychiatric problems that flourish in the hothouse atmosphere of a prison system. In forty years, that system has gone 180 degrees from rehabilitation to punishment, without regard for the long-term self-inflicted collateral damage.

My cell phone rings, and Budd’s name appears on the screen. “Nothing yet. The Guerra family is getting agitated.”

“Okay. We’re working on it.”

I decide to go back up to the prison unit until I hear from Patty. I want to be useful to Guerra and his family and smooth over the discharge. Plus, I remind myself, I have other patients there that I need to talk to.

I see Marlene Scott, the head nurse for over twenty-five years,
bending over a file at the nurses’ desk. A middle-aged, diminutive Afro-Caribbean woman, she emanates calmness and authority. The escalating curses of a patient being wheeled to his room/cell down the hall behind her do not even seem to register. She looks up and smiles at me. “Budd’s in with a patient.”

We reminisce about the old prison unit in the administration building at Bellevue, before the new hospital was built. No one wanted to go there. It was made of wide-open wards typical of the time. Kings County, where I trained, had the same setup. Everyone was in one big room with only curtains to protect their privacy. And the curtains didn’t work! On my first day as resident, I was on rounds and tried to pull the curtain shut. Dozens of baby cockroaches fell on the patient’s huge cirrhotic abdomen filled with tense ascites, fluid from a scarred and marginally functioning liver. His yellow hue was the same as the stained sheets. He didn’t move when the roaches scrambled off him onto the bed.

I ask her about Guerra. “No news,” she says, “but they’ve got a whiff of the problem. It’s hard for them, after everything they’ve been through. The possibility now that he won’t get out seems more than they can bear.”

“I’m going to see him now.”

She decides to walk with me through the unit to the waiting room. As we go, she tells me about a retirement party a few weeks earlier at Bellevue where a woman spoke of her first job on the prison unit when she was eighteen. She had called a prisoner by a number. Her supervisor asked her to step outside. He told her this was a human being and to call him Mr. Jones. She never forgot that lesson. She used it as an example of the many contradictions that crop up in trying to treat people as human beings in systems that degrade their humanity.

I see Guerra’s wife speaking intently to her son. I wonder for a second who comforts her.

I put my hand on Guerra’s shoulder and assure him we’re working on the release. Guerra just shrugs. “I was an idiot to hope. What a
pendejo
!” He looks old. In prison, everyone looks ten to twenty-five years older than they are, except the teenagers.

I check my watch and go to the nurses’ station to call Patty. No beeps, so that’s a good sign. She picks up immediately and tells me something has come up in the Mexican consulate; the minister is delayed again. He will make it in by late afternoon. He’ll call. She got the Guerra release files again and hand-delivered the right form back to the prosecuting attorney’s office. She wants me to call them to expedite it, sign it, and return ASAP. They won’t pay attention to her.

My beeper goes off several times and I retreat to the nursing station for a phone, a computer, and a modicum of quiet. Medical Director Ed Fishkin from Brooklyn’s Woodhull hospital is on the line about our lack of ICU beds and their inability to transfer three patients who have been waiting for more than a day. A young woman has falciparum malaria after returning from Southeast Asia. And she is in her third trimester of pregnancy and cannot breathe. We need an ICU bed and a team from high-risk OB, pulmonary, and critical care medicine right now.

The next call is from my daughter, Marina, inviting me out to dinner at a small bistro on First Avenue, our usual place when Diana is out of town giving a lecture. Marina was back after a post-BA year studying in Israel and was settling into a new job in Midtown. Sometimes the five of us would go out, including my son, Alexei, who lives in Brooklyn with his wife, Gladys. Diana complained that all the best family dinners happened when she wasn’t around, but she understood and appreciated the family support system.

After getting an ICU bed, I make a call to the prosecuting attorney’s office and tell her assistant about the urgency. I promise to email the attorney. I put in a few words like “justice” and “the American way” and “my friend at the
New York Times
” in the hope of hurrying this along.

I report in to Patty.

“
Jefe
, I have a turkey sandwich on your desk for when you get back
down here.” She then puts through my voice messages—all routine except the one from Diana sending me hugs and kisses from Santiago, plus she’s found me the perfect novel by Faciolince and pulsating
vallenato
recommended by her friends in Colombia. Our long-standing tradition from her innumerable travels: She finds the most interesting book everyone is talking about and the CD that you can’t live without.

I wind my way back through the gate and pick up my cell phone, then head back to my office. Too late I remember that sanctimonious Dr. Faruz is waiting. He’d been in several times in the past couple of weeks already, complaining that another department was poaching on his area. As new technologies have developed, several departments (not infrequently with a monopoly source of income) have been losing ground on what they see as their immutable rights to turf. Interventional cardiology with catheterization has reduced the volume of bypass surgeries dramatically worldwide. There are medical winners and losers in the financial game. This is why Faruz was waiting for me, though inevitably the tensions would be expressed in terms of quality and patient safety, competency, and so on. I was not sympathetic. Times change, new procedures come online all the time. Departments that try to hold on to things using technical and bureaucratic stratagems to control their monopolistic practices are not just hurting themselves. In the long run, they limit the institution’s ability to stay vibrant and adaptive and will ultimately hurt our patients.

I’m not in the mood for Dr. Faruz—I just want my turkey sandwich.

As I put my hand on the back door to my office, I hear my name called from behind. Beth, the head of the forensics unit, is on her cell phone and waves at me to wait. She listens intently into the phone. When she hangs up, she asks me if I have some free time to go with her to CPEP to see a new prisoner who was brought in recently. I think about my sandwich, then look at my phone and see that Patty has moved the appointment with the Mexican minister of health until the end of the day. I think of Dr. Faruz and turn to follow Beth back down the stairs to the ground floor.

We wind our way through the back corridors and are stopped by a phalanx of corrections officers. There are the usual officers in blue
with holstered guns, but now there are also many in white shirts and the entire area is blocked off from every direction. We see a single prisoner being led between a squadron of blue and white shirts in front of us down the hall from the Blue Room to the CPEP entrance.

He’s the prisoner I saw come in early this morning from my office window. He is shuffling in his leg shackles. He looks over at us since we are the only non-guards in his field of vision. He is totally expressionless. His eyes are alive, but he gives away nothing. His tattoos are obvious now, even more chilling since they cover every inch of exposed skin except the front of his face. His neck bears the letters
MS
and a number
13
.

Las Maras Salvatrucha. The Maras are leagues away from the Crips and Bloods. They’re relatively new to New York. I am familiar with them from my trips to Chiapas, the southernmost state in Mexico near the Guatemalan border. The Maras prey upon undocumented immigrants fleeing north. They will steal and extort everything. They will cut off arms, disembowel, or behead someone for nothing. When the Maras are sent to prisons, they take them over, organize them, terrorize the guards, and train their fellow inmates in their particularly vicious brand of violence.

CPEP, where the Mara gang member is taken, is a very controlled space. New York City police and hospital police stand right outside the doors and glass windows. The many staff members inside this prison wing are used to dealing with all kinds of difficult situations, particularly violent and unpredictable patients. “Tako”—as he is nicknamed according to his file—swallowed some silverware at the supermax prison on Rikers, and needs some X-rays and a surgical consult. We have to observe him for a couple of days while things work their way through his system and out the other end. This is a fairly common practice, and we call the patients “swallowers.” Inmates use this little trick as a way to get off the island and break up the boredom. Our Mara friend says nothing. I’m glad to get out of there and thank my colleague for taking me down with her, though I will have Maras
pesadillas
, nightmares, for a few weeks afterward.

I head back to my office as my beeper goes off. Budd. I call up.
Guerra isn’t eating. Won’t allow anything in the tube, either. His wife and son are beside themselves. I say I’ll be up.

Late in the afternoon, the ritual of getting into 19 South is compounded by the rush for elevators, the waiting, pushing, shoving off all those in a hurry to go up or down. After I make it to the floor, Budd takes me to Guerra. He looks gray. If anything, he has aged since this morning. He looks up at me, weary, and looks down at his shoes again, bent over as he is with his shoulders on his knees. His wife and son look alarmed.

“What’s up?” I ask him.

“I’m sick, Doc.”

“How come you’re not eating?”

“I’m afraid to throw it up. It’ll hurt.”

“You have to eat, Guerra, or you’re going to get weaker. You need all the strength you have for this. We will use the stomach tube now exclusively to feed you, so no worry about swallowing at all. You will reteach yourself how to swallow when you’re stronger. Your throat muscles will learn again.”

He looks at me. “It doesn’t matter.”

“Guerra, don’t give up now. You’ll be home soon. You have to save your strength for your treatment. Don’t make it harder for your wife or for your son.”

Guerra looks up again, and stares at each of them.

“Okay. Bring it on.” His wife attaches the syringe to the plastic outlet on the tube that dangles from just above his belly button—her first time feeding him, and pours in the Ensure. He holds her hand as the liquid goes in.

“Good,” I say. “You’ll both have to learn how to do the feedings and look after the equipment. It’s not hard. You’ll get the hang of it. Small amounts six times a day and slow feeds overnight by the pump. That’s it.”

I smile at them as I leave.

Back in my office, I put on some music and make myself a coffee. I email Patty for an update, but ask her to give me a few minutes if possible. I sit and look out the window, and am suddenly furious. Why is someone like Juan Guerra treated the same as the Mara? When did
mental illness and petty drug possession offenses become equivalent to major crimes? The psychiatric patients need mental health care, Guerra needs cancer treatment at home with his family, and “Tako” needs to be locked away in the supermax—not that imprisonment will deter him from continuing the terrible things he’s done. There are now at least tens of thousands of Maras and their deadly offspring spread from LA to Long Island. Do we really need to finance an incubator for more? Why are so many people, with such a wide range of problems, sent to prison as the one-size-fits-all solution?

If our goal as a society is to lock people up and throw away the key, then there is a genius to the three-strikes laws. If the goal is to make us feel safer and to create a society that is healthier and more productive, then we have failed miserably.

I pull my thoughts back to the present when Patty calls. Guerra’s papers have been signed and he is being released within the hour. She also tells me that the young woman in the SICU with a severe brain injury from her motorcycle accident has died. Normally Patty wouldn’t call me about this, but the body was left in the room for six hours before being claimed by the medical examiner, headquartered just a block north of the hospital. The family flew in from Italy, not only bereaved but irate over the lapse. They are saying they won’t be able to get their daughter home for a proper burial. I tell Patty I’ll phone the parents and apologize profusely after speaking with the attending and getting details from him. The
ministro de salud
of Mexico has arrived, she adds, and will be up in five minutes. I look at the building encroaching on my view, the steady thread of cars heading north on the FDR. One of them will soon have Juan Guerra in the backseat with his wife and son on their way to the Bronx and a future they can’t anticipate. Will he even complete the treatment? This thought starts to burrow its way into my brain. I reel it in and turn off the heart-aching fado music of Dulce Pontes as I get up to greet Mexico’s minister of health.

The walk from Bushwick in North Brooklyn had taken several hours. Ice-cold air and slushy snow on the streets had the effect of another dose of adrenaline for Tanisha. She had climbed down the fire escape outside the window in her room when commercial garbage trucks were making their predawn rounds. Her hands were freezing against the oxidized and flaking bare metal that scraped raw the skin on her palms. Three flights down and then a fifteen-foot drop to the sidewalk. By the time she was at the bottom and hanging from the rusty bottom rung, her five-foot-one frame left her with a mere ten-foot controlled fall. It was four o’clock in the morning, and the streets were empty. A flickering streetlight reflected off the snow and ice. She could see the barbershop sign as she hung for a few seconds. The lights of a 24/7 Bodega “El Amanecer” on the corner were nearly hidden in a cloud of steam from a sidewalk vent. She let go and dropped, hardly making any noise when her Converse All Stars hit the cement. She remained in a crouch, rubbing her ankles, for a few seconds.