Twelve Patients: Life and Death at Bellevue Hospital (41 page)

Beltrán knew about it all. Not just the common-knowledge stuff—Las Maras shaking down the billion-dollar business in human trafficking from Central America to the United States. Not just that they specialized in extorting the immigrants and killing them if their relatives in the north did not pay promptly, or that they sold them to other gangs, drug cartels, or the police. The way he told it, both the U.S. and the Mexican governments were involved in making sure that these immigrants did not make it north to the border. They supplied the gangs with weapons. “Mexico,” he said, “is an enormous cemetery for immigrants trying to reach the United States. This is a free-fire zone. You have shifting rules and allegiances among gangs and local and state governments and international police and intelligence forces. A perfect business for the cartels and the narcotic transshipment business. Like Vietnam, Doc. The same playbook. Did you ever see
Apocalypse Now
?”

I was thinking an ex-Kaibil could offer a lot. After all, hadn’t Blackwater Inc., rebirthed as Xe based out of the Emirates, been a haven for highly trained former U.S. commandos providing guns for hire in the Middle East and around the world? Wasn’t the Sunni Awakening purchased with dollars? A nurse’s aide, Sharma, came into the room. “Mr. Beltrán, time for your medications soon. Let me get the room cleaned up first.” She was carrying clean white sheets and a fresh towel, threadbare and the size of a large washcloth. Sharma was in her midfifties with a soft beguiling smile, a lightly freckled face, braided hair, and a voice just above a whisper. She had been at Bellevue for many years
and felt comfortable on the TB unit. She had obviously developed a good relationship with Beltrán. They talked about the weather, where to get the best Chinese food, the art class that afternoon. Sharma had been in exile for years in a Nepalese transit camp for displaced Tibetans. The 1959 Chinese invasion of her Himalayan country left her an orphan.

She trained as a midwife in the sprawling camp filled with international NGOs and through “fate” was befriended by an evangelical couple visiting from Michigan. They sponsored her application for asylum and helped her settle into a community. The growing Tibetan enclave in Queens—covering more square blocks and surrounded by Indians, Pakistanis, Colombians, Peruvians—became her home. The final maneuvers of perilous journeys to the United States through a hundred different back channels, each with a unique story. The trickles of people from distressed areas around the globe were messages in a bottle—wars over land, oil, diamonds, rare minerals, timber, grazing rights, religion, population explosion, water, environmental degradation, drugs, and shattering local economies. And then the petty thugs like Beltrán. He was no Pablo Escobar negotiating to pay off the sovereign debt of Colombia for immunity. I wondered if Beltrán knew anything about her story, and what he would say if he did. A deadly contagious disease had brought us all together. That had to be one of the messages.

I saw Beltrán again a few days later in the activity room at the end of the long corridor on the west side looking toward the Hudson River. I swiped my ID card, which deactivated the electronic lock and let me onto the unit. That was after I went past the hospital security guard behind his wooden desk. The idea of forcible controls on patients had a checkered history in public health circles—from forced sterilizations to withholding treatments for syphilis in the Tuskegee “affair.” Recent headlines broke the story of U.S. public health service physicians infecting Guatemalans with syphilis and gonorrhea to test penicillin’s efficacy during World War II. The poorest and most deprived members of society had borne the brunt of “control” efforts. In many ways, New York City had been a pioneer over the last hundred years in
a more enlightened approach to public health that resulted in improved health for its citizens. The issue of civil rights violations was appropriately on the forefront of legal activists’ agendas.

I had come to respect the amicus brief, the legal actions taken by interested third parties on behalf of clients who could not mount their own defense.
Brad H. v. New York City
was in response to a lack of outpatient services for mentally ill prisoners upon their release from Rikers Island. The prison system had become the de facto “mental hospital” for SPMIs (the seriously and persistently mentally ill) following de-institutionalization fifty years ago. The practice of releasing prisoners at three o’clock in the morning, underneath the 59th Street Bridge in Queens, the flickering white lights from a fast-food outlet spreading a halo over the scabrous concrete sidewalks of Gotham’s netherworld, with a couple of dollars and a MetroCard warranted an intervention. A tiny ecological niche of pushcarts, prostitutes, and drug dealers stuck like lichen to the grit.

Beltrán was seated at a beat-up rectangular brown plastic table with three other patients in their hospital pajamas. Julie the “therapist” aka artist who had worked on the unit for many years guided the group, who responded to her calming presence. Months being cooped together in a potentially charged atmosphere of forced conviviality could be combustible. After serving everyone instant coffee or tea, she handed out paper and brushes. “Let’s paint today, guys. What would you like to make the theme of your drawings?”

Everyone was working with watercolors that day. Mr. Alonzo, a Puerto Rican gentleman and former city transit authority employee, had severe sarcoidosis, an inflammatory disease with no known cause; he required high-dose steroids to control the worsening pulmonary fibrosis that had activated his otherwise silent tubercular infection. Clear plastic nasal prongs delivered oxygen from a small green tank hanging off his wheelchair. Nguyen was a young Vietnamese man, thin to the point of vanishing in his pale pajamas held up with an extra piece of red shoelace and a striking shaved head. His arms were heavily tattooed with snake motifs in blues and red scales. He was the son of well-to-do Saigon merchants who became Vietnamese “boat people”
fleeing the North Vietnamese takeover of Saigon in 1975. He was born in a Thai refugee camp, where his family had re-created their business buying large burlap bags of rice and sugar, dividing it into small plastic portions, and pocketing the price differentials. They were granted asylum in the United States after four years. They now lived in Texas, the proud owners of an expanding chain of fast-food stores.

Nguyen had fled “bourgeois” capitalist life to street life and drugs in the Big Apple. He started as a musician, a bass player in a band, and got hooked on free-flowing cocaine, then graduated to heroin. We were getting him invested in multiple treatment options to see if he could break the descent. His TB was almost certainly a reflection of the crowded chaotic living conditions of his early childhood and the reactivation of an otherwise silent pulmonary infection from repeated drug use and malnutrition. He didn’t want his parents to know where he was and went to great pains to obscure his location and treatments.

The final patient sitting at the table hunched over a piece of paper and drawing the apartment buildings and skyscrapers outside the window was Ngugi Yusuf. He had emigrated from Francophone Africa. As far as we could tell he was a businessman, but the details of his life were unclear and changed constantly over the time he was in the hospital. He had fled from Mauritania to France and then to the United States for asylum. He was a D-5 detention case who had failed multiple attempts to treat his cavitary TB (highly infectious lung variety) by evading and avoiding treatments with Department of Health caseworkers. After the fifth attempt and six months of trying, the team had the case reviewed by the TB bureau chief, who promptly signed an order of detention. We had decided he had much to hide and possibly to lose by letting anything out about himself. His biggest fear was ICE, the post-9/11 immigration service now a subdivision of Homeland Security. He was convinced all the authorities were interconnected and there was one giant computer that notified officialdom everywhere of his movements, including tracking his cell phone. We did not regard this as a paranoid delusion with Google Earth on our desktops, a GPS chip in our phones, drones flying over Helmand province piloted from
Nevada, and a secret court in Washington that determined access to any information from all sources.

We made it clear we were not interested in his legal status, only in treating his tuberculosis. Resistant tuberculosis was not uncommon when treatments were partial or incomplete. He had now earned extra months of treatment, additional second-line medications including daily injections, and the enhanced scrutiny of the Department of Health epidemiologists who found his case “interesting.” The last thing you wanted to be in medicine was “interesting.” Yusuf had of course made himself more widely known than would be conceivable if he had just swallowed his pills twice a week at the DOT (directly observed therapy) clinic and quietly gone about his business, whatever it was.

I sat down with the group at the table and said hello. They had seen me around the unit enough to know I was “
jefe
” and let it go at that. Julie asked if I wanted some paper, which I declined. Beltrán looked up and said, “I never joined Las Zetas. You couldn’t anyway if you wanted to.” Nobody at the table spoke Spanish except Alonzo, and he was deep into his painting and chatting with Julie.

“So how did you get into the Mexican end of things?” I asked him.

“I left Alta Verapaz through Tapachula like every other immigrant on their way out of whatever hellhole they had found themselves in. I went to meet some army buddies who had left and gone to Guerrero.”

“Pretty dangerous place, even for an ex-Kaibil,” I said.

“I knew guys from Las Maras in Guatemala whom I had helped out, and they put in a word for me. You needed someone to make you trustworthy.” He looked up again from his drawing out to the distance.

“So…?”

“I ended up working with them, doing some jobs, protection, collections, stuff like that. You Americans call it muscle.”

“So when did it fall apart? You weren’t Maras and you weren’t part of the cartels. Trust is all relative and is a finite resource.” I kept at him, interested in his journey from hunter to hunted.

“That’s for sure. My colleagues decided they needed to make some
money. We got paid nothing in the military, really nothing at all. A few quetzales a month, ridiculous when you saw what people were making including my
comandante
.”

“Independent contracting?” I asked him.

“Exactly. The Kaibiles are good at killing but it is not a business school, and we were out of our league and over our heads. Dealing on the side was punishable by death.”

“They found out?”

“I never knew. I left one afternoon when I sensed something wasn’t right and headed up north by bus and car. I never looked back. I knew they knew somehow. I dumped my cell phone and kept going. You get a feeling and go with it. You hesitate and end up as
posole
.”

“Where did you cross?”

“Jesus, they have everything covered at the borders. You have to be really careful. The
halcones
are everywhere”—falcons, or lookouts for the cartels. “Once you are in it, there is no way out of it. Alive that is. I had to go to the States for my own safety.”

“Pretty ironic, hey, Beltrán. You can’t go back to Guatemala since Las Maras are everywhere, and you can’t stay in Mexico since between them and the cartels you are a dead man. So you came here to be safe?”

“Yeah, but funny no. They are here as well.” He lifted up his pajama top and showed off the bandages over his right rib cage.

He was right, of course. Rikers Island prison system was a filter for many things in American society. For one, it was the largest prison complex in the United States, with eleven prisons; each had a capacity for two thousand prisoners. It was filled with black and Hispanic prisoners waiting for trial, serving sentences of less than one year (or they went upstate), and had a full complement of mental illnesses, HIV, and addictions. Las Maras hit the East Coast some years ago. The new generation was less obvious, avoiding the heavy tattoos and having them removed with laser treatments.

A few weeks later, I slid into the booth at the coffee shop with Detectives Swann and Jones. They were in the middle of the Towers specials and being looked after by Danny in the farthest corner of the coffee shop.

“You guys look pretty good. How are things going?” They always wore the same clothes and looked the same no matter when.

“You heard about our prize patient here?” Swann mumbled with his mouth full of the
shawarma
special. The white yogurt sauce gave him a mustache like the television commercials for milk.

“Yes. For sure I heard. In fact the head nurse on the unit stopped by my office to fill me in on the news.”

“Look, we will take care of the officer who was asleep at the switch. He has been reassigned already. No excuses, but the patient has been off isolation and can wander around the unit. Right?”

“Yes, Detective, of course. But I thought you were protecting him?” I added and then, “Hey, I know. It happens. We cannot guarantee we can stop someone from killing themselves if we are more than three feet away round the clock. We get it completely. Surprised you guys think it could be otherwise.” I mentioned a truism no one seemed capable of digesting who didn’t work in hospitals.

“Really. So much for one-on-ones. Not bulletproof, that’s for sure,” he said, swallowing hard and taking a sip from his Dr Pepper. He let the protection comment go by.

“Nothing is bulletproof in medicine, Detective. Maybe in your world but not in mine. We aren’t running a prison except on the nineteenth floor, and that’s under DOC control. You enter their universe. Families, friends, girlfriends bring in drugs regularly. Should we do vaginal inspections on female visitors? It is not an uncommon place for cocaine in a plastic lunch bag. I had a guy overdose on 17 North recently in the bathroom when a patient from the next unit sold him some narcotics in front of the nursing station. Another patient found him slumped over on the toilet with his pants down around his ankles.”