Brooklyn Zoo (11 page)

I had arrived in East Flatbush guessing that I would be unwelcome at a hospital, where the first line of defense was always medication, which I could not prescribe. But what was also starting to coalesce was that even if it embraced nonmedical interventions, the hospital had little reason to welcome me. I knew how to think about people, but while I thought this
had to be useful beyond the consulting room (in jail cells, say, or on inpatient wards), I couldn’t quite say how. Maybe the goal of internship—the whole point—came straight from Dr. Young’s form,
student applied existing knowledge to new situations
. I’d loved grad school and had wanted to believe that internship was simply its continuation, but it was not. It wasn’t the place to develop the skills I’d long most coveted, but maybe it would make me this other thing. Not a better therapist, but a better psychologist. Once Dr. Wolfe put it that way it felt like a worthwhile aspiration.

“SHE’S NEVER IN BEFORE 11:00.”

It was 10:15 on the first morning of my new rotation, and having worked up the resolve to move past the screaming sign above the psych ER’s staff entrance (“If you don’t have a key, you DON’T belong here”), I was now standing outside Dr. Tsyganova’s office smack-dab in the middle of the psychiatric emergency room. A middle-aged woman with deep red tight curls addressed me from across the hall as she unlocked her own office door, painted a shade of pink that turned my stomach like riding in the back of a car. I had arrived at 10:00, officially an hour late, but those were the instructions I’d been given by Dr. T., as she was called. I’d leaned for five minutes, and then another five and then another, against the cool wall to the right of T.’s door, watching not much at all go on along the wide, blank corridor lined with matching salmon-hued doors. A handful of patients paced the ceramic-tiled floors of the ER’s three halls—laid out like the letter Y—in various states of undress and morning listlessness. If I’d anticipated
chaos, the quiet also felt right. Outside it was daylight, and psychiatric emergencies seemed as if they should take place after dark, like other horror movie tropes. The still air smelled of urine and dust, and I concentrated on breathing through my mouth, knowing I couldn’t maintain that for the whole of my month there.

“You’re the new intern?” the redheaded woman asked. I nodded and didn’t ask what gave me away. She invited me into her office to wait for her dilatory colleague. “She’s always late,” she told me. “I’m the other ER psychologist—Dr. Brink. You can stay with me until Dr. T. gets here.” She looked tough, like a smoker and someone you might call a dame or a broad.

We entered her small, bare office, and I sat down on a plastic chair next to a metal desk strewn with files. The walls, off-white and cinder block, were the most ornate aspect of the room. She turned on the lights, but only one of the fluorescent ceiling bulbs stayed lit, the other flickering briefly and then going dark. “It’s nicer like that,” I observed.

“Not if you’re paranoid,” she said, picking up her phone to ring maintenance.

When she finished her call, she took a stack of papers from a pile and began scanning them. “New patient, came in last night, brought in by Mom. She’d been throwing up before she arrived and was complaining of stomach pains. When anyone comes in with acute medical problems, they’re seen by a physician before they’re admitted.” She paused for a moment and then added, “Hopefully.”

She went back to her scanning. “She was diagnosed with schizophrenia at her last hospital, but the M.D. who saw her last night thought bipolar.” She shrugged. Psychiatric diagnosis was famously inconsistent. “I’m going to get her. You can watch me do the interview,” Dr. Brink said. She got up and
made a move to leave but then turned to me abruptly. “Don’t open the door for anyone.”

As she left, I glanced into the hallway. Still no sign, at 10:30, of Dr. T.

Dr. Brink brought the patient in. She was a small black woman, wearing dark jeans and a tight black T-shirt. The eyeholes on her sneakers were shiny and vacant. She was my age. Her mother had found her the night before, yelling and with her head in the toilet bowl. I sat silent as Dr. Brink asked her questions about her life. She’d been a paralegal and married. Now she was neither, just in and out of hospitals, on and off medications. She lived with her mother and rarely went out. She was lonely. Her mother came in to answer more questions, and the older woman’s upset for her daughter made me want to cry from deep. We’d been together for half an hour or so when there was a knock on the door and Dr. Brink got up and opened it a smidge. Dr. T., dark haired and fiftyish, was standing on the other side looking irritated. “Come on,” she said to me, her voice shrill through the crack, spinning on the hem of her slacks without acknowledging her colleague. It was now well after 11:00. Dr. Brink opened the door wider and called after her: “I don’t want anyone to accuse me of stealing an intern!” I followed my new supervisor across the hall.

“You don’t work for Dr. Brink,” Dr. T. said as we sat down at yet another very old desk in an office as spare as her colleague’s. From what I’d seen, no one at Kings County did much to decorate, as if they might decide to flee on short notice and couldn’t risk leaving anything behind. Or maybe the larger squalor of the hospital just dampened all enthusiasm for aesthetics. In our first weeks, the interns had made plans to improve our own office, as well as the rooms we were to use in the ramshackle outpatient clinic, but we’d so far failed to
keep our promises to each other: no posters had been tacked to the walls, no curtains had been hung.

T. harrumphed and straightened some papers. Scott had prepped me for my month with her by suggesting that he found her disagreeable, which made me feel a delectable kinship with her right off the bat despite her apparent commitment to sparing all pleasantries. She and I had known each other, though not well, for a couple of months. She’d been teaching what was so far the interns’ favorite seminar, on inpatient intake. Every Friday since late July we’d been filing down to CPEP—the official name for the G Building’s ER, the Comprehensive Psychiatric Emergency Program—to watch her interview a person fresh to the place. With patients she was often gentle, but when she spoke to anyone else, she almost always sounded as if she were scolding them.

“You weren’t here yet. Dr. Brink was just trying to be helpful,” I said.

“I doubt that,” said T. “Anyway, I will give you the key to my office so you have somewhere to put your things when you arrive before me. You usually come in at nine, right?” I nodded. She reached into her bag. “I wasn’t supposed to make a copy, so don’t tell anyone you have this,” she instructed. There were so many secrets and allegiances to track.

Dr. T. went on to give me a brisk primer in how things worked in the psych ER. Patients could arrive in two ways. About half walked in on their own asking for evaluation or admission. Not everyone who requested admission was granted it, but when they were deemed suitable, they could sign the papers for a voluntary stay. The others were brought involuntarily by police or paramedics dispatched by concerned third parties. Involuntary admissions required an applicant, usually a family member or hospital administrator, and then
the signatures of two physicians: medical doctors of any variety, but not psychologists. At this I raised my eyebrows, to which T. gave a hurried shrug. She had little time to mind such territorial disregard for her expertise.

“My job here, and the one you will be helping me with, is running the EOB, which stands for Extended Observation Bed unit. It’s for patients who aren’t well enough to leave right away, but who aren’t necessarily sick enough to be admitted upstairs to an inpatient unit. We admit people to EOB when we believe they are likely to become stable within seventy-two hours. At the end of seventy-two hours they ‘time out,’ which means they’re either discharged or sent upstairs. Did you notice the two rooms at the end of this hallway? There are three EOB beds in each. One room is for women, the other for men.

“I see each of the EOB patients every day to talk to them and check on their progress. You will be running a group first thing every morning for the six patients. It’s as much a community meeting as a therapy group. The idea is that EOB is milieu treatment, which means the environment itself is therapeutic. The ER can be a difficult place to be. You’re held here, and there’s no one to ask questions of. The psychiatrist comes by for a minute, a nurse, maybe a social worker. Lots of tension builds up. The group is really important because it’s where patients can get information and have a chance to voice what it’s like to be here. Your job is to help them think about why they’re here and how they can use this environment positively.”

Dr. T. explained some particulars of the group and added that once it wrapped up each day, I would generally spend the rest of my morning in the ER seeing patients with her. She suggested I walk around and get acclimated. “Make sure to
trust your instincts out there,” she said, gesturing toward the hallway. “Rely on your feelings. If a patient is making you anxious, walk away. Move slowly, make eye contact, speak soothingly—‘Come, let’s get some juice’ or ‘Let’s go talk to the nurse.’ And get friendly with the staff. You never know when you’re going to need someone’s help.”

I was dismissed. I left T.’s office. The halls became livelier as the morning wore on and the manic energy worked its magic, and I relaxed a little more. There were handfuls of patients up and about, some sitting in the dayroom’s plastic chairs staring at the television, others pacing the hallways or leaning against walls. Two police meandered in with a dirty man in handcuffs between them (I would learn to term him “poorly groomed”) and made their way to the nursing station to check him in. A couple of flies buzzed about—I recognized them from our ER seminars. A fat black woman in a red bra and a full-length black skirt was walking in circles at the hub of the corridors chanting “Jesus is coming, in Jesus’s name” over and over and then over again. I stayed as long as I could bear and then let myself out with my skeleton key. As I reentered the main lobby of G and felt myself exhale fully for the first time that morning, I realized how relieved I was to be leaving the locked ward and just how ambivalent I felt about returning the next day.

But it was an ambivalence tinged with delight. I both did not want to be in CPEP and would not have traded it for any rotation in the world. If I could only absorb its lessons without having to spend any time there, in the near stench. Twenty-one hours later, I unlocked the door and passed the guard stationed inside. I walked down the quiet hall to T.’s office and
let myself in, putting down my things. Her computer was still on, and the garbage was filled with grease-stained food wrappers left by the psychiatry residents on duty the night before. I wondered what went on in the psych ER in the middle of the night. I was sure it was horrible because mornings had a calm-after-the-storm feel. I half wished psychologists were deemed necessary during off-hours. That we weren’t seemed just one more endorsement of psychiatry’s primacy, of its greater import.

I checked my e-mail to delay my next task, which was to gather the EOB patients for my first group. I’d lamented that the court clinic required so little of me, and I was eager to see more action here, but it felt taxing in its unfamiliarity, and it was October but still so damn hot. At 9:30, I forced myself to close T.’s Web browser and went back into the hallway. Patients were scattered about, eating breakfasts of cold cereal and hard-boiled eggs and bananas off sturdy plastic trays that made me think of my college cafeteria and sledding after the first snowfall, and I felt nostalgia for that languorous time when I might still have chosen any profession in the world.

I cajoled myself into the hallway, and as per Dr. T.’s instructions I walked the short distance to the nursing station at the hub of the Y-shaped space to get the census, the master list of patients who’d been admitted to CPEP. It would say “EOB” next to the names of the six patients registered to T.’s little unit. I knocked and was let in by a nurse’s aide. I introduced myself to the head nurse, Miss Higgins, who looked far too busy with a stack of charts and the patients lined up at her window to bother with me. “I’m the new psychology intern,” I began. If ever I’d hated a sentence … “I need to get the census.”

“Ask Rhoda,” she directed, glancing my way and then
turning to holler back at the patient yelling at her through the nursing station’s window, which was like a ticket seller’s at a movie theater, but with thicker, bulletproof glass.

I didn’t know Rhoda, and the nurse’s aide who’d opened the door for me just shook her head when I looked at her questioningly. I went back into the hallway. One of the psych techs was leaning against the wall. He was young and a little burly, which was par for the course for psychiatric technicians, who as far as I could tell were like the man Fridays of the ER. “Do you know Rhoda?” I asked.

“She’s one of the social workers here. Short dark hair,” he said. “I think she went outside for a cigarette. What do you need?”