Brooklyn Zoo (12 page)

“A census,” I told him.

“Hang on,” he said. He let himself into the nursing station with his key and came out with a sheet of paper. He handed it to me. “Last night’s. But you’re working with Dr. T., right? No one was admitted to the EOB since then. This should do.” I thanked him and then thought to introduce myself. Though I couldn’t imagine any staff member particularly wanting to bother with an intern, T.’s pointed instruction replayed in my head: I was supposed to make friends. I told the tech my name and stuck out my hand to shake his. “Kelvin,” he said in response, smiling. “Let me know if you need help finding anybody.”

I looked at the list. Only three patients seemed to be registered in the EOB, all men. Dr. T. had said there would be six, but had she meant six max? I walked back down the hall, past T.’s office and into the farthest EOB room, the one for women. Like the rest of the ER, it had a cold concrete floor and frosted windows that couldn’t be seen out or smashed. Two patients were inside eating their breakfasts, sitting on vinyl mattresses
that had been set into low, wooden platform beds built into the floor. Maybe the females had been accidentally left off the list? “Good morning. Are you EOB patients?” I asked. I felt too harried and sounded it. They stared at me blankly, but I wasn’t sure that this ruled them out. Did EOB patients know they were EOB patients? It probably wasn’t the first thing on their minds.

“I was sexually harassed at Woodhull!” one hollered at me, putting aside her tray. She was hefty, wearing a gray minidress and a cropped denim jacket. Both were a few sizes too small on her. Her words poured out like her flesh where it met the bands of her clothing. “I’m filing charges. I need a lawyer. Are you a lawyer? I was minding my own business. I filed a police report. That’s a stack of papers that are read by the police. I am going to launch a lawsuit. A suit is worn by a lawyer, but that is not the same as a lawsuit.”

The other woman was dressed in a hospital gown and also seemed to want my attention. She broke in, speaking in slow motion or as if she were underwater. “Excuse me, miss? I’m ready to leave. Can you sign my discharge papers? There’s nothing wrong with me.” The first woman looked at her with exasperation.

“Excuse me, but I was talking to the lady, putting together words, phrases, sentences, but not the kind they give out in court,” said gray dress.

“I’m sorry, but I can’t help either of you.” This was true, but it sounded so wrong. I tried to come up with something more therapeutic. “Someone else will help you soon. I have to go find the patients on my list,” I explained, holding up the census. They looked at me as if I were crazy, and I reinforced that idea by suggesting they have a nice day.

In the men’s EOB room next door—identical down to its white peeling paint—I discovered two more patients. One was lying on a vinyl mattress, wrapped from head to toe in a gray flannel blanket. The other was asleep on the hard floor, despite the two empty beds. I saw Kelvin in the hallway and motioned him over. He smiled and walked toward me. I appreciated his good humor. “Should I wake them?” I asked. He approached the man on the floor and nudged him gently with his sneaker.

“You don’t ever want to bend over a patient here to wake him up,” he explained as he nudged. “You can’t be sure what shape he’s in. If he’s psychotic, or even just startled, he might lash out in response. You don’t need to get punched in the face, and he doesn’t need to suffer the consequences of hitting you.” I nodded. The patient just grumbled and rolled over, his arm slung to his side. Kelvin bent down, keeping as much distance as he could, and read the patient’s plastic admission bracelet. He recited the name to me: not on my list. Apparently, anyone could wander into the EOB rooms to get some rest.

Kelvin walked over to the man in the bed. He nudged him as well, with his hand this time, still keeping his distance. The patient pulled the blanket off his face to look at us. I explained who I was and asked his name. Bingo. On the list. “We’re going to have a group in the dayroom in a few minutes. Would you like to join us?” I asked. He returned the blanket to his face. It hadn’t occurred to me that a patient might refuse, and so I had not asked Dr. T. if group was mandatory. Even if it was, I couldn’t imagine how I would enforce attendance. I thanked Kelvin and went to explore the rest of the ER. One down, two to go.

With an aide’s help, I found my second patient, an old and sickly looking man, standing in the doorway of the bathroom
in his pajamas with urine running down one leg. “I’m going to have to get him cleaned up. Can you talk to him later?” asked the aide. I was still not breathing through my nose but knew instinctively that he stank worse than even the room around him. I wasn’t supposed to feel this way—and there was the rub. The first lesson of graduate school in clinical psychology is that “supposed to feel” is a distinctly un-clinical concept, and what you
actually
feel provides important information about a patient’s interpersonal world. But I wanted nothing to do with this man. (“Neither did his mother,” said the voice of one of my professors in my head.)

“Please,” I said, motioning the aide forward. She led him off, holding his arm.

I called my third patient’s name out in the small, bleak waiting area at the farthest point from the EOB rooms. No one responded. I walked back to the center of the Y and found a nicer, air-conditioned room with five vinyl reclining chairs next to the nursing station. There was a man sprawled on each chair. I spoke my patient’s name once again. This time someone responded. “That’s me,” he said, opening his eyes. He was dressed and clean enough. I approached him.

“I’m Darcy,” I said. “I work in the Extended Observation Bed unit, which you’ve been admitted to.”

He nodded. “I know. Been here before.”

“Normally, there’s a morning group for EOB patients to help get you oriented, but this morning it’ll just be you and I,” I said, making the decision not to have a proper group, as if it were not a choice made for me. “Do you have any questions?” I asked. He did not.

I explained that he would be in EOB for a maximum of seventy-two hours and that Dr. T. and I would be speaking
with him later to see how he was doing. He seemed content and thanked me for the information. “Just one question,” I said to him. “Why are you sleeping in here when you have a bed down the hall?”

He pointed toward a small window air-conditioning unit. “The AC,” he said. “It’s cooler in here.”

It was 10:15 by the time I let myself back into Dr. T.’s office to wait for her. It had taken me forty-five minutes simply to locate three patients and not have a group. “You’ll do better tomorrow,” Dr. T. assured me when she came in at 11:00 and I told her about my morning.

“Was the census right? Are there only three patients today?” I asked.

“Yes, unfortunately,” she said. “I have to talk to admissions. We get a thousand dollars from the state for each bed, but only when they’re filled. Sometimes the psychiatry residents forget about us, admit people right upstairs, where there are rarely enough beds. If they can’t be transferred to another hospital, which most of them can’t be, because they don’t have insurance, they end up sitting around the ER for several days waiting for a bed to open up, while they could be in EOB actually getting treatment.”

“And what if someone doesn’t want to come to group? What do I do?” I asked, telling her about the man in the blanket.

“Once in a while, if someone is new to a medication, he might be too tired to come, but we can’t know how a patient’s doing if he’s in bed all day. Group is a critical part of this experience. You need to be getting across the point that treatment is not just sleeping. We expect them to function here.

“Also, you have to think about the way you say things.
Don’t ask ‘Would you like to come to group?’ But rather ‘Get up. It’s time for group now.’ My son is grown, but when I was learning to do all of this, he was in preschool. I learned how to be good with the patients by watching his preschool teachers. Structure is the trick, with little kids and with psychotic patients. The more things escalate, the tighter the structure you need. But always empathic,” she concluded. “So let’s go talk to the man in the blanket—Mr. Bonture.” She had his chart on her desk and glanced at the admission note before we left her office.

Mr. Bonture was right where I’d left him, asleep, or at least wrapped head to toe in his blanket despite the heat. “Wake up, Mr. Bonture,” directed T., standing near but not within arm’s reach of the bed. “Mr. Bonture, sit up please,” she said. He peered up from his blanket, unwrapped it, and sat up. “Good morning,” she said.

“Morning,” he replied, groggily. He was wearing a hospital gown.

“How are you doing today?” she asked in a tone one might use with a small child.

“I want to sleep,” he said, still groggy.

“This is not a hotel,” she said firmly, her voice still up a pitch. “You have to get out of bed and get dressed. You’ll feel more awake then. You’ll get some food.”

“Okay,” he said, but turned away from us, lying back down, pulling the blanket only up to his chin this time.

“Have you gotten your medicine today?”

“No,” he said, back still turned.

She sighed and explained to me that the hospital’s computer program for drugs was not all that efficient. “The private hospitals have a much better one. It costs a million dollars.
We probably lose more than that each year because ours is so subpar.”

She turned back to Mr. Bonture. “I want to see you dressed and in my office in half an hour,” T. said.

“Okay,” he replied.

I followed Dr. T. back into her office, relieved because I figured that she hadn’t had much more luck with him than I had. I didn’t want to look bad, or at least not any worse.

She continued our lesson. “The ER is not like long-term therapy. In long-term therapy you work with a wide-angle lens. Here we use a telescopic lens. We only talk about the most immediate issues.”

She opened Mr. Bonture’s chart and showed me the admission note. He lived in a group home for the mentally ill and had been brought to the ER after threatening to kill his roommate. “We’ll call his caseworker at some point and ask if he has any history of violence. The note doesn’t mention any, but we always need to confirm with collateral sources. When we talk to Mr. Bonture, we’ll ask him, ‘Do you want to kill your roommate? Do you want to kill yourself?’

“I don’t care about his words really. I want to see his emotional reactions. Anyone can tell us they’re not homicidal. But is he guarded when he responds? Is he sincere? Affect is such a rich language. To be of use here, you need to learn to read it perfectly. You want to know how deep the psychosis goes. How bad is it. Lean on the sore spot and see how the patient reacts. Become progressively more challenging. You want to see how he responds while he’s in here—in this safe environment. You’ll see when we interview him.”

When Mr. Bonture was up and dressed, he knocked on the door of T.’s office. He was still a little groggy but said he
wanted to sit down and talk. He’d been to G-ER before and was presumably well enough to know that release required some cooperation. This was a good sign.

“Are you feeling a little better?” T. asked.

“Yes, a little better.”

“Less angry?”

“I’m not angry,” he said, shaking his head.

“What happened with your roommate?”

“He disrespected me. He insulted me.”

“So what did you do?”

“I told him not to disrespect me.”

“What else?” she asked.

“I threatened him.” He was sheepish now.

“Threatened what?”

“To kill him. I didn’t mean it, ma’am. It was just that he insulted me.”

“You can’t go around threatening everyone who insults you. What was your plan?”

“I hoped to hurt him,” he said emphatically.

“Do you have a weapon?”

He nodded. “My fists,” he said. “I’m a boxer.”

“You don’t look very strong.” It was true. He did not.

“I am, ma’am. He’s strong, too, though. It would’ve been a fair fight.”

“People on the streets of the city can be insulting. Do you plan to go around beating up everyone who insults you?”

“No, ma’am.” Mr. Bonture sounded sincere.

“What are your other options?”

“I’ll ignore them. I’m better than that.”

When he left, Dr. T. asked if I understood the point of the brief interview.

“You pressed the issue, saw how he reacted. You questioned
his judgment and also insulted him, saying he didn’t look strong,” I said.

She nodded. “The ‘insult’ was sincere. It was what I was thinking. It’s important that you are honest here all of the time. Patients sense when you’re disingenuous.” She went on, “Maybe he just needed to cool off. His insight and judgment certainly seem to have gotten a little better. I’ll talk to the psychiatrist about adjusting his medication. We’ll keep him another night and make sure he still looks okay tomorrow. You’ll see how he does in group.”

Upon arrival on the third day at my new rotation, Dr. T.’s words from the previous morning replayed in my head like a strophic melody. “You’ll do better tomorrow.” I tried not to dwell on the fact that doing better simply meant successfully gathering a small handful of confused people into one room. To think about the six years I’d spent in graduate school to arrive at this moment was self-defeating.
I was becoming a better psychologist
.