Brooklyn Zoo (18 page)

Afterward, as I told T. about the brief meeting, I surprised myself by bursting into tears. Though my eyes regularly teared in response to sad stories, the bursting was another matter. It came on like a sneeze, but with less warning. It was notable, and it was the second time in my life it had happened. The first had also been in supervision, during graduate school, and my supervisor back then had hypothesized the tears really belonged to the patient I was discussing, who’d appeared to feel nothing as she detailed a childhood filled with unthinkable neglect. Was this that? The idea suggested a certain emotional contagion addressed by theory—a patient’s split-off feelings are communicated nonverbally to the therapist, who can unconsciously process them and give them back in less potent form, like a mother bird chewing food for her chick. But I also had my very own preexisting despondent feelings
about difficulties I was powerless to affect. What of this bursting was about the Finchers, and what of it was about me? That was always the unknowable thing.

T. handed me a tissue and waited. I wasn’t sure what part of my thinking to share. I saw there was little time, in a psychiatric emergency room, to contemplate the esoteric questions of graduate school outpatient treatments. “Things move so fast here you never get a chance to process how you feel. I think it’s been building up. I’m sorry for the tears.”

“Never apologize for having an emotion,” T. said. “Just make sure you give it some thought.”

“My sister lied to the police and told them I pulled a knife on her.”

“My boyfriend called the police for no reason and told them to bring me here.”

“My wife is the one who needs help. I called 911 and asked them to bring me here to set an example for her.”

“I had a couple beers and thought I wanted to kill myself, but now that I have no more drink in me, I’m feeling good, and I have no reason to be here.”

Such were the collection of stories that began my mornings. By week three I had conquered the patient roundup and the television, finally to find myself dealing with actual psychological problems—rampant externalization and denial.

T. instructed: “When the whole group is blaming someone else for why they’re here, say, ‘I find this hard to believe. All these doctors here are so stupid as to admit you for no reason? They want to make you all suffer while the real bad guys are out there going about their lives?’ ”

“I’ve been asking them to think about what’s going on inside of them, rather than what’s going on outside,” I told her.

“No,” she said. “Too sophisticated. Say to them: ‘None of you have any problems?’ ”

“They’ll say they don’t,” I said glumly. That particular day I had run what felt like a pronouncedly stubborn and self-defeating group.

“Then say, ‘Okay, well, I guess we’ll just have to agree to disagree.’ ”

But I was also getting sharper. When a patient I had been indulgent with during group said to me, “You understand me so much better than Dr. T.,” I knew right away that he was a substance abuser and that I had missed this issue and Dr. T. had not. For the rest of that day, each time he saw me in the hall, he told me that I should get a raise. Actually, the opposite was true. The next day, T. and I spoke to him together. T. asked him if he had any thoughts about what they’d talked about the day before. He could not remember the conversation.

“I think it had something to do with your drinking,” I told him. He never mentioned my raise again.

Of course each time I felt satisfied with my growing competence, there was something to remind me of how little I knew, if not about my field per se, then certainly about the world. One morning Rhoda presented me with a Mr. Rain, thirty years old and unwashed. “He was brought in for threatening to shoot someone at his new group home,” she told me.

We went into T.’s office to talk. He was gentle and truly not smart. He told me that he hated his new residence. I asked if he thought he had any alternatives. “I was in foster care once,” he said. “I liked it. Can I go back there?”

After Mr. Rain and I finished, Rhoda came in to ask
whether he had access to a weapon. I didn’t know, because despite his presenting problem I hadn’t thought to ask and the very idea that he could have obtained a gun sounded preposterous to me, which I didn’t hesitate to tell her. She didn’t hesitate to look at me as if I were an idiot.

“This is East Flatbush! You can get a gun on any street corner!”

There were other things you could get on Brooklyn street corners that I didn’t know much about either, but I learned about from people like Mr. Tacks, who had been quick, in morning group, to let me know that he didn’t belong in the psych ER. During group, Mr. Tacks’s story concerned calling the police in order
to set an example for
his wife. It changed when I sat with him one-on-one. “I called them
to come take her away
, but then I realized she needed to be home to watch our daughter, so I went instead,” he said.

“That doesn’t make any sense, Mr. Tacks.” I liked that line, it was so knowing and world-weary. I’d stolen it from Dr. T.

“What makes no sense is keeping me here. I’ve got multiple businesses to run, and being in here just keeps me from making money for my family. I’ve been away long enough. I just got back from upstate in May. My businesses are suffering.” He spoke quickly and a little too loudly and was having more fun than anyone deserved to have in the psychiatric emergency room. Sure, mania had its downside, but it could also be a hoot.

“What did you go upstate for?” (I felt so satisfied, knowing he meant prison.)

“Assault,” he said. “It was my fourth incarceration. My second or third there was a corrections officer who disrespected
me. Me and my boys went and found him. They beat the guy. I waved around a gun, decided not to shoot. We showed him.” He puffed out his considerable chest.

“But you went to jail for …”

“Four years,” he said. “And I’m taking names of people who piss me off here.”

I took a deep breath. A danger to others, possibly. Poor insight and judgment, for sure. “So what you’re saying to me—someone who works here—is that if you get angry at any of the staff members, you will track them down and hurt them? Do you think that assault is a good idea? Do you think that telling me of your intentions is a good idea?”

“What are you talking about? I didn’t say that.”

After we were done, Mrs. Tacks had come to visit, and I brought her in with him to get a clearer sense of why her husband was there in the first place. “The last time he was hospitalized was at Elmhurst ten years ago. They told him to call 911 if he ever needed help. He woke up from a post-beer nap feeling depressed and called EMS. I told him not to do it,” she said. “Now he’s stuck here for a while, right?” I informed her he’d been admitted for seventy-two-hour observation. She continued, “I called the police on him last week for putting his hands on me. He slapped me, and they took him away, but actually I hit him first. It didn’t look too good for him,” she said, pointing to her rounded belly. She was notably pregnant. She continued, “He got back from jail seven months ago, and just like that we’re having another kid. I have two older kids, but our first daughter together is four. I had her while he was away. He didn’t even know about her until he got home.”

Mr. Tacks was quiet for a change. “Why did you hit him?” I asked her.

She gave him a dirty look. He said, “She’s so jealous. I went out to the store, and she thought I was with another woman.”

“How long was he gone?” I asked her.

He answered before she could: “Five minutes.”

“Has he been unfaithful to you in the past?” I asked her.

“Yes,” she replied.

“We weren’t together then!” he said to her, and then turned to me to explain. “When I got out, I slept with one of my hos.”

My eyes opened wide, and I didn’t bother to try to hide my middle-class surprise. “You’re a pimp?” I asked him.

“Not anymore,” he said.

I took a deep breath. “What goes on between the two of you that things get so heated that you’re hitting each other?”

He brushed me off with his right hand, apparently incensed by the question: “I’m a shooter, not a hitter.”

Mrs. Tacks was no more abashed about her own antisocial tendencies. “I held up a bank once with my asthma inhaler. They gave me money, and I never got caught.” Again I was stumped. My silence unnerved her: “How else was I supposed to feed my kids?”

T. laughed when I recounted the meeting. “Your typical narcissistic-borderline couple,” she said. Narcissists, who have a fragile sense of self that they bolster with grandiosity, often pair with borderlines, who are likely to provide them with the idealization they crave. “Who else did you have in group this morning?”

I listed the names, forgetting the toothless woman and then remembering. “Oh, and Shirley.”

“She’s going home today. We should see her first. Why do you think you almost left her out?”

“She lives in a group home. She doesn’t have any front
teeth. I think I see her and assume she’s a hopeless case, so I end up being more focused on the other patients. Also, she was interrupting the others a lot. I felt really annoyed; it’s so hard to get a conversation going in there, and she was making it harder.”

“Don’t be so quick to dismiss her as un-helpable. Teach her something,” she said. “Ask the other group members to talk about what it’s like for them when Shirley interrupts. She may not get it now, but it will stay with her. We know Shirley here. We see her and other people like her over and over. The staff starts to get frustrated. I’m no exception. Just last week I saw Sequoia Diaz and rolled my eyes, thinking, ‘She’s back again!’ She used to come in every month. And I saw her, and it was obvious I was exasperated, and she said to me, ‘But, Dr. T., it’s been almost eight months!’ And it had been. She said, ‘I’ve been trying, but it’s hard!’ So I told the staff to congratulate her on going almost eight months between ER visits.”

I found Shirley in her miniskirt and her headband and asked her to come to T.’s office. She was so friendly toward me, and I felt guilty for my indifference toward her over the past three mornings. As Dr. T. and I spoke to her, Dr. Amony came in to wish her well, which I had never seen him do with any of the other patients. In his suit and his accent he was as dignified as a head of state, and I thought that Shirley was a valued customer, and I saw that it made her feel good. “Be calm at your residence,” he told her, serene but stern.

I walked Shirley toward the front to meet her caseworker, who would take her home. Shirley was so excited she tried to hug me with a toothless smile. “No touching!” I said reflexively, feeling like an insensitive jerk but also not wanting her fleshy bosom pressed against mine. I stuck out my hand to shake hers instead, which of course involved touching and
might have been confusing. She asked for my card. I hoped her request meant that she hadn’t noticed my coldness, though it would have been better, for her own good in the world, were she able to pick up on others’ signals, no matter how rejecting. At any rate, I didn’t have a card. I apologized.

When there were only two EOB patients and one refused to get out of bed, I did not have a group. I asked a Miss Williams, who was standing in the hallway peering over her shoulder, to come into T.’s office alone. She was my size but with a psychotic stare intense enough that it left me cold inside. I kept the door to the office open as we sat down because one of the few things I’d learned in grad school about working with psychotic patients was that their delicate sense of safety was predicated on being able to flee. I also made sure her chair was closest to the door. She was fragile looking and rather beautiful, if not so well-groomed, like a television actress made up as a crazy person for a role. She had light brown skin and haunted amber eyes.

I began with simple questions to see how disoriented she might be. She knew the date, the day of the week, the name of the hospital, and even that we were in the G Building.

“How old are you?”

“Twenty-three,” she responded. Her chart said thirty-nine, and she looked it.