Brooklyn Zoo (28 page)

“We’ve developed a good relationship over the last couple weeks. Maybe I can convince him,” I said.

“It’s worth a try,” said Dr. Winkler, “but we need to start thinking about other long-term care options, just in case.”

I located Buck in the corner of the dayroom with his back to the other patients, his head down. “Zachary’s at it again,” he whispered to me. Zachary was one of the tough guys, in his early twenties. He dressed like a thug, but he was amiable enough. I’d tried asking him to leave Buck alone, but he denied hassling the older man at all, and I wasn’t sure what to believe. Zachary was sitting quietly on the vinyl couch watching morning television.

“We need to have a serious talk,” I said, and Buck followed me to the tables and chairs.

“I’ve got to call Mayor Bloomberg,” he said, agitated, as we sat down.

“That can wait,” I told him.

“No it can’t. I’m on parole, and he likes me to check in,” he said.

“Buck …,” I started.

“Where’s your pen? I need you to write some things down.”

I’d left my pen in the chart room, and I told him so.

“Well, go get it!”

“Not right now, Buck.”

“Why not? I’ll walk over there with you.” He got up.

“Not right now, Buck,” I repeated.

“Come on!” He waved his hand to set me in motion.

“Not right now,” I said. He was thwarting my agenda, and my irritation with him poked sharply through my voice.

Buck froze. I’d satisfied his whims for weeks, never breaking from form, implicitly promising our solicitude would go on and on and never stop, though that could never really be. Buck looked over his shoulder at no one.

“Damn, Zachary, leave me alone!”

I looked to make sure, and Zachary was still twenty feet from us, impassively watching Regis and Kelly Ripa and their singsong routine. When I channel surfed past them at home, they sounded only half-grating, but heard amid the anguish of the institution, their merry voices taunted. “What was that?” I asked Buck.

“Zachary’s picking on me again!” he said.

“He is?” I asked.

“You heard him!” said Buck.

“What did he say?”

“He said you’re getting irritated with me.”

Reflexively, I named the defenses in my head: introjection
(taking a feared part of a caretaker in, as if to control it) and projection (expelling it onto another because it feels unacceptable in the self). No wonder I’d been so compliant. Buck could no more tolerate evidence of my ambivalence toward him than he could get the mayor on the phone. To know that I could become angry with him was too destabilizing. If it was Zachary who was claiming I was irritated, Buck could simply rail against him—an external enemy—and insist it wasn’t true, which kept our relationship safe. What had he lived through that made such byzantine maneuvers necessary?

“It’s not fair of me, but I
am
irritated with you, Buck,” I said. “Maybe that’s difficult for you to know.”

Buck responded only with stillness, and I wasn’t sure he’d heard me at all. Defenses are deeply ingrained, escaping our notice completely until the moment we’re ready to give them up. Buck wasn’t there—not even close. But if it wasn’t a watershed moment for him, the interaction had an impact on me. Just like outside G, I saw, what transpires in the relationship between patient and therapist offers the best chance at growth. Not just stabilization, but a true getting better. Since my arrival on G-51, I’d wondered how to be a therapist to my inpatients, as if this were somehow only marginally related to being a therapist elsewhere. The ensuing self-aspersions kept me railing against imaginary external enemies of my own, a million little Zacharys. They drove me mad, but worse: in my need to pay them homage, I risked doing disservice to the people entrusted to my care. Holding on to my own convoluted belief that all that was bad and wrong and unworthy resided in me came at a cost, and it was no longer just to myself.

Buck sat back down. I told him I’d go get my pen.

The Justice Department was coming, and the paperwork had to be in order, and that could mean spending as much as triple the amount of time with my charts as with my patients. It was ludicrous, but like so much in the G Building there seemed no way of getting around it. One morning I went in early because it was quietest then and I had a stack of treatment plans that needed finishing. I unlocked the chart room expecting to find it abandoned, but instead it was filled with a group of skinny strangers, fifteen or twenty of them, and young. They were leafing through charts as if they were cheap paperbacks, and a schoolteacher, it seemed, was keeping close watch over them as if to make sure they didn’t trip each other or destroy property. Someone with some authority must have approved whatever this was or they would not have been let inside, but the charts were filled with medical information that was not only legally private but, I thought, morally so. I was only an intern, and so it was not my place to say anything, which had become so frequent a conundrum that by now it made me want to yell. “What’s going on?” I asked their authority figure.

“Nursing students,” she said. They looked young for college, but maybe that was only because over the course of years I had suddenly become old.

There was no place for me at the table. When people began to arrive for the morning meeting, there was no place for them either, and the teacher finally asked her charges to stand up. They did but held on to the charts. Dr. Winkler entered and asked what was going on.

“Nursing students,” I told him through pursed mouth, hoping he would become outraged and kick them right
out, but that was not his way, or he would not have lasted so many years at that hospital, or maybe at any. He just sat down, and we had our usual morning meeting but more crowded.

The next day I walked onto the unit, and the same students were all over the dayroom talking to patients. There was so much activity you couldn’t hear the television, which was lovely, and the patients seemed to be enjoying the flurry, the closest thing they could expect to a party. I located Domenica, the would-be daughter of Beyoncé, who was proving a difficult case. She was relentless in asserting that she didn’t have anything to talk about. Her distraught mother had become equally resolute about not taking her home, as explosive and potentially dangerous as the family deemed her. Until Domenica and I got somewhere, or she was granted a bed at Kingsboro, she would remain on G-51. I told her I wanted to discuss how she felt about her mother’s decision. It was painful to think about, and so she was ignoring me. This was how it had generally gone between us. One of the students came over. “Can I listen?” she asked.

“You’ll have to ask her,” I said, nodding toward Domenica, who shrugged at the student and grabbed the word-find book the girl was holding. Domenica flipped through it.

“She’s having a hard time accepting her situation,” I said to the student, but for Domenica’s benefit. The student wanted to know if she could ask some questions.

“You’ll have to ask her,” I repeated, my patience so easily thinned. Domenica shrugged again. The student looked at Domenica as if she were an animal at a zoo rather than a relatable human being, which on bad days was not so different from how most of us who worked there looked at her, and my anger intensified still.

“Were you ever abused?” the student asked, an especially abrasive way to begin. Domenica nodded.

“Were you ever physically abused?” she went on. Domenica nodded again.

“Were you ever sexually abused?” This time Domenica shook her head. I knew from previous discussions she was lying, and she looked a little nervous. I cut in, struggling mightily to be nice to this person whose poor judgment and lack of sensitivity I did not think lent themselves to her chosen field.

“Look, these are deeply personal questions. The answers are important if you’re treating someone, but as long as you’re just here to observe, you should stick with more neutral topics,” I advised her from somewhere on high.

She looked at me blankly. “But they’re on the list,” she said.

“The list?” I asked.

“The list of questions we’re supposed to ask,” she said. I looked over at the schoolteacher, who was watching from a corner, and wondered what kind of sadist she was.

“Sometimes you have to use your own judgment despite what’s on a list. If your nursing college isn’t teaching you that, you’re not getting your money’s worth.” I was full-blown nasty now.

“College? I’m not in college. I’m a tenth grader,” she said.

I was lashing out at a fifteen-year-old. This is what the G Building had reduced me to: thera-pissed. It turned out the students were from one of the city’s vocational high schools, which explained the naïveté of the girl I was speaking with, but certainly not why anyone had let her onto a locked psychiatric ward two days in a row. Patients could be unpredictable. Fights sometimes broke out. And what about privacy? This was no place for teenagers on a field trip.

“Gimme a dollar,” I heard Domenica demand of the tenth grader as I walked away. I saw Buck sitting with a young man a few tables over and got within earshot.

“I used to drive a taxicab,” Buck was telling him. “That’s because I was a cer-ti-fied peer coun-se-lor. Write that down!” The openmouthed boy just looked back and forth between Buck and his list of questions and did not manage to get even one in edgewise.

As a substitute for comprehensive psychological treatment, patients were moved around, from unit to unit, whenever there was any trouble. Mr. Bernard, whom we believed to have dementia, was suddenly transferred from G-51 to another ward after a sexually preoccupied patient accused him of attempted rape when he crawled into his bed one night. Mr. Bernard had been getting into the wrong bed regularly with nothing more on his mind than going to sleep. He was just confused, and putting him on a different unit altogether could only disorient him more, and my book told me that such a decision should always be carefully considered by the treatment team, but that never seemed to happen. I was his therapist, for whatever that was worth, and was certainly not consulted. Transfers took place late into the night, or on the weekends, when there were no meetings, just the decisions of overworked staff who understandably didn’t want any difficulty in their jurisdictions. Dr. Begum and Dr. Winkler were leery of transfers from other units for that reason. To be fair to everyone or maybe to no one, a kind of Yankee Swap developed, and challenging patients were traded back and forth between wards like baseball cards. Sometimes the reason for getting rid of someone was obvious (if counterproductive for
the patient himself)—for instance, guys like Marvin Mavin, who scared people. Sometimes it was so illogical that you had to be there to believe it.

In late January, Zeke came from his rotation in the psych ER to our intern case conference eager to talk about a patient he’d just met there. The man’s wife and two young sons had recently been killed in a car accident, and he had asked to be admitted in order to prevent his own death by suicide. Losing one’s entire family at once was on everyone’s short list of worst nightmares, and I could barely stand to hear about it. But Zeke was interested in hearing more. So even though he wasn’t currently on the inpatient rotation, T. and Scott gave him special permission to continue to work with this grieving man after he left the psych ER and came to G-51. By the time the man was admitted up to the unit, though, shock or denial or both had set in, and he began doing his best to make trouble: selling contraband items like cigarettes, provoking other men into fistfights. Over just a few days he became very unpopular among the staff, who I assumed like me could barely stand to fathom the bottomless pit of his pain. Even though Dr. T. had followed ER protocol and confirmed the man’s story with his remaining extended family, various members of the treatment team began to believe that there was no way anyone who had just buried his wife and kids could be acting like this, and they decided he must have made the whole thing up. It was likely the overwrought man wanted desperately to believe that himself, and the staff’s response to him was a manifestation of this poignant desire. If there had been a functional psychologist on the unit, she might have called a team meeting to communicate as much and to defuse the situation; his behavior might even have gotten addressed therapeutically. Instead, a nursing aide came in one morning claiming to have seen the man on
America’s Most Wanted
the night before. The staff went on the warpath, trying, in a flurry of Internet searching, to confirm his newly alleged criminal past. Though they failed, the man had to be transferred to another floor, as our team’s hostility toward him had finally reached an untenable pitch. Then Zeke fell on some black ice and tore his ACL and was out for three weeks, so the man lost his therapist, too.