Voodoo Chile

It’s Valentine’s Day, my first year of residency at Mount Sinai Hospital.
I work all day and then stay the night as well; I am on call tonight. I roam the hallways alone. I have been a doctor out of medical school for all of eight months. Mostly, I lay low in the call-room and pray that no one needs me, living in constant fear of a medical emergency. A psych emergency I can handle; it’s the ‘code blues’ that terrify me. I just did four months of medicine rotation at the Veteran’s hospital, where I lived in mortal fear of anyone’s heart stopping. When I had to stay on call overnight, I would cower in my bed under the thin blanket. I couldn’t sleep due to the pounding of my heartbeat, reverberating in my chest and in my head. I was sure that I’d be called to someone’s bedside and fumble impotently with the medications and machinery as they lay dying.
My Mount Sinai call is passing by uneventfully. I have eaten some chocolates out of heart-shaped boxes on this ward and that, making my rounds one last time before I head to the call-room to get some sleep. Schmoozing the nurses as best I can, I ask them to think of any last-minute orders that I can write before I turn in, so they’ll be merciful and not call me unless it’s urgent.
A nurse on one of the wards asks me to see a new admission, a 24 year old guy named Calvo who is quite literally bouncing off the walls. He came up from the ER earlier in the evening, and the nurses are having a hard time containing him. I walk into his room; he has no roommates, thankfully. He is extremely fearful and agitated, climbing onto his bed then jumping off of it and pacing around his room, ending up on his bed again. He is fixated on the fact that he will not live through the night. He is convinced a curse has been put on him, through the Cuban Voodoo called Santeria. I had never heard of Santeria until I moved to New York City, but the nurses here believe in its power.
“You’re not going to die,” I keep reassuring him. I ask the nurses to give him an injection of Ativan, the most commonly used sedative used on the inpatient wards, and I go to the call-room and try to get some sleep.
At 2:30 in the morning, I get a call. “We’re having trouble getting Mr. Calvo’s vital signs,” explains one of the nurses, in a heavy accent. I figure she just needs help with the blood pressure machine or something, so I lace up my sneakers and go to the bathroom down the hall before heading to the ward. I walk into the patient’s room, assuming there’ll be a nurse in there struggling with a BP cuff, but he is alone. Immediately it becomes clear why the nurses are having trouble getting his vital signs. Mr. Calvo is lying in his bed, staring straight up at the ceiling, a look of terror on his face. His eyes are wide open, his pupils fixed and dilated, and he is cool to the touch.
“Oh my fucking God! Please tell me this guy is a DNR!” I’m begging as I run into the nurses’ station. At the VA, if a patient was a Do Not Resuscitate, we wouldn’t have to run a code. Many of the older, sicker patients had orders not to revive them. I grab his chart, but of course, there’s no big orange sticker on the front; he’s a young guy—as far as I know, a young, healthy guy.
“Jesus! Call a code!” I yell to the nurses.
I sprint back into his room and start CPR. Or what I can remember of CPR. I am adrenalized, swearing, scared, angry. “What happened? Why is this happening?” I am talking to myself, soothing me with mindless chatter. “Just do the compressions and the breaths, don’t panic, breathe.”
Other doctors start to arrive at the code, thankfully, and I continue doing chest compressions while they start IV’s, give him oxygen, and inject multiple medicines to get his heart started again. “Clear!” the code team doctor shouts, as they attempt to shock his heart back into a rhythm.
But it’s no use. The man has clearly been dead for a while. I knew he was dead when I got there. No one can say with any certainty when he died, or why in God’s name he died, but every doctor in that room knows that he is now dead. My patient. My mess to clean up. The code is over, and all the other doctors leave. Like a wild party I have thrown, the keg is dry and the guests have moved on. The room is a mess. There are IV packages and tubing on the floor; there are EKG leads, face masks, and gloves littering the bed.
He is still staring at the ceiling, impervious.
I go to the nurses’ station and start to make the calls: the on-call attending, the ward attending, the inpatient director, Dr. Fanques. I am on the phone for what seems like hours as the adrenaline slowly diffuses out of my brain. When I am calmer, I take a deep breath and call the family. I have to tell them in my broken Spanish that I am incredibly sorry, and there is no logical reason, but he is dead.
“El murió!” his sister screams. “El murió!” She sobs into the phone and hands it over to her husband. They want to come into the hospital to see him, and I tell them where to park. We’re going to need an autopsy to figure out what the hell happened, but I save that for when I can talk to them in person.
I need to fill out a death certificate, which I have never done before. I call the medical examiner’s office to get some advice. I don’t know why he died, or how he died, but I’m supposed to fill out an official form for the city which explains his death. The pathology resident on call at the morgue is very helpful in explaining how I should fill out the form. I can’t simply write that his heart stopped. It is the result, not the cause, of his death as far as the pathologist is concerned. Also, he doesn’t think my listing a voodoo curse as the proximal cause of death will fly. We are bonding over my predicament at four in the morning, flirting not-so-subtly, and I am tempted to ask him out. Out of respect for the dead, I do not.
I leave the nurses’ station when the paperwork is completed, and I ask the nurse to page me when the family shows up, but of course I can’t go back to bed. I wander the wards and go to my office. My favorite patient, the toothless old schizophrenic lady with tardive dyskinesia, is wandering the halls. TD is an irreversible side effect from some of the older antipsychotic medicines (the newer antipsychotics are much less likely to cause it, carrying a risk of obesity and irreversible diabetes instead); it manifests as uncontrollable movements, often in the mouth and hands. She sees me and gives me the biggest, sweetest smile while her tongue darts in and out of her wrinkled mouth. I tell her everything, and she nods her head sympathetically. I don’t know how much of this she gets, for she is quite possibly demented, but I want to connect with someone, and her loving gaze is almost enough.
In the morning, I have to explain what has happened to the residency director, my father figure at the hospital.
“I heard what happened last night, Julie,” he opens. “How are you doing?”
I sit down in his office, in the cushy leather chair across from his desk, and I start to cry. It is the first time I have cried for the dead man. It feels good to finally break down, but I worry that I’m making Dr. Wilson feel uncomfortable. He’s a shrink, though; he’s probably used to people crying in his office. I look to my right, where, as if to assure me, a box of Kleenex is ready and waiting.
“I feel like I threw a party and now I have to clean up the mess,” I choke out between sobs. I blow my nose and continue, “I mean, the code. Whenever I went to codes at the VA, it was always somebody else’s patient. When the code was over, I left. This time it’s my patient. They left all this trash in the room, and I had a bunch of paperwork I had no clue how to fill out, and they left me with a corpse. Do you know what I mean?” I don’t know why this is how I start, as a victim, in trying to explain my failure, but it is what’s foremost in my mind, for some reason. I guess it’s a symbol of my new responsibility as a physician, which I don’t want. I want to go back to being a guest at the party, when I was a medical student watching the action, and not the host of a failed attempt at resuscitation.
Dr. Wilson murmurs something comforting about this being something we all goes through, but then he gets down to business. “Listen, Dr. Fanques is going to need you to write up everything exactly how it happened. There’s some confusion about exactly when the code was called. Was it before you got there or after?”
“After,” I answer. “I told the nurses to call it.”
“Well, that’s not exactly how they’re portraying it,” he tells me. “So why don’t you go home and write up the whole story. Try to have it for him tomorrow morning.”
“Dr. Wilson, I’m leaving for my week off tomorrow afternoon, so if there’s any sort of meeting about this, I’m not going to be there.”
“That’s all right. I think we’ll be able to get through that without you, as long as we have your written statement.”
I go home, write up the entire case as best I can remember, and pack for my week with my parents in Palm Springs. I have never needed a vacation more. I can’t wait to fall asleep on the plane.
Fast asleep on the plane…

“Julie?!”
“What?” I startle, looking frantically around the pitch black room. Where am I? Am I hallucinating? I could swear I just heard a voice say my name.
“What do you want me to do with this guy?”
The clock by my bed says 4:12. There is a phone in my hand. “Oh… Uh… I’m sorry. I must’ve just spaced out. Acid flashback,” I joke. “Can you maybe rewind a little? I think I might’ve missed some of your presentation. I think I fell back to sleep while you were talking. I’m really sorry. Can you just start over?”
I haven’t thought about that Valentine’s day in years. What made me think of it now?
“Whatever, sure,” says the resident. “He’s a twenty-seven year old guy, history of bipolar disorder and cocaine abuse. Parents say he’s been off his lithium for a few months, at least. Brought in by ambulance from home. He’s grandiose, thinks he’s got supernatural powers, pretty hyper-religious, hyper-verbal. He keeps going on and on about Santeria. Isn’t that some kind of Haitian Voodoo? Or is it Cuban? You ever heard of it?”
“Yeah,” I clear my throat. “Yeah, I’ve heard of it.”

Being a patient on an inpatient psych ward can be a lonely, loveless experience. There is nothing to do all day, and the walls are the same drab gray as the chairs, the food, and the staff. As a third year resident, I would sometimes bring my guitar to the Veteran’s Hospital in the Bronx and play for the patients on the schizophrenia research ward, where I was the chief resident. I couldn’t help but play songs that I thought would have special meaning, like John Lennon’s Watching the Wheels. (People think I’m crazy, dreaming my life away…) or Joe Walsh “Life’s Been Good” (they say I’m crazy but it takes all my time…).
There was one veteran who had a strong, fixed delusion that he was Elvis. He didn’t have the hair for it, but he could sing pretty well. I made a point of learning “Love Me Tender” so he could show off in front of the other patients on the unit. There was another patient there who often wore dark sunglasses and expended a certain amount of energy trying to look cool, slouching on the couch, sucking on his teeth. He was a big Jimi Hendrix fan, and I would let him play my guitar for his friends. He would brag about how he had a recording contract pending, or a concert coming up, and I would nod my head appreciatively, trying not to wince as he strummed my acoustic guitar atonally.
In college and medical school, I played in a band, and I finally had to quit when third year rotations came around, but I never gave up on music. During my surgery rotation in the emergency room, I would sometimes sing to my patients while I was suturing their wounds. I remember one guy who beat up his girlfriend when he was drunk. She had several brothers who came looking for him. By the time he walked into the ER, he was a mess. I was new at suturing, but my surgery resident thought it would be okay for me to practice on him. (That’s how it was in medical school. We learned as we went along, often performing procedures we had only seen once, practicing on unsuspecting patients.)
I spent hours meticulously cleaning and sewing the man’s numerous lacerations while singing lullabies: old James Taylor and Joni Mitchell songs, anything I could think of to keep me occupied and him distracted. The music helped me to treat him kindly, to think of him as a baby who needed to be sung to sleep. He had been treated harshly already, beaten nearly to death, and I felt he deserved my tender ministrations. He gradually dozed off while I was sewing, and I hummed to myself while the smell of the alcohol in his blood wafted toward my nose.
When I got to Bellevue, I would occasionally sing for the patients, but it happened less as I got older. There was one especially rowdy night when the patients were forming a rag-tag group, back in the old CPEP before we moved into the larger space. They were singing “He’s got the whole world in his hands.” The song wasn’t my idea, but I was willing to sing along with just about anything, and the patients were substituting in various things to be “in his hands.” Someone improvised a verse: “He’s got the Bellevue Hospital in his hands.” I sang along, believing it whole-heartedly as I grinned skyward.
There were times during a CPEP shift when I would start to feel down, and I would get that old “I’m a cog in a machine” feeling. Those were the nights I would sing my signature song to the nurses, accompanied by a jig, of sorts. Stolen from a stand-up comic, it went a little something like this: “I don’t care. I don’t care. I don’t care.” Then I would add in the chorus, who I imagined would come behind me with quivering jazz hands, “She does not care! She does not care!” It was a perennial favorite, that song. Nancy would ask me to sing it for her every once in a while, or she would start it for me, hoping I’d join in, if she saw me getting riled up about something I could not control.
And then there was the tap-dancing. After Jeremy and I bought our house in the country, I found a cute little dance studio by the train station. I signed up for weekly lessons. I hadn’t taken a dance class since I was three years old, when my mom would drive me to the purple house on the other side of town for my obligatory ballet class. I’ll tell you, nothing is quite as frivolous or liberating as learning to tap-dance when you’re pushing forty.
After I found out that Julia, the social worker, also knew how to tap dance, I insisted she bring in her shoes on the weekends. There were a handful of stolen moments on Saturday nights around 11 or so when we would go out to the hallway and do our little routine. We devised some dance steps to accompany the Soul Coughing song “Down to This” with the chorus “You get the ankles and I’ll get the wrists.” I fantasized if we ever had a CPEP talent show, it’d be the perfect theme song, tap-dancing around the issue of restraints.
Occasionally, when Julia and I were feeling brave, we would dance right in the nurses’ station. The nurses loved it, but the patients didn’t know what to think. Perhaps they thought they were hallucinating, or maybe they understood that we needed to let off a little steam. I hope they took it in stride, as they took most things that happened in CPEP.
One time we were tap-dancing in the hallway outside of the doctor’s call-rooms. I learned, years later, that two of the doctors were in a call-room having sex, and were quietly waiting for us to finish dancing so they could clandestinely leave. These are the sorts of confessions I heard when residents became attendings and felt they could confide in me more freely.
Singing, dancing, guitar playing: there was time to squeeze in music and merriment at my job, in between the paperwork, the interviews, and the sedatives. There were plenty of patients who sang their songs—sang them loud, sang them proud. Anytime a patient serenaded me, I’d try to be an appreciative, attentive audience. Song choice can tell you a lot about how someone’s feeling.
Or how I’m feeling. Often, after getting to know a patient for a few hours and devising a treatment plan in the hopes that they could leave the CPEP and have a better life, I’d be tempted to sing the last few strains of the song “So Long, Farewell” from The Sound of Music, the high notes of “goodbye” fading away as the patient walks out the door, past the metal detector, and into the cold heart of the city.

It is the Summer of 2003. We’ve been pretty busy lately and it looks like I’m going to need to call EMS for diversion again. When there are too many patients on triage and we have no empty beds upstairs, or there are simply too many patients in the area, then I can call the diversion desk at EMS and ask them to take us out of the loop. It is a phone number I know by heart by now, and even though the call is supposed to be made by the CPEP director, I often make it myself.
As EMS is quick to remind me, diversion is a courtesy. The city will try to shield us from any new patients arriving by ambulance, but there is no guarantee. It works to some extent; maybe we get seventy-five percent fewer EMS cases, but inevitably they still arrive. Either the drivers will say it didn’t come up on their screen, or they didn’t hear the announcement, or the diversion call came in after they already had their patient in the bus and were en route to Bellevue. Then there’s the driver’s iron-clad no-fault excuse, which is that the patient wasn’t called in as a psych case but as a medical case, so dispatch thought they would be brought to the medical ER. Either way, once they show up I can’t turn them away. There’s nothing I can do to stem the tide of EMS cases beyond calling in diversion, and the walk-ins are still going to come regardless of whom I call, so there’s only so much I can do to relieve the pressure of the incoming patients on the area.
I start my sign out by announcing, “We’re on diversion. Confirmed by EMS operator 8758. It’s good ‘til noon, for what it’s worth.”
“So, on the admissions team, we have a voluntary, Mr. L, thirty-six year old African-American male, walked in saying he needed to talk to someone. He states he feels depressed, and that two days ago he tried to jump in front of a bus. He gives a questionable history of saying he was in the military in Korea as counterintelligence, but he can’t talk about it. We have no idea if this is true or not. He seems odd; he’s a loner, he’s gone through many jobs in the past few years. On exam, he is thought disordered, with circumstantial speech. He’s also markedly hypervigilent, and he didn’t sleep at all last night. We put him on Risperdal and Effexor, and prn’s for agitation.
“Next up is Mr. B, a forty-one year old Hispanic man who was brought in by his family, who all asked for the infamous Bellevue baloney sandwiches, by the way. We started him off in the EOU, but he’s not looking any better, so we switched him to a 9.39 last night. He’s got a history of seven detoxes at Bellevue alone, and at least twenty stints at rehabs. He steals from everyone, including his family. He has a history of multiple suicide attempts, he’s been pulled off more than one bridge. He looks internally stimulated and has persistently been voicing suicidal ideation with a plan. He’s on a Librium taper, Depakote, Seroquel, and vitamins.
“Mr. L, a thirty-two year old Asian male with a history of schizophrenia, Cantonese speaking only. 18 South is full for the moment so we’re holding him. He was brought in by his sister after he disappeared for six weeks and showed up in the Tufts ER in Boston. His sister says he has a Bellevue history, but he was registered with a new number so I have no idea if he has an old chart floating around but I’m hoping someone on18 South will recognize him. He’s grossly psychotic, disorganized, disheveled. He looks like he’s hearing voices and his sister interpreted for him that the voices tell him to go to Boston. He’s on Zyprexa 10mg.
“Then we have Mr. D, a twenty-eight old white male transferred from the Tisch ER, where he walked in saying that government agents were following him and he felt unsafe. He has a prior history of bipolar disorder and he’s off his meds. He’s irritable, grandiose, referential, hyper-religious. Apparently at Tisch he made threatening statements about his brother. I have no idea if the brother has been warned or not. I doubt it because the patient isn’t giving up any phone numbers. He had lots of weird things with him when he got to Tisch, kitchen implements, a certificate that says he’s a minister which I’m assuming he got off the internet. Anyway, we put him on Depakote, Risperdal, Klonipin, the holy trinity of mania meds. He’s a good teaching case if we have any med students today.
“Another 9.39, Mr. X, sent over to us from the Peds ER. He’s 21. Peds goes up to 25, in case anyone doesn’t know. But child psych stops at 18 so he’s ours. Apparently his father dropped him off saying ‘he’s crazy.’ Four months ago he had a car accident and he’s been complaining of headaches ever since. Also for the past four months dad says he’s increasingly bizarre, talking to himself, laughing maniacally for no reason. He smeared his own blood on his face and all over the wall. The patient says he’s been using cannabis for the past four months to treat his headaches. We ordered a head CT, obviously, and he’s on standing Risperdal. Also, prn thorazine works great for him.
“Also a 9.39 is Ms. T, eighteen year old Hispanic female, brought in by EMS after her boyfriend called 911 because she’s been acting paranoid, responding to internal stimuli. On exam, she is absolutely paranoid, convinced the CPEP staff was planning to kill her. She’s also voicing homicidal ideation toward her mother. Mom says she’s been like this for about a year. So, she needs a first break workup. Oh, here’s the most important thing, she had her thyroid removed or partially removed about eighteen months ago and for some reason she’s not on any thyroid meds, so there’s a chance this is all related to that. She’s on Risperdal and half prn’s. We’re waiting for labs and thyroid numbers and I bet they’ll be off the wall. See if she can go to the teaching floor, will ya?
“Next up, Ms. W is a thirty-three year old white female, also a 9.39. She was brought in as an EDP, smelling like booze. She was trespassing at an apartment building where she hangs out a lot. She’s been having sex in the basement, probably smoking crack, I’m waiting on a urine drug screen. The landlord called 911 because he was sick of her hanging around there, I guess, and she wasn’t being quiet about it. She came in on Saturday, really loud, agitated, incoherent, talking about aliens. She was definitely drunk and probably high on cocaine, but on Sunday, she was still really manicky, grandiose, paranoid. She threw all the food off her tray all over the place and got five of Haldol, two of Ativan, and fifty of Benadryl IM as a prn. The big problem with her is she’s hypersexual. She’s been propositioning everyone, staff and patients alike, and she touched the penis of one of the guys in the EOU. She’s got a history of being on lithium, but we started her on Depakote, Risperdal, and Klonipin, amen. She’s going to need sexual acting out precautions when she goes upstairs, whoever updates her chart.
“We got another hypersexual patient who needs acting out precautions for upstairs too. Ms. W, twenty-six year old African American woman brought in by EMS naked, grossly psychotic, screaming about how the cops raped her. She denies a psych history but keeps saying ‘I relapsed’ and ‘I’m crazy.’ She’s been masturbating and flashing since she got here. Urine tox is pending. She’s on Depakote and Risperdal as well as prn Librium and vitamins.
“Ooh, actually, we have one more hypersexual patient. I might as well clump ‘em. Ms. K, a late thirties, early forties German woman. By the way, she has insurance, GHI, so we gotta transfer her out of here. God forbid Bellevue should make a deal with some of these carriers. You can probably ship her back to Cornell; she just got out of a one month stay there a week ago. I already called billing to let them know we need a transfer. Anyway, she lives here and her mom came to visit from Germany and I guess she didn’t like what she saw. Cornell discharged her on four different meds but she’s taking none of them. She seems to prefer Vivarin and Benadryl. So she’s totally agitated from the caffeine, but she’s confused from the anticholinergic effects of the Benadryl. She’s also been drinking. She’s been bumping into people on the street, getting violent with strangers, very labile and irritable with mom. Mom called 911 and then our gal ran away from the cops. When she got here, she started to do a little strip tease for the triage nurse. She’s going to need sexual acting out precautions too. I restarted her meds, more or less. I simplified the Cornell regimen a little bit, not that it matters because she’s not going to stay here anyway.
“You know what? There’s still one more hypersexual patient. Something in the water, I guess. Mr. F is a twenty-eight year old man from Africa with a history of psychosis. He was sent over here from the shelter after he assaulted a worker there, unprovoked. Well, maybe he felt provoked. He was dancing and she asked him to stop. Anyway, he’s very odd, sexually preoccupied. He’s got a history of delusions but currently he’s calm here and his only complaint is that people don’t want him to be happy. He says he used to have a chemical imbalance but he’s fine now. Also, he keeps trying to touch the other patients because he believes he can heal them. He’s been taking Zyprexa at the shelter up until about five months ago, then he stopped it on his own. He’s willing to restart the Zyprexa and he’s been compliant with it all weekend. He’s also been propositioning the doctors, nurses, psych techs, and disrobing every chance he gets. He’d be good for the teaching ward if any beds ever open up upstairs.
“The EOU is full. No surprise there. We have a couple of peds cases, and one of the patients is probably an admission but we put him in EOU cause the hallway is completely full of stretchers with patients waiting to go upstairs. So, first peds case is Ms. M, a seventeen year old Hispanic female who was visiting New York City from Georgia with her mom and ran away. She was found two weeks later at grandma’s house in the Bronx. She is very thin, dressed in men’s clothing. She’s got a history of truancy, assaultive behavior with questionable criminal charges, cannabis abuse, lying to mom. It sounds like oppositional defiant disorder versus conduct disorder. Her urine was positive for cocaine and she’s got track marks on her arm, which is new behavior for her per mother. Mom is understandably freaked out, asking to maybe file a petition to let the state try to handle her for a while. Does anyone here know what a PINS petition is?”
“It stands for Person in Need of Service,” one of the psychiatric residents answers. “The parent asks the state to supervise the child. Sometimes they go to a foster family, sometimes they get court ordered to a locked unit.”
“Right. The mom met with one of the social workers over the weekend. I think it was Julia, who explained all her options to her. Someone from child psych will follow up with the mom and the patient today.”
“Next kid is Mr. B, seventeen year old Hispanic male who ran away from the foster home where he’s been staying for nine months due to an abusive father there. He got lost, got upset, ended up calling 911. He seems very simple when you speak with him, and he may be mentally retarded. He’s got a history of conduct disorder, marijuana and alcohol abuse, and mood swings. He was in a state hospital for two years, ages fourteen to sixteen, and he has a day program, so we should be in touch with them today. Also, he needs some face time with social work, or a psychology intern maybe. He just found out his biological father was killed in the Dominican Republic recently. Peds knows to come see him today.
“Also in the EOU is Mr. J, a thirty-seven year old Hispanic man brought in by EMS after he scratched his wrists in front of Saint Luke’s Roosevelt hospital. SLR asked EMS to send him down here. I guess they know him already. He’s a heroin addict, alcoholic with a history of violence. He stabbed someone about six years ago and was in prison for awhile. He seems pretty impoverished when you talk to him, probably borderline IQ. The weird thing with him is he has nystagmus and we have no idea why. Anyone know which drugs cause nystagmus?”
“Dilantin?” asks one of the visiting psychiatrists from North Shore Hospital.
“Right, that’s one. You can see the eyes wiggle horizontally on extreme lateral gaze. Tegretol does that too. What about drugs of abuse?”
“PCP,” mentions a psychiatry resident.
“Good. That’s an important one. The other time you can see abnormal eye movements is with MDMA, or Ecstasy. Anyway, he denies ingesting any drugs beyond his usual heroin, so we’re not too sure what to make of it here. He needs a neuro consult.”
“Next up is Ms. W. She’s a thirty-seven year old white female with a long history of alcohol abuse and a recent Beth Israel detox three days ago. She relapsed immediately. She walked in, tearful, saying she can’t take it anymore and she’s suicidal. She seems pretty depressed and hopeless, so we put her in the EOU and started her on a Librium taper. She got put on Effexor at BI so we continued it. Also, she’s on synthroid so we’re waiting on thyroid bloodwork. She’s divorced and she’s been sleeping at shelters. She’s in pretty bad shape. She feels like she has no one who will take care of her. But now, at least, she has us. Right?”
Silence.
“Okay, so, onward. EOU bed five is Mr. P, a thirty year old white male who walked in asking for help, stating he tried to overdose on heroin, alcohol, and Xanax. He came in pretty high, and his story is inconsistent. He’s changed the amount of heroin he shot; he says he shoots a bundle a day, which is ten bags for those of you who don’t’ know. He usually shoots five at a time, twice a day, but his overdose was only six bags. Then he changed it later to say he shot all ten at once. Also, he initially denied hearing voices, then later reported them. He’s using a lot of psych lingo like he’s been through this all before. ‘I’m unsafe. I’m a danger to myself.’ ‘I’m severely depressed and need to be hospitalized.’ Anyway, he is still endorsing suicidality the last time we interviewed him, but there aren’t any beds anywhere, so I’m not too sure how long we can sit on him. He needed twenty of methadone on Sunday. If he’d contract for safety, there’s one bed left on the detox ward. See if you guys can explain that to him, okay? As long as he’s reporting hearing voices to kill himself, we can’t admit him to an unlocked ward, but that’s the only place that has a bed open, so he’s gotta recant if he wants to be off the street.
“Last up in the EOU is Ms. T, a twenty-five year old white female who was brought in by her boyfriend of two years. She’s Catholic, and currently suicidal. She got pregnant unexpectedly, lost her job due to morning sickness, and then had an abortion last week. She’s feeling terribly anxious and guilty. She scratched her face up pretty bad. She’s got a history of being raped about six years ago, and also made a suicidal gesture by overdose not long after that. I think this AB is bringing up a lot of old memories for her. She needs some time here to get it together, and a good outpatient therapy referral after that. Maybe crisis clinic can follow her during the transition? I think she can probably go in a day or two.
“On Hold we have a thirty-eight year old woman, Ms. F, who was brought in by EMS with ESU escorts in a body bag. When we unpeeled the bag, she was swathed in bright orange clothing. She was spitting, cursing, and threatening staff so she got 5,2, and 50. I don’t have much of a story on her. She was found on Fourth Avenue and Third Street drunk and agitated, and she hit a cop, so I guess they called ESU for back up. Do people know what ESU is?
Silence.
“It stands for Emergency Services Unit. They’re basically 911 for the cops. When the police need help, especially with psych cases, they call ESU. ESU helps to sedate the patient, or just wrap them up in a body bag to get them here. If a patient comes in wrapped in those blue canvas bags with the handles, you know ESU was involved in transport.
“Anyway, she’s on hold. She’s pretty drunk, and now she’s sedated so I just have her on prns’ and Librium prn.
“Also, we’re expecting a transfer from Lincoln Hospital. A guy who’s arrested for assault. He punched a wall at the precinct, so they brought him to Lincoln Hospital for X rays but there’s no fracture. He was too agitated for Lincoln to send back with the cops, so they shlogged him and sent him here. Also, Lincoln said he’s very irritable, making both homicidal and suicidal threats, and he’s drunk. Last time I looked, he was still sleeping.
“Enjoy!”
I gather my folder, my water bottle, and my sweater and head for the door. EMS is bringing in another case as I walk out.
“We’re on diversion,” I say as I head for the door.
“Oh, really? No one told us that,” answers the driver.


The Memorial Service

Several months after she has died, we have a memorial service for Lucy. It is in a large church, and the turnout is good. She was universally well liked, and people have come not just from NYU and Bellevue, but from St. Luke’s Roosevelt, a hospital she worked at before Bellevue. There are some people from Temple University Hospital as well; I appreciate that they made the trip up from Philadelphia to honor Lucy, and I am happy to see some of them again after all these years.
Sadie has asked me to speak. I try to relax and not get too emotional listening to the other eulogizers, so I’ll be able to get the words out when it’s my time to go up to the dais.
Daniel is talking about how Lucy was his hero. That’s a big theme in my piece too. No surprise there, I guess. But after today it’ll be out in the open, how we both thought of her as our hero. How we are so alike, yet at odds. Will anyone else notice that besides me.
Daniel goes on to add that his grandfather was also his hero, and he is doubly put upon because his grandfather recently died. “This has been a bad month for me,” he complains.
“I can’t believe he’s making it into something about him. That is so typical,” my friend Gideon the social worker, whispers to me. “This is not about you!” he hisses, slightly louder.
It is my turn to speak, and I quickly ascend the carpeted stairs, take my place at the podium, and take a slow, silent breath. I wish it wouldn’t, but my voice is quivering, the paper shakes in my hand as I read what I have prepared.

Lucy Jones was my friend.
She was my colleague, and also, intermittently, over the last dozen years, she was my hero.
When I was a second year medical student at Temple University in Philadelphia, I was doing research on the psychiatry ward. I would see this one resident when she was post-call, usually wearing a red Hawaiian shirt with her hair sticking up every which way. She had a Southern accent, and she was funny, and irreverent as all hell. She had a way of talking to the attendings at staff meetings that simultaneously would ruffle their feathers and tickle their funnybones.
I immediately looked up to her. I felt we had a bond somehow, that we were cut from the same cloth, and she was me, only five years ahead of me. I think on some level I simply wanted to be her.
I even felt personally vindicated and validated somehow, when she was named Chief Resident in her fourth year. After a while, I got up the nerve to ask her if I could hang out at the psych ER with her when she was on call. On the day we agreed that I would come in, I spent the afternoon making Korean wontons so I wouldn't come empty-handed to the ER. Not a single patient came in that rainy night, and we got to talking while we ate our wontons.
I thought she was so cool, and smart.

Six years later, I began my job at the Bellevue CPEP.
On the first day when I walked in, there was Lucy. I knew I was in the right place.

The times I remember most were in the early days when Lucy would be post-call and sleep deprived, and even more disinhibited than usual, on Thursday mornings, which was when we'd have faculty meetings with Dr.McGill. He used to have to separate us because otherwise, we'd sit together and make wisecracks and whisper to each other throughout the meeting. Afterwards, we'd share a cab uptown and gossip and scheme during the ride.

She confided in me that she had had breast cancer a while back, and that I should get supplemental disability insurance. I did.
She told me to see her accountant. I did.
She told me to go to her therapist. I did, and I owe her a debt of gratitude for that one, I can assure you.
She told me to use her weekend house in the Hamptons; it was empty during the week, and I did that too.

And when she told me Dr. McGill was leaving, and she was going to be named the new director, I could barely believe it, I was so excited for her, and so proud of her.

And then she called me one day while I was in her house in East Hampton and she was in the city, and she told me that her cancer was back.
And I asked her if she was scared.
And she said "Am I scared? Hell No! I'm mad as hell."
And I thought she was bluffing, but she wasn't.
I told her I loved her and hung up the phone and cried.
She was angry and I was scared.

And after it was over, and the fight, fought so valiantly and completely, was finally done, I was the angry one.

It is simply unfair that she has to go and I get to stay.
I feel guilty when I lie on the hammock at my house and do the crossword, because I know she would be doing that at her house, if she were still here.
I felt guilty a lot when I was pregnant, especially. I felt so healthy, happy, and growing with life, and Lucy was getting sicker, and thinner, and more pessimistic. I was just starting my family, and she knew she'd be leaving hers. "You and I are at very different places in our lives right now," she said to me once, in her Queen-of-the-Understatement way.

Lucy always knew she was going to die. We spoke about it often, pretty much every time we talked, after a while. She needed to talk about it, but knew it upset people too much to discuss it. That was one of the recurrent themes: she worried about how upset her cancer was making those who loved her. How hard it was on JoAnn, or her mother, and she also hated to think of the effect it would have on Hal. At her funeral, Hal and Molly, my daughter, were playing together in the back of the church, oblivious to the significance of the service occurring on the altar. She would've loved that, I think.
She also would've loved the scene following the service, when we went to Louse Point. Lucy had kayaked there with Sadie at sunset late last summer. She told me she knew it might be the last time she'd see that view. We all went down to the water to throw our white roses in, but the wind and tide would not cooperate, and it seemed as if she were throwing the flowers back at us. Lucy didn't want us to feel sad, or to grieve at her loss. But that was impossible, and she knew it.

My heart goes out to each of us who is mourning her absence.