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The View from the Vue
By Larry Karp
Jonathan David PublishersCopyright © 2000 Larry Karp
All rights reserved.
Don't Go Away Mad
Once, when I told a young woman that I was working at Bellevue Hospital, she burst out with, "Oh, that must be just fascinating. That's where they send all the real nuts." I assumed that she was referring to the patients in the Bellevue Psychiatric Pavilion, but I did worry a bit. In any case, my new acquaintance rapidly followed up her emphatic declaration with a request that I tell her "all about it."
That, in fact, would have been a major project. The Bellevue psychiatry building, constructed in 1935, was already long outmoded by the time I went to work there. Its seven floors of wards were divided into facilities designed to provide care for inmates according to their degree of impairment. The most seriously disturbed patients were confined on the top floor; below them were the moderately ill. The remainder of the building was given over to the care of patients with less critical mental disorders and to outpatients. Parts of two of the floors were set aside as psychomedicine wards, for mental patients who also suffered from serious bodily illnesses.
The physical characteristics of the psych building did very little to enhance the moods of inmates suffering from depression. Any patient who was not depressed on admission, and was capable of relating to his environment, didn't take long to experience a whopping dejection of spirits. Windows were few in number, and those that did exist were covered with bars. The hallways were long, dark, and dirty. Wards were overcrowded, understaffed, filthy, and malodorous. The beds were crammed into every available alcove, one right next to the other. Patients were either sprawled on the beds or sat on wooden chairs, usually clutching their belongings in paper bags, to guard against the otherwise inevitable theft. Too often, they simply stared into space; there was nothing else to do.
The wards for the most serious patients were genuine chambers of horrors. Shrieks, screams, and groans reverberated down the corridors in a never-ending cacophony. Here and there a patient stood motionless, perhaps with a stream of urine running down his leg to form a puddle at his feet. Others lay uncommunicative, apparently unaware of the feeding tubes which were keeping them alive.
The worst patients, those reduced to either animal or vegetable status by deficiency or aberration of mentality, passed the time by mutilating themselves or others at every opportunity, or by assuming a rigid fetus-like posture for weeks or months on end. Therapeutic psychiatry being as primitive as it was, all we could do for these people was to keep them fed, relatively clean, quiet, and as far from harm's way as possible. Had they been dogs or horses, we'd have shot them without a second thought. But they were human beings, so we gave them tranquilizers.
My first exposure to psychiatry at The Vue came during my second year of medical school. We had a series of weekly lecture -demonstrations at which the professors would describe the manifestations of the different psychiatric diseases, and would then interview illustrative cases before us. It looked very easy.
The doctor sat in a chair opposite the patient, a picture of calm assurance, asking question after question, and appearing not in the least disturbed when the patient gave a seemingly inappropriate answer. When that happened, the professor usually picked up on something the patient had said and quickly changed the direction of his inquiry, but he was never at a loss for something to say. He maintained, at all time, an attitude that bespoke thorough command of the situation; he was totally unflappable. I thought that psych was going to be a breeze.
When the third year came around, I was assigned to spend six weeks on the psychiatry service. I was in a group of eight medical students assigned to Dr. Samuel Rothstein. Dr. Rothstein was a large, handsome man in his mid-forties whose eyes exuded kindness and understanding. On the first morning, he took us to the ward, selected a patient, and began to talk with him. The patient was a hopeless schizophrenic and, in response to Dr. Rothstein's quiet but firm probing, told us all about the astonishing collection of disembodied voices and peculiar creatures which lived within the distorted confines of his mind. The performance sent shivers along the vertebral columns of the uninitiated, but there seemed to be no reason for trepidation or anxiety. It still looked very easy.
After Dr. Rothstein had dismissed the patient, he answered our questions. Then he told us he thought we were ready to try a psychiatric interview on our own. He handed each of us apiece of paper. Mine bore the name Robert Jackson. Dr. Rothstein told us that after we had interviewed and examined our patients, he'd discuss their problems with us. Buoyed by eagerness and enthusiasm, I went off in search of Mr. Jackson.
The ward nurse told me that Mr. Jackson usually hung out "over there." She pointed to the end of a long corridor. I thanked her and strutted away, chin high.
As I made my way along the corridor, I began to notice the figures alongside me. They were men of all ages, sizes, and shapes; all in the same general state of disrepair. Some were sitting or lying motionless; others rocked to and fro; and still others paced. A middle-aged man, wearing a hospital bathrobe and badly in need of a shave, came forward and clutched at my spotless white coat. As he did, I pulled away by reflex.
Suddenly I realized I was all by myself, and that I was not only going to have to interview one of these patients, but also perform a physical examination. All my confidence emulsified and floated out the nearest window, between the bars. My pace slowed perceptibly, and I almost tripped over an old man who was stretched out across the hallway.
I had no sooner recovered myself than he grabbed my pants leg and wouldn't let go. After I had pulled away, I went on past another fellow who was masturbating onto the immobile, staring schizophrenic next to him; and then I passed a codger who was holding his little paper bag of personal belongings in his left hand, while he used his right hand to direct his stream of urine against the wall. By the time I reached the end of the hallway, I was shaking. I saw a young man sitting there, staring out the window. In a voice about two octaves higher than my usual, I asked, "Mr. Jackson?"
Mr. Jackson turned very slowly, and then took about thirty seconds to glare at me. He was about twenty-five years old, and he had long, straight black hair, and the most angry, hating, hostile eyes I have ever seen. Going up another octave, I explained that I was Dr. Karp, and that I had come to interview him.
Silently he motioned me to sit down in the chair next to him. I thanked him, sat down, and gave my folder of papers a professional shuffle.
My mind was racing. I thought, My God, what happens if I ask this guy a wrong question and he gets pissed off at me? He'll kill me and drink my blood and leave me lying here and they'll never find me; they'll think I'm just another catatonic patient.
Finally I forced myself to be calm. I'm being silly, I thought. He won't hurt me. And I won't ask any wrong questions. I drew a couple of deep breaths and then noticed that all this time Mr. Jackson was staring at me with hostility in his eye and a sardonic little smile at the corners of his mouth.
I knew I had to start talking, and I drew in another breath. No hesitancy now, Karp. Show him who's boss.
"Well, Mr. Jackson," I said. "Why don't you tell my why you're here in the hospital?"
Mr. Jackson ran the fingers of his right hand through his hair. Then he looked up slowly and glared into my eyes.
"Well, Doc," he drawled, in a subtly mocking tone, "it's like this. The reason I'm here is that I think all the paranoids in the world are out to get me."
In the end, I managed to survive my interview with Mr. Jackson, but it took a bit of prodding by Dr. Rothstein to get me to see my second assigned patient. Fortunately, that encounter was considerably less traumatic, and after interviewing and examining a few more patients, I even managed to regain a part of my original confidence. One issue, though, continued to haunt me and make me uneasy: the claim by the patients that they had been railroaded to Bellevue. It seemed that every patient I interviewed, who was in any way capable of conversation, sooner or later informed me that he or she was at that moment talking to me only because an enemy had arranged for the patient to be involuntarily committed. The sole variation on the theme was in the nature of the enemy.
By far the most frequent committer of the innocent was the F.B.I. It seemed, however, that the Feds persecuted only the most blatantly psychotic inmates, and it was pretty easy to disregard such a complaint when the patient followed it up by pointing his finger at an uninhabited corner to show me the G-man who was still tailing him day and night. Less clear-cut were the situations involving supposed commitments because of the complaint of a spouse or another relative. Sometimes the hospital records bore out the basic truth of the complaint, sometimes not. In either event, as a group, the patients making this claim did not seem as strange as the F.B.I. bunch, and I experienced a good bit of difficulty in trying to sort out justified anger from paranoia.
What do you think when an enraged, but seemingly coherent man tells you that the cops dragged him off to The Vue because his wife claimed he had attacked her with a knife, but that in reality he had done no such thing. To make the situation thoroughly incomprehensible, a patient of this sort sometimes also said that his wife had been trying to get rid of him for some time, and that the first thing he was going to do upon his release was kill her. Such a guy was definitely more than a little dangerous, yes. But crazy? I could never tell. Every now and then, one of the less violently inclined "referrals" would eventually get out and promptly hire a lawyer in an attempt to squeeze a little monetary compensation out of the city.
No such patient caused me more confusion — and embarrassment — than Solomon Washington. Mr. Washington was one of the patients assigned to me during my third-year clerkship. He had been admitted late the previous night, and when I sat down to interview him, had not yet run the gamut of the residents. He was still quite willing to talk to a doctor. In fact, he was eager.
He was a huge black man, weighing well in excess of two hundred pounds, and stood six-four in his paper Bellevue slippers. His bearing was of extreme, perhaps excessive, dignity, which at times approached the Amos n' Andy burlesque style. But despite the physical resemblance and the similarity of mannerisms, Mr. Washington was no Andrew H. Brown. By his own account (which was very readily offered) he was a 1950 graduate of the University of Pennsylvania, with a major in economics.
"With that kind of background, what are you doing living on the Bowery?" I asked him.
"Please don't be so crass as to think that every resident of a Bowery flophouse is an ignorant, uneducated hobo," he answered. "The common denominator of Bowery existence is nothing more than lack of money. There are those of us who simply are down on their luck, you might say."
"I didn't think jobs were so hard to come by for economists," I said, my voice a bit snottier than was called for.
"Oh, true, very true indeed, my dear young fellow," said Mr. Washington with all the haughtiness at his command. "You are quite right, if you're talking about white economists. But I'd like to see you in my skin for a little while, trying to get a job. Perhaps then you'd understand better. No, the unfortunate truth is that Negroes just aren't faring terribly well at the moment in the economics job markets."
Round one to Mr. Washington.
"Let's go on," I said hastily. "Why don't you tell me how you happened to end up at Bellevue." I smiled in what I hoped was an ingratiating manner.
"I'll be most happy to, if you'd like," he said. "Though I must say, it is a rather painful subject — literally painful, I might add." He rubbed a black-and-blue area under his left eye, as though for emphasis.
"I'd appreciate it," I said. "It'll help me understand your case better."
Mr. Washington shook his hand rapidly back and forth. "No problem at all," he said. "It's quite straightforward, really. Last night, at about three o'clock, I was standing on the corner of Third Avenue and Fourteenth Street when some young men — some young white men, to be specific — accosted me and asked whether I had a match. It happened that I didn't. You see, I don't smoke, and so don't usually have matches on my person. I told them I was sorry, whereupon they became rather abusive. They started to call me names, and —"
"What names did they call you?" I asked.
Mr. Washington rolled his eyes expressively. "Well, Doctor," he said. "They began with nigger, as perhaps you might have expected, and they ... well, shall we say, they accused me of behavior that would have made Oedipus feel uncomfortable."
I fought to keep my face properly straight. I nodded soberly, and gave a professional um-hum. "What did you do?" I asked.
"Now, Doctor ... uh ... I'm sorry, what did you say your name was?"
"Oh yes, Dr. Karp. Certainly. As I was about to say, Dr. Karp, I'm not trained as a prize fighter. I'm not aggressive and I do all I can to avoid violence. I tried to walk away. But they didn't permit me to do that. They followed me, calling me those terrible names, and then one of them shoved me into the wall of a building while another one punched me in the stomach. At that point I decided that I had been forced to take a stand, so I hit the second fellow, the one who had punched me. When I did that, all of the miserable hoodlums jumped on me and started to beat me up. I fought back as well as I could, but I was definitely getting the worse of the affair when two policemen came by and broke up the fight. I couldn't have been more grateful, of course, and was about to thank my benefactors when one of the young men said, 'That nigger bum tried to get a quarter off us, and when we wouldn't give it to 'im he pulled a razor on us.' Before I could utter a single word of the truth in my defense, one of the policemen hit me with his billy club and knocked me unconscious. The next thing I knew, I was a guest in your establishment."
I talked to Mr. Washington for a while longer and could uncover no mental aberrations. There were no signs of psychosis: he did not seem to suffer from delusions or hallucinations. He was oriented as to time and place, knew who the President was, could count backward from one hundred by sevens, and could correctly explain the meanings of different proverbs. The longer we spoke, the more convinced I became that because Mr. Washington was black and penniless, he had indeed been railroaded to The Vue. I began to feel angry. Finally, I could think of no further questions to ask him, so I thanked him and explained that I was going to present his case to the doctor in charge.
Mr. Washington stood up and extended his hand, which I gripped. "Thank you very much, Dr. Karp," he said. "I do trust that you will attempt to effect my prompt release from this unjustified confinement."
I assured him emphatically that I was firmly in his corner, proceeded directly to the chart rack, pulled out his chart, and read the police report from the cops who had brought him in. It said that he had been drunk and abusive, but made no mention of his set -to-with the gang of white youths. I ground my teeth loudly. Did they have to add falsification by omission to injustice?
Leaving a cloud of smoke to mark my spot, I sought out Dr. Rothstein and poured out the story in a torrent. Dr. Rothstein stood there quietly throughout my performance. When I finished, he asked, "What did the admitting resident have to say about him?"
I gulped. My righteous indignation had prevented me from looking past the police report. Together we went back to the chart rack and read the resident's write-up. It was concise and to the point. It said that Mr. Washington had reeked of the demon rum and that he hadn't been making much sense when he spoke. The resident's diagnosis was: acute alcoholic psychosis.
"That psych Admitting Office is a snakepit," I said hastily. "Maybe the resident read the police report but didn't have enough time to actually spend talking to Mr. Washington."
"That's possible," Dr. Rothstein said. "But I don't think it's very likely."
Neither did the rational part of my mind, but that entity had already been submerged in my emotions. "You come and talk to him," I urged. "You'll see he's no more crazy than we are."
Dr. Rothstein smiled and followed me to Mr. Washington. He listened as the patient told his story again, and then we walked away together.
"Well?" I asked as we moved out of earshot.
Excerpted from The View from the Vue by Larry Karp. Copyright © 2000 Larry Karp. Excerpted by permission of Jonathan David Publishers.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Introduction: An Overview of The Vue,
1. Don't Go Away Mad,
2. It's Hard to Get Good Help Nowadays,
3. Of Bums and Camel Drivers,
4. The Chicken-Soup-for-Lunch Bunch,
5. Gays, Too, Came to The Vue,
6. Marriages Are Made in Heaven,
7. Things Ain't Always What They Seem,
8. The Healing of John the Baptist,
9. I'd Rather Be Lucky Than Good,
10. The Dumping Syndrome,
11. A Receptacle for All Purposes,
12. You Rape 'Em, We Scrape 'Em,
13. Come Quick, Doc, He's Dead,
14. All the Monkeys Weren't in the Zoo,
15. Visitations at The Vue,
16. A Blood Brotherhood,
17. They Shall Beat the Interns into Pruning Hooks,
18. And Gladly Did They Learn,
19. Internship Is Fun and Good for You,
20. Everything's Up-to-Date at the Vue,