A Fatal Debt

disturbed person who decided to walk in off the streets. You only had to ride the subway to realize how many of those there were.

“Who is he?” I said, sighing.

“It’s a Mr. Harold Shapiro. Harold L. Shapiro. And his wife, Nora Shapiro, brought him in,” she said, as if the names settled the matter. And they did.

“I’ll be there in a minute,” I said.

Don’t make exceptions, we were always taught, it never works out well. But if there was anyone who had to be treated as a special case, it was Harry Shapiro. I didn’t know him, although I’d read something in The New York Times about him losing his job as chief executive of a Wall Street bank in the financial crisis. The piece suggested that he’d deserved it, that he’d never realized the risks his bank was running. I knew one thing, however. At that moment, I was standing in the Harold L. and Nora Shapiro Pavilion, a wing of New York-Episcopal Hospital that held various wards, including Twelve North and South.

The Shapiros had donated $35 million to the hospital, allowing it to thrust itself out over the FDR Drive, and a plaque on which their names were etched greeted every driver who drove north through the tunnel beneath. So they were not to be taken lightly, especially if he was ill. I’d experienced what happened when donors came into the hospital they had funded. Furtive calls would soon follow from administrators or even board members. Don’t go out of your way, they would say, but do everything you can. We usually took the hint.

I decided to leave my schizophrenic by himself for a while. He was safe enough, even if he wasn’t coherent. When I got down to the ER, I found Maisie in the doctors’ room at the end of the corridor.

“Yes … yes … I’ll make sure he knows,” she was saying on the phone in the tone of someone already fencing with authority.

Maisie looked at me inquiringly, and I shook my head. I didn’t want whoever it was second-guessing the treatment before I’d even seen the patient. She silently held up four fingers: room four. I found Harry sitting on the cot in the room, wearing a Polo Ralph Lauren shirt, pants, and a blazer. His shoulders were hunched, his head bowed, and he was shivering. It could have been a symptom of anxiety, but it was ice cold in there. I swear they kept the rooms refrigerated. We often asked maintenance to fix it, but they never had.

Room four was identical to the others on the corridor: it had a hard cot dummy-proofed to prevent anyone from using it to harm themselves or the staff, a plastic chair, and a glass panel facing the hallway so the nurses could examine the occupant at leisure. Its distinguishing feature was a bad oil painting of a red-roofed Italian seaside town, screwed to the wall in case anybody tried to do some damage with it, on which one literacy- challenged occupant had scratched: “Train to Tijooana.” Maintenance hadn’t fixed that either.

The fact that Harry was still in his clothes was a cause for concern, and I noted the hovering presence of Pete O’Meara, the ER security guard, who was standing by the door looking unhappy. He had a big, jowly face and was capable of subduing most patients who looked threatening, but he’d met his match in Harry.

“Hello, Mr. Shapiro,” I said. “I’m Dr. Cowper, the attending psychiatrist. I’d like to have a chat, but would you mind changing into a gown first? It’s hospital procedure.”

Harry raised his head and I saw his dark eyes for the first time. I knew then why Pete had backed off. They were like the embers of a fire that had died down but would flame up if prodded. Of all Harry’s qualities, his ability to intimidate was the most striking. Even then, in that state, I wouldn’t have tangled with him. He was powerfully built and trim, as if nervous energy had burned off all excess fat. His eyes were set deeply into a lean face with a sloping forehead and an aquiline nose. He looked like a Roman centurion who headed a merciless legion that had just fought its way through Gaul, taking no prisoners.

“This is bullshit,” he muttered. “I’m not a lunatic.”

“Of course not,” I said. “But we have rules in place to protect everybody. You’ve been in the security line at the airport, haven’t you? You don’t want to be the one guy who makes a fuss.”

That was my usual line, and it wasn’t a bad analogy-we were also wary of hidden weapons. Harry hadn’t been to LaGuardia in a long time, I later found out, but it worked. He gazed at me for a few seconds before nodding.

“Okay, let’s get on with it,” he growled.

“Good. Mr. O’Meara will take your things and get you a gown, and I’ll ask the nurse to take some blood. Then I’ll return.”

Back in the doctors’ room, I found Maisie examining Harry’s chart, which had just been spat out by the computer. All the patients got their blood pressure taken and their insurance checked before they reached us.

“I don’t think he’ll have trouble paying the check,” she said.

“See if there’s room at the Four Seasons, just in case.”

That was our name for York East, a six-bed ward on the thirteenth floor that was a high-rent version of Twelve South for those who paid $700 a day on top of insurance for better amenities. The food was fancier and they got their own rooms, with en suite bathrooms, although the doors were locked just as firmly against their departure. It was more like a hotel, but there was no checking out.

“Who was that on the phone?” I asked.

“Sarah Duncan. Mrs. Shapiro rang her before they came in and she wanted to know what was happening. I said you had things under control.”

Sarah Duncan was Episcopal’s president, a silver-haired Chicagoan who had elevated her briskness to a managerial art. I recalled that Nora Shapiro sat on the Episcopal board, which muddied things further-it meant that Duncan’s career was in her hands. Glancing at Harry’s chart, I saw that he was fifty-eight and had been treated at Episcopal before, but only for routine things such as colonoscopies. His blood pressure was a little high and he was on Lipitor, but he was otherwise in good health.

Back in room four, Harry was still on the cot but now in a gown, and a nurse was wheeling away the phlebotomy cart, having drawn his blood.

“So,” he said. “Dr. Cooper, is it?”

“Yes. It’s spelled Cow-per, but the w is silent,” I said, feeling as ridiculous as I always did when I had to explain my name.

“Some fancy British thing?” he said acidly.

“Perhaps you could explain why you’re here,” I said.

Harry paused to consider and his head dipped. He looked flat and he talked slowly, both symptoms of depression. I was already getting a sense of what was going on in his head. It looked like a male midlife crisis of the kind we dealt with day in, day out. I’d have to check what was under the surface, but I wasn’t too concerned. He was probably in more mental pain than he’d ever experienced in his life, but it would pass.

“Not so great,” he said glumly. “Things have been tough. I lost my job.”

He stared out into the hallway and I waited in case he had more to say, but he remained silent. He wasn’t telling me any more than he had to, which made getting an exact fix on his condition more difficult. I ran through the standard list of questions.

“I’m going to ask some things about your state of health, Mr. Shapiro. How’s your appetite?”

“Okay. I eat.”

“Do you drink?”

“A little. A glass of wine with dinner.”

“Take any drugs?”

“Nothing like that.”

“How much sleep do you need at night?”

“I can get by on five hours or so. I used to be in the office by six a.m., get ahead of the day.”

“Before now, have you been through long periods of feeling sad or hopeless?”

“I’ve never been that way.”

“Ever had prolonged periods of feeling excited, with lots of energy, as if you were on top of the world?”

Harry regarded me levelly, having realized where I was leading. Many patients who arrived with depression had undiagnosed bipolar disorder, and their manic phases had been mild enough to be adaptive-to take them to the top. I’d known a few Wall Street patients like that, and a couple of doctors, too.

“I’m not crazy. I told you.”