Ten minutes later, the deal was done and I was on the phone to the charge nurse in York East. We didn’t send ER patients up with a full report, just a summary of the initial diagnosis and a mental status exam. Danger to self, danger to others, unable to care for self-whatever was our reason to admit them to a closed ward, rather than just send them away with some pills and an outpatient appointment. When they were assigned to an attending and a team resident, they would be examined again. My job was almost done.
“I’m admitting a fifty-eight-year-old male with a differential diagnosis of adjustment disorder with anxiety and depressed mood, or major depression,” I said, running briefly through Harry’s symptoms and affect. “His spouse is supportive and will visit tomorrow.”
Stepping outside, I saw Pete pushing Harry in a wheelchair toward the elevators as Nora watched their retreat. Everyone we signed in was wheeled up to the wards with their notes on their laps to make it harder for them to escape on the way. It was the last I thought I’d see of him.
3
There were plenty of others like Harry around that time. Not as well-known or as powerful, with their names carved on the hospital’s walls, but all with the same crushed and baffled air of highfliers who’d fallen to earth.
When I’d been a resident, I didn’t know how many cases I’d treat of clinical narcissism, but suddenly it was all around me. We were taught about a condition called narcissistic injury, a blow to the egos of the self-centered and manipulative. Their personalities had been formed by a parent they’d been able to please only with achievement, who’d never given them unconditional love. Wall Street must lure such people because the hospital was full of them-all wanting special treatment, claiming to know more than I did about therapy, and generally being insufferable.
To have their status stripped away was a terrible blow. They came through the ER and the clinic in agony after the crash had triggered their plummet into anxiety or depression. They sat silently by themselves, pale-faced and shaking, their brains whirring to make sense of how it had all gone wrong. One thing was clear: They didn’t want to be treated by a thirty-three-year-old psych a couple of years out of residency. I looked too young, although I was as old as some of them. I wasn’t important enough.
One of them, a man in his thirties who’d run a real estate fund on Madison Avenue, had been there a couple of weeks before Harry. The fund had $2 billion at its height but was down to nothing, being squeezed by the banks that had lent him money. A friend of his brought him in one night after fetching him from a hotel room where he’d holed up, high on Ketel One vodka and cocaine, screaming at the room service waiter. I’d admitted him, but the next day, sobered up, he wouldn’t look at me. He’d demanded to see a real doctor.
Which was why, when I returned on Monday for morning rounds on Twelve South, I didn’t expect to be paged by Jim Whitehead, the York East unit chief and head of inpatient psychiatry. I couldn’t afford to alienate Jim if I wanted to get on in my career, but when I called him back, he sounded irritated.
“I have a patient here who’d like to be seen by you, Doctor,” he said formally. “Mr. Shapiro.”
Jim was tall and solemn and had stiff black hair with a few gray flecks distributed throughout: even those were carefully delineated. His shirt and suit were always clean and pressed, as if dirt and crumbs slid off them. It beats me how he kept pin-sharp creases in his pants despite being seated for most of the day. When not on York East, he had a lucrative private practice into which he gathered quite a few of his Episcopal patients.
Despite Jim’s mood and the difficulties I feared it could cause me, the news that Harry had asked for me gave me a thrill that I tried to keep out of my voice. I’d thought of Harry a few times that weekend and had even let myself fantasize briefly about him becoming my patient-hadn’t Nora hinted she wanted that? Despite his temper, Harry had many attractive qualities. He was wealthy and well known, and having the whole wing named after him made him a trophy asset that other doctors would covet. Besides that, he was intriguing. There was another story there, behind the headlines, which I wanted to hear. Best of all, I was confident that I could help him, since middle-aged depression is highly treatable. My fantasy was coming true.
I left the Twelve South residents to get on with running things and made my way out of the ward, unlocking and relocking the secure double doors with the jangling bunch of keys that hung at my belt. We referred to patients slipping out as “elopement” rather than “escape,” as if it were a romantic adventure, but I felt like a jailer. York East was one floor up, with a view over the river toward a new condominium block in Long Island City topped by a sign that said FOR RENT. I found Jim in his office by the ward, reading notes on the clipboard he always carried with him. I walked in and sat in front of his desk.
“Mr. Shapiro?” I said.
Jim carefully finished what he was doing before looking up, signaling that he wasn’t going to be distracted by the affair. “Mr. Shapiro,” he said before waiting silently, as if his job were to listen and mine were to explain.
“I don’t know very much about the case, I’m afraid. I admitted him from the ER on Friday. Danger to self. It was the first time I’d seen him, so I’m surprised he’s asked for me. Has he been assessed?”
Jim furrowed his brow, which was as close as he got to an open display of annoyance.
“Not for want of trying,” he said. “I was told of his admission on Friday night and I came by on Saturday morning so we could start treatment immediately. It sounded as if he was in distress.”
“He wasn’t cooperative?”
“When I arrived, his wife was with him and they wanted privacy. I came back yesterday, but Mrs. Shapiro said he’d wait to see you today. She apologized, but said it was typical. He always puts his trust in a small circle of people, and he’s taken a liking to you, it seems.”
“Interesting,” I said, trying to portray Harry’s rejection of Jim as an insight into his personality we could examine together. But Jim still looked irked. Harry was used to others being at his beck and call, I imagined. He probably hadn’t noticed the significance of Jim’s arrival to see him on the weekend.
“There we are,” Jim said, looking at his watch. “I’m due in Westchester early this afternoon. I’ll leave him in your hands.”
We had a facility in the New York suburbs for the well-off who wanted to recuperate in more bucolic surroundings. I’d wondered on Friday whether to send Harry there, but it had been late.
Jim unlocked the unit and guided me to Harry’s room, which was about the best we had at Episcopal-the medical equivalent of a penthouse suite. It had a wider bed than the cots on Twelve South and a couple of soft chairs in institutional brown next to a window that overlooked the East River. Harry was pacing up and down by them, clenching and unclenching a fist. He was wearing a crisp monogrammed shirt and looked livelier, but his expression wasn’t any more welcoming.
“Dr. Cowper has arrived, Mr. Shapiro. I’ll let you two have a talk,” Jim said, and he slipped back out. I heard the door to the ward click shut as he left.
“Hello, Mr. Shapiro. How are you feeling?” I said.
Harry glowered at me, his eyes burning.
“I want to leave,” he said quietly.
“I see. Well, let’s talk about that,” I said, crossing to his side of the room and taking one of the chairs.
He briefly stood there glaring before sitting opposite me. It was a lovely morning and the sun was casting a square of light on the floor. There were many worse places to get stranded-an airport, a police station-but his reaction was typical of people who woke up in a secure ward after being persuaded to sign in. They found themselves locked up, with sharp objects removed for safety, needing to ask permission for anything, and they went crazy if they weren’t in that condition already. I glanced at Harry’s notes. There was little there but a scrip for Klonopin, a longer-lasting tranquilizer than the Ativan I’d given out in the ER. His mental status had not been fully
