assessed, and he hadn’t been interviewed about his history or started on antidepressants. The only psych he’d talked to at length remained me, on Friday night.
“How have you been sleeping?” I said.
“I want to leave,” he repeated slowly, as if I hadn’t listened the first time. I found it hard to hold his intense gaze.
I tried to prevaricate. “I know it must be difficult to be here, but I think it’s a good idea to talk so I can get a sense of how you are. Then we can start on treatment and you can leave, maybe in a day or two. We don’t want to keep you in here any longer than you’re comfortable with, believe me.”
Harry flinched with irritation and got up to stare out of the window. “I don’t think you heard what I said,” he growled over his shoulder.
I didn’t like what I was seeing. Harry was just as moody as he’d been in the ER, but more agitated, which was a bad combination. Patients who are very depressed may think of killing themselves, but they lack the energy to do it. The trickiest moment is when they start to feel slightly better and more capable of action. He was also angry, which was worrying. Suicide is an act of hostility, not only to the suicide victim himself, but also to the person he blames for his plight.
All in all, I wasn’t inclined to release Harry before he had stabilized and I had a better sense of what was going on in his head. Legally, I was in a far stronger position than he. Having signed himself in, he could petition to be let out at any time. But the hospital was allowed to hold him for seventy-two hours before his lawyers could spring him. It would be a disaster if things got that far, given that Harry had paid for the wing in which he was incarcerated, but I didn’t imagine that it would. Three days would be plenty as long as he calmed down.
“What worries you about being here?”
“I can’t sleep,” he said, turning to me. “The bed’s uncomfortable, the blankets are thin, I was cold all night. The traffic noise kept me awake. I’m fine, don’t you understand? There’s nothing wrong with me.”
I listened to the buzz of the cars on the FDR Drive. It sounded pretty routine for New York, and fainter than the noise in my own apartment, but that wasn’t the point. Anxiety and wealth had made Harry hypersensitive. The thread count on the grayish sheets was lower than he was used to, and there was no goose-down duvet. He wouldn’t have noticed either if he’d been at ease.
“I’m sorry, Mr. Shapiro. Perhaps we can discuss all this with your wife and make a discharge plan. We’ll try to agree on a way forward.”
Harry gave a cynical grunt, but he at least agreed to wait for Nora. On the way back to Twelve South, I considered my predicament. Jim’s escape to Westchester had put me in charge of Harry, and he was becoming a difficult assignment despite my earlier wish to get hold of him. I couldn’t in good conscience let him out immediately, but he had a lot more power than most patients-and no compunction about using it.
My best hope, I thought, was Nora.
An hour later I was standing in what we generously called the library, a room with a sprinkling of books and a computer on which patients could send email, listening to Lydia Petrovsky, a birdlike patient who had been with us for a week. Unlike Harry, she showed no sign of wanting to leave-quite the opposite-but her insurer was threatening to withdraw coverage and the finance department wanted her out. As I was trying to persuade her to go back to her apartment and attend the day clinic, my pager vibrated with a summons to see the president.
Sarah Duncan’s office was in a corner of the Shapiro Pavilion, with a view toward the Queensboro Bridge that went to waste. Her twin assistants were both pale and pretty, in their mid-twenties, and dressed immaculately in short skirts and chunky jewelry. One gave me a bottle of water from a small refrigerator and a pro forma apology for Duncan keeping me waiting, which seemed to be the normal course of events. Then she returned to clicking through emails. Since no one else was appreciating the view, I looked at the cars rumbling over the bridge from Queens to Manhattan. The Williamsburg Bridge and the far reaches of Brooklyn were visible through its girders as a cable car looped its way to Roosevelt Island.
“Dr. Cowper?” said a low voice from the doorway, making me jump in surprise. “Please come through.”
Duncan had translucent eyes, silver hair shorn into a bob, and a face that was too smooth to be natural. She scared me. I followed her into a cool corner office that was laid out neatly with no stray papers. There was a sofa, two armchairs, and a glass-topped desk with two inch-thick files resting on it, a fountain pen set precisely beside them. None of the furniture was the standard-issue stuff of the kind that cluttered the rest of the place. She stood by her desk, moving a sheet of paper in front of her and examining it minutely.
“Dr. Cowper, I’ve just been reading about your work here.” She tapped the file. “Very impressive, I must say. You are clearly a highly valued member of the team,” she said, as if pinning a minor medal on me.
“Thank you, Mrs. Duncan. That’s kind.”
“I didn’t interrupt you, by the way? You have a few minutes to spare?”
“It sounded as if it was urgent.”
“That’s one thing I like about doctors-always ready for an emergency,” she said with a curt laugh as she gestured for me to sit opposite her on a sofa. There were clearly other things about us that she didn’t like. “This must be one of the trickiest situations I’ve faced in my time here.”
“I take it you mean Mr. Shapiro?”
“I count myself as a friend of Nora Shapiro, whom I recruited to our board, so I’m anxious to do everything we can for them. You did the right thing to admit him, but I’m hearing that he now prefers to be discharged.”
“He told me so this morning.”
“I take it that we can fulfill his wishes,” she said, gazing at me firmly.
There was a pause while I thought about what to say, apart from:
“That might not be best immediately. I’m worried about him leaving while in a fragile condition. I’m sure you understand.”
She sighed and tapped her finger on the arm of the sofa. “Dr. Cowper, you’re a young man and you’ve got a long and hopefully distinguished career ahead, so let me explain something to you, between ourselves. The Shapiros are very important to the future of this hospital. I recently discussed with Nora our plans for a new cancer wing, and she’s talked of making a generous donation that might help to save thousands of lives.”
“I see,” I said, shifting in my seat.
I remembered not taking Duncan’s call in the ER, gesturing to Maisie that I wasn’t available. How smart I’d been then and how stupid now to be in the middle of this political mess. How could I balance my duty to help Harry against the lives of others whom his money might help? The trouble with psychiatry was that patients believed they could diagnose their own state of mind pretty well, and the more disturbed they were, the more likely to believe they were fine. It was Harry’s view of himself against mine.
“If we lost her support, that would be a tragedy, not just for us but for many, many patients.”
“I see that, but-”
“So, look. The last thing I want is to interfere in your treatment of Mr. Shapiro, but surely he can be cared for outside these walls?”
“Well …” I paused, trying to think of a way out. “I’ve agreed with Mr. Shapiro that we’ll talk with his wife later and agree on a plan.”
Duncan gave me a frosty smile as she got to her feet. “Good. I’ll leave you to make a decision.” She walked to her desk and, as I got halfway out the door, added in a low voice: “Do ensure it’s the right one.”
I found Harry sitting with Nora in the patients’ lounge in York East, which looked like a hotel lobby. It had halfway decent furnishings and a flat-panel television-an advance on the old cathode-ray sets fixed to the ceiling in Twelve South. There was no one else in the room, just the two of them side by side on a sofa with hands intertwined.
Nora disentangled hers and got to her feet, leaving Harry sitting by himself. “I’m so glad to see you again, Dr. Cowper,” she said.
Seeing her, I had the same feeling as the first time. She wasn’t like Harry or Duncan, with their easy recourse to intimidation. She didn’t behave like a powerful person or someone on a higher social level-her affect was of surprise at being in that position at all. After my encounter with Duncan, I knew the only way I could avoid either doing something I felt unhappy about or making myself unpopular with my employer was to persuade Nora that her
