I had arrived in New York City only six weeks prior. It was the fifth week of my fellowship. I still couldn’t find some of the units in Bellevue Hospital.
“There’s a new consult,” the attending told me. “The patient is on a D5 hold. It could be interesting.”
I learned many new acronyms during my first few weeks in New York:
A PES is a Psychiatric Emergency Service. It means that psychiatric services are available in an emergency department. This, however, does not guarantee that the PES has its own dedicated space.
“There’s a PES in the city that is literally an open hallway of the emergency room. They put pink gowns on all the psychiatric patients,” a resident told me. “Can you imagine? No one wants to wear a pink gown. Patient privacy is out the window, too!”
A CPEP is a Comprehensive Psychiatric Emergency Program, which is part of a hospital system. As its name suggests, it offers comprehensive services: a mobile crisis unit (think of something like a Batmobile, holding a combination of social workers, nurses, and psychiatrists, that responds to urgent mental health situations in the community); a dedicated physical space that provides emergency psychiatric services in a hospital; and EOB beds.
“What are EOB beds?”
“Emergency observation beds. It’s like a mini-psychiatric unit in the emergency room. If someone gets hospitalized involuntarily and there aren’t any inpatient beds available, he can stay in an EOB bed. Or if someone comes in drunk, he can stay in an EOB bed until he sobers up. He doesn’t need to take up a bed in the hospital. It’s quieter in the EOB. They don’t have to see and hear all the stuff that happens in emergency room, like when a lot of nine-three-nines come in.”
“And a 9.39 is when someone is involuntarily committed to the hospital for psychiatric reasons, right?”
“Yup.”
I didn’t know what a “D5 hold” was.
The attending said, “A D5 hold is when someone is held involuntarily in the hospital because they haven’t been able to finish a course of treatment for tuberculosis. There are different levels. D5 is the most restrictive. Patients on D5 holds couldn’t—or wouldn’t—take the tuberculosis medications as outpatients or even under ‘directly observed therapy’, which is when they have to show up at a clinic and a nurse watches them take the medication.”
“Oh.”
“These patients on D5 holds often have severe substance abuse problems and personality disorders. They can be here for a long time.”
“Like how long?”
The attending chuckled.
There was a security guard posted outside the door. He glanced up at me.
“Hi, my name is Dr. Yang”—I pointed to my ID badge—”and I’m here to see—”
As he started to look away, he mumbled, “Talk to the nurses inside.”
I shut my mouth and peered through the thick glass windows. I saw open doors, but no people. As I was turning around to point this out to the guard, a nurse passed by. I shook my hand at her. After looking at my ID, she unlocked the door and let me in.
“Hi, my name is Maria Yang, I’m one of the psychiatric consult fellows and—”
“Oh, you’re from psych!” she said, pulling her glasses down while peering up at me. “You’re here to see George?”
“Yes—”
“—in that room.”
“How long have you been here, George?”
“Too long.”
“How long is ‘too long’?”
“I was stupid when I first got here, I was dicking around, I don’t know, I just didn’t think it was a big a deal. I was okay, ya know? I’m better now. I think I got six months left.”
“Six months left, okay. But how long have you been here?”
George was reclining on his bed. He looked up at the images he had taped to the wall; they were glossy magazine photos of slender women in bikinis. He sighed.
“When I was outside, I talked to women who looked like that all the time. They liked me. They wouldn’t leave me alone.”
“When’s the last time you had a conversation like that?”
He pushed himself up into a sitting position.
“Almost two years.”
For the next two months, I saw George on a weekly basis for informal psychotherapy. Thankfully, he was housed in the unit that didn’t require respiratory precautions. We didn’t have much privacy. His roommate offered to leave each time we met.
George told me that the last time he had been physically outside was the day he was forced to enter the hospital.
“I coulda left over a year ago, Doc, but some guy brought in dope and planted it in my pillow and told everyone else that I was dealing. I coulda killed him, I really coulda. They drew my blood around that time, Doc, ‘cuz they thought I was using, too. My rifampin level was low, it was too low, so they made me stay longer. And then this other thing happened and I couldn’t get out.”
He told me about the special Friday night meals: They had Chinese take-out last week. It was probably going to be tacos this week. He liked fried chicken the best.
“They give you these tokens if you do stuff. You make your bed, you clean up, you get tokens. Tokens get you chips and candy. They get you magazines sometimes, too.” He pointed at his paper harem.
He told me about all the different doctors involved in his care.
“I’ve trained a lot of the docs here, I met them when they were interns and now they’re big residents! They’re only here for a lil’ bit, though.”
Soon, my time came to rotate off service.
“Okay, see you, Doc. I only got four months left. Maybe you’ll see me outside, that’d be nice, right? You can meet all of my girls.” He winked at me.
Our paths never crossed again during my time in New York. And, thereafter, I never took for granted the daily opportunity to breathe fresh air.
References:
- New York City’s Bureau of Tuberculosis Control
- World Health Organization’s comments on human rights and involuntary detention for xdr-tb control
Maria Yang, MD 