Categories
NYC

5:30am in the Financial District.

Prior to my departure from New York, my boss there granted me permission to freely write about the work I did in Manhattan. Though there are many psychiatrists in New York, very few work literally in the streets of the city. Future (original) posts will describe in greater detail my experiences as a “homeless psychiatrist”. As an introduction, here is a post that I originally wrote the following in December 2009.


The moon still floats in the sky at 5:30am and the wind coming off of the river feels like a cold pickle against the skin.

A parade of vehicles make their way south on Broadway, their tail lights glowing red in the dark ink of the yet unwritten day. Large trucks, the kind with eight or ten large wheels, roaring engines, and rattling cargo, rumble slowly along, their unoiled brakes screeching with each push of the drivers’ brakes. Taxis wander along the road, veering to the right, then to the left, then back to the right, of these large trucks, like flies looking for a place to rest their wings. Impatience overtakes the taxi drivers and intermittent honking ensues.

Underground, the subways are filled with people. Most of them are not Caucasian. Most of them are men. Many of them wear construction belts and boots. When the subway reaches the last stop, most of the people file off. A dozen or so, however, remain in each car. These individuals are wearing multiple layers of clothing, are surrounded by pieces of luggage and plastic bags stuffed with what look like more plastic bags, and are fast asleep in postures that look uncomfortable. These are the homeless who have found shelter, warmth, and relative peace for the night.

Back above ground, the sidewalks are almost empty. A young woman wearing tech clothing on her body and ear buds in her ears jogs past, her exhalations light, wispy, and grey. An older man in a dark suit, a yarmulke on his head, and a beard on his face ambles past, following the lead of his golden retriever. The space in front of the New York Stock Exchange, usually filled with tourists, chain-smoking day traders in bright coats, seemingly important men in three-piece suits, and police officers touting assault weapons, is completely empty.

The tiny trailers filled with pastries, bagels, and coffee are already set up and on site. The men inside, however, are napping, their chins tucked into their chests, their crossed arms resting on their abdomens that gently rise and fall with each breath.

A woman approaches one tiny trailer and giggles when she realizes that the merchant inside is sleeping. The man suddenly awakens upon hearing her and bolts upright.

“I’m sorry,” he sheepishly says. “What would you like?”

A few delivery men hoist boxes onto their hand carts. They swiftly push the cart into motion and easily steer the cargo along the sidewalks. Some of them whistle. Some of them frown.

A man sits on a rolling luggage cart, which is purposely positioned above a heated grate. His tattered clothes gently flap from the heat emitting from the vent. His nails are thick and yellow from growing yeast and grime is packed in the ridges of his fingers. To his left is a shopping cart, packed with plastic bags filled with newspapers, aluminum cans, and styrofoam containers. To his right is a lidless jar of peanut butter. A white plastic spoon or fork sits inside.

He faces the street and large trucks rumble past, their bright white headlights slicing through the darkness. Farther out, the lights along the river glow peach-orange, their reflections wobbling and choppy in the water.

The man’s lips move, though no sound comes forth. He shrugs his shoulders and then reaches over to the jar of peanut butter. He deftly pulls out the spoon, opens his mouth, and puts a glob of peanut butter in. He is missing many teeth.

The moon will set, the sun will rise, and the city will wake up. And the man eating the peanut butter will disappear.

Categories
Uncategorized

BRB.

Niagara Falls

Posting will be sparse for the next week or two as I am currently relocating from New York to Seattle… and marvelling at some sights along the way.

In the meantime, I invite you to browse the archives.

Thank you for your patience and understanding.

Categories
Nonfiction

Stairwell.

Originally posted in 2005:


I lingered in the stairwell for a few moments—just a few—today.

The entire stairwell is composed of concrete. The walls are off-white and the floor is now that dingy copper-grey-brown color from years of feet tromping up and down and up and down again on those tired steps. The ceilings are probably close to fourteen feet high and a slim, scratched, rectangular window starts about six feet from the floor. One has to be standing on step two or three from the ground to actually look out the window.

The liquid orange light of the dying sun—and it dies so early these days!—poured through the small gaps between the thick wall of charcoal clouds surrounding the city. A shiny white ribbon of car headlights rippled far below; to its right was a parallel ribbon of shimmering red tail-lights.

It’s cool in that stairwell; the vents that allow the chilly air flow in aren’t visible. Very few people use that stairwell, partially due to its distant location from the rest of the hospital, partially due to the low temperature of the ambient air. It has been completely empty every single time I have set foot in there.

And those few moments of respite are necessary. The ambient noise of the hospital—the malfunctioning IVs, the flushing toilets, the retching or crying or moaning or snoring or yelling patients, the ringing telephones, the beeping pagers, the tapping of keyboards, the thuds of dropped charts, the clatter of dropped silverware, the weird syncopated tonal rhythms of the ventilators, the sobbing of family members, the murmuring of the teams rounding, the sighs of the housestaff and medical students, the uneven rumbling of the cafeteria carts rolling past, the quiet Christmas music floating from the guitar in the performer’s arms—can be too much.

Sometimes it seems like the suffering that surrounds us all never ends. Even though miracles may be happening in every single room—the birth of a baby, the healing of a wound, the deaths of millions of bacteria in the blood, the sealing of fractured bones, the clotting of a wound in the esophagus…

… and for those few moments in the stairwell, everything is quiet and still.

And when my right hand turns the handle and I fling the door open back into the hospital, I am ready to jump right back into the fray.

Categories
Fiction

Just a Little.

Originally written in 2004.


It’s just a little after five o’ clock in the morning and I’ve come to see you. I ask if I can perform a pelvic exam on you; you reluctantly say yes. I try not to think about it too much as I insert my gloved fingers into your vagina, feeling your body tense with pain as I try to hasten my examination. I withdraw my hand from you, the fingers glistening with millions of particles of HIV.

It’s just a little after five o’ clock in the evening and I’ve come to see you. You’re not in the room, but your vomit is. Bright, chunky, thick red stuff that has splattered all over the white tiles of the floor. You didn’t even have to stick a finger down your throat. You’re 19 with a variant of anorexia and bulimia. All you have to do is think about it and you can make yourself throw up. You’re thin, almost too thin, but you think you’re terribly fat. You’re also terribly lonely, terribly empty, and terribly beautiful, but never beautiful enough.

It’s just a little after one o’clock in the morning and I’ve come to see you. You’re ignoring me but you roar to life when I dig my knuckles into your chest. You shout at me that you f—ing have respiratory problems and that you have a f—ing difficult time breathing and that you f—ing just want me to leave you alone, goddammit, because you’re in the f—ing hospital and why can’t you just f—ing be left alone in the f—ing hospital because you just don’t feel like you can f—ing breathe, goddammit. So why don’t you f—ing just go away, goddammit. And then you ignore me completely, pretending you are asleep.

And then you assault the nurses and we put you in three-point restraints.

It’s just a little after two o’ clock in the afternoon and I’ve come to see you. There is only one thing left to do before we can send you home. You’re doped up on morphine because your back is killing you. Your mother died last year, your wife died this year, and you live alone with your seventeen-year old daughter. Alcohol helps take the pain (which pain?) away. Neither you nor I are pleased about what I need to do, but we get it done quickly: You roll over, I pull down your pants, you shift slightly, I put on the glove, you breathe in, I insert my finger, you tense up, I withdraw my finger, and we both exhale in relief.

No blood in your stool, sir. Now we can send you home.

It’s just a little after two o’ clock in the afternoon and I’ve come to see you. Your feet are purple, your face is red. Chocolate brownie is in your hair and tears stream down your face. You lean forward, I try to sit you up. You keep leaning forward, choking on your tears, drowning in your love for methadone. If you don’t have it, surely your heart will break. You’re acting weird, why? Your body is acting weird, why? I want you to get better now, now, NOW, because I want to go home. I’m tired and I can’t think straight. And yet you look sicker and sicker and sicker.

It’s just a little after four o’clock in the morning and I’ve come to see you. The water reflects the slightly orange lights of the city. Layers of grey clouds coat the horizon. I see the trails of lights of the city streets. It is a different world, a silent world, a world where people aren’t sick. It seems so far away, even though the realms are separated only by a plate of thick glass.

Categories
Fiction

The Illustrious Dr. Vane.

I originally wrote the following in 2006. The character of Dr. Vane is based on two physicians at the medical school I attended. One evening, a good friend of mine, now a radiologist, saw one of the physicians walk out of the hospital. Struck by what she saw, she uttered the last line of the story. That line inspired me to write this tale.


Once upon a time, in a hospital far, far, away, there was an aging man. His name was Dr. Vane.

Dr. Vane was a senior attending surgeon and tenured as a professor. His fellow surgical colleagues viewed him with great admiration; the surgery residents deferred to him with great reverence; the medical students shied away from him with quivering fear.

The pate of his balding head, ringed with neatly-trimmed grey hair, gleamed underneath the fluorescent lights of the hospital. Deep-set eyes of liquid jade, an aquiline nose, and a strong jawline created a profile that commanded respect and communicated confidence. Time had left multiple wrinkles in his face and the looser skin gently dangled from the scaffolding of his skull. A sharp dresser, he always wore crisp, long-sleeved dress shirts of muted, solid colors; dark, pleated slacks that fell perfectly along his legs, such that the one-inch cuff stopped only one-half inch from the floor; a brightly patterned (but tasteful) necktie in a Windsor knot; and black leather loafers without any scuffs. Over this ensemble was his long, white coat that lacked any blemishes or loose threads. Christopher Vane, MD was embroidered upon the left chest of his coat with royal blue thread. One single pen, encased in a shell of polished silver, was clipped inside his pocket.

(When he wasn’t in the operating room, of course.)

He shuffled quickly. Although he was only leaning forward from the waist, people often thought that his entire body was tilted forward as he walked through the hallways. It was as if his body was trying to keep up with his head, that cranium that held the brain that knew so, so much.

Everyone—everyone—gave him a wide berth when they saw him approaching. It mattered not if he was in the cafeteria, purchasing a small cup of coffee—”no cream or sugar”—during the morning rush or if he was leading rounds in the intensive care unit (ICU) with the sixteen-member surgical team; the sea of people parted around him upon sensing his presence.

“Good morning, Dr. Vane,” everyone breathed, hushing their voices a bit as they greeted him. Sometimes people would try to hold his piercing gaze, but most failed. They had to look away—down to the floor, specifically.

Sometimes Dr. Vane offered a terse reply with his solid, tenor voice: “Morning.” Other times, he simply continued walking, the slight breeze from his rapid ambulation the only evidence that he was present.

“GET OUT OF MY OPERATING ROOM!” he occasionally roared, hurling the Kelly scissors across the room. They landed with an unsettling clatter on the drab green tiles. The scrub nurses simply turned to the steel table covered with sterile blue cloths and plucked another pair of Kelly scissors from the smorgasbord of surgical instruments before them. The medical students pulled on the retractors a little harder. And the stunned resident paused, still clutching the Mathieu needleholder.

“YOU HEARD ME! LEAVE!” he gruffly shouted. “UNTIL YOU KNOW THE ANATOMY, DON’T COME BACK!”

The resident, shunned, plodded from the operating room. Dr. Vane muttered obscenities under his breath.

“What is a reducible hernia?”

Dr. Vane believed in, practiced, and was well-versed in the art of pimping.

“And an incarcerated hernia?”

Medical students never felt at ease around him.

“And strangulated?”

At least one of them burst into tears in front of the entire team during each rotation.

“How about a pantaloon hernia?”

Everyone said, though, that Dr. Vane was incredibly smart and talented. Everyone could learn something from him and that encyclopedic brain of his.

“What? You don’t know? Have you even opened a book since you’ve started this rotation? You must be one of the laziest medical students on rotation right now. How about Littre’s hernia?”

“No? Then go home. You’re useless. Don’t come back until you know the different hernias.”

Dr. Vane seemed to always be in the hospital. Some of the residents (privately) joked that he never left. “He’s dedicated to his work,” they remarked. “When he’s not operating, he’s writing journal articles and book chapters. Have you seen his CV? It goes on for pages and pages!”

And there was some truth to their words: Residents had witnessed him breezing through the ICU while they were frantically pre-rounding before twilight had melted into dawn. Medical students attempted (and failed) to discreetly walk past his office, the door usually ajar, after their morning lectures. He was invariably the first person present for morning report. The on-call residents noted that he frequently answered their pages from a hospital telephone. Even if it was well past 11:00pm.

Dr. Vane, however, did leave the hospital, although he always longed to return. He did not enjoy shopping for groceries, getting gasoline for his car, standing in line at baseball games, or dining with his family at restaurants.

Other people never gave him any respect. The young lady at the grocer accidentally hit him in the right hip with her cart and she did not even notice (let alone apologize) for her error. The attendant at the gas station didn’t say anything; he just took his money and crassly chewed on gum with his mouth open while Dr. Vane sat in the leather seat of his luxury sedan, waiting for the time to pass. The people sitting in front of him at the baseball game frequently stood up (thus obstructing his view) and the crush of people frequently wobbled into him, jostling him much more often than he liked. Some of the teenagers looked at him and smiled in apology—always with a somewhat pitiful expression on their faces. Waiters and waitresses brought the cheque too early and did little to mask their impatience while he pored over the menu.

Outside of the hospital, he was not the illustrious Dr. Vane.

He was just another old man.