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Nonfiction NYC

Visiting Rikers Island (I).

As my days in New York are ending, the details of terminating with patients, saying good-bye to dear friends, and relocating to the other side of the continent are consuming my time and energy. As a result, I will repost some earlier writings.

Following is the multi-part story of my visit to the jail of New York City. Everything in the account (except for some names and labels) is true.


Across the street was a large sign advertising the entrance to Rikers Island, the jail for the City of New York. On our side of the street were several check cashing and bail bond storefronts. There was also a jewelry store. A hot dog truck was parked near the intersection.

No buses were approaching. A small crowd of people was gathered on the corner, patiently waiting. They, however, were not at the bus stop.

“The bus does stop over there to go to Rikers, right?” he asked the woman standing at the periphery of the crowd.

“Yes, that’s where the Q100 stops. There’s a van that goes there, too. It’s coming.”

“A van?”

“Yeah. Two bucks to get across.”

“Oh, thanks,” he said. “We’ve never been here before.”


The empty van, painted blue with E-Z Travel splashed in yellow on the sides, pulled up to the curb. The driver, short and mustached, turned the car engine off and came around to the passenger side. He wordlessly slid the door back and pulled out a thick stack of bills. He looked up.

We were in the back of the line and people silently handed over money to him to enter the van. His thin fingers smoothly sorted through the stack of bills to provide correct change. He did not look at me as he took the two dollar bills from my hand.

We crawled inside and sat down. Every single person in the van belonged to a racial minority group.


The van rumbled across the two-lane, sidewalk-less bridge. Planes sat in clusters at Laguardia Airport to the right. The waters of the East River below were choppy. A dark, long-necked bird passed overhead.

Not even five minutes later, the van came to a halt outside of an old building painted an institutional shade of dull white. We all crawled out of the van and looked at the chain-linked fences surrounding the cement campus.

“That’s a great way to make money,” I commented. “A mile for two bucks? Nice.”

My companion agreed as we made our way around the building that looked like a terminal for a small airport. Metal barriers guided us to the entrance, which had both a ramp and a set of stairs. A wall of lockers lined one side of the building. A police officer—hair tightly pulled back out of her face, hands on her hips, firearm at her side—shouted: “C33 and C34 are not open today. If you are visiting someone in these wards, you cannot come in today. Everyone else, take a white bin.”

We pulled our bags from our shoulders and walked inside.


I had purposely removed the small Swiss Army Knife that usually resides on my keychain. The blades on the contraption could do no serious harm, though civil servants often thought otherwise.

“No hoodies, no jackets, no cosmetics, no food items, no electronics,” another police officer shouted. “Put your bags in a bin and then step through.”

My bag and my jacket were already in a bin and rolling along the conveyor belt when I heard this. As I stepped through the metal detector, it beeped.

“Put your arms out,” the police officer on the other side of the metal detector said. He guided the metal detector wand across my chest. “Turn around.” He repeated the motions.

Meanwhile, yet another police officer was digging through my bag and listing all the violating items. “No lip balm, no cell phones, no water, no food, no scissors.”

Still another police officer was also pulling offending items from my companion’s bag.

“Okay,” he said. “We’ll be right back.”

“Where can we get keys for the lockers?” I asked. “We’ve never been here before.”

“You pay with quarters,” the police officer said. “Fifty cents.”

As we turned around to leave the building, I noticed the “Amnesty Box”. The box was about waist high and had a thin slot on top. The words “Amnesty Box” were in faded red and blue hues and the letters were shaped to suggest beauty or hope or joy. The box looked like a tithing box.

Later I would learn that boxes weren’t meant to hold money.


Only a few locker doors hung open like baby birds crying for food. Quarters were jammed in their slots. There were smaller lockers on another wall, but they were too small to hold all the prohibited items we had brought with us.

“Next time, we’ll just leave all this stuff at the office,” he said as he scanned the wall for functional lockers. His efforts paid off and we soon put our offending items inside: A tangerine, two cell phones, hand sanitizer, lip balm, scissors, water bottles, gum, and keys.

We re-entered the building and heard one of the police officers loudly commenting for all to hear: “What does he think he’s doing? Everyone else is taking off their jackets and sweaters and he walks in here, doesn’t take off anything, thinks he can just walk in like that….”

The young man in question turned around so another police officer could wand him.

The police officers dug through our bags again, running their hands deep into each pocket. Since the metal detector beeped again, I was wanded again.

“Where can we find out where The Person is?” my companion asked an officer. The Person didn’t know of our visit, as he said that he hadn’t been able to speak to The Person directly.

“Go to the information window,” an officer replied, pointing deeper into the building. We followed the queue inside.

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Adaptation.

He walked into the shade of the alley, where the walls stretching up from the street were windowless and the thick metal doors down below leaned into plastic crates. Muffled voices of grocers drifted outside. His eyes scanned the stack tied with string. After pulling away the one he wanted, he tucked it under his arm. The corrugated edges rubbed his calloused fingertips.

Passersby carried Louis Vuitton bags, brooms, torsos of mannequins, floor lamps, ladders, and miniature dogs. He carried the flattened cardboard box.

He made a wide turn into the building to get the box inside. It banged into the banisters as he climbed the four flights of stairs to his apartment.

After shutting the door behind him, he dropped the box onto the floor of his austere bedroom. He pulled the knife from his pocket, extended the blade, and drew it along the heavy fold. The box slumped open.

Not long ago, he would have put it on a heating grate during winter. In the summer, he would have put it in the shade of scaffolding. The box didn’t have a soft surface, but it was smooth. It was more forgiving than concrete.

He didn’t want the mattress. It was flimsy. It moved when he moved. He liked the feeling of the solid earth beneath him. It was one of the few reliable things in his life.

He pushed the cardboard to the space on the floor next to his bed. Shaking his head, he pulled the mattress down to the floor. He picked up the cardboard and placed it directly onto the platform. He nodded.

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Hospital Visitors.

Oh, Larry, I hurried over to the hospital as soon as I heard. It’s so good to see you!”

Larry turned his head and squinted at the visitor. Before he could smile, a fit of coughing overtook him.

“You don’t have to say anything, you need to rest. Do you want me to get you some water?”

A string of faint yellow saliva dangled from his lower lip. It wobbled as he shook his head. Closing his eyes, Larry murmured, “It’s nice to see you. I’ve been thinking about you.”

Another fit of coughing shook his thin frame. The Maserati Quattroporte blinked its headlights in concern. The engine revved as it looked around the room for tissue. As the Maserati was about to roll out of the room to ask for help, the Stock Options ran into its rear bumper.

“Larry!” the Stock Options exclaimed, pushing past the car. Larry groaned, rubbed his ribs, and shifted in bed. The Stock Options flung themselves into his lap.

“The Monogrammed Shirts told me what happened! I’m so sorry! Is everything okay?”

Larry held the Stock Options between his thin fingers and nodded. “I’m fine.”

“I’ll have to tell the Beluga Caviar and the Rolex Watches! We heard about the accident from the Gulfstream Jet! Everyone is so worried, they’re all heading over here to see you.”

Larry closed his eyes and winced. It hurt to breathe. Through gritted teeth, he asked, “The Summer House in Bridgehampton. It knows, right?”

“Yes, yes,” the Maserati said. “The Summer House is driving in right now. Probably stuck in traffic trying to get into the city.”

Exhaling, Larry sunk into the pillows on the bed. The Maserati brushed Larry’s hair out of his face. The Stock Options gently squeezed his fingers. He was falling asleep as the Callaway Golf Clubs stepped into the room.


When patients are in the hospital, their stuff won’t visit them. People who love them will.

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Fatigue.

I was one of them just two weeks ago, he thought as the interns approached him. They think I know what I’m doing just because I’m the senior resident.

His interns had admitted ten patients that night. They did the best that they could, but often needed his help. And then there were the two codes. He was tired.

The interns and medical students gathered around him for “pre-rounds”. He wanted them all to have updated information about the patients before meeting with the attending physician for “rounds“. With one hand he pulled a folded sheet of paper out of his long white coat. His other hand grasped a pen that was poised to write.

“Who is this?” he asked, pointing into a room. The intern who admitted the patient shuffled through her papers, pulled out a sheet, and began to rattle off the pertinent details about the patient. Everyone else looked at her, turning away occasionally to yawn into their hands.

“Thanks,” he said, walking into the room. They followed him in. He spoke quickly: “Hi, Ms. Patient. My name is Dr. Resident. I work with Dr. Intern here. Do you mind if I listen to your heart and lungs?”

Ms. Patient, who was poking at the slurry in her breakfast bowl with a plastic spoon, nodded.

She was in the waiting room for an hour. For the five hours she was in the emergency room, a woman in a neighboring space screamed in agony. Her nurse here had asked her many of the same questions asked of her while in the emergency room. She tried to sleep on the lumpy bed that was regularly inflating and deflating, but the beeping machines in the room and the discomfort in her chest would not let her rest.

She was tired.

After pulling the stethoscope down from his ears, Dr. Resident said, “Your lungs are a little noisy, but everything else sounds good.”

The squad of white coats surrounding her bed nodded.

“That’s good,” Ms. Patient murmured. Dr. Resident nodded and walked towards the door.

“Dr. Resident?” she called out.

Yawning, he snapped his mouth shut before turning around.

“Yes?”

“They did an X-ray this morning. Did it show anything?”

Dr. Resident nodded. “Yeah, they saw something, but they’re not sure what it is. It’s probably just a pneumonia, but it could be cancer. We’ll know more later.”

He breezed out. Her mouth opened slightly as she watched him leave. The interns and medical students all looked at each other, but not at her, their eyes wide and lips tight. They filed out silently after him.

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We are also Them.

I am nearly through Gayle Greene’s book, Insomniac, which is part memoir, part science writing, about insomnia. Greene identifies her target audience in the first chapter: people who experience insomnia, physicians and others who treat people with insomnia, and people who conduct research on insomnia.

As such, those who are not in her target audience might find themselves nodding off while reading the book. She describes the nightly (and daily) experiences and effects of insomnia, the known science and research of sleep, and available treatments. There’s a fair amount of neuroscience in the book—though, thankfully, Greene is a literature professor and writes with skill and clarity. If only all scientists could write like literature professors.

Her descriptions of physicians who expressed disbelief towards patients with insomnia caught my attention. She gives examples of physicians who blame patients for their symptoms. Others suggest that patients must be “wrong” because their reported symptoms don’t match what physicians learn in textbooks… or because the symptoms don’t show up in textbooks at all.

Those physicians imply that patients are making stuff up. They sound like arrogant windbags. I winced when I read their comments.

Of course, we physicians would like to think that we would never say things like that. Those physicians are the big jerks. We’d like to think that we are always empathic, compassionate, and nonjudgmental.

I would be a fool to believe I am never one of them.

The further I progress in my career, the more I realize how little I know. Older, wiser physicians who have mentored me have consistently commented, “As you get more experience, in some ways you will have less confidence. You will wonder what the heck you are doing.”

True dat.

We physicians should strive to accept what our patients tell us. If we don’t know the answer, if we don’t know what’s going on, if we aren’t sure how to proceed, we should acknowledge and accept that uncertainty as ours. Blaming patients—directly or indirectly—doesn’t help anyone. The vast majority of patients don’t make stuff up. They want to get better. And if they could get better without us, they would certainly choose to do so.