Education Homelessness Lessons Medicine NYC Policy

Involuntary Commitment (I).

It’s winter in New York City. The temperature is hovering around 32 degrees Fahrenheit. Large, slushy snowflakes are falling from the pewter sky.

You are already familiar with this woman; you had met her the previous Spring. No one is sure of her age, but she looks over 65 years old. She had said that she had immigrated to the US when she was in her 20s because she had a scholarship to a prestigious university. Something interrupted her schooling. She ultimately stopped attending classes and hitchhiked here. She’s been homeless on the streets of New York ever since.

She has never shared her date of birth for fear that the government would use that information against her. It’s not clear if her stated name is really her name. She’s a familiar figure in the neighborhood; people regularly give her styrofoam bowls steaming with hot soup, sandwiches wrapped in white butcher paper, shiny cans of soda, and cups of coffee. Some people have been giving her food for the past ten years. Upon receipt she murmurs, “Thank you,” and nods her head on her slender neck.

She never makes eye contact. The irises of her eyes have grey halos and her gaze is usually over your right shoulder. You’ve tried to learn more about her past, what led to her homelessness, and her interest in housing, but she usually ends the conversation and walks away. One time before bidding you good-bye she did comment, “The government secrets are safe with me.”

People in New York walk past her everyday while she sleeps and never realize it: She buries herself underneath black garbage bags stuffed with paper. What looks like a mountain of trash on the curb or underneath scaffolding is actually her private fort.

“The paper keeps me warm,” she has said. To prove her point while the autumn winds sent the dying leaves swirling through the air, she rolled up a sleeve of her parka to reveal wads of newspaper crumpled in her clothing. At times she donned a hat made out of a paper bag and stuffed it with newspaper to warm her head.

It is not yet 10am on this snowy morning and the weather forecasters predict that the storm will worsen as the day goes on. The snow is already sticking to the sidewalk. Over six inches are predicted to fall in the next few hours.

Today, the woman’s camp is underneath the short awning of the back door of a clothing boutique. Underneath her is a flattened cardboard box, the corners already beginning to darken and soften from the snow. On top of her are only four or five garbage bags, fewer than what usually covers her. Upon hearing you, she sits up and her face, as expected, does not show any expression.

Her parka is unbuttoned and underneath is a thin white shirt with a tattered collar. The skin of her neck is mottled and red.

“There’s a snowstorm coming through, it’s supposed to be pretty bad. Would you be willing to stay in a shelter until it’s done?” you ask.

“No, I’ll be fine.”

“It looks like you’re cold; you don’t have as many bags as you usually do and your skin is turning red. We don’t want you to be outside when it is this cold out,” you try again.

“I’m fine.”

“We worry that if you stay out here, you might get frostbite.”

“I’m fine.”

“Where have you gone in the past when there were big snowstorms?”

“I’m fine.”

Meanwhile, snow is beginning to collect on her coat, her bags, and in her hair. She makes no motion to move.

Does this woman have a mental illness? Does she need to be sent to the hospital for psychiatric evaluation? If she doesn’t want to go to the hospital, should she be forced to go to the hospital against her will?

Education Nonfiction NYC Observations PPOH

Daily Schedule: Assertive Community Treatment.

A sample agenda as the consulting psychiatrist with an assertive community treatment (ACT) team:

7:55am. No one is at the office yet. Insert a key into the gate in front of the building. The gate makes grating and squeaking sounds as it rolls up. After entering the building, quickly disable the alarm, lock the door on the way in, and roll the gate back down. From the medication room, pack into a brown paper bag a pair of gloves, two alcohol pads, one band-aid, a pinch of 2×2 gauzes, a portable sharps disposal container, and a pocket-sized bottle of hand sanitizer. Unlock a different cabinet and fish out a small box that contains liquid haloperidol decanoate, a long-acting antipsychotic medication. Drop that into the brown paper bag.

Leave the office, secure the building, and make sure that the gate is rolled completely down before walking away.

8:40am. Arrive at a patient’s[1. All patients described here are composites of people I have seen across time.] apartment uptown. She lives with her mother, grandmother, and her mother’s boyfriend. As usual, she’s still sleeping, even though she knew that this visit would occur around 8:45am. She’s wearing a strappy tank top and baggy pajama pants. She rubs the sleep form her eyes. She walks back into her bedroom. An electronic rose is in the corner next to her mirror. Different colored lipsticks are on the table. There is a desk lamp on the nightstand, as well as several magazines.

She shrugs her shoulders after realizing that her offer of a seat on the unmade bed was politely declined. She’s doing pretty well: She’s re-enrolled in GED classes and is studying to take the test, though she’s finding the math portions difficult. She’s still going to the local bar on weekends, but denies getting drunk. When she also denies smoking marijuana, her response seems honest, though her next visit to the office will include a urine drug screen test. The antipsychotic medication isn’t causing side effects. She asks for advice on how to avoid bad boyfriends.

9:30am. Arrive at the second patient’s apartment after a subway ride further uptown. He lives with his elderly parents. He’s not doing well. He yells at his mother and his father often locks himself in the bedroom so they don’t have to interact.

He begins to share that he is dating a woman, then suddenly comments that he hasn’t drank any alcohol in months. His mother interjects and says that he has come home very late at night smelling of alcohol. The stories from the past week spill from her mouth; she’s watched him cross and re-cross the same street for two consecutive hours. Sometimes he yells about the gods who have failed him. Small items—vases, salt and pepper shakers, silverware—have started to go missing from the apartment.

He says he’s taking his medications, but his mother says that she finds pills in the trash cans. He mumbles under his breath.

No, she hasn’t had to nor wanted to call the police. No, he doesn’t want to go to the hospital. He’s eating the ham and cheese sandwich that she’s made for him. She asks what will happen next.

“If you feel unsafe, call 911 and call the ACT team. Don’t wait. Just call. We’re all worried about him.”

He rolls his eyes and asks the wall why anyone would think he would hurt anyone. He doesn’t seem to remember that the last time he developed symptoms and drank alcohol, he punched his daughter.

10:40am. Arrive at the third patient’s apartment after a bus ride across town. He’s an elderly man who believes that his neighbors have stolen his internal organs and that cannibals will eat him if he leaves the building. These beliefs as well as gait problems keep him in his apartment. This is the person who will receive the haloperidol injection.

The usual conversation about his medication ensues. He’s willing to accept the medication, but wants to discuss again why it is at its current dose. The reasons haven’t changed from last month. He nods in what seems to be understanding, though then asks, “The medication will not make my skin turn blue, right?”

This is a significant improvement from a year ago.

Three large cockroaches skitter across the countertop. Two empty cartons of orange juice sit on the kitchen table. He looks into the living room, which holds his bed. He doesn’t go into the bedroom anymore. He still cries when he thinks about his dead wife.

He rolls up his sleeve and looks at his arm when he receives the injection.

“It never hurts when you do it.” He’s probably just being nice.

11:45am. Arrive back at the office. A patient sits on the curb, smoking a cigarette, while chatting up a cab driver. Everyone says hello to each other.

11:50am. Two of the social workers are in the office. They and the secretary all share events from the morning. One of the ACT patients may leave the hospital tomorrow. One of the social workers will escort him directly from the hospital back to the apartment if the hospital discharges the patient.

“I’ll visit your guy tomorrow morning,” the other social worker says, referring to the second patient who lives with his elderly parents. “We’ll check in with him every day this week.”

12:00pm. Work on documentation from the morning visits. Mindlessly eat lunch.

12:53pm. Fourth patient arrives for his 1pm appointment. He greets everyone with a warm smile.

He recently started volunteering at the library and teaches young children how to read. He rides his bicycle around Central Park to help keep his blood sugars under better control. His daughter is coming to visit for the holiday. He plans to cook salmon for dinner tonight. He’d rather have fried chicken.

“I’m scared to lower my medication, Doc,” he says. “I don’t want to end up at the hospital again. But if you think all this weight gain might be from the medicine, I guess we could try it—you said real slow, right?”

After some more discussion, he concludes, “No, let’s not change the medicine now. Lemme get through the holidays and then we’ll try. Real slow. Real slow.”

His wishes are honored without argument.

2:00pm. The fifth patient hasn’t arrived.

2:10pm. The fifth patient still hasn’t arrived. She’s more organized than people might initially believe, but she’s rarely punctual.

2:17pm. “Heya doc, how you doing, how you doing,” the fifth patient says, flopping down on the seat. She’s chewing on a popsicle stick. She’s tied the two ends of a necktie together and is wearing that around her neck like a necklace. Four other neckties are tied around her neck the same way. Ear phones cover her ears, but they’re not plugged into anything. Her striped socks are pulled over her baggy sweatpants.

“Heya doc, how you doing, how you doing, the vapor’s hot today, so hot. The icicles bring down the vapor, the vapor pulls the magnet and the poles spin, they spin, that’s what makes the Earth spin, the vapor around the Earth spins, too, spins like a record, so cool, so cool….”

She just finished her first week as the filing clerk for the drop-in center. The staff there said that she did good work and that she seems to like it, but she occasionally breaks out into song.

“Do you like your new job?”

“Yes, yes, but I want them to like my new job, too. I like the money, too, I can buy myself some new shoes, new blue shoes, new blue frue true krue shoes, so krue, so cruel, cruel world.”

On the way out, she flings the popsicle stick into the trashcan and belts out, “NEW YOOOOORK… CONCRETE JUNGLES WHERE DREAMS ARE MADE OF….”

3:05pm. Sixth patient arrives. He sits down and looks out the office window into the lobby. Everyone said hi to him as he walked in. He didn’t respond.

He doesn’t say anything in the room. He doesn’t make any eye contact. He examines his nails. He reties his shoelaces. He rolls up his pant legs. He strokes his beard. He fishes a half-smoked cigarette out of his pocket, then puts it back in.

“What’s going on? Is something wrong?”

He sighs and shakes his head. He gets up and doesn’t look up in acknowledgment when he hears entreaties to stay. As he walks out of the office, he finally says, “I’ll be back.”

3:20pm. Ask one of the social workers to follow the Tacit Man out of the building with hopes that they will have a conversation.

3:22pm. Watch from the lobby while the social worker and the Tacit Man talk. They’re actually speaking to each other.

3:25pm. The social worker walks back into the building and the Tacit Man walks across the street.

“Tacit Man is fine, just having a bad day,” the social worker says. “He’ll come back tomorrow to see you, same time.”

“Thank you!”

3:27pm. Call patients to remind them of meetings scheduled for tomorrow. Most of them answer their phones.

3:45pm. Resume documentation with occasional interruptions from other patients wandering into the office to say hello.

4:35pm. Coordinate plans with the social workers for tomorrow. Discuss medication changes, medication deliveries, and which patients need closer monitoring.

4:45pm. Leave the office. That same client who was sitting on the curb and smoking is still sitting on the curb and smoking. He waves hello. I wave back.

Education Homelessness Medicine Nonfiction NYC Observations PPOH

Daily Schedule: Homeless Outreach Team.

A sample agenda as the consulting psychiatrist with a homeless outreach team:

8:17am. Arrive at the office, which is in a tall building that is a short walk from the New York Stock Exchange. Speak with the case managers and social workers about who should be seen that day.

8:55am. Walk with a case manager to the ferry terminal meet Paul[1. All patients described here are composites of people I have seen across time.], who is a young man the outreach team has seen over the past two weeks, particularly in the early morning. Paul has said that he lives with his father in Washington Heights. When asked why people see him at the ferry terminal at night, he only repeats that he sleeps in his father’s apartment at night and walks the 10 miles to and from the ferry terminal every day. He doesn’t say much to people, but he’s often mumbling to himself. The security guards have shooed him out. He returns everyday.

He’s sitting in a chair with a ripped jacket draped over his head. Dirty sweatpants that are three sizes too big hang off of his slender frame. When he hears “good morning, outreach team” for the third time, he slowly pulls the jacket off of his head. His eyes are closed. When he hears “are you okay?” for the second time, he opens only one eye. With some prodding, he says his name, but says little else.

“I gotta go to work,” he says as he gets up. The sweatpants begin to slide down his hips. He’s not wearing any underwear. He starts to walk away and the legs of the sweatpants begin to bunch around his ankles.

“If you want, we can get you a pair of pants that will fit you better—”

He starts to walk faster and does not listen to entreaties to stop. With his left hand he grasps the waistband of his pants and walks down the escalators. He blends into the crowd of people exiting the terminal and is soon on the road outside, walking north.

“That’s Paul,” the case manager says.

“We’ll try again tomorrow.” Provide teaching on different strategies to build rapport—maybe present him with a pair of pants? a package of underwear?

9:20am. Say good-bye to the case manager and hop on a subway and head uptown, but don’t exit the station. On a bench near the rear of the station is Eleanor. She’s been homeless for over twenty years. She’s wearing two jackets and her fingernails are painted pink. No one has ever seen her nails unpainted. They always look manicured.

She’s darning socks with her wrinkled hands. Nearby is her large rolling suitcase, which is open today; inside are more jackets, several pairs of shoes, and two large bags of potato chips.

“Hello,” she says quietly. She smiles. She reports that she is fine, but her back hurts this morning. She wasn’t able to lie down last night to sleep. The security guards frequently asked her to move.

“You could move into a small apartment where security guards wouldn’t bother you. It would be your own space.”

“Oh, but I can’t,” Eleanor says. “They will exterminate me if I do that.”

She’s said this consistently over the past seven months.

“The alien transmissions—they use the satellites—tell me that I’m not allowed to move inside. They’ll exterminate me if I do. They’ll use electrocution. I don’t want to be exterminated. I can’t.”

With much coaxing, she’s actually been able to visit a housing project to see a studio apartment, but she refused to actually step into the room.

“I’ll get exterminated.”

She also declines to take any medication.

“The only medicines that work are potato chips and chocolate. Dark chocolate works better than milk chocolate. I feel better when I eat chips and chocolate.”

It’s hard to argue with that. She declines housing again today, but she’s open to another visit later on in the week.

10:00am. Get back on the subway and get off at the stop two stations away. Climb the stairs out of the station. Barry is sitting cross-legged in front of the bodega. He’s rocking back and forth while smoking a cigarette. Barry says he’s been homeless for the past eight years and the bodega owner says that Barry has been sitting out there for the past five years.

“I’m sorry,” Barry greets. A stranger leans over and leaves a deli sandwich and coffee for him. Barry mumbles, “Thanks.”

The dirt on his arms and hands indicate that he hasn’t showered in several weeks, maybe a month. Dirt is packed underneath his fingernails and bits of food are stuck in his beard. His fingertips are yellow and knobby with callouses.

“I gotta get back to work, I gotta get back to work,” he says, pointing at the building across the street. “I think my boss would give me a job again, I did good work while I was there, I did good, I did good.”

Barry also declines housing again today. “I gotta get a job first before I get an apartment. A man’s gotta work first, he’s gotta work, I gotta get back to work.”

The office receives his monthly cheques for disability (schizophrenia), but he won’t withdraw any money. His bank account has tens of thousands of dollars in it. He could afford to rent a small room, but he won’t do it. He can’t say why.

“It’s starting to get cold. If you don’t want to move inside, can I at least bring you a jacket or two?”

Barry stubs out the finished cigarette. He stops rocking.

“Yeah, sure,” he finally says.

11:00am. Team meeting. Discuss progress on different clients the team is following. Two people moved into transitional housing in the past week! One moved into permanent housing. People are excited about the individual who moved into permanent housing because he was homeless for over ten years. He often shouted at and hit himself for sins he said he committed. Despite that, everyone liked him, including the police, because he also had a sharp sense of humor. He also fed the pigeons every day.

He refused to move inside for over a year. After multiple visits to the housing project, he finally said he would give it a try. It’s been three days and he hasn’t left. Sounds like he was adjusting fairly well to his new digs, but he still sleeps on the floor.

12:00pm. Lunch. Chart the encounters in the morning.

12:45pm. A case manager brings a man to the office who is willing to sit for a psychiatric evaluation. A plastic bag hangs from the man’s hand. Inside is a brown paper bag that holds two 24-ounce cans of beer. One of them is open. He looks down at the bag.

“I won’t drink this now. Please don’t throw them away.”

He’s been homeless for four years. He was sleeping on the floor of the pizza parlor where he worked as a sweeper, but the owner was closing the business because of financial problems. He now sleeps on trains, in subway stations, sometimes in parks. He tries to avoid the shelters because people have stolen things from him.

“I know I have an alcohol problem,” he says, his eyes sad. “It wasn’t always this bad. I don’t know how to stop. Sometimes I think I will never stop, even though I hate waking up in the hospital. Life is too hard. Beer helps me feel better. ”

1:45pm. Charting that encounter. Diagnosis determines what housing he is eligible for.[2. “Diagnosis determines what housing he is eligible for.” This is an example of psychiatrist as an agent of social control.] It’s not clear if he has a “severe and persistent mental illness”. Suggest that he return in a week; the meeting can happen outside if that’s easier. No recommendations for medications right now, but harm reduction in his alcohol use would probably be helpful. He demonstrated insight, but that may not result in behavior change.

1:55pm. Case manager asks for help with a person who lives in a park. Hop into the team vehicle and drive north.

2:20pm. Arrive at the park. The client was there earlier in the day and said that he would be there, but a walk through the park shows that the client isn’t.

Three people by the picnic tables wave hello. The outreach team sees them regularly, though they are not eligible for this program. They have been drinking, but they are not grossly inebriated. They laugh as they tease us for following them around; everyone is now enveloped in the strong fragrance of fruity, sugary alcohol.

They each hold a bottle of beer that sits inside a wrinkled brown paper bag. They offer some. They aren’t offended when their offer is declined.

2:30pm. Walk around the park one more time to find the original client. He’s still not there. Children play with a ball on the lawn, multiple games of chess are in play, students read thin books on park benches, couples hold hands as they walk along the park paths, elderly women sit and watch people walk by. The three people who are drinking alcohol laugh loudly.

2:55pm. Arrive back at the office. A client is sitting in a chair by the door. He says nothing, but he looks upset.

A case manager requests consultation.

“This guy never agrees to come in,” she whispers. “Maybe you could talk with him? He’s been homeless for a long time, but finally agreed to move into an apartment about eight months ago. He was doing fine, even saw the psychiatrist there once or twice… but apparently he’s been sleeping outside for the past two days and won’t say why.”

There are introductions. The man doesn’t want to get up from his seat. He frequently looks at the door during the stilted conversation.

“How are you, Charlie?”


He learns what the case manger shared. He says nothing.

“How long have you lived there?”

“A few months.”

“What’s it like?


“Anything you like about it?”

“It’s warm.”

He suddenly starts talking about the freedom of living outdoors, except the cops harass him sometimes. He also doesn’t like the kids who try to set him on fire. The zombies send them to do that. He’s tired of the zombies.

“Who are the zombies?”

“I don’t know! Stop asking me questions!”

He abruptly gets up. Everyone pauses.

Charlie wipes his mouth on his sleeve. He drops back down into his seat.

“The zombies want me to be homeless. Every day, same thing: ‘You’re a homeless motherf-cker’. Damn!”

He talks more about the zombies and his apartment.

“You wanna try going back this afternoon? We can take you there. It’s starting to get cold out. You mentioned that your apartment is warm.”

Charlie chews on his lip and snarls.

“Let’s get into the car so I can drive you back,” the case manager gently says. He says nothing, but he gets up and walks out of the office. Everyone looks at him.

“You gonna drive me back there now or what?” Charlie mumbles.

3:45pm. Go visit a local church to try again to speak to a young man. No one is certain of his name. He believes the church is his home: The pews are his beds, the altar is his kitchen. He has washed his clothes in the font of holy water. He occasionally yells “in tongues” at parishioners. When security guards have consequently escorted him out of the church, he has tried to “cast the devils out” of them. He notably avoids the church during formal services.

Inside the church, tourists and visitors speak in hushed voices as they walk through the aisles. The security guards nod hello.

The young man is seated quietly in a pew in the chapel. His eyes are closed. He doesn’t respond to whispered entreaties to go outside and talk. He keeps his eyes closed, his hands clasped, and he breathes quietly. Another security guard watches him.

4:05pm. Back at the office. Charting.

5:05pm. Depart the office and get swept into the current of people walking towards the subway stations. Automatically look for people who are homeless along the way. It’s too crowded right now; the homeless can’t find any places in there that offer peace.

Step onto a train and notice a sleeping man holding a tattered backpack to his chest. His clothes are soiled, including his three oversized coats and flimsy cap. The soles of his shoes are ripping off, showing the dingy yellow socks inside.

A lot of people get up so they don’t have to stand or sit near him. Most people don’t look at him.

I do.

Lessons Medicine Nonfiction NYC Observations Seattle

Doctor as Patient.

It had been about two years since I last saw a primary care doctor. I was still living in New York City. My initial—and only—appointment with that physician lasted nearly an hour.

The front desk clerk had a round, pale face. Behind her was a textured wall over which ran a thin sheet of quiet water. Lush leaves spilled over the brim of the planter onto the marbled countertop.

“I’ll let the doctor know you’re here,” she nearly whispered.

He was a family practice physician. He was friendly. He smiled at me. He asked me if I lived in the city. When he learned that I worked as a psychiatrist, he commented, “Wow. That’s hard work, Dr. Yang.”

It was professional courtesy to address me by that title, though it didn’t feel right to me. I looked down to mask my discomfort. My feet dangled off of the examination table.

“Do you have a private practice?”

No, I said. I worked primarily with people who were homeless.

“Oh,” he said. “That’s even harder work.”

He asked me about my medical history, then my family history. He went through the major components of a physical exam.

He told me about his work as a primary care doctor. As a physician in primary care, it was getting more difficult to stay in business. He previously worked in New Jersey, but had been practicing in New York for a few years. He didn’t think he would leave the city. He was established now.

His technician then put square stickers on my chest and the EKG machine printed out my heart rhythms. Next, I took a deep breath in and held it as another technician took a chest X-ray. And then, another technician, who apparently worked as an anesthesiologist when he was living in his native country, told me not to worry too much when he drew my blood.

“It won’t hurt at all,” he snickered.

The physician called me two weeks later. He said that everything looked fine.

My primary care appointment in Seattle was one of the first visits of the physician’s day. I walked into the medical center and looked at the directory. I must have looked perplexed. A portly man with glasses asked, “Can I help you find something?”

“I’m looking for Dr. X’s office.”

“Fifth floor.”

Dr. X wasn’t a physician in private practice. Are there even family practice doctors in private practice in Seattle? I wasn’t sure how long the appointment would be. Not long ago, I was working with primary care physicians who had appointment lengths of 20 minutes. I envied them. I only had 15 minutes with each patient. A lot could happen in those extra five minutes.

The medical assistant was wearing a plaid shirt and black high-top sneakers. I couldn’t help but think that no medical assistant would dare wear anything like that in New York.

He left me alone in the exam room and I waited. It was a cold room and the gown was thin. I hoped that my doctor wouldn’t be harried and rushed.

After the physician knocked on the door, she quickly entered and gently shut the door behind her. She was about my age. She wore a long white coat and her stethoscope was around her neck. I immediately thought of the snarky comment one of the surgery residents had made about internists when I was a medical student:

“They wear their stethoscopes like they’re dog collars.”

“Hello, Ms. Yang—Dr. Yang? Dr. Yang, right?”

“Yes,” I said. There was that professional courtesy again.

She didn’t ask me many questions. I had filled out the general health questionnaire prior to the visit; she reviewed my responses. She typed some notes on the computer while we talked.

With what seemed like some sheepishness, she provided counsel on vitamin D. Maybe she thought that I was already aware of this. Maybe she thought that she shouldn’t go on about it because I had resources to look it up myself. Maybe she didn’t want to seem condescending. I couldn’t help but think, Don’t worry about me—just do your job. I don’t follow vitamin D as closely as you do, just as you don’t follow schizophrenia as closely as I do.

She went through the major components of a physical exam. We soon were talking about her job.

“Yeah, I went to a Prestigious Residency, but it really was malignant,” she said, pushing on my abdomen. “I’m so glad that I have this job here.”

“Do you mind if I ask about any productivity requirements you might have?”

“You may not believe this, but my schedule is built so that I only have seven patients scheduled in the morning and seven in the afternoon. I can add more on, but that’s the general schedule. That gives me time to call patients, return e-mails, and spend more time with geriatric patients, since, you know, they often have a lot of health problems and need more time.”

I was silently doing the math in my head. Seven patients for an entire morning! There were days when I had seven patients scheduled in two hours!

“Yeah, I can’t imagine working like that,” she said.

She spoke quickly after she completed the exam. “If you have any questions, you can call me or send a message through the website. It was nice to meet you.”

As I was getting dressed, I found myself wondering about all the tests she could have done, but did not. Wouldn’t it have been nice if she had baseline studies for me? What if I developed an arrhythmia in the future? Wouldn’t a previous EKG be useful for that? And what about basic labs? What if my kidneys start to peter out? Wouldn’t it be nice to know that they were fine in 2012?

And then I caught myself. Most women my age are healthy and without medical problems. I hadn’t endorsed any symptoms that would warrant further intervention. Tests had their risks, too.

Doctor as patient. I considered myself lucky that I was able to leave without new diagnoses or the need to return within a few weeks.

And I remembered again what it was like to be a patient.

Nonfiction NYC Observations


During my first year in New York, I packed my lunches in plastic grocery bags from Morton Williams. That is where I purchased cartons of frozen Shop Rite veggies, picked through Cortland apples, saw packages for matzoh ball soup, and overheard elderly women bicker with cashiers over the price of the deli pasta salad.

My lunches were simple: thin sandwiches, leftover pasta and vegetables, string cheese, fruit, nuts. If I wanted a treat, I’d slip in a few cookies.

Upon sitting down at the round table in the office next to the large windows overlooking the East River, I unwrapped my lunch. Several of the attending psychiatrists showed great interest in my food.[1. I have never before nor since experienced so much fascination from others about my lunches.]

“So… what did Dr. Yang bring for lunch today?

“What homemade goodness are you having?”

Sometimes they stood over me; sometimes they pulled a chair out and sat down, leaning forward to inspect the contents of my lunch.

“What’s in that? Eggplants? Tomatoes? I smell garlic.”

“What kind of apple is that?”

“Leftover pizza, right?”

As I confirmed or otherwise explained the ingredients in my lunch, sometimes they congratulated each other for their discernment. I nodded and resumed eating. They wandered away towards the door.

“So… diner?”

“It’ll be crowded. How about the cart out front?”

“The diner is always crowded, but they make good fries.”

“Okay, the diner it is.”

The team nurse often entered the office after the psychiatrists had left. She spoke with a Brooklyn accent, dressed with class, and carried herself with confidence. Though the wrinkles around her eyes and on her hands revealed her age, she argued with vigor when she disagreed with the director of the service. He would persist, though knew to relent: She was a strong woman.

Sometimes, upon finding me eating alone, she would sit down at the table. She shared history about the department, interesting developments in other parts of the hospital, and updates about patients I had seen.

She also shared her sadness about her son. He was killed while serving in the military a few years prior and the anniversary of his death had just passed. Though she was smiling, her eyes were already full of tears. Her voice cracked as she apologized for crying.

“I miss him so much,” she said, dabbing her eyes with a ball of tissue. As she pulled apart the ball, she murmured, “My mascara is starting to run, isn’t it.” More sad than annoyed, she motioned me to walk with her to her desk. Her computer wallpaper was a photo of her son in his military uniform.

She pulled out a compact and examined her eyes, wiping away the trails of diluted mascara on her cheeks. She was still crying.

The sky was dark. A storm was coming. The arcs of the grey clouds were descending upon the lines of the housing projects and warehouses across the river. Her screensaver began flashing photos of her dead son.

The office door opened; the psychiatrists were back from lunch. The nurse quickly wiped her nose and forced a smile.

“Time to get back to work,” she said, standing up.