Read Online Twelve Patients: Life and Death at Bellevue Hospital by Eric Manheimer - Free Book Online Page A

of us who knew his story understood that the father had abandoned him as a small child. He and his mother lived in poverty, and the father failed to provide child support. His visits, when they happened, were short and unannounced. Tyrone lived for them. He was on the waiting list for the state hospital. There had been too many failures sending him home and to alternative “residential” homes in the archipelago of child and adolescent facilities. What was his future? His life trajectory? Next stop adult psychiatric unit, or Rikers Island, or a mix of both? You didn’t need to be a soothsayer to see into the future.
    The part of the brain that processes emotions and perceived inputs like fear into rapid bursts of hormonal outputs is called the amygdala or emotional regulator. It’s the part of the deep ancestral brain that responds directly to environmental signals, premonitions, and threats. The conscious neural connections to protect this part of Tyrone’s emotional brain from being directly activated were poorly developed, perhaps destabilized by childhood trauma or even stress in utero as a developing fetus. The external environment offered no stabilizing or mitigating relief. The hope of his team of therapists was that routines and predictability, rewards for positive behavior, and careful schoolingunder reliable supportive supervision could start to rebuild the missing pieces. Create a mini scaffolding to build upon. He desperately needed to be cared for and loved. The moving pieces on our units, the staff rotations and shift changes, vacations, and absences for illnesses, made it all seem confusing and reproduced the most profound emotional activation in him, rejection. The state hospital would be a short-term “solution” in this situation. Drugs would calm his behavior, and he would be looked after in a reasonable environment in central Queens.
    I caught up with Tanisha a few days later in PS 37, the inpatient school for kids. This New York City school is at the opposite end of a long corridor from the adolescent psychiatry unit. All of the classroom windows look out onto the East River. She was sitting in a social studies classroom with three other teenagers. The top of her head half covered a notebook. Mr. Vargas waved me in and introduced me to the class. I sat next to Tanisha and asked, “
¿Qué tal, Tani? ¿Cómo va el diario?
How are you doing and what’s up with your diary?” The kids were encouraged to journal and use art to express themselves. They used the large pads and colored pencils and crayons to share something about themselves. We reviewed the art as part of the forensic evidence of the kids’ emotional “temperature” at daily rounds.
    The drawings were posted around the units and exhibited in the hospital’s giant atrium. Like outsider art, art from untrained, non-professional artists, some of it was spectacular. It was the amygdala speaking truth to power. And some of the most provocative art came from patients who could not verbalize what was going on in their heads. I had gone to outsider art exhibits in New York where the best work was by hospitalized patients forgotten in long-term facilities. Martín Ramírez drew exquisite and intricate pictures of interiors full of trains on used brown grocery bags. The recluse Henry Darger created erotically charged internal fantasy worlds of a depth and richness and erotic sensibility that gave you pause. Cracks in the wall. How to interpret the subtle signs from the kids’ hidden worlds? What did the newest diagnosis, conduct disorder, mean? An authorization to use Zyprexa?
    Tani. That’s what she was called on the unit; her
abuela
had calledher Tani. “I am writing about my life. Besides, I am finding things I had forgotten. Places where I had lived and people who I knew but had been buried someplace. I have seen some strange stuff. You guys think I am making it all up.”
    “You know, Tani, we hear and see some unbelievable things