What Dreams May ComeMature

Easy night like any other. His “partner” had snuck off to do a four hour shift at the Grand Central Post Office as an hourly mail sorter. Irony, there; the guy could barely read  English but he knew his numbers and could get by sorting by the zip codes.  This left Martin on his own doing the rounds at Bloomingdales at night in his blue windbreaker with Metropolitan Guardian Service splashed across the back,. There were always supposed to be two of them on duty from closing time until the first stragglers came in to work at 7AM.

No big deal covering for the guy. He did the same for Martin when he’d get a gig as a bartender/host at Malachy’s three blocks up on Third Avenue. That was a sweet deal; he only had to speak normally with the fresh off the boat brogue to welcome the shit-faced Irish-Americans who all thought being Irish was a good thing.

The easy night changed at 11:14PM when Martin got off the elevator on the third floor and saw there was someone curled up on a couch in the Men’s Department. At first, Martin did a quick step away toward the elevator, but he held steady and semi-yelled at the figure on the couch to get the hell up. No response and Martin got closer, realizing that it was a kid sleeping in the middle of New York’s busiest area, in New York’s most famous store.

Dilemma. The rules called for him to get his partner on the walky/talky and then phone the headquarters’ number for further instructions. Martin couldn’t call his partner because he was doing the illegal shift at the Post Office and because the goddamn guy had the contact numbers for the headquarters. Martin could tell it was just a little kid in shorts and socks and a striped polo shirt and a hat on his head. He knelt down beside the child and tried to wake him; he nudged him and tapped his feet to get a response. Nothing. Worried now, Martin leaned over him to reassure himself that the kid was breathing and, finally, the child rolled over on his back. Martin’s first reaction was more of a laugh than a sigh of relief when he saw that the boy’s hat had IRELAND written across the front. It was  the kind of thing tourists bought at Shannon Airport  as  souvenirs; no Irish man, woman or child would wear it!

 Martin went the safe route. He called his sister-in-law who worked the night shift at the Nineteenth Precinct Police Station on 67th and Lexington and explained the situation. He couldn’t call his boss because he didn’t know the number. His partner was unreachable until 5AM; they’d both be fired and the other guy was basically on a Green Card kind of Visa and would be immediately deported for working one job , let alone the second job. Martin’s  sister-in-law considered herself a Yank.  She’d been in the US for nine years and labored to cover the traces of Galway in her speech. But, she knew how to be very Irish when it was going to be helpful.  She told the desk sergeant (another product of County Galway) of the situation her brother-in-law was in. The desk sergeant said he’d handle it and told her to get her brother-in-law to open up Bloomingdales’  northside door on Lexington Avenue in ten minutes and his “guys” will take the elevator up to three and get it all sorted out.

It went well. It was sorted out. No one was fired and the boy with the IRELAND hat entered the system.

The two patrolmen tried talking to the boy who kept falling asleep but they knew he wasn’t in any kind of medical crisis so they carried him down the elevator and told Martin to keep out of it. Martin agreed : he knew nothing about nothing. The boy was placed in the rear seat of the patrol car with one of the cops sitting with him and they sped up Lexington to Lennox Hill Hospital on 76th Street. The cops brought him in through Emergency and said he been found sleeping in a doorway with no ID on Third Avenue.The nurse on duty put him in a wheel chair and asked the policemen to wait  while she got the kid  checked out and readied the paperwork for the cops to sign. She wheeled off to a curtained room and the cops told the attendant they had an emergency call and would be back in an hour. Of course, they didn’t come back.

Male Caucasian child, age and identity unknown was examined every way possible, but aside from his general lethargy and an almost wax like covering of his eyes- which was easily washed away- he was pronounced fit. Fifty one inches tall , sixty eight pounds, no obvious cuts or contusions, no dental work, light to almost blond hair cut very short. His clothes, except for the hat with IRELAND written on it were unremarkable. Socks and shorts and skivvies and tee shirt all very clean, but not new.  Probable age was six  or  seven. And, he was mute.

Healthy but mute; healthy but unidentified; healthy and unidentified added up to  a clearly uninsured situation.

The Lennox Hill Hospital admitting doctor knew the rules so he called  Bellevue Hospital and said he was transferring an abandoned child who seemingly suffered a mental disorder and could not be adequately treated at Lennox Hill. Bellevue was noted for its extensive psychiatric  care unit and it was a city hospital which couldn’t refuse the admission. The Bellevue clerk asked the doctor for the name of the patient’s insurance carrier and was assured  that all the details would accompany the child. Of course, when he sought out the nurse and/or the police men who had deposited the child a few hours before, they were no where to be found.

The Lennox Hill ambulance carried the child downtown to Bellevue and the whole process started again. The ambulance driver had no paperwork except a chart stating the boy’s vital statistics of height, weight, blood counts and blood pressure and that his only identification was the word IRELAND stitched on the hat he was wearing when found.  No paper work, big problems. He was seated in the chaotic waiting room in a wheel chair and was in no visible distress and was ignored for a long while. He was brought to a passing nurse’s attention when he almost fell out of the wheel chair because he was sound asleep.  The nurse caught him and sat him back in the chair and asked him his name. No reply, but she was sure he understood the question. She took his hand and asked him to follow her to the admissions desk where she learned that no one remembered who brought him in or why he was left sitting with a plastic wrapper holding a medical chart from Lennox Hill Hospital on a lanyard around his neck. Again, no answers and no one was responsible. The nurse, Anya Salonka, felt as though she’d never left the Philippines. Here, at Bellevue, chaos, noise and ignorance of responsibility ran rampant in this always busy maelstrom of poor patients, over worked staff and too little time. She would take over this case herself.

Anya took the chart and the lanyard from the child and stood at a counter in the examiniation  area. She added RC under the blank space for religion (she figured that the Irish were as Catholic as the Filipinos) and she wrote in today’s date and time of arrival at Bellevue as 9/12/06. She flagged the first harried intern she saw and tried to explain that her patient was a possible psychiatric admission that he should attend to. Dr. Izra Patel, newly arrived from Mumbai, nodded to indicate his understanding of the little Filipino nurse’s heavily accented English. He whisked the again wheelchaired boy into a recessed area and helped him up on to a gurney. Dr. Patel told the boy he was going to gently examine him and would be asking him some questions. He started with the usual: How are you feeling? Do you feel any pain? Did you fall down? Did anyone hurt you? It was the usually long night at Bellevue and it took Dr. Patel at least six questions to realize there were no answers . He kept talking, resorting to his native Urdu and probed the child’s ears and eyes and mouth wondering if he was deaf . All throughout, the boy was calm and unafraid of the taps and touches, the blood pressure cuffs. Dr. Patel felt this child was very accustomed  to hospital procedures and that there was no sign of fear in his eyes. Again, Dr. Patel spoke to him in the lilting cadence of his native India. Rather than question him, he told him that he was in New York’s best hospital  and that he was going to send him for xrays and a MRI just to make sure everything was ok. He told the boy he’d be seeing him again later.  The doctor felt strangely assured that the boy understood him even though most of what he said was spoken in Urdu. Dr. Patel noted on the chart that came with the boy that he wanted procedures to eliminate any questions of trauma and he added that the patient was apparently deaf. He helped the boy back into the wheelchair and brought him back out to nurses’ station. Luckily he saw the same nurse who had brought the boy to him and he showed her his addenda to the chart and asked that he be kept informed of the test results. Nurse Anya smiled at the boy and she could tell that he knew her and maybe he even smiled a little at her.

 Down corridors, up elevators and down more corridors finally ending  at XRay. She added a request for a Cat Scan above the signature of Dr. Patel and asked that she be paged when the procedures were complete.

Three hours later, the over-tested child was put on a gurney and Nurse Anya was paged , to no avail. Her shift had ended at four AM. The doctor who had ordered the tests, Dr. Patel, was then paged and after the third responding Dr. Patel  had said  “it must be another Dr. Patel” the clerk requested a bed for the sound asleep child.  He was taken to the children’s psych ward on the sixth floor even though he looked to be old enough for the adolescent ward. The kindly attendant saw the pale and frail sleeping child as too obvious prey for the wildness of the adolescents who ranged from cocaine dependents to the frantic scourges of  dementia. The sixth floor it was and it was calm and pretty quiet thanks to the youth of the patients and to the liberal doses of phenobarb (and the more potent drugs available to the staff). The boy was sleeping so soundly that he was just eased into a bed and covered, un-drugged . The staff was promised a full admitting dossier when the day shift got in at six AM.

Wake up time in the children’s ward at Bellevue was flexible. Some of the patients started their day with pills, some were allowed to rise up from usually fitful sleep  on their own time table. When the staff member for the fourteen bed or cradle ward that the unknown mute child had been put into opened the ward door she was  surprised to find him up and wandering from bed to crib as though checking up on his room mates. He stood at each bed and looked at the child in his or her bed for a moment and none of the kids seemed upset by his nosiness. Rather, they seemed becalmed by him. The nurse went to him and led him back to his bed to read his chart  for instructions as to meds and breakfast specifications. Blank, no instructions, just his vitals and that he’d been admitted by a Dr. Patel the night before as a probable psychiatric case. Just another day in the crazy world of the poorest and sickest of the city. She told the boy to stay in his bed for a moment while she called around for instructions.  He stayed for what seemed to him a long time and got up to continue his surveying of the ward. They were mostly little kids and mostly limited in some way. Two of the boys were tied to their bed sides with cloth manacles. He decided to untie them. No sounds were uttered and the kids took to following him with their eyes, The recently untied came from their beds and each held one of his hands. The procession grew and there only five children still in their cribs who were unable to grasp the idea of moving freely. The new boy, the mute boy, lifted them from their confines and nudged them to walk around the room with him . A few of them moved haltingly on their own and the remaining children were carried by the bigger kids. All in silence, all smiling , all slowly walking the very edges of their confinement. It was a beautiful sight to behold except that it was such a dynamic and portentious insurrectionist move to the horrified staff nurse when she returned to the ward . She recoiled in fear that her charges would gang up on her and try to escape the room. But, all was calm and easy. Again, in total silence, the children went back to their own beds and the mute boy carried the three most helpless back to their cribs and then returned to his bed.  This almost serene display of control and order was an even bigger shock to the nurse. She left the room again and locked the door and ran to her supervising nurse who was embroiled in the machinations of too many questioners and no time to try to answer each ward nurse’s pleas for more, more, more of anything and everything. She turned on the scared nurse from what was considered the easiest ward on the entire psych floor with a withering look that asked what could you possibly to complain about?

Whispered words of parades and untied restraints and controlled silence and a strange boy who was leading the children around the ward. The supervisor roared laughing, “What’s to complain about? He’s probably the new Faith Healer we’ve all been praying for!” But, she did go back to the ward with her frightened nurse.

Calm, glorious calm greeted them. The Supervisor was directed to the new boy, the instigator and she picked up his chart from the bedstead and read the almost useless information. She asked the boy his name and he looked at her as though fully comprehending the question; he said nothing. She noted that he’d had a full round of xrays and Cat Scans and MRI’s the same night he was admitted. The admitting doctor was the dreaded Dr. Patel. There were probably twenty  Doctors Patel interning or as residents in Bellevue. India was providing well-trained doctors to the poorest cities and county hospitals all across the country and they were as welcomed as the Filipino nurses were. And the name Patel was the most common name in India.  She took the chart with her and instructed the ward nurse to do the usual—get them fed and drugged where necessary and supervise their showering and to keep them grouped until the daily walk around by the staff psychiatrists and psychiatric interns  at ten AM.

Chart in hand and the rare chance to ream someone out who was ostensibly her superior. She paged Dr. Patel and dismissed the first four who respondents, She wanted one who was on  duty last night in the Emergency Admissions area.  Finally, a hit. That would be Dr. Izar Patel an intern who was three months into his internship. She snapped that she wanted him on the phone or in person within five minutes or else she was going to the Board of Review. All said loudly at the nurse’s station, all to good effect in asserting her power.  Twenty-five minutes later she was awarded an acknowledging call from Dr.Mort Stern, a greatly feared ganzenmacher who wanted to know who she was and how she had the audacity to to try and imperiously berate any of his staff. Stuttering and red faced she whispered into the phone that there was a troubling situation with one of Dr. Patel’s admissions and she needed clarity. Stern told her he’d  give her the clarity himself.

Doctor Morton Stern was revered and feared in equal order. His nurses and the interns he supervised were quick to exalt him to their confreres and just as quick to avoid him at all costs.

He arrived on the sixth floor with a humbled Dr. Izar Patel and a young psych intern from Mt. Sinai Hospital. They swept on to the floor as though they were conquering heroes and the resident sixth floor staff fled in all directions. It was obvious that Drs. Stern and Patel had no idea where they were or where they should be going. A couple of loud and assertive coughs brought the now shy head nurse to them. She fawned at Dr. Stern and visibly ignored Dr. Patel and the young  lady  from Mt. Sinai. She led them to the day room, a chaotic mix of shouting and sobbing , stumbling and resisting  kids, all  who looked to be under seven years old. She circled the room to a quiet corner where some twenty or so kids were grouped around one boy who was looking at them each in turn and saying nothing. They were at peace. The head nurse pointed to the child in the center  and handed his flimsy chart to Dr. Stern. He regarded it for a few seconds and asked Dr. Patel for his input. Dr. Patel looked at the boy and at the chart and softly replied that he had been handed the case, “I mean the child” by a nurse and that he found him in good health except that he was mute and that he had been brought to the hospital from another hospital as a possible psych case. He continued that he ordered XRays and an MRI and it looks like someone added a Cat Scan. He then handed the boy off to the nurse who had brought him to his attention earlier. He had not heard back from the tests and he was sorry if he had done anything wrong.  Dr. Patel was assured everything was in perfect order and that he had no reasons to apologize. But, they were all standing there in a sea of calm carved out from the bedlam of noise and discomfort all around them. Dr. Patel went to the boy and said “hello; are you comfortable? Are you happy with all these children around you as friends?” The boy stared at him in seeming acceptance and agreement with the sentiments expressed. Dr. Patel then started the same thread of questions directed at the child but said them in his native Urdu  tongue. As before, the child said nothing but he did give an almost imperceptible  nod that seemed to be acknowledgement. Dr. Stern was stunned. “What the hell was that about?  He certainly isn’t Indian or whatever language you were talking. Just what are you doing?” Dr. Patel shrunk  into his scrubs and stammered that when he was examining the boy the night before he had lapsed into his native tongue after the boy had not responded to the questions in English. He explained that  India  is home to twenty four different languages and many more dialects and that, from force of habit, he had reverted to the way questioning was done in hospitals in India.  The answer wasn’t enough for Dr. Stern. He turned on the sixth floor ‘s head nurse and asked her assessment of the boy. He wanted to know had he been fed, drugged, examined in any way and what was the general cause for her earlier call? She stammered and shrugged to indicate their surroundings. The sea of calm in the absolute center of noise and frenetic movement  was reason enough. Finally, she offered that this boy was the reason for the difference. Dr. Stern stammered back, “He’s too good for you here; is that it?” No give nor take. Two over-egoed medical personnel facing off in front of a child who was watching the by-play like he was observing a tennis match. Dr. Patel mildly interjected that he would search out the results of last night’s tests and then inform the hospital Human Services department to put out Missing Persons data to the city in hopes of getting the child the help he needed. Dr. Stern opined that such notification should already be in progress, but he motioned to Dr. Patel to follow through to make sure. Silence again, and Dr. Stern had to do something. He told the Head Nurse to report directly to him with the young boy when their morning activities in the day room were over. She nodded her approval, and motioned to the boy to rejoin his circle of patients. No problem there. And, serenity reigned. The din of the room seemed to lessen and the children (141 patients under the age of sixteen were in residence in the sixth floor psych ward) nearest the new boy were also growing calmer. And the concentric circle of decreasing clamor spread slowly to an almost inaudible hum as patient after patient took care to slow his or her over-active reacting to the hidden stimuli that so penetrated their minds. The sea of calm was the most frightening thing that had ever happened on the sixth floor of Bellevue Hospital.

Nurses long accustomed to the constant tension and the warning signs of potential danger were now faced with what the largest dosage of Phenobarbital could only dream of. It was wrong; it was unnatural; it was more terrifying than the always feared riot by the inmates. Dr. Stern was unnerved,too. He took command as was his way. He told the nurse to bring the child with him now to his office . She knew there was paperwork that needed signatures before releasing a patient but this was Stern, who was the final arbiter of all things at Bellevue , so she took the boy’s arm and led him toward the departing figure of Dr. Stern and his entourage as they headed to the elevator.  The noise level in the day room rose gradually to a normal cacophony as the new boy went away from the room.

Complication times ten. As the elevator doors opened to transport the assembly of doctors and nurses and one small boy, their progress was halted by the simultaneous arrival of the noted Dr. Steve Ringle and a group of seven  psychiatric interns intent on doing their scheduled rounds on the sixth floor. The normal courtesies prevailed. “What brings you here to the sixth floor, Morton?” “I was responding to an alarmed call from your nurse here regarding the young boy here. I’m bringing him to my office  for a proper exam.” Doctor One vs. Doctor Two. Who is the bigger deal? Who has the most face to save? Who has the ego to protect at all costs? Stalemate decided by Dr. Ringle who with the seven onlooking interns outnumbered Dr. Stern’s small band.

Dr. Ringle said he’d personally escort  “his patient” to  Dr. Stern’s office when he had finished his rounds. With the slightest of nods he motioned the head nurse to bring the child along as he swept into the ward’s day room leaving Dr. Stern and Dr. Patel and a red faced Mt. Sinai intern to get on the elevator and descend to the main floor.

Dr. Ringle and his admiring  group of interns, did their appointed rounds. He noticed that the little boy seemed to have a calming influence on those around him. The usual uproar emanating from over a hundred kids ---all  here because of diagnosed mental health deficiencies --- was softened in a general and very pleasing way. None of this affect could be traced to the little boy, but doctors and nurses all looked at and to him as though he was generating this feeling of content. Rounds went well and quickly and Dr. Ringle grouped his interns and the ward head nurse in one of the small offices that framed the dayroom. The child was left in the care of another nurse.  Dr. Ringle opened his discussion with the usual query, “What did we learn today?” Silence , not the usual competing for points by the interns . Dr, Ringle addressed the Head Nurse and asked her to review the “history” of the little boy who seemed to have such a huge   impact on those around him.  The story, repeated for the third time was simple.”An ambulance from Lenox Hill Hospital delivered him last night. No paperwork except for cursory notations of height and weight and a suspicion of mental health questions. Dr. I. Patel in Admissions checked him out and sent him for CAT Scan, M.R.I. XRays and a Bone Scan. He was deposited to our floor after midnight and assigned a bed in our so-called cradle room with 13 other patients. After shift change, the assigned nurse opened the door to the room and found the boy wandering the room and seeming ly trying to communicate with his fellow patients. The nurse hustled him back to his bed and read the almost blank chart.  She then left to initiate the breakfast service. She returned to the locked room and was shocked to see that the ambulatory kids were walking around the room and three of them, including this new boy, were carrying those patients who weren’t able to walk. Most shocking, she noted that two of the boys were usually tied to their beds with soft  cloth ties and that these had been untied  to allow them to join the parade. The nurse came running for me with the chart and I tried reaching the Admitting Dr. Patel and , to make a long story short, my call was misinterpreted by his Supervisor, Dr. Stern and he came on the floor to witness what you all have just seen. This Admitting Dr. Patel talked to the boy in English and in some Indian language and we all thought that the kid understood him in both languages. The boy has some kind of ability to slow down, calm down the rest of the patients.”

Long answer but no answer at all to Dr. Ringle  and the interns.

Dr.Ringle excused the head nurse and again addressed “his” interns. “How do we explain this, any of this, all of this?” Now the answers flowed and the normal competition exploded. One opinion was that the boy was auto-didactic, this was immediately contradicted as too limiting. Then it was suggested as a clear case of autism on an Asperger’s slant.  And then, “Were there case records of both of these potential diagnoses being found in the one patient? “ Every one had a somewhat feel of a diagnosis; no one had a diagnosis to nail down. Tellingly, neither did Dr. Ringle.

He sent for the boy and again, the child was willing to be surrounded by the curious adults. The boy was escorted to a chair and was asked to sit down, which he immediately did. Dr. Ringle introduced himself and the other s in the room and said they’d like to question him. The child was calm and looked to each of the speakers and never said a word, but they all believed that their questions were understood.  One of the interns was from the Philippines and,  after hearing the nurse say the boy seemed to understand  the Indian Doctors’ questions in his native tongue, he ventured forth in Tagalog  asking the same general questions that had hitherto elicited no responses. Again, there was an immediate recognition by the assembled doctors that the boy heard and understood the question; he just wouldn’t voice a reply. Dr. Ringle asked the intern what was the language he had just used and was told it was the primary language of the Philippines.  Dr. Ringle made a mental note to clear his mind of beliefs that the Filipinos all spoke Spanish. He’d table that for now. Now he had an incredible quest. “Who, what, why were the secrets behind this adorable little boy?”

The End

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