Twelve Patients: Life and Death at Bellevue Hospital (9 page)

“Dr. Eric, we know each other. I met you years ago at Bellevue, first in the coffee shop and then after my mother’s operation.” I thought back and tried to fix Lila and her mother in my mind, but nothing came up.
“Lo siento, Lila, mi memoria me falla.
My memory fails me.”

“I heard you were very sick yourself,” she said quietly and knowingly. I had not expected that the neural networks transporting news of my life traveled to the amygdala of central Brooklyn.

“First we met in the coffee shop. Danny was serving both of us across from each other. He told me you were
el jefe
, the chief, and I apologized and interrupted your lunch to ask a favor.” Lila smiled
easily and widely. I started to remember a little about the long-ago lunch. Her mother needed surgery for a major problem. It was elective yet it was not elective—meaning that you would die without the surgery, and you had a high percentage of dying with the surgery. I had brought up the case with Greg, the head of cardiovascular surgery. He had personally sewn in the double valves and bypassed the diseased coronary arteries. She’d had a rocky post-operative course but then one day turned the corner. A few days later I saw her walking down the hall with her son on one arm and on the other a daughter. This was Lila, that Lila from many years ago. “You helped my mother. What can I do for you?”

She made me a thick espresso from a silver stovetop aluminum coffeemaker and loaded a tiny cup halfway with sugar. She set a plateful of cookies and cakes on the table. We both took our seats, and she listened intently as I began to talk.

“So Tanisha or Tani has one chance left as best we can determine.” I pulled out the drawing she had given me a few months earlier. It covered most of the table; we moved the plates and cups to the sink. “This is one of her dreams of Mochi in La Republica. Your mother’s hometown and where you grew up before coming to New York City. Tani has adopted the stories and the town and the animals as her own. She has dozens and dozens of stories, names, people, events, miracles, births, funerals, crazy people. She knows more about
el cabrón Trujillo
and his henchmen than anyone I know, myself included. It is as if your mom were an oracle and Tani, her amanuensis. She took copious notes in her head and never forgot so much as a flavor. She is now writing it down and putting it into pictures, into art.” I stopped, exhausted from the emotional drain of communicating everything I needed to—not forgetting anything and yet not overwhelming Lila. I had to be fair about all that Tani had been through. Lila was an adult who had lived in the real world and had no pretense.

“You cannot live without love, Eric. It is not possible. Animals need to be loved, and especially people. People don’t need money to be successful. There is a lot of confusion today about this. My family all lives within three blocks of this apartment. My mother and father lived
across the street. We saw each other all the time and stayed in touch constantly.” Her phone had gone off at least fifteen times during the visit. She would check the number and hit Hold. Only when her husband called did she say, “
Mi amor
, I will call you back after
el doctor
leaves.” Her philosophy was very simple and direct: You loved other people and were loved back. Both were necessary. She was explaining to me how her world worked.

I had my brown leather briefcase with me; I had left it with my jacket in the living room. I got up now and brought it to the kitchen table. I took out a black journal and put it on the table. “
Lila, Tani ha estado escribiendo un diario de su vida. Ya van cinco tomos.
” Tani wrote a diary of her life; she has completed five of them. “
Por favor
, this journal is about her time with
Abuela
Lola. Her memories of the life your mom lived in DR, the tales she told to the children living with her. Her philosophy and the life she passed on is all in this book, handwritten in Spanish. I borrowed it from Tani and told her I wanted to share it with a very special person who would understand it and keep it to herself. She has shared her journals with me as she completes them. What I know of her is what she has written. Much more than what she has said. I think life has been too painful for her to say it out loud even to people she is starting to trust, even a little. We all leave her.”

We sat across from each other and didn’t say anything for a few minutes. Lila looked at the picture, the colorful animals flying across a sky darkened by an eclipse of the sun. She saw her mother and father in the center of the picture and pulled it closer to her.

“Dr. Eric, I will read it and then talk to my husband. I understand what you are saying. And I understand what you are asking. We are a poor family. We don’t have a lot. Except one another. My husband works all the time and worries about our expenses and our health. He is a good person and loves his children and his grandchildren.”

Our conversation drifted to the neighborhood and how much it was changing. The apartments were going co-op, and Lila was worried about the future of rent control and the New York State legislature, but she liked the safety and the variety of families that were moving in. “I feel more Jewish than ever before,” she said with her usual smile.
“I used to see Rabbi Schneerson being driven around on his way to visit people at Downstate hospital. He was a wonderful man and a real community leader. Look at how the community has grown.” She had moved over to the window and parted the white gauzy curtains while looking down on the street. “You know, it doesn’t matter really which religion you believe in. There are many religious people who cannot love anyone or accept love from anyone.”

At that point we both moved toward the door. I grabbed my coat and my ancient brown leather briefcase. We hugged at the door and she kissed my cheek. “
Voy a llamarte, Eric
. I will call you, don’t worry.” I retraced my steps to Clarkson Avenue, where I’d parked across the street from the large campus of Kings County Hospital. I’d spent ten years here learning how to become a doctor. It all flooded back to me as I unlocked my car and paused for a few moments looking up and down the streets that were increasingly less familiar. The new buildings’ red brick hadn’t had a chance to weather, and the glass-and-metal entrances were surreal. I took my time driving down Flatbush Avenue and over the Manhattan Bridge. The traffic was heavy, the potholes merciless on my aging Volvo, but I savored just being in Brooklyn, another time zone, another planet in the galaxy of New York.

Back at the hospital, I met with the child team and let them know I had met with Lila Pagan privately in her home in Flatbush. Briefly I went over the visit, leaving out most of the details. More than anything I did not want to raise anyone’s hopes that the Pagan family could or would be able to take on the responsibility of becoming foster parents for Tani. In addition to making this decision, they would have to go through the process of applying to be foster parents and enter into a long process of interviews, background investigations, and multiple home visits by social workers before being accepted. They were an intact family, emotionally connected, financially not desperate, and had a physical home that was appropriate. There was also a record of the
abuela
’s care and dozens of kids over many years well looked after. The system had almost seventeen thousand kids in foster care in New York City at any one time. There were thousands entering and leaving annually. Many kids had impossible needs.

The system at the moment had “seized up,” according to one social worker I had talked to about Tani. A mother had left a very young child with her younger boyfriend. The baby had been bludgeoned to death. Aside from the criminal investigation, there had been a cover-up. As one of our Bellevue kids commented, “I would rather get beaten by my own parents than my foster parents.” I knew if Lila was going to accept this, it would not be for the money. It would be for her the memory of her mother and for Tanisha. Or not at all.

A month passed. One day as I was finishing up lunch across the street from the hospital at East Bay, an alternative Greek diner, my cell phone vibrated and then starting ringing. Lila’s name came up. I waved to the group and took the call in the space between the double entrance doors. “
Dr. Eric, habla Lila.
”

I pushed into a corner of the closet-size space. My own hearing was really compromised; my family was pushing me to get hearing aids. “Lila, how great to hear from you,” I practically yelled into the cell phone. She wanted to meet with me. My offer to come to her house again was politely turned down. Her son, the police officer, was going to drive her to Manhattan, and she would be there this afternoon at three.

“
Por supuesto
, of course, Lila, that is perfect. Mezzanine Room 30. We will be waiting for you.”

We were waiting in my office at two thirty. The head of child psychiatry and the social worker Ana. We were nervous and made some small talk about the new child psychiatry unit that was going to be built since St. Vincent’s hospital had closed, leaving a huge gap in city beds for kids in crisis. I made espressos for everyone, and we ate chocolates from a clear plastic box labeled “ORGAN DONOR NETWORK NEW YORK CITY.” Lila was on time and came in the room with her son Enrique, the New York City cop, in uniform. Patty ushered them in and shut the door quietly.

After polite hellos and hugs I introduced the group to the Pagan family and asked them to sit. Lila had a shopping bag that she put
on the table. First she took out the black journal I had left with her, and then Enrique put a heavy large rectangular package on the table wrapped in heavy paper surrounded by bubble wrap and taped carefully.

Everyone was completely quiet, waiting patiently for Lila and her son to lead us where they had planned to go. “Doctors, we have had almost a month to read the journal and share the information with all of my brothers and sisters, all nine of us and husbands and wives. In fact many came over to my house to read the journal out loud to one another. It never left my sight, I assure you.” She looked at me. “The painting,
el cuadro
, we took the liberty of having framed with glass to protect it. All of the children wanted to see it and touch the animals.” I got a scissors from my desk and handed it to Enrique, who slowly and methodically cut the layers off protecting the
cuadro
. When he was done, he put it up on its side and sat it on the arms of an empty chair at the end of the faux-marble conference table. The other doctors hadn’t seen the picture before. It was elegant with a simple wooden frame and a gray border around another narrow band of white.

Lila continued. “From the journals, we learned things we didn’t know about my mother. The stories were all about her childhood. Many of the episodes, if not most, we knew by heart ourselves. We lived them and were in many of them. Tanisha must have memorized them almost word for word since they are the way my mother would talk and how she would tell a story.” She was animated now and had engaged all of us completely. I felt a lot lighter. My heart stopped beating so hard.

“I didn’t know my mother had gone to Haiti and brought some babies back to DR. They had been abandoned after birth and needed families. I mean, we all went back and forth across the border, we were only a few miles away and there was all kinds of buying and selling. My father made money selling cans of gasoline when things were difficult. And many families came across the border desperate from starvation and the Tonton Macoute under Papa Doc, who were like Trujillo’s henchmen, butchers.

“She used to say, ‘What is a border? These are people just like us,
but they have no trees on their side since the
caciques
have cut them down and sold them to the United States. They have flayed the country alive’—she would use the expression
despellejar
.

“Tani used my mother’s expressions in her Spanish. It was like reading my mother’s journal, though she couldn’t possibly have written one since she only could write and read a little. We had Sunday dinner at my house and we read some passages together, everyone came over. Just my brothers and sisters early so we could talk together. My husband took some time off from his livery to sit with everyone.” Lila slowed a bit.

“I asked them all about what you requested we do as a family for Tanisha. Everyone remembered Tanisha. She disappeared with the social worker after my mother passed on. All of the kids were gone. We picked up the pieces of our lives after the long illness and got back to our husbands and wives and our children.” I wasn’t sure if she thought we felt bad about her. We certainly didn’t. It never occurred to us. The kids were moved constantly for a million different reasons. Tani had the record as far as any of us knew. The world of foster care could be a monster, hard, painful, with both wonderful people and predatory sociopaths.

“My mother would have taken Tanisha in with her. If this happened and you had approached Lola, she would have taken her to live with her without further discussion. She loved Tani, and it is clear from the journals and the picture that Tani loved her and felt completely that she was her
nieta
, granddaughter. We will do the same as my mother and take her into our family.” She said it matter-of-factly.

I heard her say it before she did and started to get up as she was finishing her sentence. I walked over to her and we hugged for some time. I shook hands with and hugged the burly New York City cop sitting next to her. The doctors and social worker, too, hugged Lila and her son, then gradually made their way out of my office back to the twenty-first floor.

The details were not insignificant, but they were really beside the point. There was nothing that we could not finesse, manage, catalyze, push forward to make this happen. Tani would stay with us on 21 until
the paperwork had gone through and the Pagans had been made her official foster parents. That would also give them all time to get re-acquainted. We could keep her in a holding pattern on the unit waiting for a “bed” at the state hospital. In the meantime there was schoolwork that we would supplement with more writing and lots of artwork. There would be no intermediary placements. She would go from the one place she felt safe into another place I knew in my heart would be her permanent home.