Random Thoughts from a Restless Mind

Bellevue Hospital, and the Bellevue Hospital residents provide medical care for the New York City prisoners who are housed at Riker’s Island. This is actually quite an opportunity, especially for a child of suburbia like yours truly. It’s not as if I had never come across people in the criminal justice system prior to my Bellevue days, it’s just that I didn’t have such routine and regular contact.I don’t remember exactly, but there are at least three or four entire floors at Bellevue dedicated to the care of Riker’s Island inmates who have medical problems. One or two are for the criminally insane, and others who have some degree of mental illness. The remaining two floors house prisoners with problems as varied at coronary artery disease and pink eye. As disconcerting as it was for someone like me to enter a locked ward, the accommodations at Bellevue were at least a full order of magnitude nicer than those at Riker’s Island. This provided an interesting opportunity for Riker’s Island inmates to create a medical reason to leave The Rock, and created a very interesting learning opportunity for all of the residents  to discern real from not so real.

This  might have been the most fun part of my entire residency experience.

People who have something to gain from having an eye problem all seem to have the exact same complaint: “I can’t see.” Sometimes it’s “I can’t see out of my right (or left) eye,” and sometimes it’s simply “I can’t see.” The savvier the patient, the more subtle the symptom. The trick as the doctor on call is to simply demonstrate that their vision is substantially better than what they are describing. Oh yeah, it’s important to do so in such a way that you don’t make them too very angry; you don’t want to become a Bellevue Hospital “target” yourself!

Every resident develops a repertoire tricks that he or she will use, a go–to list that tends to work for the majority of the malingering patients. To be truthful, especially when caring for children, sometimes the patient is actually convinced that he or she really CAN’T see. The kids are really pretty easy, though. I found, and frankly continue to find, that even with my limited attention span (often described as being slightly shorter than that of your average gnat) that I have more patience than almost any child under the age of 18. Most eye charts will start with a 20/10 line, and then move through 20/12, 20/15, and then several to many 20/20 lines. If you start at 20/10, by the time you get the 20/25 or 20/30 that line looks absolutely enormous! I think I’m batting about .997 in kids with 20/400 vision in the ER who “miraculously” and up with 20/25 vision in the exam room.

Folks who have something to gain from being diagnosed with visual loss weren’t always wards of the state or city. Occasionally there would be people who stood to gain from being diagnosed with profound visual loss for other, less existential reasons than wanting a ticket out of Riker’s Island. My favorite was a Hispanic woman who came with an entourage of family members, her complaint being complete and total loss of vision in both eyes from some vague and poorly defined trauma suffered at the hands of a landlord who was trying to evict the her from a rent–subsidized apartment. Her examination was totally unremarkable. Everything about her eyes was so  normal it was eerie. My suspicions were high because she just didn’t seem all that distraught over her new blindness, you know? There’s an instrument called an indirect ophthalmoscope which is used to examine the peripheral retina. The light we use can be cranked up to a level which is quite frankly rather painful. I explained to my patient through her translator that I was terribly sympathetic, and very concerned about how she would ever be able to survive if she was  evicted, what with her being totally blind and all. I just had this one last test to do, to look at her retina. With phasersset on stun I started to examine her eyes with the light cranked up. She started screaming in Spanish. What’s she saying? What’s she saying? Remember, now, this is a woman who has no light perception, everything in her world is black. Her son grabbed my arm and started yelling at me. “Turn that light off. It’s too bright. It’s hurting her eyes!” Yup, just another satisfied patient.

The prisoners really were the most fun, though. You had to be on your toes because some of them were actually quite dangerous. If the corrections officers were chatting amongst themselves in the waiting room you could be pretty sure that the patient in your exam chair was nonviolent. If, however, there was a corrections officer standing roughly 1/2 inch from each arm of the patient, well, that was one you had to worry about. But the prisoners got it, they got that this was a game. If they could beat me they got a stay at the Bellevue Hilton. On the other hand, if I got the best of them, it was back to Riker’s Island. The guys who complained of decreased vision in just one I were actually not too difficult to fool. Again, all I had to do was prove that the vision and the supposedly “blind” I was normal. We quote discovered” all kinds of sight threatening needs for a new pair of glasses at two o’clock in the morning in the Bellevue consultation room.

The guys who complained of decreased or lost vision in both eyes were more challenging and therefore more fun. Can’t see anything at all? Piece of cake. All I have to do was prove that they had locked on to some image. There must be three dozen prisoners who complained of total loss of vision in both eyes who headed back to Riker’s Island one minute after entering my consultation room after they leaned over to pick up the $10 bill that I put on a footstool of the exam chair. Did you know that your pupils constrict when you focus on an image inside arm’s-length? You can imagine how handy that three-year-old Sports Illustrated bathing suit issue came in, and how many prisoners learned about accommodative pupillary construction after looking at THAT picture of Christie Brinkley.

There is one story out of all of my adventures with the Riker’s Island prisoners that stands apart. It was July, and I was doing my duty helping out the new first-year resident on one of his first nights on call. We got a call from the ER about this terrified patient who had lost vision in both of his eyes; he was defenseless. Dave, now a world famous pediatric ophthalmologist, was really unsure of how to proceed so I told him that we would do it together. We sat back and watched very carefully as the prisoner entered the room. He was totally on his own, not assisted in the least by the corrections officers. He managed to navigate around all of the little articles I had placed between the door and examination chair, not hitting a single one. He found the chair, turned just like you or I would, and sat down. His examination was perfect, naturally. After putting drops in his eyes to dilate his pupils this is what I said: “I can see that you are terribly frightened sir, and frankly I can’t blame you. I’m very concerned about your vision, and I’m going to do everything I possibly can to make sure that you are alright. I just put some drops into your eyes so that your pupils will dilate. Dr. Granet and I will then examine your retinas once the drops have worked. We are going to talk about what we’ve seen so far. Please go back into the hallway and take a seat in the blue chair, and we’ll come and get you in just a few minutes.” The prisoner left the room, once again navigating the “mine field” without incident.

Dave bowed his head, a little tiny twitch at the corner of his mouth as he shook his head. “There’s only one blue chair out there, isn’t there?” He smiled as he strolled over to the door. Sure enough, there was our patient, very calmly sitting in the single blue chair, surrounded by a dozen empty red ones!

We had to invite the corrections officers into the exam room when we explained our findings.

Little did I know how hard it was going to be to help my Bellevue target, Jean. He didn’t know he was being mugged when the gangbanger asked him for his jacket. How could he? He only spoke French. He couldn’t tell the police officer who came to the scene that it was HE who had been assaulted. How could he? He only spoke French! At Riker’s Island he had no idea that the gangbanger sharing his cell was demanding his fancy, leather sneakers. How could he? He, well, you know…

So what could I do? How could I help? What could I possibly do to help make the end of this very bad day a little bit better? Well, first off, I clearly needed to make sure that Jean did not go back to Riker’s Island any sooner than was absolutely necessary. The prison guards, who had now become quite a bit more interested in Jean knowing  his story, agreed that nothing but very bad things were likely to happen to this young, skinny, soft boy from France if he ended back at Riker’s. We decided to keep him at Bellevue as long as we could.

What else? Well, the theme that runs through Jean’s very bad first day in America was his total inability to tell HIS side of whatever story he was in because he spoke only French. I decided that what he really needed was to be able to tell his story, and to do so we needed someone to translate for him once he left Bellevue. No problem, right? I mean, we were in New York City, the biggest, most cosmopolitan city in all of America. Should be a snap.

It turns out that there’s actually quite a bit of France in New York. I called the French Consulate hoping to have someone from France take charge of my French target. It was pretty late at night, around midnight if I recall, and the consulate was closed. “Please leave a message…” No problem. Bellevue is on 1st Ave. at 27th St., and United Nations is only a couple dozen blocks north on the same Avenue. I rang up the French delegation to the UN. They, too were closed. “Please leave a message…”

I imagined out loud what it must be like to call France itself. You know, just ring up the country and talk with whoever answers the phone. This was back in the days of answering machines, not those ubiquitous “for thus and such press one” messages. At midnight midweek I told the guards it would certainly go something like this: “Thank you for calling France. Our business hours are Monday through Friday, nine o’clock in the morning until five o’clock in the afternoon. If you would like to negotiate a trade agreement, sign a peace treaty, or seek political asylum, please call back during normal business hours.”

Okay then, plan B. Lots of other folks speak Parisian French in New York City. I thought the next logical place to look for Francophones would be at a French restaurant. Good thinking, right? At this time in the mid-1980s the most famous French restaurant in the United States was Le Cirque, so I gave them a call. A  little after midnight the restaurant was still open and still busy. I asked the woman who answered the phone if anyone there spoke French. Yes, indeed, there were lots of folks who spoke French. In fact, there were more than a dozen French citizens who worked at Le Cirque! Great, I said, I have this young man from France who has been assaulted and he needs someone to help him tell his story to the police and to the judge. (I was getting visibly psyched; the prison guards were smiling). Oh no, Monsieur, we are MUCH too busy to do any such thing. We could not POSSIBLY have anyone available to provide that type of service. Have a pleasant evening Monsieur.

Wow. Made me think of that Robin Williams routine where he describes a conversation with a Frenchman. “(Puffs on a Galoise) We are French (sneers)… we don’t care.”

Now I’m stuck. It’s almost 1 o’clock in the morning and I can’t think of any other way to get someone to translate for Jean. Think! Think… think… think. What would I do if it was ME? Who would I call if I was in a foreign country and needed a translator, needed help with the language and the authorities? And then it hit me: American Express Global Assist! Remember those commercials? Any help you could ever need any time anywhere, as long as you were a cardholder, American Express would be there. I reached into my pocket, pulled out my wallet, and took out my own American Express card (which I had never actually used). I dialed the number on the back of the card and the very helpful operator connected me to American Express Global Assist, and the equally helpful operator there put me on with the head of their French translation department, right there and then. I told her the sad story of Jean the target and then handed him the phone.

BINGO!

The only thing left to do now was to keep Jean at Bellevue through the night so that he wouldn’t have to go back to Rikers; my friendly pair of prison guards pointed out that if we did, indeed, do this, Jean would miss the bus taking him to court, and would end up spending an extra day at Rikers. The guards were now fully into the project, however, and they agreed to ride the bus with Jean back to Rikers, and to sit with him in a duty room so that he did not have to go back into the prison population. Not only that, they personally escorted him into court (off the clock, on their own time) and delivered him to a French speaking attorney whose assistance had been arranged  by American Express Global Assist. Upon hearing the story the judge threw out all charges, and the city of New York and American Express put Jean on a plane home to France that very afternoon.

There’s a very nice epilogue to this story as well. Many months later I received a letter in that same consultation room at Bellevue Hospital. There was a brief type written note from American Express. Dear Dr. White, we apologize for the delay in delivering this note. In the excitement of helping Jean we failed to obtain any of your contact information. Please accept our apologies. Please let us know if we can ever be of any assistance to you, or your patients, in the future. Sincerely. The note was wrapped around a postcard, the message written in French.

Thank you for saving my son’s life.

There are only two kinds of people in New York City, targets and people who hit targets. At Bellevue Hospital we took care of the targets.