Inside Out

PrintWhen you approach New York’s Bellevue Hospital on 1st Avenue and 26th Street, its magnificent gated fence looms above. Enclosing the original redbrick structure, it stands tall and spiked, constructed from wrought iron and coated in black. Menacing yet strikingly beautiful, the main gate bears the simple words “Bellevue Hospital” in a font imbued with traces of an asylum. Separating interior from exterior, it speaks of a time long past. The imagination can only run wild with what lies beyond their craggy form.

Bellevue is a buzzword. It denotes “nuthouse,” and “loony bin.” It is referenced in countless films and books as the solution for the mad hatter traipsing through the house uttering nonsense. It is its own punch line.

Unbeknownst to many, however, it is also the oldest public hospital in the country and the training ground for many top American physicians; yet, its infamous moniker often conceals the care and compassion that happen inside.

During the past year, I have worked in Bellevue’s child and adolescent psychiatric inpatient unit, conducting trauma screens, in-take interviews, and assessment scales for various psychiatric disorders. Many of the children I screened were plagued by loneliness. They had slipped through the cracks and seemed lost to the world. They ran the gamut of personas and ranged in age from five to 17.

Some refused to speak; others could not stop talking. Some came from the foster-care system; others from the Upper East Side. Some hugged me; others spit in my face.

Several months ago, I attended the initial assessment of a 10-year-old boy from the Dominican Republic. Having the fewest credentials in the room, I pulled up a chair and sat in the back.

The boy had been adopted and entered the United States at the age of five. Prior to his adoption, he suffered from severe neglect and malnourishment. His mother had admitted him to Bellevue for disorganized thought patterns, increased mood swings, and overt aggression at school. When I entered the room, he sat facing the wall, crouched like a timid animal with eyes tight shut. It was hard to imagine that such a child a few days ago had put his fist through the window.

He was asked questions and answered few. When the boy was asked to recite his birthday, he said he didn’t know. How odd, I thought. With the other patients I had met, even the most damaged, all knew their birthday. Children love to tell you their birthday. They tell you their age down to the very last detail—eight and three-fourths, ten and a half, nine and a quarter. I had never met a child who could not recall his own birthday.

After the assessment, I was invited to meet with the physicians and discuss the diagnosis. I sat in the corner as each resident and medical-school student presented. Their diagnoses were elaborate, layered, and sophisticated beyond the little medical knowledge I had gained. The birthday episode was not mentioned. The attending physician nodded her head and said little. To my surprise, she asked me what I thought.

“I find it very odd that the boy doesn’t know his birthday,” I said.

The attending offered a small, knowing smile.

“Yes,” she replied, “it is quite unsettling.”

It was later discovered that the boy was mentally retarded. In accordance with the group’s original assessment, there were signs of comorbidity with bipolar-1 and generalized anxiety. However, the true culprit was more obvious: the boy didn’t know his birthday because his brain could not comprehend the concept.

I am at the bottom of a long ladder that points toward medicine. Sometimes I’m not even sure if I’ve made it onto the first step. However, I have discovered that my intuition—my ability to sense when something is awry—is perhaps on the right track. Sometimes the solution to the problem is simpler than we perceive. Often, the solution is in our capacity to listen.

Jessica Halper ’11 lives in New York City, where she is finishing her postbaccalaureate for medical school. She currently works as a research assistant on trauma and posttraumatic stress disorder studies at NYU Langone Medical Center.

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