The Three Doctors of Riverdale
Mark Bernay, M.D., posed primly on his blue-plastic bucket-chair. He crossed an ankle over a knee; his brown polished shoe gleamed. He still wore his camel-hair coat, which is why he’d draped a clean sheet from the ward supply-closet over his seat before he sat down. On his right, Igor Bruck, M.D., straddled orange plastic and studied his notes. On Dr. Bernay’s left, David Winston, M.D., Ph.D., pressed against his charcoal wool-and-cashmere coat that was folded carefully over his pink-plastic chair-back.
About ten feet away from them, facing them as he rested his palms on the white robe that draped his thighs, reposed Jeffrey Ekstrom, twenty-nine years old, a patient at Riverdale. None of the doctors was looking at him.
“…Delusions are persistent, pathological beliefs that are not modified by reality,” Dr. Bernay was saying.
“I know the symptoms of schizophrenia perfectly well,” Dr. Bruck interrupted. “But the patient also has a complex. And narcissistic personality disorder. There is definitely a ‘pervasive pattern of grandiosity’ and an intense need for worship and admiration. He has an expansive sense of his own importance — within the parameters of his specific fantasy he exaggerates achievements, and demands to be recognized as superior to others. He is arrogant, feels entitled, and believes he’s special and different and can only associate with others of his own sphere. But given his intense conviction, I feel his positive symptoms will respond well to lorazapam and haloperidol alone. His negative symptoms….”
“But that’s one of the anomalies of this case,” Dr. Winston cut in. “He has few if any negative symptoms such as blunted affect, poverty of emotion, alogia, anhedonia, or asociality. He is on the contrary, usually talkative and is anxious to socialize with other patients, even to the point of invading their personal space….”
Jeffrey’s feet were flat on the green vinyl-tile floor. His eyes bounced from one doctor to the other, as each spoke.
“Which is why I feel he doesn’t need an antipsychotic at this time,” Dr. Bruck said, his tone curt and cold.
Dr. Winston narrowed his eyes so that his round face with the receding hairline looked like a ruddy egg. “Dr. Bruck, this is Paranoid Type, and I believe Risperdal would be effective.”
“He doesn’t appear to be in distress, and is able to function quite well….” Dr. Bernay said as his head bobbed up and he made a brief attempt to engage Jeffrey’s attention before he stretched his mouth to one side, and checked his watch with a flourish. “He should be maintained on a benzodiazepine and perhaps haloperidol, but we could recommend an atypical antipsychotic PRN….”
Dr. Bruck snorted. “We’ve already prescribed PRN medications. Clearly, we need a new strategy….”
“Why?” Dr. Winston demanded. He fingered the buttons of his wool, cotton, and cashmere suit.
Dr. Bernay glanced at him. “Is that a Zegna?” he asked.
“Yes, yes it is. It cost me over three-thousand dollars, and the scarf — which is also cashmere, was close to four-hundred.”
Dr. Bernay sniffed. “My camel-hair coat was nearly two-thousand. And the shirt by Ermenegildo Zegna too? I think you should’ve gone with a Simon Spurr.”
Dr. Bruck laughed. “I’m wearing a Spurr shirt. I love this gray and white check. Cost me five-hundred dollars….”
“But the tie,” Dr. Bernay said, “the tie is common grey silk by Eton. And a little too wide. Should be narrow, sleek, no more than three-inches wide….”
“And what in the world would you know about ties, Dr. Bernay?” Dr. Bruck said, his voice shaking just a little bit. “Always in your Hermes cotton silk turtlenecks.”
Jeffrey sighed and moved his tongue around in his mouth, thinking of his roommate, Robert, who developed tardive diskinesia. Robert’s tongue protruded and moved in every direction, and he made smacking noises, and blinked a hundred times a minute. “I blessed him, touched him, and he felt better,” Jeffrey said to the three doctors.
“We didn’t ask you anything,” Dr. Bernay said sharply. “Be quiet.”
“You’re some fine psychiatrist,” Dr. Winston said. “I also have a Ph.D. in psychology, if you recall. I think you need to work on your attending patient-communication skills.” He crossed one leg over the other.
“And what are those? Armani wingtips? Honestly, Dr. Winston, you have no sense of style,” Bernay said.
Dr. Bruck cleared his throat. “Excuse me, we need to deal with this patient. May I remind you that I’m a member of the American Board of Psychiatry and Neurology, and I’m a professor of Psychiatry at the Einstein Medical Center. I was listed as one of the best doctors for 2011 by New York Magazine….”
Dr. Bernay straightened, and brought his Pierre Hardy shoe off his knee, slammed it to the stained and broken floor. “I was on that list too, and you know it. I’m Director of the Family Center for Psychotic Disorders, and Director for the Division of Biological Psychiatry at the University Medical Center. I attend thirty-five hospitals and crisis units in the metropolitan area.”
Dr. Winston shifted in his seat and self-consciously stroked his tie and tried to keep it covered with his left hand, as it was a seventy-five dollar royal-blue by Smart Turnout. “Igor,” he said, “we’re all members of the American Board of Psychiatry and Neurology. And I don’t like to brag, but I’m Executive Associate Dean for Clinical Affairs, and Chief of Staff for University Hospital’s Forensic Psychiatric Unit. I’m also Psychiatrist in Chief at the City Medical Center….”
Jeffrey tilted his head slightly and watched them. He wanted to float up and away, out of the sunny day-room. He shook his long curly brown hair, and raised his bearded chin. He lifted both of his sandals off the floor, raised his arms straight out in front of him so that the sleeves of his robe rolled down and hung from his elbows.
Dr. Bernay’s face darkened. He peered furiously at Dr. Winston. He moved to the edge of his seat, dislodging the protective sheet. “And I have served on the FDA Advisory Board, the NIH Panel of Scientific Review, and I’m the editor of the Journal for Clinical Psychopharmacology.”
Dr. Bruck’s white shock of hair seemed to frizz and stand straight up. His blue eyes glared behind his glasses. “I have authored or co-authored over two-hundred papers and book-chapters, and I’ve edited six books . I am also sole author of the book, ‘Delusions for Modern Times.’ I am also a member of the International Society of Psychiatry….”
“As am I,” Dr. Winston said. “I am also the Director of the Bipolar and Psychotic Disorder Residential Program at the Medical Center of Queens.”
Dr. Bernay stood up in front of his chair, one fist clenched at the edge of his iPad — a gold and jade ring sparkled on one knuckle. He raised his other hand and hit at air. “I am a member of the Society of Biological Psychiatry, and the American Academy of Clinical Psychiatrists….”
Dr. Bruck also leaped to his feet. “And I am a member of the World Psychiatric Association, and I founded the Family Psychotic Disorders Program right here at Riverdale Hospital!”
Dr. Winston rose slowly, elegantly, calmly. He carefully tucked his tablet against his vest. His little eyes flashed. “And I helped develop Riverdale Hospital into a psychiatric facility in the first place!” He smiled smugly.
Jeffrey folded his arms in front of him and came to his feet, as well. “I forgive you,” he said. “Go with God,” he added, making the sign of the cross. They ignored him, and continued shouting at one another. The little one named Winston and the taller one with the fake British accent, Bernay, looked about to come to blows. “Please, my children,” Jeffrey said softly.
“I am past president of the Northeast Psychiatric Society and I appeared as a consultant on The Today Show,” Dr. Winston shouted, spittle spraying with his words as he jutted his face upwards.
“My research is renowned,” Dr. Bernay countered, hovering over the shorter Dr. Winston. “I was awarded the Itterson Award for Research in child and adolescent bipolar disorder….”
“I am a millionaire!” Dr. Bruck nearly screamed. “I have a condo worth millions in Tribeca!”
Jeffrey pursed his lips and shook his head. He backed away, then turned and headed for the exit. “And I’m only Jesus Christ,” he said to himself as he held his robe hem and shuffled out the door.