Clouds of Unknowing

I’m in the break room writing my notes while my coworker Jorge fiddles with his iPhone.

“Check this shit out,” he says.

I look up from my paperwork. My younger colleagues are very enamored with their smartphones. “What?” I say.

“Siri,” Jorge says. “What planes are flying overhead?”

“You’re kidding me.”

Jorge’s phone beeps and he hands it to me. “Take a look.” Sure enough, the screen displays the flight numbers of all the planes soaring above our heads.

“Ahmed!” I say. “Hand me the Stinger Missile!”

“Exactly what I was thinking,” Jorge says.

“Why do we need to know this stuff?”

Jorge shrugs. “It’s out there, man. You can download an app, point your phone at the sky and it’ll tell you the flight number of every plane it sees.”

Richard, one of our nurses from Nigeria, chimes in. “You Americans make too much information available.”

“You think people can track Air Force One using this thing?” Jorge says.

I figure Siri is tapping into a database of information beamed from the passing planes’ flight transponders, similar to the system air traffic controllers use.

“Let’s hope the Air Force is one step ahead of Apple.” I say.

I’m flying out of New York this week. The thought of some Al Qaeda nutjob using his phone to send a warhead into my plane gives me the willies. While not an authority on military hardware, I know super portable missiles like Stingers have a very limited range. A terrorist would have to target a plane as it was taking off or landing and the flights displayed on Jorge’s phone are tens of thousands of feet up. To take them out would require a large and powerful rocket. I hope the cops would notice such a thing being prepped for launch in a parking lot.

“America’s openness makes it a great country,” Richard says. “But it’s also her greatest weakness.”

He’s right to some degree but I say nothing. Too complicated an issue for break room banter. I finish my notes, check on the patients one last time and clock out.

Walking to my car I look up and see the running lights of several planes blinking like rubies against a black velvet sky. Hundreds of people in pressurized tubes using aerodynamics to fight gravity are streaking to destinations unknown.

I could whip out my phone and find out all about them, but I don’t. Part of the fun of looking at airplanes is wondering where they’re going, Paris? Rome? Tahiti? What are the stories of the people on board? Are they excited? International spies? Or just a harried businesswoman stuck between two extra large passengers? Are they drinking champagne in first class or coach passengers bemoaning the lack of free peanuts? Right now a young man might be stroking his first love’s hair as she nestles against his shoulder while the guy behind them types up an idea that’ll lift millions out of poverty. Maybe the woman in seat 5A is a film star reading a script or a ravishing model traveling to a bikini shoot in Maui. If technology tells me I’m dreaming upon a Fed Ex plane delivering Amazon purchases to Albuquerque that would spoil the mood.

I shake my head. We are bombed with too much information. Tonight I crave mystery. There can be joy in hidden things. Hope dwells in clouds of unknowing. Fools may go where angels fear to tread – but sometimes they win.

Forgetting about Al Qaeda and Stingers I get into my car and drive home. Soon I’ll be flying beneath a canopy of stars. You’ll just have to imagine where I’m going.

Decade

Waiter Rant is ten years old today. If you told me when I wrote that
first post that it would lead to book deals, the NYT Bestseller List, Oprah, The Today Show and hundreds of radio and print interviews I would have said you were suffering from cocaine induced psychosis. But that’s indeed what happened. Life is wondrous and strange.

So much has happened to me in those ten years. I owe the faithful readers of this blog more thanks than mere words can express. Of course, my agent Farley Chase has to be singled out for his perseverance and optimism as well as the good folks at Harper Collins. And I would be remiss if I did not thank my wife Annie for her faith and unwavering support. I love you, darling.

As a new husband and father, I look forward to what the next ten years will bring. I hope you’ll continue reading this blog as my life enters a new phase.

My sincerest gratitude to everyone!

Nice Guy

It’s a cold December night and I’m taking my co-worker Tamisha home. She missed her bus and I don’t want her waiting at a bus stop freezing and alone. What can I say? I’m a nice guy.

“You sure you know the way?” I say, guiding my car through the streets of Newark.

“Sorry,” Tamisha says. I always take the bus and don’t drive. My sense of direction is rusty.”

To my the right glass sheathed apartment buildings designed by Mies van der Rohe tower over us, their windows winking like a binary code of light and dark squares. Ahead of us the Cathedral of the Sacred Heart sits on a hill bathed in light. Despite the weather plenty of people are on the streets.

“”There’s my cousin,” my passenger says. “Little jerk. He should be home.”

“How old is he?” I say, looking at a group of kids clustered under a streetlamp.

“Twelve.”

Something tells me these kids aren’t coming back from the malt shop. But Tamisha is black, I’m white and voicing my opinion would probably be awkward. Instead, Tamisha speaks for me.

“Already up to no good that one,” she says, “Damn shame.”

“Anyplace for kids to go in this town at night?”

“Now?” she says incredulously. “What do you think?” My silence withdraws the question.

“Make a left here,” Tamisha says. “ Steve, this town is crazy. One day some gangbangers had a gun battle in front of my house and bullets went into my baby’s room.”

“Jesus!” I say. “That’s insane!”

“We moved the next day,” she says. “But our new neighborhood isn’t much better.”

A large speed bump appears out of nowhere and I hit the brakes. “Like those?” Tamisha says. “City put them in to slow down carjackers escaping to the highway.”

I’m actually very aware of carjackers. My eyes are constantly checking the rearview mirror and I give the cars ahead of me plenty of room. Rule number one, don’t get boxed in.

“Ever since that white guy got shot in Short Hills people are suddenly interested in carjackers,” Tamisha says. “Happens here all the time.”

“The murder rate is going up I understand.”

“You have no idea. I’m Brick City born and bred but my husband and I want out of here.”

“Looking for a place?”

“We are but we can’t afford a car and take buses to work. So it has to be somewhere close to the hospital.” That will limit her options.

“Where do you live?” Tamisha asks me. I tell her.

“What a beautiful town,” she says. “Lovely houses, safe, good schools. You’re lucky.” For no reason at all I feel guilty.

“Lots of good people in this city,” Tamisha says. “But the bad ones run it. Sucks.”

After ten minutes of driving around I pull up to Tamisha’s apartment. She lives on the second floor of a house. Despite the temperature being in the lows teens, several young men are sitting on her porch.

“You see that shit?” Tamisha says, pointing to them. “They don’t even live here. That’s what I have to put up with.”

“I’ll wait until you get inside,” I say.

“Let me call Ralph.”

Tamisha gets a hold of her husband and a minute later the front door opens. “ Now I can go in,” she says. “Thanks for the lift.”

“See you tomorrow,” I say.

“Be careful going home.”

Tamisha walks past the men on her porch and go inside without saying a word. Then I notice all the guys on the porch are looking at me. Makes sense. I’m a stranger in their neighborhood. If the tables were turned I’d wonder what the hell they were doing in my town. Fair? Of course not.

Ten minutes later I park in front of the cigar shop. “Hey, Steve,” Rich, the proprietor, says. “Enjoying the weather?”

“I just dropped a co-worker off in Newark. It’s even colder there.”

Rich’s eyes narrow. “Where in Newark?” I tell him.

“Promise me you’ll never do that again.”

“Why?”

“Are you fucking stupid? You know how many people get shot in that area? You have a baby on the way, don’t be an asshole.”

“I’ve been driving around Newark for years. I know the score.”

The proprietor flicks an ash of his cigar. “Steve, you are too nice. That’s your greatest weakness. If you got blown away your co-worker would be on T.V. saying, “He was such a nice man!” but you’d be dead. Fucking dead. What good would you be to your wife then?”

“I dated a girl in Harlem for years,” I say. “Nothing ever happened to me there.”

“Newark is not Harlem.”

I spend an hour at the shop and then go home. With no traffic it’s fifteen minutes from my house to Tamisha’s but we might as well be on different planets. As I look at my pregnant wife sleeping Rich’s words ring in my ears. “You’re too nice.”

People have told me the same thing before. While it’s true suburbanites have overblown fears about the “inner city” Newark isn’t a playground. I know a guy whose cousin was carjacked at gunpoint on McCarter Highway. But my personality has gotten me into some interesting situations over the years and most people told me I was crazy afterwards. I guess I have one of those “where angels fear to tread” things going on.

I shrug to myself. Was I irresponsible taking Tamisha home? I have a kid to think about. Should I be a little more cautious? Do I have to change how I’m wired? If I’m honest, I like that part of myself. But will I pay a price for it one day? Thinking about poverty, race, inequality and my own shortcomings, I turn on the boob tube to shut off my buzzing brain.

Thinking about it will only take me to a place I’d rather not go.

The Greatest Casualty

It’s 10:00 PM and I’m sitting in the day room of the psych unit writing my patient notes. Because the hospital’s somewhat antediluvian, I have to scribble them out by hand. Unfortunately a Medicare auditor recently complained she couldn’t read my chicken scratch so my boss advised me improve my penmanship. Abandoning the cursive scrawl of my youth, I slowly print words like disorganized, delusional, and confabulating with the care of a medieval monk transcribing an illuminated manuscript. Well, you can almost read it.

After half an hour of writing the arthritis in wrist suddenly flares up. As I massage it I look around the unit. Half the patients are watching television and the other half are zonked out in their rooms. We have a fairly mixed group of patients this evening – schizophrenics, depressives, two really far out bi-polars, a demented old woman and someone the docs haven’t figured out yet. Most of our clients are “frequent flyers” which means I see them over and over again.

“Can I talk to you?” a voice behind me says.

I turn around. It’s Gustavo, a paranoid schizophrenic we admitted three days ago. “Sure Gustavo,” I say. “What’s up?”

“They’re watching me you know. I’m worried all the time.”

“Who is watching you?”

“Them,” he says pointing to the ceiling. “There’s cameras everywhere.”

Gustavo is absolutely right. With the exception of the patients’ rooms and the showers, the entire unit is blanketed with CCTV cameras. We’ve made no effort to hide them.

“The cameras are there for your safety and mine,” I say.

Occasionally a patient tries tearing the unit apart. If there isn’t time to reach a panic button or call for help, the theory is the security guys will see the fracas on their screens and come running. But the reality is the cameras are there to watch me. Assaults, neglect and sexual abuse perpetuated by staff are not unknown in the mental health world.

“But my phone’s tapped,” Gustavo says. “The government is watching me through the television. They got drones, man. Robots! They watch me from the sky.”

When I started working psych twenty-four years ago everything Gustavo’s saying would be patently ridiculous. Now it’s not. Governments monitor our emails, listen to our phone calls, use drones to look for terrorists and have the ability to watch us surreptitiously though our computer’s camera. The police scan our license plates with high speed readers, track us down through our cell phones and use Google Earth when planning a raid on a crackhouse. It’s not paranoid to think Big Brother is watching you when he is watching you.

This has ramifications for dealing with the clinically paranoid. You can’t say, “It’s all in your head, now take your meds.” Mentally ill does not mean stupid. My patients read the papers. They see how privacy is being eroded in our hyper connected world. Paranoia is a “thought process heavily influenced by fear and anxiety, often to the point of irrationality and delusion.” Well, how many of your “sane” friends spin conspiracy theories about how the government is using the Internet to watch our every move? How many times have you heard a parent worry about their kid doing something stupid online that will be digitally archived forever and scare off potential mates or employers? Twenty years ago such thoughts were for the tin-foil hat crowd. Now we’re all thinking them. We’ve entered the era of Paranoia 2.0. So instead of bullshitting my patients, I’m straight with them.

“Yes, Gustavo,” I say. “We live in a world where a lot of what we do can be recorded and analyzed. The police use drones and the CIA can tap people’s phones. You’re totally right and there’s a lot of debate about it. But let me ask you, why do you think they’re after you personally?”

“I don’t know.”

“You up to something? Planning to overthrow the government?”

“No man, I’m straight up American. I tried to join the Army.”

If you’re not doing anything illegal I doubt they’re looking at you.”

“But they’re everywhere.”

“I worry about that stuff too,” I say. “But when worrying about it screws up your life, when you start yelling at people and don’t trust anybody, not even your own mother, then something’s wrong.”

“But my Mom called the cops on me!” Gustavo says. “She’s in on it!”

“She’s looking out for you, man,” I say. “She doesn’t want you to get hurt. Listen, when you take your meds do you have paranoid thoughts?”

“Not as much.”

“You keep taking those meds and you’ll be outta here in no time,” I say. “Just relax. You’re safe with us. Okay?”

Gustavo shuffles off, not looking convinced. He’s only been here a few days and the drugs we’re giving him haven’t fully kicked in yet. But I fear the increasing omniscience of modern technology is just exacerbating the suspiciousness Gustavo’s illness inflicts on him.

I’ve written previously about how uneasy our brave new world makes me. Just the other day a college kid told me how she submits her term papers through a system called Turnitin, a computer system designed to sniff out plagiarism. But when she told me how her school’s “Office of Academic Integrity” occasionally suspended innocent students tripped up by the system’s unfeeling algorithms, I thought of Orwell’s Winston Smith toiling away at the Ministry of Truth. I also watched this kid happily use free services like Twitter and Facebook on her phone, blissfully unaware that nothing’s free and the data stream she’s producing is being sold for profit.

My shift finished, I go home to find the baby sleeping in her crib and Annie passed out with her iPad glowing softly in her lap. Feeling uneasy I pour a finger of Scotch into a tumbler and flop down on the living room couch. As I feel the liquor burn a path down my throat I turn on the television, but the jabbering talking heads disgust me and I switch it off. Thumbing on my smartphone, I check my email. My mother has sent me some disturbing news. A mentally ill homeless guy stabbed a man to death in my old hometown.

The daughter of the man who was killed was a friend of my sister-in-law. Scanning the news reports I read a sad and familiar story. The homeless man’s territory was a strip mall. He slept in a restaurant and washed his clothes at the neighboring Laundromat. Clean and presentable he never caused any trouble. Then the restaurant closed and he was forced to live in a boarding home in a bad part of town. He deteriorated after that. Probably went off his meds. Now a man is dead, one month before his was to meet his first grandchild.

I think of Gustavo. Most mentally ill people don’t commit acts of violence, but when they’re off their meds and actively hallucinating bad things can happen. I know this because patients have sent me to the ER more times than I care to remember. Untreated, Gustavo could end up preyed upon or commit violence himself. And when he’s discharged he’ll probably end up in a boarding home just like that assailant.

The reason so many of my patients are frequent flyers is that they don’t have a decent place to live. Families are often unable to cope with them so discharged patients go to boarding homes, halfway houses and shelters. Some of these programs are good, but many of them are run by lazy incompetents more interested in profiting from government contracts than providing care and supervision. Assaults and abuse are common. Patients have their medications stolen and sold on the streets.

Deinstitutionalization, the closing of mental hospitals nationwide and moving the patients into the “community” has been a disaster. In 1955 the U.S. had 300 hospital beds for every 100,000 people. Now the national average is around 15, with some states barely having 5. As a result the penal system has become the largest provider of psychiatric services in the country and deadly encounters between the police and mentally ill are daily news. When I was on my honeymoon in San Diego I was stunned by the legions of homeless psych cases wandering the streets. They all didn’t need to be locked up but a large number of them required constant care. We need to be building mental hospitals not closing them.

But let’s face it, as a nation we’ve thrown these people away. They’re shadows – modern versions of untouchables. Who care what happens to them? If you watch television commercials you’ll see where our priorities now lie. We’re constantly enticed by young and shiny people to enthusiastically embrace the promise of the Digital Age, Have you ever seen that commercial for American Express? A well dressed hipster in a coffee shop buys an expensive bauble online and gets a fraud alert on her phone. After confirming her purchase was legit, she leans back in her chair with a smug blissed out look on her face while the announcer proclaims, “This is what membership is. This is what membership does.” Hey, I don’t like people ripping me off either, but Amex is using the same systems that allow governments and corporations to hoover up every byte of information about us they can find. Don’t believe me? Apply for life insurance. The underwriters know all about you. We’re in danger of becoming just ones and zeros. Data. A commodity. A product observed, dissected and quantified with inhuman precision. The problem is that commodities are used up and thrown away. Just like the mentally ill. Just like Gustavo.

Technology has given us many gifts but it has now enabled Orwell’s dark vision to threaten us in ways even he couldn’t have imagined. The interconnectedness of human beings is being replaced with a pale digital imitation – to the detriment of empathy and compassion and to the advantage of those who exploit us. We are being forced into digital cocoons that foster self-interest and consumption. People like Gustavo have no chance in this world. If we’re not careful we’ll create a new breed of people like him.

I finish my drink. Maybe I’ve been working around paranoid people too long. but dealing with the mentally ill has made me feel their pain in my gut. A veteran co-worker always tells the new recruits, “Imagine what it’s like to be them. No one likes them. No one wants to sit with them, take them to dinner or let them into their homes. They’re passed on the streets like they’re nothing everyday.” The answer is to take care of them, to protect the least among us. That’s what membership in the human race means. That’s what membership does. But we’re not doing it. Worrying about the world my daughter will inherit I realize why I feel uneasy.

The greatest casualty of 1984 was human love.

.

Stranger Danger

I’m driving down a busy street when Natalie starts screaming. At this point I’ve discovered my daughter’s wailing doesn’t always constitute an emergency so I keep going. But when her cries hit migraine inducing decibel levels I start to worry. Is she strapped in too tight? Something in her eye? Pulling her own hair again? Better check it out.

Since pulling over on a commercial thoroughfare is a recipe for disaster, I hook a right onto a residential street and park in front of a house. A boy about seven years old is standing in front of the driveway while his father washes his car. When I get out of my car the father runs over, picks his son up, and whisks him into the garage. Jesus.

Undeterred, I open the rear passenger door and my daughter breaks into a smile. Little faker. She was just jonesing for Pops. I knew I should have bought her that jumper that read, “When I cry I get stuff.” But I check her straps anyway, scan the backseat for hazards and then pat her little head. “We’ll be home soon, honey,” I say.

As I climb back behind the wheel the father in the driveway is watching me like a hawk. So much for the universal brotherhood of daddydom. To be fair, from his vantage point he can’t see I have a baby in the car, but his protective impulse strikes me as paranoid. The odds of a stranger snatching your child in broad daylight are astronomically low. Do I look like a kidnapper? White slaver? A strung out junkie trying to find kiddie kidneys for the Chinese organ market? To make sure I look in the rear view mirror. A pudgy but well groomed middle-aged daddy stares back at me.

“Paranoid asshole,” I mutter under my breath. Then I smile, wave cheerily at the man and drive away.

If I’m honest, part of me is hurt that someone thinks I might hurt a child. A few weeks ago I was walking Felix in my neighborhood when I came across two little girls about four and seven years old sitting on their front steps. The older girl asked, “Can I pet your doggie?” Since Felix is super friendly I said sure. I’ve let lots of kids pet him. But before the girl took two steps a female voice from within the house screamed, “Get back in here!”

“My mommy won’t let me pet your dog,” the girl said,

“You have to listen to your mother,” I said. “Go back inside.” As I walked away I heard the screen door open and the mother say, “What were you thinking? That man could have taken your sister!” I’ve lived in this neighborhood for eleven years. I’m not an unknown quantity. And this lady thought I was a kidnapper too? Wow.

I actually feel sorry for those children. While I’m all for protecting kids, I think the above mentioned parents are teaching their tykes the world is always a dangerous place. That’ll hurt them in the long run. The more reflective part of me wonders if the adults had bad experiences which powered their behavior, but I just figure they’re paranoid.

I know a mother who constantly pours over sex offender registries, saw the police shoo an old man enjoying his lunch by the playground off the premises and overheard a father explain the modus operandi of serial killers to his grade-schooler. I’m not denying evil exists or advocating a pollyanna view of reality, but I think a lot of this “stranger danger” insanity is more about people’s inability to handle their anxiety over the world’s perils than it has to do with childrens’ welfare.

Am I being too harsh? Just today a kid stabbed a bunch of his high-school classmates and we all remember the unspeakable atrocity of Newtown. But I’ve been working in mental health on and off since 1990 and I can safely say the person most likely to abuse, injure, molest or kill a child are their own parents or a close family member. I’ve seen it happen in households rich and poor, educated and uneducated. But let’s face it, that doesn’t sell papers. It’s the boogeyman in the bushes that drives ratings in our 24/7 news world. And despite all the terrible things that have happened, your child’s school is safer than it was when we were children.

When my Dad was little he was taught to “duck and cover” in case the Russians dropped the big one. Now we have kindergartners doing active shooter drills. Most of the horrors we see on the news are the result of people with untreated or under-treated mental illness. If you’re worried about wackos doing in your kids, or you for that matter, petition your congressman to raise taxes and fund mental health programs. The psych unit where I work part-time is overwhelmed because the state’s been closing psychiatric hospitals when they should be building them. Nah, that costs money. That’s “Big Government.” We’d just rather talk about how unsafe we all feel while funding for programs to keep parents from hurting their kids is siphoned away to bail out car companies that sell cars that kill people and subsidize coal companies that contaminate our drinking water. Instead of expelling a schoolkid for making a gun out of his thumb and forefinger, send those clowns to prison.

Trust me. I’m not blasé about my child’s safety. I will teach her what to look out for at an appropriate pace appropriate for her age. I’ve seen a lot of dangerous people over the years. Just yesterday I had a patient describe how he’d cut my throat. I’m not ignorant of danger but I will not raise Natalie in a world where she’s worried everyone’s a possible predator. I didn’t grow up like that. Neither will she. And remember this, when people are screaming how unsafe you are, the odds are good they’re profiting off your fear.

Getting on the highway, I suddenly remember I have to pick up frozen kale (Yuk) at Trader Joes. Luckily for me, I snag at spot in the store’s crowded parking lot. Leaving Natalie in the car, I open the trunk, take out the carriage and unfold it. Then, just as I’m about to unlatch the car seat, a woman in a mini van misses the carriage by an inch as she races into a newly opened spot by the front door. Of course, she’s on her cell phone.

Those are the strangers you have to look out for.