Shortly after my arrival at OBCC, Kelly took a weeklong vacation, leaving me to run things alone. Given my administrative experience at the Mental Health Center, I felt okay with it, and things started off smoothly. The office coffeepot was the early morning gathering place, and I enjoyed chatting with the crew before the day began. Theresa and Kathy prepared to assess the morning GP referrals while Lynn Cosgrove, wearing a taboo Montefiore lab coat, would start off on the MO. While we sipped coffee, Dr. Diaz, keeping one ear attuned to the early morning chatter, puttered with the plants that sat atop the file cabinets. Pete Majors, the primary Bing clinician, had the longest commute, and he and Dr. Christian were the last ones to rush in and join us before things got under way.
After everyone had cleared out, my first order of business was the basket of referrals. I logged each one in, careful to ensure they’d be evaluated within the seventy-two-hour mandatory timeframe. Toward the bottom, one referral puzzled me. A Bing inmate named Rafael Ramirez was complaining of numbness and tingling, which struck me as a medical issue. I pulled his chart and was surprised to see that he’d recently been evaluated by Mental Health three times, with chart notes indicating nothing more than irritability and anxiety. The attending psychiatrists must have considered even that to be mild because they’d prescribed no medication. I took it up with the chief physician, who was also baffled as to why the referral was given to mental health, and he agreed that medical should check him out.
The following day, Dr. Sackett informed me that the medical team’s efforts had been thwarted because Ramirez was in court. On Wednesday morning, he’d completed his Bing sentence and was transferred out of OBCC.
By Thursday morning, I’d forgotten all about Ramirez when I got a disturbing call from Janet. “Mary, did you hear the news? There was a suicide, a hanging at AMKC, general population.” I sat up straight. While suicide attempts were an everyday occurrence on Rikers, completed suicides were infrequent and, for the Mental Health Department, particularly upsetting. Although our interventions kept suicides down to a handful a year, we could not prevent them all.
“And I hate to tell you this,” she added, “but he was just transferred from the Bing.”
“The Bing! What was his name?”
“Rafael Ramirez.”
Rafael Ramirez! How in the world did numbness and tingling translate to suicide? I got off the phone with Janet and started pacing the room. This was terrible. What happened when he’d gone to court? Maybe he’d been given a stiff sentence. I just didn’t know.
Even though I’d never met Ramirez and he’d killed himself in another jail, this was the closest I’d come to a suicide. When I’d been a clinician, I was fortunate that, of the hundreds of depressed inmates I’d worked with, none had killed themselves. But when it had happened to others, Montefiore Hospital, our former employer, was always supportive, bringing staff together, allowing us to talk and grieve. But it was a new day, and the phone had yet to ring with a call from St. Barnabas.
As the day wore on, I learned through the grapevine that his chart had been found in proper order, with all protocol followed. This brought a certain relief, but of course it would not bring the dead young man back. I kept reviewing the sequence of events, wondering if there might have been a different outcome if I hadn’t referred him back to medical. But even if I’d scheduled him for another evaluation, his appointment wouldn’t have been until the tail end of the seventy-two hours, at which point he would already have been gone from OBCC. It would have made no difference. Still, I felt I needed to talk this out with my superiors, so I stayed close to the phone. But by Friday afternoon, when there was still no call from Central Office, I realized that the support we’d been afforded by Montefiore was a thing of the past. Instead, I simply said a quiet prayer for the soul of Rafael Ramirez.
The following Monday Kelly returned, to my great relief. The suicide had unnerved me, and I didn’t want to run things alone anymore. But it wasn’t to be. Just as George had sat me down when I started at the Mental Health Center, Kelly did the same. No, she wasn’t quitting, but she was taking time off for a surgical procedure. Recovery would be anywhere from two to eight weeks.
Kelly’s announcement hit hard and, in hindsight, was my strongest cue to get out. But I didn’t see it. What I saw was that we had a great staff, a manageable building, and with it the potential for high-quality work. If this was the final hurdle before things settled down, I could do it—especially if Kelly was only gone for two weeks, although in my heart I knew that was unlikely. Kelly had already had several run-ins with St. Barnabas and wouldn’t be rushing back anytime soon. Realistically, I was looking at the full eight weeks—if she returned at all. In a phone conversation with Hugh Kemper, he tried to be encouraging. “Kelly’ll be back before you know it. And don’t forget, I’m interviewing for a clinical supervisor, so that spot could be filled before she even returns. Let’s think positive, Mary!”
I wanted to believe him, but when we hung up, I knew I was in for a long, hot summer.