It is too much sorrow to bear and it is sorrowful daily.
This morning. our beautiful subway system became a terror scene. And who can't imagine it--everyone living in New York takes the subway and knows this basic fact--once the doors closed, you are trapped. Most of us have become accustomed, even inured to the quotidian dance--change subway cars, get off early and change trains--not because of a plan, but because you just don't feel safe in that car, on that train.
But this is different. You just can't escape unscathed when maniacs have guns.
I used to work for the MTA, screening and recommending individuals for Access-A-Ride. Emotionally impaired individuals, thanks to ADA, have the right to receive these services. Our training consisted of six hours of a nurse telling us--when in doubt, deny, deny, deny. It was all very funny--until I had to start. The screening was to take 5 minutes. Or less. We gave a part of the standard mental status evaluation--like that is a reliable and valid measurement of whether someone is stable enough to take the sardine car. I started to recommend services--and was harassed--to change the reports. When I refused, I said, "These are just my recommendations. You are under no obligation to follow them." So they tried to get another psychologist to change them. She refused--it is not ethical. So they fired me--"Do you know how much money you are costing us?" I tell everyone this story. There is no shame in being fired for being a caring individual who thoughtfully uses logic.
But since that time, I wonder how many poor souls who shove straphangers off the platform (and worse) had attempted to get these services--and were denied. And I guess, the proof of the pudding is that they are able to get on the system. So they don't need the services.
But I don't doubt that the poor soul turned maniacal was one of those.
This is what happened when we don't care for our sick. And we don't have the health care resources anyway. Our hospitals are decimated by the Guiliani period--attrition and then closing lines. During the Guiliani years, psychologists who worked for the public hospitals got 0 raises. For years. Guiliani had no respect for public service. He wanted to starve the system into conniptions. And succeeded. Today, a psychologist who works for the public hospital earns $75K/year. The median income for psychologists in NYS is $116,000/year. Psychologists in the public hospital have the same credentials as any other psychologist--doctorate + state license. For your $75K, you receive the total scorn of management and heavy case loads. This is the definition of insanity--doing the same thing over and over again and expecting a different outcome. You expect psychologists to work for less money, see more patients who are sicker, work with fewer resources?
The mayor says he has no money to do otherwise. We cannot afford not to do otherwise.
We cannot afford a system that works on dichotomies. Hospital management makes 4x what staff makes and provides no clinical services (although they manage to see private patients on city time).
Any doctor who works for the city should expect to carry a clinical load. And all doctors make what all doctors make--just like it is everywhere else in the world. A psychologist with a doctorate makes the same as a psychiatrist.
And all doctors are equal. Psychiatrists seem to expect they, like army generals, give orders and the rest of us just carry them out. The paramilitary structure of the hospital system must be toppled.
We can't afford to keep on keeping on. It didn't work in the past. It's not working now. And the anomie is killing us.