Behind the Deadbolts

I arrived early at the clinic for my 5 p.m. group, but all ten women were already waiting for me, most of them holding Christmas cards and plastic dishes covered in aluminum foil. “Hello, Doctor,”Mrs. L said, “Feliz Navidad.” A chorus of greetings followed as the others took their cue from Mrs. L, who liked to think of herself as the group’s co-leader. In fact, she, like all the others, was a patient for whom I prescribed medications for depression and anxiety. But instead of seeing each of them individually, Iwasmanaging themall in a 1-hour group, thebrainstormof theclinicdirector,whohad toomany patients and an overwhelmed staff. The group was remarkably homogeneous: all the women were immigrants from the Dominican Republic in their 30s and 40s, and all were single mothers abandoned by the men in their lives.We hadmet eachmonth since the summer, and the group had become somewhat of a social event for them. “You’re too skinny, Doctor,” Mrs. L said, “So we brought some things to fatten you up.” She and all the others always addressed me formally, but they continuously mothered me. I smiled, slightly embarrassed, and waited for the next inevitable line. “You need to find yourself a nice girl to cook for you,” she added on cue. Mrs. L and the others in the group all lived in the streets around New York’s Presbyterian Hospital in Washington Heights. Theneighborhoodhad its grit: abandonedbuildings, boarded-up windows, and colorful graffiti, not unlike other parts of New York. But in that year of 1994, Washington Heights was also the epicenter of the city’s ongoing crack epidemic, with the city’s highest murder rate. Yet here in our group, I saw only the mothers and young grandmothers who held the neighborhood together tenuously. Many of them raised several generations under one roof, trying to keep the younger ones from the violence just outside the door. Each time we met, I got a glimpse of what went on behind the deadbolts: their pride in cooking sancocho, their off-color gossip, their love of dancing merengue. Most of the women were now stable on their various medications, so in recent months I tried to use some of the group time to discuss therapeutic issues. That week the neighborhoodhadmade theheadlines: large lettersdescribed how a child had been caught in the crossfire of rival drug gangs. Shewas in our hospital in critical condition. I knew the story was the talk on the street, so I asked how these women, all mothers themselves, were dealing with the tragedy. One of the women said that she had heard the gunshots fromher apartment. Not to be outdone,Mrs. L, sitting next to me, cleared her throat. “I saw a boy shot on my street,” she said in a matter-of-fact way. “Hewas bleeding and crying for help, but no one came out because he still had a gun in his hand.” Her story opened up the others’ memories. “Last year, we heard guns and lay on the floor. A bullet came through the window and hit the wall.” “They put a gun to my nephew’s head and stole his sneakers.” The stories kept coming, strikingmewith their violenceand their resigned delivery. I had opened up a discussion that was beginning to get out of control as their descriptions grew progressively more gruesome. “I saw a man burn a lady in the subway with lighter fluid. He took her bag.” “They threw a man from a moving car in front of the emergency room. I think he was already dead.” Only onewomanwas quiet, but I could see tears streaming downher face. Younger than the others, Alma (a pseudonym) was also the newest immigrant, having arrived one year earlierwith a husbandwho had quickly left her and her three children. I knewfromher chart that she lived inawell-known building run by drug dealers. They controlled the building like an army, a teenage soldier always out front, armedwith a menacing look and an obvious bulge at his side. “Do you want to say something?” I asked her. Alma didn’t nod or shake her head, but just continued crying. I didn’t know if she cried from all the stories of violence she was hearing, from her own experiences over the past year, or from the broken promise of a better life in New York. “It was yesterday,” she began in a whisper. “I went to my cousin’s forapartywithmychildren.Wegothome late.When I got off the elevator, I saw that my door was open and two men from my building were coming out of my apartment. They were carrying all of our Christmas presents. They laughed when they saw us. My little girl asked me why the menwere taking her presents. I said theywere taking them to kidswhodidn’t havemoney. I knowshedidn’t believeme, and it just made the men laugh louder. They laughed until the elevator closed.” The group was remarkably homogeneous: all the women were immigrants from the Dominican Republic in their 30s and 40s, and all were single mothers abandoned by the men in their lives.