INSIDE THE BOX | John Wang
Somewhere across the ocean, a boy leaves home with nothing but his dreams, and climbs into a box on a boat. Inside, he faces near-sensory deprivation, with only the sounds of muffled voices around him, in a language he cannot understand, blending together with the rumbling of waves.
Days go by, until finally, the box opens. Bright light beams in through the open lid, a door to an unfamiliar world. The boy crawls out and sprawls onto the ground, the voices around him louder now.
Time passes in this new world. Confused, scared and alone, still surrounded by voices, the man crawls back into the box. Inside, he can be a boy again, his home nearby and his dreams intact. He shuts the lid.
“You’re going to be a huge help - he’ll do so much better with someone who also speaks Mandarin.”
I scoot my chair over next to my attending, who offers encouragement. It is the first day of my first outpatient rotation in psychiatry residency. Together, we peer into the desktop screen.
Our camera rests at one end of a long wooden table, surrounded by white walls. A stout-looking young Chinese man shuffles into frame. He sits at a chair next to the head of the table at the other end, offering a view of only his left side. He wears thin wire-frame glasses, and has a scruffy, wispy beard. He stares down, takes out a notebook and begins scribbling into it, muttering softly. The audio is fuzzy, and I lean in closer, as if it will help me hear him more clearly. I begin asking him questions:
你感觉怎么样? How are you?
Silence.
Seconds go by as my words travel through the screen and down the long wooden table.
After what seems like an eternity:
好. Fine.
Our back-and-forth goes on like this, my questions met with a brief “好” or the occasional English “OK,” as he continues scribbling in his notebook. Eventually, he stands up and shuffles away. I end the call feeling discouraged and self-conscious. Was it my unpolished ABC (“American-born Chinese”) speech that makes our connection hard? Beside me, my attending remains optimistic. She informs me he likes to be seen, and often walks in multiple times a week. “He’ll warm up to you. You’ll have another try.”
The next week,Covid precautions are lifted at his residence, and we meet in person. He walks in, dressed in a thick puffy jacket for the snowy winter. He sits across from me, takes out his notebook and begins scribbling and muttering softly. His glasses and scruffy beard are only a few feet away, and I can hear him more clearly.
你感觉怎么样? How are you?
好. Fine.
你在写什么? What are you writing?
他们告诉我要回中国. They tell me to go back to China.
你现在听到声音了吗? Are you hearing voices?
他们告诉我要回中国,去恢复. They tell me to go back to China, to heal.
I mull over the history I had reviewed. As a teenager, he was trafficked to the United States in a small container by the Snakeheads, a smuggling gang operating out of Fujian province in China. In the States, while working to repay his debts to the Snakeheads, he developed psychosis. Twenty years later, despite heroic combinations of clozapine and other antipsychotic medications, the psychosis persists.
After a brief silence:
我十五岁. I’m fifteen years old.
他以前住在中国哪里? Where did you live in China?
我十五岁. I’m fifteen years old.
His repetitive speech frustrates me. Despite our more fluid dialogue, he still feels far away, like my words aren’t reaching him. No matter what I say, he remains trapped, in a delusion of still being fifteen, or by voices beckoning him to return to China to heal. He remains the teenager captive in a box, the lid tightly shut, my words drowned out by the surrounding muffled voices.
Still, I dare to imagine that my Mandarin might be good enough to eventually reach him. I return home that day and finally open the book about psychotherapy for psychosis sitting on my desk. I Google “best ways to improve Mandarin for an ABC” and watch the recommended YouTube videos from a Reddit thread. I fantasize about being the one to set him free.
Later that week, on his birthday, he shows up unannounced with a cake. My attending and a few nurses gather, to sing for him and blow out the candles. It is a lovely but somber celebration, his healthcare providers standing in for the family he left behind across the ocean in China, all those years ago. He stands very still and stares at the cake, seeming to mutter the words to the song under his breath. A nurse cuts the cake and hands him a slice on a plate. Slowly, he holds out the plate to my attending:
给你, 医生. For you, doctor.
Now rusty with time, the lid of the box creaks open, and a sliver of light trickles in.
A glimpse of a real connection with him - he recognizes his birthday and his doctors! For a moment, he seems to be in our world. The world where he landed in New York City many years ago, where he lives confused, scared, alone, longing for close relationships, where this clinic is the closest thing he has to a home.
I start eagerly planning my approach for our next visit. Perhaps I’ll ask him about his birthday, if he had ever celebrated one before, how he liked the cake, how he felt while everyone sang for him and wished him a happy birthday. Anything that could bring us closer, to help my words finally reach him, for us to connect with each other.
Maybe I could extend a hand to the scared teenager inside the box.
The next Monday, he shows up to the clinic and sits down on a chair in the hallway. He stares straight ahead with a flat expression, refusing to move or speak. My attending and I sit down in the chairs on either side of him. We both try speaking with him; me leaning on my ABC Mandarin again, her leaning on a longer history of good rapport.
怎么回事? What’s going on?
Silence.
He sits still in the chair next to me, staring at the ground. His brow is furrowed, his eyes blank but intense, as if mulling over something intensely troubling.
After a few more good minutes of effort, suddenly, he swings a fist at me.
I lean back quickly, and luckily, dodge the punch. My attending isn’t so lucky. We both get up and stand back, and he follows us, leaping up from his seat with a loud grunt. He furiously chases after my attending, yelling in rage. I watched dumbfounded as he corners her and pummels her in the face and chest several times with his fists. Only after two nurses behind me shout and jump into the fray do I also join, each of us grabbing a limb on the patient to separate him from my attending.
As we take him down, he kicks and screams, drool flying as he writhes around, speech garbled and stilted. Sprawled together on the ground, I repeatedly try to reassure him, our bodies and words becoming tangled with each other.
神经病! 放松! 你搞什么鬼呀! 放松, 我们想帮你! 我.是.中国人! Nerve disease! Relax! What in the evil spirits are you doing! Relax, we want to help you! I. AM. CHINESE!
The box is open, but he does not take my hand.
The bright fluorescent lights of the clinic hallway beam in through the open lid of the box, a door to a world the man thought he had escaped from. He crawls out and sprawls onto the ground, the voices around him louder again.
Seconds go by as he continues thrashing, my words hanging in the air, mixing with his shouts, but never reaching him. If only I knew a better way to say “relax.”
I feel helpless and guilty for opening the box.
Eventually, security officers arrive. They take over holding him down, and I retreat to a corner. I watch as he flails at the officers and continues shouting at them in Mandarin. They respond by shouting, “Calm down!” I know that to him, these are just more voices he cannot understand.
I float back to the scene, inform the officers of the language barrier, and encourage him again to relax. My words fall flat as he kicks an officer in the face. They flip him onto his stomach to continue holding him down. I retreat and wait for EMS to arrive.
By now, I know where this is going. EMS will take him to a hospital where he will be admitted to a locked psychiatric unit. While Mandarin is one of the most common second languages spoken in the U.S., I feel he would be lucky if he encountered even one Mandarin-speaking provider while admitted. He will be taken from his home and locked away in another box, surrounded by more voices in a language he cannot understand. I picture his teenage self, the boy longing for a home and people to love. I thought I could be the one to set him free, but instead he will be trapped, again.
EMS finally arrives. Confused, still shouting and fighting in his psychotic state, he is handcuffed by the officers and placed in the stretcher, English words flying around him. I watch them take him away.
As they leave, the door slams shut.
John Wang is a fourth-year chief resident in the New York University Psychiatry Residency Training Program. Dr. Wang was raised in a family of Chinese immigrants and developed an interest in the health and wellbeing of immigrants early on in his education. After receiving his BA from Washington University in St. Louis, Missouri, he attended medical school at New York University, where he trained with a diverse patient population, furthering his passion for working with immigrants and their families.