Post Reports: Deep Reads – The Nurse in the NYC Subway (April 26, 2025)

Hosts: Martine Powers and Elahe Izadi
Reporter: Ruby Kramer
Release Date: April 26, 2025

Introduction

In the April 26, 2025 episode of Post Reports, The Washington Post delves into the challenging and often overlooked world of Lisa Singh, a psychiatric nurse working the overnight shifts in New York City's subway system. This episode, part of the Deep Reads series, offers a poignant exploration of the intersection between mental health, homelessness, and urban policy, highlighting the human stories behind controversial city initiatives.

Lisa Singh: The Frontline Psychiatric Nurse

[00:00 - 02:30]

Ruby Kramer introduces Lisa Singh, a 53-year-old psychiatric nurse dedicated to her role in the chaotic environment of the NYC subway system. Lisa's responsibilities include assessing individuals who exhibit signs of homelessness, drug addiction, and untreated mental illness. Working nights from 8 p.m. to 4 a.m., Lisa confronts the complexities of making swift, humane decisions about whether to involuntarily remove someone from the subway environment using a policy tool known as "a958."

Notable Quote:

"My name is Lisa. I'm a nurse," Lisa calmly begins each clinical assessment, striving to convey empathy amid the subway's noise and haste. [05:30]

The NYC Subway: A Hotbed of Urban Crises

[02:31 - 10:45]

The episode paints a vivid picture of the subway as a microcosm of broader societal issues. With homelessness at record highs and assaults on the rise—tripling since 2009—the subway platforms have become arenas where mental health crises and spontaneous violence frequently unfold. Incidents such as a woman being set on fire and a man being pushed in front of a train underscore the urgent need for effective intervention strategies.

Notable Quote:

"He's not thinking," Lisa reflects on her decision-making process during a tense removal situation. [15:20]

Policy Context: The a958 Protocol and Political Pressures

[10:46 - 20:00]

Central to Lisa's work is the a958 protocol, a section of New York State's mental hygiene law that permits the involuntary removal and hospitalization of individuals with mental illness who cannot meet their basic needs, regardless of whether they pose a danger to others. This policy has gained traction amidst political pressures from figures like Mayor Eric Adams and former President Donald Trump, who advocate for more forceful approaches to restoring order in major cities.

The episode discusses the implications of expanding involuntary removals, highlighting debates around their humanity and effectiveness. Governor Kathy Hochul's support for these measures has further ignited policy debates, questioning whether such interventions truly serve the best interests of vulnerable populations.

Notable Quote:

"I'm still trying to figure that out, but it's a 958," Lisa explains her tentative approach during a complex assessment. [12:15]

Daily Challenges and Critical Decisions

[20:01 - 35:00]

Lisa navigates a series of intense encounters, each presenting unique challenges. From a non-English-speaking woman exhibiting potential delusions to a disabled man adamantly rejecting assistance, Lisa must quickly assess each situation to determine the appropriate response. The limited time and resources amplify the difficulty of her role, as she often contemplates the potential consequences of her decisions.

Case Study: Removal of a Cantonese-speaking Woman

At [09:25], Lisa assesses a woman at the 34th Street Herald Square station who exhibits physical injuries and possible delusional behavior. Despite language barriers, Lisa works with Captain Han Ji Liu to communicate and evaluate the woman's needs. The situation escalates when paramedics arrive, and the woman resists removal, culminating in her being forcibly taken despite her pleas in both Cantonese and English.

Notable Quote:

"The decision had been Lisa's alone," highlighting the weight of her responsibilities. [25:40]

The Human Element: Lisa's Personal Journey

[35:01 - 45:00]

Beyond her professional duties, the episode delves into Lisa's personal background, revealing her motivations and emotional struggles. Raised by parents of Indo-Guyanese and Puerto Rican heritage, Lisa experienced feelings of ostracization, which fostered her empathy towards marginalized individuals. Her transition from a psychiatric emergency room to the subway system was driven by a desire to make a tangible difference, despite the emotional toll.

Notable Quote:

"Love is such a huge motivator. I don't believe that fear is the number one motivator," Lisa shares her philosophy on patient interactions. [42:10]

Systemic Challenges and Aftercare Concerns

[45:01 - 55:00]

The episode highlights systemic issues surrounding aftercare for individuals removed under the a958 protocol. Reports are sent to a city-wide command center, but Lisa remains unaware of her patients' outcomes post-hospitalization. This gap raises concerns about the long-term effectiveness of involuntary removals and the continuity of care for those affected.

Notable Quote:

"What if we had left him there or if we missed him or we were short staffed. What could have happened?" Lisa ponders the consequences of potential oversights. [30:50]

Moments of Connection and Reflection

[55:01 - 60:00]

Despite the often tense and adversarial encounters, Lisa seeks to establish genuine connections with those she assists. In one poignant interaction, she engages with a disabled man who vehemently refuses help, demonstrating her unwavering commitment to understanding and supporting individuals amidst their struggles.

Notable Quote:

"Would you like a pair of socks?" Lisa offers compassion in the midst of chaos. [58:25]

Conclusion: Navigating Compassion in Crisis

Ruby Kramer's storytelling captures the delicate balance Lisa must maintain between enforcing policy and extending humanity. The episode underscores the complexities of addressing mental health and homelessness within an urban framework, questioning the sustainability and compassion of current approaches. Lisa's experiences serve as a lens to examine broader societal challenges, urging listeners to reflect on the human cost of policy decisions.

Final Reflection:

"My body language, the calm tone of my voice. I have to send one message out into the noise and chaos of the New York subway system. No judgment whatsoever," Lisa encapsulates her approach to her demanding role. [59:45]

Key Takeaways

• Complex Interventions: The a958 protocol represents a controversial yet pivotal tool in managing mental health crises within public spaces.

• Human Impact: Lisa Singh's narrative highlights the personal and emotional dimensions of policy enforcement, emphasizing the need for compassionate care.

• Systemic Gaps: The lack of continuity in aftercare underscores the limitations of current systems in providing comprehensive support for vulnerable populations.

• Policy vs. Humanity: The episode invites a critical examination of whether forceful policy measures align with humane treatment and long-term solutions.

This summary encapsulates the critical elements and emotional depth of the "The Nurse in the NYC Subway" episode, offering a comprehensive overview for those who have yet to listen.