Lucy was busy with the radio, and approach control did not seem to want to acknowledge us because air traffic was so congested, and controllers were not very interested in aircraft flying at seven hundred feet. At this altitude in this city, the rules were see and avoid, and that was about it. We followed the East River over the Brooklyn, Manhattan, and Williamsburg bridges, moving at ninety knots over crawling garbage barges, fuel tankers, and circling white tour boats. As we passed by the crumbled buildings and old hospitals of Roosevelt Island, Lucy let La Guardia know what we were doing. By now Ward’s Island was straight ahead. It was appropriate that the part of the river at the southwestern tip was called Hell Gate.

What I knew about Ward’s Island came from my enduring interest in medical history, and as was true of many of New York’s islands in earlier times, it was a place of exile for prisoners, the diseased, and mentally ill. Ward’s Island’s past was particularly unhappy, as I recalled, for in the mid-eighteen hundreds, it had been a place of no heat or running water, where people with typhus were quarantined and Russian Jewish refugees were warehoused. At the turn of the century, the city’s lunatic asylum had been moved to the island. Certainly conditions were better here now, although the population was far more maniacal. Patients had air conditioning, lawyers, and hobbies. They had access to dental and medical care, psychotherapy, support groups, and organized sports.

We entered the Class B airspace above Ward’s Island in a deceptively civilized way, flying low over green parks shaded with trees as the ugly tan brick high-rises of the Manhattan Psychiatric and Children’s Psychiatric Centers and Kirby loomed straight ahead. The Triborough Bridge Parkway ran through the middle of the island, where incongruous to all was a small circus going on, with bright striped tents, ponies, and performers on unicycles. The crowd was small, and I could see kids eating cotton candy, and I wondered why they weren’t in school. A little farther north was a sewage disposal plant and the New York City fire department training academy, where a long ladder truck was practicing turns in a parking lot.