For Six Years, Pamela Cisneros Seemed Stable — Then One Quiet Change Left Her Family Wondering What Went Wrong Before the Times Square Tragedy
For nearly six years, Pamela Cisneros’s family believed they had finally found a rhythm that worked.
It had taken years to get there.
There had been frightening episodes, hospital visits and moments when those closest to Pamela didn’t know what the next day would bring. But eventually, according to her brother Patrick Peralta and father Mario Cisneros, regular psychiatric treatment appeared to bring something that had once seemed elusive.
Stability.
Pamela attended monthly appointments. Her family said she received long-acting medication by injection. She visited relatives frequently. She ate dinner with her parents. She found work. She lived quietly in Woodside, Queens.
Her brother remembered something particularly important about those years.
As long as Pamela was receiving treatment, he said, she seemed fine.
And she wasn’t violent.
Then, sometime during the final months of her life, something changed.
Her father stopped accompanying her to appointments.
Her brother discovered that Pamela was apparently handling part of her treatment herself.
Then she stopped showing up for family dinners.
Days later, the family saw Pamela on television.
She was in Times Square.
She was holding two knives.
And a 32-year-old mother named Erin Piacenti was dying.
The family now wonders whether Pamela had stopped receiving her medication. But no public medical record has confirmed that theory, and it remains exactly that: a family’s attempt to understand an act they say was completely unlike the woman they knew. (monorepo-sample1.nyt.net)
Long Before Times Square, There Was Another Pamela
To understand why Patrick struggled to comprehend the images on television, one has to go backward.
Decades backward.
Before psychiatric treatment.
Before hospitalizations.
Before Times Square.
Patrick remembered Pamela as his little shadow.
When she was about five years old, he would go outside during the summer to play with his friends.
Pamela followed.
“She was a happy-go-lucky kid,” he later recalled. (testc.arcamax.com)
She was the younger sister who wanted to be wherever her brother was.
The family grew up in Queens.
Pamela eventually became an adult, married and had three daughters. She pursued an education and, according to relatives, later obtained a master’s degree in psychology. She also worked at different points for a lawyer involved in immigration matters. (gothamist.com)
From the outside, there were periods when her life looked completely ordinary.
Inside the family, however, something had begun changing.
Patrick said Pamela’s mental-health difficulties emerged more than two decades before her death, around the period after the birth of her second daughter.
He described postpartum depression and what he believed was later diagnosed as bipolar disorder. (gothamist.com, univision.com)
Life became more complicated.
Her marriage eventually broke down.
Two daughters would live in Florida with their father, while another daughter requiring full-time care lived in Brooklyn. (nypost.com)
But Pamela kept moving forward.
Until eventually, in 2019, everything reached a frightening point.
The Subway Tracks
Seven years before the Times Square attack, Pamela experienced a severe crisis.
According to police records and her family’s account, she tried to jump in front of a subway train at the Union Turnpike-Kew Gardens station in Queens in March 2019.
She survived. (monorepo-sample1.nyt.net)
For her family, the incident became a turning point.
Mario Cisneros, Pamela’s father, became more involved in making sure his daughter received treatment.
He began taking her to monthly appointments at Jamaica Hospital Medical Center.
There, according to Mario, Pamela received injections that appeared to help keep her stable. (monorepo-sample1.nyt.net)
Patrick offered a similar account.
Pamela had difficulty consistently taking daily psychiatric medication, he said, so she received monthly injections instead. (testc.arcamax.com)
And slowly, something seemed to change.
Not overnight.
Not magically.
But enough for her family to notice.
Pamela appeared to be doing better.
Six Quiet Years
Six years is a long time.
Long enough for a family to begin believing the worst period has passed.
Long enough for crisis to become memory rather than expectation.
Patrick described those years simply.
“For the last six years now, she was getting injections and nothing was wrong,” he told the New York Daily News. (testc.arcamax.com)
Pamela lived alone on a tree-lined street in Woodside.
Her building manager remembered a tenant who caused almost no trouble.
She greeted people.
She paid her rent.
She kept largely to herself.
“I never heard a peep out of her,” the manager told The New York Times. (monorepo-sample1.nyt.net)
Meanwhile, family remained part of her routine.
Pamela regularly visited her mother and stepfather.
Dinner was almost habitual.
She came in the afternoons.
She appeared at family celebrations.
Earlier in August, she helped organize a birthday gathering for her stepfather. Patrick saw her there.
She seemed normal.
There was nothing, he said, that suggested what would happen weeks later. (gothamist.com, arcamax.com)
Her father believed his daughter had turned a corner.
And perhaps that is why what happened next was so difficult for him to understand.
“Don’t Worry About Me”
In April 2026, Mario was prepared to do what he had done repeatedly over the years.
Drive Pamela to her appointment.
But this time, his daughter said she didn’t need him.
She could go alone.
Her father later remembered her reassurance:
“Don’t worry about me.” (monorepo-sample1.nyt.net)
On its own, there was nothing necessarily alarming about the exchange.
Pamela was 49 years old.
Wanting to manage an appointment independently wasn’t evidence that something terrible was coming.
Mario accepted what she said.
His daughter was doing better.
Why shouldn’t she be able to handle it herself?
But after August 31, that conversation returned to him.
Because Mario did not know whether Pamela continued receiving treatment after she stopped going with him.
Public reporting has not established whether she attended subsequent appointments or received her prescribed medication during the months before the attack. (monorepo-sample1.nyt.net)
And that uncertainty became central to the family’s questions.
Then Patrick Learned Something Else
Patrick’s account contained another detail.
He said he discovered Pamela was no longer necessarily going in person in the same way she had before.
Instead, he understood that she had begun administering the medication herself.
That worried him in hindsight.
Their parents were elderly.
They could not constantly check whether their adult daughter had followed every step of her treatment.
Patrick began wondering whether Pamela might have missed injections during her final months. (testc.arcamax.com)
But it is crucial not to turn that suspicion into fact.
Patrick did not know that she stopped treatment.
Her father did not know.
Reporters did not know.
There is currently no publicly released medical evidence establishing when Pamela last received medication or whether a missed injection caused her behavior on August 31.
The family’s theory helps explain their confusion.
It does not medically explain the attack.
One Week Before the Attack, Another Routine Broke
Then came a much more visible change.
Pamela stopped coming to dinner.
Normally, her visits were frequent enough that her absence became noticeable.
One evening without Pamela might not have mattered.
Then another passed.
And another.
The family started wondering where she was.
“It was weird because she didn’t come at all last week,” Patrick remembered. (gothamist.com)
They called her.
Eventually, Pamela’s mother spoke to her on Saturday.
Pamela said she was fine. (gothamist.com, arcamax.com)
There was no obvious emergency.
No warning that, approximately two days later, her family would see her face on television.
Monday Afternoon
August 31 began as an ordinary Monday in Manhattan.
At approximately 4:24 p.m., according to police, Pamela was near West 41st Street and Seventh Avenue carrying a red Target bag.
Inside were two kitchen knives.
A 68-year-old man named Tak Kam was nearby with his wife.
They did not know Pamela.
Police say Pamela pulled out the knives and stabbed him in the abdomen.
He survived.
Approximately twenty seconds later, she encountered another stranger.
Erin Piacenti.
Erin was 32 years old and was heading home to Chester, New Jersey.
Pamela stabbed her in the abdomen, police said.
Erin was taken to Bellevue Hospital.
She died. (monorepo-sample1.nyt.net)
The entire encounter between two women who had never met lasted only moments.
But its consequences would extend across two families forever.
Erin Had Just Returned From Maternity Leave
The cruelty of Erin’s death becomes even more difficult to comprehend when placed beside what had been happening in her life.
Five months earlier, Erin and her husband, Frank, had welcomed a daughter.
Madison.
Erin had spent five months on maternity leave.
August 31 was her first day back at work.
She was a vice president at Bank of America, a graduate of the University of Pennsylvania and Fordham University School of Law.
But when the workday ended, she wasn’t simply a banking executive walking through Manhattan.
She was a mother going home.
Her baby was waiting.
She never arrived.
Police have described the attack as random. Nothing publicly reported suggests Erin knew Pamela or did anything to provoke the encounter. (apnews.com)
Four Minutes With Police
After the attacks, officers confronted Pamela near West 43rd Street.
She still had a knife in each hand.
According to NYPD Commissioner Jessica Tisch, officers formed around Pamela and repeatedly ordered her to drop the weapons.
For approximately four minutes, they attempted to persuade her.
Pamela refused.
Police then deployed Tasers.
They had no apparent effect.
Authorities say Pamela moved toward the officers while still holding the knives.
Two officers fired.
Pamela was struck and transported to a hospital, where she died. (monorepo-sample1.nyt.net)
The New York Attorney General’s Office of Special Investigation has since opened an investigation into Pamela’s death, as required for incidents in which police actions may have caused a civilian death. (ag.ny.gov)
Patrick Saw the Video
Patrick did not learn what had happened through a family phone call.
He saw it on the news.
At first, he wasn’t sure.
There was something familiar about the woman in the video, but he desperately hoped he was wrong.
Then clearer photographs appeared.
And Patrick knew.
It was Pamela.
The little sister who used to follow him outside during summer.
The woman who had eaten dinner with their parents.
The sister he had seen at a birthday celebration only weeks earlier.
Now she was the woman in a video holding knives as police surrounded her.
“I was shocked,” Patrick recalled.
He was still numb when reporters spoke to him afterward. (arcamax.com)
And one question kept returning.
What happened?
“She Was Never Aggressive”
Patrick repeatedly emphasized the same point.
Pamela had struggled.
She had experienced serious mental-health crises.
She had hurt herself.
She had been hospitalized.
But according to him, she had never shown violence toward other people.
“She was never aggressive,” he said while describing the years when treatment appeared to be working. (gothamist.com, testc.arcamax.com)
That statement cannot erase what happened in Times Square.
Nor does it contradict the evidence of August 31.
Instead, it explains why Pamela’s own family was struggling to recognize the person in the video.
Patrick described it as though something had suddenly changed.
“It was like a switch,” he said. (gothamist.com)
But he couldn’t explain what flipped it.
A Family Searching Backward for Answers
After tragedy, memory becomes an investigation of its own.
The family returned to April.
Pamela saying she could attend appointments alone.
They returned to the question of medication.
Had she received the injections?
They returned to the week before the attack.
Why did she stop coming to dinner?
They returned to Saturday.
Why did she say she was fine?
And they returned to the birthday gathering earlier in August.
How could someone who seemed normal there become the person seen in Times Square weeks later?
No publicly established answer currently connects all those points.
There are only fragments.
And grief has a way of making fragments look like a puzzle that must have a solution.
Sometimes it doesn’t.
Mental Illness Is Not the Same as Violence
There is another distinction worth preserving while examining Pamela’s history.
Millions of people live with mental-health conditions without ever harming another person.
A psychiatric diagnosis by itself does not predict violence.
Pamela’s relatives themselves stressed that despite her history, they had not known her to behave violently toward others before August 31. (gothamist.com, testc.arcamax.com)
Whatever combination of circumstances produced her final actions remains unclear.
Her family’s accounts provide context.
They do not provide a diagnosis of what happened that afternoon.
And they certainly cannot change the outcome.
Her Father Had Only One Thing to Say About Erin
Mario Cisneros could have spoken only about his daughter.
Instead, he spoke about Erin too.
He apologized.
“Nobody should take a life,” he said after trying to understand his daughter’s actions. (monorepo-sample1.nyt.net)
For Mario, grief came tangled with another family’s grief.
His daughter was dead.
But someone else’s daughter was dead because of what Pamela had done.
Someone else’s wife.
Someone else’s mother.
There was no way to mourn Pamela without confronting Erin.
Two Stories Ended in the Same Hospital
There is something haunting about the final geography of the tragedy.
Pamela and Erin were strangers.
They had lived separate lives.
They belonged to separate families.
They had no reason ever to appear in the same story.
Then Times Square placed them within seconds of each other.
Both were taken to hospitals after the violence.
Both died.
But the stories that led them there were profoundly different.
Pamela arrived after years of documented mental-health struggles and an armed confrontation with police.
Erin arrived because she happened to walk past a stranger at precisely the wrong moment.
One story raises difficult questions about treatment, crisis intervention and what a family may or may not be able to control when an adult relative is seriously unwell.
The other contains no such ambiguity.
Erin was an innocent victim.
The Question Patrick Cannot Answer
Patrick knows what he remembers.
For years, Pamela appeared more stable.
She received treatment.
She visited family.
She ate dinner with their parents.
She worked.
She lived quietly.
Then something changed.
Perhaps treatment changed.
Perhaps something happened that her family never saw.
Perhaps future investigations or medical information will offer answers.
For now, none of those possibilities has been established.
Patrick can only return to the last ordinary memories.
His sister at the birthday gathering.
His mother speaking to her on Saturday.
Pamela saying she was fine.
And then Monday.
Two knives.
Two strangers attacked.
One young mother dead.
Police surrounding his sister.
Gunshots.
Everything that followed.
Six Years of Stability Cannot Explain One Afternoon
That may be the most difficult part for Pamela’s family.
They had believed they understood the pattern.
Treatment seemed to help.
Routine seemed to help.
Family seemed to help.
For six years, they thought she was doing better.
Then, in less than a minute in Times Square, a life of complicated history collapsed into an act none of them recognized.
Patrick’s suspicion about missed injections may eventually prove relevant.
Or it may not.
Until medical evidence establishes what happened, it remains a grieving brother’s attempt to make sense of the senseless. (monorepo-sample1.nyt.net)
But there is one part of the story that requires no theory.
Erin Piacenti was 32.
She had returned to work that morning after five months with her baby.
At the end of the day, she began the journey home.
She should have reached Frank and Madison.
She didn’t.
And whatever happened inside Pamela Cisneros’s mind during the weeks before August 31, that is the consequence that remains after every unanswered question.
A father is wondering what happened to his daughter.
A brother is replaying six years of treatment and one strange week of absence.
And somewhere else, a five-month-old girl will grow up hearing stories about the mother who should have walked through the door that Monday evening.
That is why the unanswered question about Pamela’s final months matters.
But it can never become bigger than the life that was taken.
Because behind every attempt to understand what happened to Pamela is another truth that needs no explanation at all:
Erin was simply going home.
For more stories of lives tragically cut short, read about Carla Jeffery’s final Instagram post before her untimely passing at 33 or hear Erin Piacenti’s family break their silence after her death in Times Square and what the suspect’s brother had to say.
