Weekends at Bellevue: Nine Years on the Night Shift at the Psych E.R.

3.9/5 ( ratings)

No one is immune from mental illness. After working at New York City’s Bellevue Hospital for nine years, as the psychiatrist in charge of admissions at the psych E.R. on Saturday and Sunday nights, I came away knowing this for sure. Over the years, I admitted heiresses and art dealers, altar boys and college students, homecoming queens, studio executives, bankers, lawyers, correction officers, and the list goes on. No matter who you are, what you do for a living, how much money you have in the bank, or how often you go to church, circumstances can transpire that will bring you to Bellevue. This is one of the hardest lessons for our patients to learn. My years at Bellevue taught me many things, life lessons I could never have hoped to receive elsewhere, but the main take-home message was this: cherish your sanity, for it can be lost in the blink of an eye. Sometimes I saw the same patients repeatedly, alcoholics and addicts who were hitting bottom in regular cycles, showing up when their funds ran out. Other times, however, I met patients with no psychiatric history, who ended up at Bellevue when a bad break-up led to a suicide attempt, or a shared cigarette at a bar led to a PCP-induced psychosis. There are so many ways in which a life can suddenly unravel, and many of my patients could specify just when that started to happen for them--whether it was joining the army, leaving home for college, or living through the death of their child. Many of the people I encountered at Bellevue tried strenuously to convince me that they did not belong there. Or vice versa. A big part of my job was learning how to separate the genuinely disturbed from the fakers , and to identify the people who had been misunderstood, misdiagnosed, who weren’t mentally ill at all. After a few years of Bellevue experiences under my belt, I developed a sixth sense for what real crazy looked like, sounded like, and yes, smelled like. One night a young man was brought in to the E.R. because he was found on a street corner preaching to passersby to give up their worldly possessions. I knew enough to listen and wait, and not rush to judgment, even though it might have seemed a no-brainer to admit him. Once I was able to draw him out, I learned that he had taken psychedelic mushrooms and then spent time in a Chelsea art gallery known as COSM, which I myself had been to and knew to be an intense, inspirational and potentially overwhelming experience, something that might well unhinge a person on mind-altering drugs. I spoke with him gently as his trip slowly ebbed, helping him to navigate his re-entry in the city hospital where he had landed with no money or identification. He stayed in touch with me for months afterwards, grateful that I was there to protect him when he soared--however briefly--beyond the boundaries of normal behavior. There is a diaphanous membrane between sane and insane. It is the flimsiest of barriers, and because any one of us can break through at any time, it terrifies us, causing us to turn our backs on those who remind us of this painful reality. But spending so much time with people who marched out of the lockstep of sanity has made me less forgiving of the way the mentally ill are ostracized and shunned. We owe them something better. And we should remember that the barrier separating "them" from "us" is not nearly as secure as we might think.--Julie Holland