I have signed out my private practice for the month of July. My patient load is zero. I have closed one chapter of my life, but I have not yet opened the next. I suppose this is the whole idea of summer vacation: not working. I can focus on caring for myself and for my family. I can get some perspective now that I am away from the hospital. Determining who is sane, who is ill, who needs to be locked up for their own good, and who may run free, like the wind … this is no longer my bailiwick. Now I decide what to make for dinner, and whether to do laundry today or tomorrow.
Oh, God, will I die of boredom? Sky of blue and sea of green, every one of us has all we need. But will it be enough for me?
The sun hangs fat and low on the horizon as the Technicolor display begins. Wisps of clouds decorate the sky, layered with hints of the vermillion, fuchsia, and tangerine to come. I search for the moon as my board bounces on the rolling waves, carrying me out to sea, farther away.
Actually, too far away.
I have been sailing west for too long. I need to reach the shore before it gets too dark to see and be seen, just as I needed to leave Bellevue before I faded into the background, before we became the same drab color.
I head into the wind and come about clumsily. It’ll take a few days to work the kinks out of my form, but at least I haven’t fallen in yet. My T-shirt is dry as I approach the shore, my forearms aching.
I look behind me once more, to take in the mango-papaya sunset. It is the medical new year, Independence Day weekend, and I am not going back to the hospital. I’m not a cog in the machine anymore, but I still feel my wheels spinning. I remind myself: It will take some time to work those kinks out too. Head for shore, and everything will fall into place.
Jeremy and Molly are frolicking like dolphins in the waves as I glide past them, hooting and crowing. “Yay, Mommy!” Molly shouts.
I grin triumphantly as I release the sail, pushing it away from me as I fall backwards into the water.
Paperback Writer
It’s a snowy Sunday afternoon in January, and I haven’t stepped foot in Bellevue for six months.
My life has slid into a predictable routine. I see patients mid week, take the kids up to the house on Friday, and come back Sunday night to do it again. Monday is my errand day; we have a sitter to watch Jojo, and I’ve started back up with Pilates. My life is simpler, and it feels infinitely safer, but I’m not sure it’s better. And there’s no going back. I will never have a job like CPEP again. Not only do I miss my Bellevue comrades, I miss the rush of being in charge, talking to the cops, feeling decisive, helping the people the rest of the city has avoided and discarded. I miss never knowing what’s going to happen next.
Like a junkie in withdrawal, I find it easy to glorify the good old days spent high on adrenaline with my crew. It will take some more time to adjust to my new life.
CPEP was all about diagnosis not treatment, triaging not fixing. Most of my job was simply determining who’s in and who’s out. My life isn’t like that anymore; it’s not so black-and-white. Now, it’s all about the long view: raising a family, writing books, following my private practice patients month after month. I’m treating people who are no longer lost to follow-up. I am responsible for the outcome, good or bad. Luckily, my patients are getting better and staying well, for the most part. They are grateful to me for my ministrations, and their families are likely relieved that I’m helping to shoulder the burden of maintaining their mental health.
Still, I know someone else could be doing this type of work, someone more sedate. Not everyone is built for Bellevue like I was. Should I have stayed because I could? Am I really contributing in the same way now? I still find myself talking to the homeless schizophrenics on the street, telling them to head to Bellevue when they look like they’re going south. They’re my people, and I can’t help but do a little community outreach while I’m waiting for the subway.
It’s snowing like crazy here at the house, and I’m supposed to give a Monday morning lecture to the residents at CPEP, something I’ve agreed to do in order to keep up my voluntary faculty position. More important, I am meeting Nancy for breakfast at the coffee shop before I teach, at the end of her Sunday overnight shift. Though I’m dying to catch up with her, it will have to wait. Jeremy and I are pretending we’re snowed-in so our whole family can play hooky from school and work. I’ll find another Monday morning to head down to the hospital.
I call Nancy to reschedule. An unfamiliar voice answers the phone, “CPEP.” A new clerk.
“Hi. This is Doctor Holland; I used to work there. You may not know me.” It’s the first time I’ve had to speak like this to someone at CPEP, and it feels awful. “Is Nancy working tonight, do you know?”
I am put on hold. The new clerk is afraid to give out any information about a CPEP employee, because she has no idea who’s calling. I appreciate her reluctance, actually. I’d want the same level of security if someone were trying to track me down, asking if I’d be there tonight.
I’m on hold for a good long time, listening to the Bellevue propaganda that plays ad nauseam, in Spanish, Mandarin, and English. When I was working there and had to put someone on hold, I used to just put the phone down on the counter, instead of pressing the hold button, as long as I was feeling merciful; that recorded message can seem like torture after you’ve heard it a dozen times.
A man gets on the phone and says, “Hello, Miss? Yeah, so, um … no one here has any idea who Doctor Holland is. We have no record of any Doctor Holland working here.”
I am speechless.
“You’re kidding me,” I whine. “No one there knows who I am?” It is a narcissist’s worst nightmare. My so-called legacy is already nonexistent, faded into oblivion a mere six months after I leave. It simply cannot be. “Wait a minute! Who is this?” I demand.
“It’s Henry,” my friend says, and I can hear his smile. I’ve known Henry for thirteen years; he was my chief resident during my second year of training at Mount Sinai. Actually, I’m the one who recommended he get a job moonlighting at CPEP. “In fact, I’m looking at your picture right now,” he says. He is holding a copy of my Ecstasy book in his hands, which he has taken from the bookshelf in the nurses’ station.
“What’s going on there today?” I ask hungrily.
“Oh, the usual,” he deadpans. “We had a stabbing.”
“Weapon?” I ask, sliding into CPEP shorthand-speak.
“Pen. Hidden between the guy’s gluteus maximi.”
I like his pluralization of “maximus.” Nice touch. “How’d he get that?”
“We figure it came out of the social work office. It was unlocked.”
“We’re going to have to step up security,” I say, as if I still work there and need to send out a memo: Guard your pens. They can be used to stab patients in the neck.
The patient who did the stabbing is the same man who was arrested for running into the UN naked. I’d heard about him in the news and assumed he was brought to Bellevue, but I’m surprised that he has become violent, and mention this to Henry. “Usually the naked guys are harmless.”
“Yeah, you figure anyone who’s willing to be so vulnerable wouldn’t be very paranoid.”
I realize we are on the same page. It is bittersweet, to be immediately understood, yet distanced.
“I miss it there.” I sigh. I remember the buzz of the hive, the acuteness of the patients, the predictable level of chaos, punctuated by the unpredictable. I think about Chuck, the last night we worked together, turning away to hide his tears as I left the nurses’ station to turn in for the night. “Every Saturday at six, I still feel the pull of the hospital. I feel like I’m supposed to get in my car and go to Bellevue so I can see everyone.”
“Well, we all miss you, too, you know,” Henry says.
“And you really had me going with that ‘No one here knows who Doctor Holland is.’ I couldn’t believe there was already no one there who remembered me.”
“Oh, I don’t think
anyone here will be forgetting you anytime soon,” Henry assures me.
“You better not,” I threaten faux-menacingly, hanging up the phone.
I will never forget Bellevue. And I couldn’t bear the asymmetry if my passage through the hospital had no impact, my footprints already washed away by the changing tides of each successive shift. I don’t want CPEP to forget me, and I surely don’t want them to forget Lucy. If I close my eyes, I can see her pulling down the New Testament from the nurses’ station bookshelf, randomly opening up a page to guide her. I want Weekends at Bellevue to sit alongside it on that shelf, a testament to our time spent together at the hospital.
My nine years at CPEP, like an extended gestation, helped to make me what I am—a better doctor, a better mother, and a writer. I walked into that asylum one person, and I walked out another. I didn’t alter the machine—I’m not sure anyone could have—but it surely had its way with me.
Glossary
2 PC—two physician certificate. An involuntary admission lasting up to sixty days.
5 and 2—5 milligrams of the antipsychotic Haldol and 2 milligrams of the antianxiety sedative Ativan. 9.13—voluntary admission.
9.39involuntary admission, lasting up to two weeks.
9.40seventy-two-hour Hold. An admission to the EOU (extended observation unit).
18 South—an acute ward with Asian-language-speaking staff. Mandarin-and Cantonese-speaking patients are preferentially sent here.
19 West—the male forensic unit.
20 East—the dual diagnosis unit (also called the MICA unit, for Mentally Ill, Chemically Abusing patients).
AES—Adult Emergency Services. The medical ER at Bellevue.
Akathisia—an inability to remain still, an uncomfortable physical compulsion to pace, or shake one’s legs arising as a side effect from anti-psychotic and some antidepressant medications.
AOB—Alcohol on Breath.
Attending—a doctor who has finished residency, often the doctor in charge.
Blue room—Department of Corrections holding area.
Bridge up—a person on a bridge about to jump.
Bundle—ten bags of heroin.
Camisole—a euphemism for straightjacket.
CPEP—Comprehensive Psychiatric Emergency Program. The psychiatric ER at Bellevue.
Debridement—removing infected or dead tissue from a wound.
D.O.C.—Department of Corrections. NYC prison guards, who work at Rikers and Bellevue.
DNR—Do Not Resuscitate. An order on a medical chart instructing doctors and nurses to forgo heroic measures if the patient is dying.
EDP—emotionally disturbed person, NYPD terminology for a psychiatric patient.
Eloping—a euphemism for escaping a locked ward.
EMS—Emergency Medical Services. NYC ambulances and their drivers, who are often EMTs (emergency medical technicians).
EOU—Extended Observation Unit. CPEP’s six-bedded unit for seventy-two-hour holds.
ESU—Emergency Services Unit. When NYPD needs backup, they call ESU, which helps to subdue and restrain patients.
Hold—an involuntary status to observe the patient for up to twenty-four hours.
MR—mentally retarded.
MTA—Metropolitan Transportation Authority. NYC bus, subway, and train system.
Malinger—to fake being ill, or mentally ill.
Malingerer—someone who fakes illness for personal gain.
Moonlighter—a doctor who is hired to work extra shifts during nights, weekends, and holidays. This can be a resident or an attending.
NYFD—New York Fire Department.
Neuropathic—a symptom coming from nerve irritation or damage, a neuropathy.
O.T.D.—Out the Door, discharged.
PINS—Person in Need of Service. A parent petitions the court to step in to help with child supervision.
Prn’s—as-needed medications, as opposed to standing medications, often given for agitation, anxiety, or alcohol withdrawal symptoms.
Psych techs—the staff in the nondetainable area who have the most patient contact.
Resident—a doctor who is still in training, but has chosen a specialty (e.g., a surgical resident, a psychiatric resident). Residencies typically last three or four years.
Shark—sociopath. Often a malingerer. Sociopaths are not truly mentally ill, but their lives are disorganized and they may prey on the patients.
Snake pit—an old-fashioned way of referring to an asylum or mental hospital.
Standing medications—those medications given daily, as opposed to prn medications.
Acknowledgments
First of all, I want to thank every single patient I have ever come into contact with, bar none. You enriched me, and I am forever in your debt. If I have helped you get back on your intended path, I am pleased. If I thwarted you, frustrated you, or much worse, I am deeply sorry. I hope it helps you to know that I am still struggling to become a better, kinder, gentler person now than I was then.
My agent and friend, Kirsten Manges, did her job and then some, helping me to land a book deal and making my dreams come true, basically. At Bantam, Beth Rashbaum, editor summa cum laude, saw the potential in the manuscript that came her way, and helped me to make it shine. Michael Cunningham helped to champion this book and served as ambassador to the publishing world.
Thanks to my readers and advisors: Jessica Wolff, an astute line editor and advisor who helped me early in the process, and Kate O’Connell, who gave me great advice about narrative arcs and character development. Simone Solondz boldly recommended I cut out some of the more provocative and objectionable stories, Marjorie Ingall provided an equally brave critique, Elizabeth Stein helped me to make some painful cuts and sutures, and Jen Dohne and Collective Copies of Amherst assisted with manuscript preparation.
Richard Gehr and Gary Greenberg helped me to shape and mold this book. William Ridinger proffered tireless, meticulous notes for multiple rounds of rewrites, and is a heckuva pen pal. Steven Fressola, Joel Bassuk, and Michael Hogan were a great cheering section. David Rhoads, Jim Fadiman, and John Howell provided much-needed eleventh-hour critiques and support.
There were certain psychiatrists throughout my training who were particularly inspirational: Ed Schweizer at Penn, John Benson at Temple, and Jack Hirschowitz and Ann Callahan at Mount Sinai.
To my husband, Jeremy, thank you for all your sage advice and balance.
To my parents, sisters, and my children, Molly and Joe, I am blessed to have your love and understanding.
About the Author
JULIE HOLLAND, M.D., is a psychiatrist specializing in psychopharmacology. An assistant professor of psychiatry at New York University School of Medicine, she spent her weekends running the psychiatric emergency room at Bellevue Hospital for nine years. She is the editor of Ecstasy: The Complete Guide, A Comprehensive Look at the Risks and Benefits of MDMA. She lectures widely and has been quoted in Time, Harper’s, Los Angeles Times, and The Wall Street Journal. Holland has appeared as a medical expert on the Today show, Good Morning America, and CNN. She is in a private practice in New York City and lives with her husband and two children in the Hudson Valley.
Copyright © 2009 by Julie Holland
All rights reserved.
Published in the United States by Bantam Books, an imprint of The Random House Publishing Group, a division of Random House, Inc., New York.
BANTAM BOOKS and the rooster colophon are registered trademarks of Random House, Inc.
LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA
Holland, Julie
Weekends at Bellevue / Julie Holland.
p. cm.
eISBN: 978-0-553-90697-4
1. Holland, Julie 2. Psychiatric emergencies—New York (State)—New York. 3. Bellevue Hospital. 4. Emergency physicians—New York (State)—New York—Biography. 5. Women psychiatrists—New York (State)—New York—Biography. I. Title.
RC480.6.H655 2009 362.2′1097471�
�dc22 2009021187
www.bantamdell.com
v3.0
Table of Contents
Cover
Title Page
Dedication
Note to the Reader
Chapter 1 - Mother Nature’s Son
Chapter 2 - Ticket to Ride
Chapter 3 - A Day in the Life
Chapter 4 - Hello Goodbye
Chapter 5 - Girl: (Temple Medical School, Philadelphia, 1988)
Chapter 6 - Another Girl
Chapter 7 - Think for Yourself: (Residency, Mount Sinai Hospital, NYC, 1992)
Chapter 8 - If I Fell
Chapter 9 - Welcome to the Machine
Chapter 10 - Two of Us
Weekends at Bellevue Page 33