Free Weekends at Bellevue by Julie Holland

I start working at Bellevue that I finally appreciate what sets psychiatry apart from the rest of medicine. Medical illness has an endpoint: death. Psychosis is boundless; the degree to which someone can lose their mind is infinite. Most nights at CPEP, I’ll think I’ve just seen the craziest patient ever, and then inevitably, a week later, a new patient will best the last.
    Walking into my workplace is a bit like taking a hit of acid. I know all kinds of weird shit is going to go down, and I steel myself to handle it, because I also know that fifteen hours later I’m going to walk out the“other side.” I just have to hold on tight and trust that it’ll end with me still in one piece. One night I arrive at CPEP, and two patients in the observation area are both sweating and grunting. We have not one, but two women who believe they are giving birth. One of them swears it is the baby Jesus who will soon be delivered unto us. Those are the good nights, when the lunacy is funny, and going with the flow is painless. The nurses and psych techs (the staff in the nondetainable area, who have the most patient contact) strive to keep things light as we go about our business. All of us have chosen this line of work because we want to help others, but we learn over time that we have to set some limits. Most of us cauterize our bleeding hearts by using humor as a shield, so there is plenty of laughter erupting behind the scenes.
    After just a few weekends at my new job, I see it’s not going to be quite that easy. Treating everything as a joke will only get me so far. The problem is, I have a hair-trigger empathy switch, and because I am emotionally incontinent, my tear ducts leak with little provocation. If I see war, disasters, or orphans on the evening news or in the paper, my gut tightens and a lump forms in my throat. I can’t abide the unfairness of it all. If I’m going to make it at CPEP, I have to find a way to tolerate hearing about the experiences of the mentally ill, the addicted, the unwanted. Maybe most people’s lives are equal parts hope and despair, but at Bellevue, grief trumps optimism every time. There are sad stories everywhere. Pretty much every shift, if I let it get to me, there’s at least one patient’s story that will tear me up inside.
    So I start to toughen up. I can’t allow myself to get bogged down in the darkness, so I choose to have a little bit of a negative charge around me to keep it at bay. I adjust my filter a bit, tweaking the EQ so the sympathy frequency is turned way down. I pretend I don’t care, and after a while, I start to believe it. I pretend nothing fazes me, and pretty soon, it seems like nothing does.
    To prevent the misery from overwhelming me, I strip away the pitiful details and focus on the bottom line. Where does this patient need to go? Is he a keeper? Will he survive if I send him back out to the city streets? Or will someone else be in danger if I release him?
    To the outside observer, I appear hardened, uncaring. Maybe other people would play it a different way, but this is my game plan. I am all business, except that I go for the cheap laugh whenever I can, whether with the ambulance drivers and cops or the Bellevue police, nurses, andpsych techs. But on the inside, if you could hear my interior monologue, it is pure Kurtz … “The horror.” I am aghast at the indignities these patients endure, and there are occasionally times I am afraid for my own safety.
    I can laugh all I want, just like a teenager on acid, but I’m kidding myself if I think I’m going to walk out of here unchanged.
    By the time I leave, nine years later, my suit of armor will have become dented and worn through with rust. A working mother of two with a heart of mush, I will be unable to harden myself any longer to the atrocities to which I bear witness.
    I’d love to tell you that it was a gradual, step-by-step progression, from hard-ass to maternal, that it was a smooth narrative arc.