Excerpted from “Committed: Dispatches from a Psychiatrist in Training” by Adam Stern, director of psychiatric applications at Beth Israel Deaconess Medical Center’s Berenson-Allen Center for Noninvasive Brain Stimulation and an assistant professor of psychiatry at Harvard Medical School.
I stopped for two croissants and two coffees in the lobby coffee shop on my way to the ER. I typed in the five-digit code to get into “the bunker,” a tiny room with no windows that the psychiatry staff holed up in to get work done when near the emergency room. There I found the senior resident, Rebecca, staring blankly at the whiteboard that listed the patients waiting to be seen.
“Breakfast?” I asked.
“You stopped for coffee? There’s no time for coffee. Look at this. Look.”
There were eight patients waiting to be seen.
“I don’t understand how they can have a whole team of residents and attendings during the day and leave one second-year resident to carry the load all night.”
“Well, and an intern,” I added.
She shot me a look.
“Right. And you. Well, we better divide and conquer. You take these four, and don’t send anyone home without first presenting the case to me. Understood?”
But she was already out the door with her clipboard. I sighed and took a slug of my coffee, looking up at the names of the four patients Rebecca had assigned me.
“What the [expletive]?” I asked.
It was practically my whole patient list from the month before. Jane, Paul, Ginger, and Deborah were all back in the ER within a matter of weeks.
“What’s impossible?” a woman from the other side of the room asked without looking up from her computer.
“Oh, nothing. I’m just surprised to see some of these names.”
I turned my gaze from the board to the woman.
“You’ve been sitting there this whole time?”
“Who are you?”
“I’m Nancy, the bed finder. I find all these patients beds either here or around the city when they’re admitted. You’re going to want to be nice to me because I’m the only way these patients get out of your ER.”
“Good to know, Nancy. Want a croissant and a coffee?”
“Well, thank you very much,” she said, sticking out her hand, still not looking away from her screen. “So what’s impossible?”
“It’s just, this list of patients I’ve been assigned, they’re — they’re all the patients I was taking care of up on 4 South.”
“Well, they were doing well when I discharged them. I guess I’m just surprised to see them back here.”
“Kid, they always bounce back.”
I took a bite of my croissant and headed out with a clipboard I found next to the printer.
Jane, who had managed to avoid court-mandated treatment for anorexia, was the first patient on my list and the first room I came across on my way through the Green Zone. She was 21 and had an intellect and work ethic that had gotten her into Harvard but was devastated by her anorexia.
Like all of the patients in this part of the emergency department, she was being held behind glass sliding doors in a barren room with only a gurney inside. Her mother sat next to her with puffy eyes staring at the floor.
“Jane,” I announced as I entered.
Impossibly, she looked even thinner and more frail than when she had left. And at that point she weighed 78 pounds.
“Oh good, it’s you.”
Our eyes met as we took each other’s measure.
“What brings you into the emergency department today?” I asked, knowing exactly what the answer was.
“Are you an idiot? Do you need me to tell you everything all over again?”
“I find it’s just good to let my patients tell me what’s going on.”
“I’m not your patient. I’m just seeing you because you’re the only idiot here.”
“Okay, Jane. So, help an idiot out, will you? Up on 4 South, you told me how it was all going to go, and you were right. What about now?”
“Times have changed. This time Medicine and Psychiatry are going to have a pissing contest over whether I’m stable enough to be admitted to Psychiatry. Medicine’s going to say I am fine to be admitted to 4 South, and Psychiatry’s going to say my body-mass index is too low, along with my heart rate and glucose.”
“Who’s going to win?”
“Psychiatry, of course. They never take anyone that makes them nervous medically, and I make people nervous.”
“Okay, Jane. Thanks for showing me the way. Anything else I should know?”
This time I made eye contact with her mother, who just shook her head.
“Your shoes are untied.”
I looked down. Right again, Jane. I bent down to tie them and looked back up at her.
“I’ll let you get some rest, but give a shout if I can do anything for you.”
“Let me get some rest?”
She was adept at calling out nonsense.
“You know what I mean,” I said, exiting and closing the sliding glass door.