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#Post#: 521--------------------------------------------------
Holland, WEEKENDS AT BELLEVUE: NINE YEARS ON THE NIGHT SHIFT AT
THE PSYCH ER
By: agate Date: October 18, 2014, 12:38 pm
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Julie Holland, MD, WEEKENDS AT BELLEVUE: NINE YEARS ON THE
NIGHT SHIFT AT THE PSYCHIATRIC ER (2009)
Julie Holland, MD, became a psychiatrist and landed a post as
the weekend attending physician in the Bellevue CPEP
(Comprehensive Psychiatric Emergency Program, the psychiatric
ER at Bellevue)—a position she stayed in for 9 years, until,
after having two children, the lure of the comparative safety of
motherhood, home and hearth—and a (probably lucrative) private
practice led her to quit.
This book purports to be about her weekends at Bellevue.
We do get to know about some of the patients she saw—probably
the more sensationally lurid ones, like the man who had
concealed a razor in his rectum. But all too much of the book is
given over to miscellaneous details from the author's life: her
first colonoscopy, a well-nigh interminable account of her first
labor, and later a description of the very scientific way she
and her husband went about trying to conceive their second
child. We also get passages about her association with
actor/monologist Spalding Gray. We become aware that she and her
family have not only a Manhattan apartment but a country house
as well. She makes it clear from the outset that one attraction
of working intensive weekends at Bellevue (a couple of 15-hour
shifts) for her was that she would have her week free to do
whatever she wanted.
Fair enough, and understandable, particularly for someone in a
high-stress job such as hers must have been. But how is she
performing on that high-stress job? After the catastrophe of
9/11, she wants to find out if she’s needed at the hospital, and
says she spent 30 hours on the phone trying to reach the
hospital. She didn’t go in until days later. In fact, days after
9/11, she decides to get her nails done: “’I haven’t had a
manicure in months.’” She spends the days after 9/11 kayaking
and hiking in the woods.
She doesn’t soon leave her world of cocktail parties, Cape Cod,
and sailing just because emergency personnel might be in great
demand during a national disaster.
At another time she tells a patient she’s giving him the
Methadone he’d requested but actually intentionally gives him
the very powerful (and often dangerous) drug Thorazine even
though she knows that lying to a patient about what medicine
she’s giving is against the law. She seems almost proud of
herself for being flexible enough to do something like
this—mostly to accommodate a cop who wants this man sedated to a
“dead weight.”
She makes it clear that she’s often in danger as an ER doc at
Bellevue. She gets threatening phone calls and anonymous
suggestive phone calls. She’s afraid she’ll bump into a rapist.
One patient punches her.
OK, it’s a dangerous job. I wouldn’t argue that point for a
minute. But she has police flanking her at all times. She knows
all of them personally and works closely with them.
--As, of course, she would need to, given the system she is
working for. The mental health system, at least in the US, is
organized around a flagrant violation of human rights, after
all, even though most people prefer not to think about this
fact.
There are several ways in which a person can be locked up for
mental illness, and none of them is truly voluntary--unless that
person has money (quite a bit of it) and can sign himself up in
a private mental hospital of his choice, in which case he is
free to sign himself out as well. The rest of the US citizenry
finds that “voluntary” hospitalization is really an illusion.
Someone who has been reported as being a danger to himself or
others is offered two choices: go voluntarily with the officers
who will transport him to a locked mental ward, or else the
officers will take that person by force.
As anyone who has ever observed any part of this process knows,
“force” means just that. There are several police, fit as
fiddles and of course armed. If the person puts up too much
resistance, more force is applied. “Restraints” are used. A hypo
is given—an injection speedily and efficiently administered so
that the person quiets down fast. Later he will become aware
that he is in a place with bars on the windows, from which there
may be no escape.
“Voluntary”? And yet in her Glossary for this book, Holland
provides the shorthand used at Bellevue: “913” for a voluntary
admission, “939” for an involuntary one, and then there is the
“940” category, for a 72-hour hold, for an admission to the
Extended Observation Unit or EOU.
All through this book I felt that there was an elephant in the
room, and Holland never saw it. The system she was serving is a
brutal way of locking up people society finds inconvenient or
threatening, getting them out of the way, and usually doing so
very expeditiously. A psychiatrist can diagnose psychoses like
paranoid schizophrenia after interviewing a patient for only a
few minutes. Who looks at how long that diagnosis written on a
form took? Who looks at how that diagnosis was made? Nobody.
Julie Holland goes jauntily along, rather evidently enjoying her
immense power. She can decide whether a patient will be sent to
a different facility, sent back to prison, released, medicated.
Many people’s lives have been altered irreversibly by people
like Julie Holland, MD.
While she’s at it, she emphasizes her own desirability. She
gleefully details her several sexual encounters in the call room
with male doctors. The boy friend who must have become her
husband at some point in these nine years isn’t mentioned in
this connection. Later she gets a new boss, Maxwell, who kisses
her effusively and unexpectedly on the lips at a party—sickening
her. And so on.
This book is appallingly bad. Not just because it reveals the
author to be alarmingly unprofessional (and apparently almost
proud of the fact) but because she indulges in trendy language,
as in “My tough-guy confrontational thing is so over,” and the
account is sloppily written.
And yet towards the end Holland is exuding compassion for the
homeless on the street: “They’re my people”—as she prepares to
leave Bellevue forever, and she smugly concludes that “Not
everyone is built for Bellevue like I was.”
Her specialty seems to be psychopharmacology and she clearly has
great faith in the efficacy of drugs in overcoming mental
disorders. She is presumably whipping off prescriptions in her
private practice even now. One can only be glad that she is no
longer at Bellevue, but there is the unfortunate probability
that other psychiatrists, like her or far worse, have come along
to replace her.
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