Julie Holland thought she knew what crazy was.
Then she came to Bellevue.

New York City's Bellevue Hospital, the oldest public hospital in the United States, has a tradition of "serving the underserved" that dates back to 1736. For nine eventful years, Dr. Holland was the weekend physician in charge of Bellevue's psychiatric emergency room, a one-woman front line charged with assessing and treating some of the city's most vulnerable and troubled citizens, its forgotten and forsaken--and its criminally insane. Deciding who gets locked up and who gets talked down would be an awesome responsibility for most people. For Julie Holland, it was just another day at the office.

In an absorbing memoir laced with humor, Holland provides an unvarnished look at life in the psych ER, recounting stories from her vast case files that are alternately terrifying, tragically comic, and profoundly moving: the serial killer, the naked man barking like a dog in Times Square, the schizophrenic begging for an injection of club soda to quiet the voices in his head, the subway conductor who watched a young woman pushed into the path of his train. As Holland comes to understand, the degree to which someone can lose his or her mind is infinite, and each patient's pain leaves a mark on her as well--as does the cancer battle of a fellow doctor who is both her best friend and her most trusted mentor.

Writing with uncommon candor about her life both inside and outside the hospital--her professional struggles, personal relationships, and the therapy sessions that help her crack the hard shell she's formed to keep the pain at bay--Holland supplies not only a page-turner with all the fast-paced immediacy of a TV medical drama but also a fascinating glimpse into the inner lives of doctors who struggle to maintain perspective in a world where sanity is in the eye of the beholder.

From the Hardcover edition.

Mother Nature's Son

On a warm day in early spring, two New York City cops and two EMS workers roll a gurney down the hallway, escorting a man to the entrance of Bellevue's psychiatric emergency room, where I work. Lying on the stretcher underneath a white sheet, with a head of dirty blond hair beaded and dreadlocked, he is naked, sunburned, and screaming. I walk out to greet my new patient as the drivers hand me his paperwork to sign.

"What'd you bring me?" I ask eagerly. I can see he's a live one. I love the live ones.

Over the shrieking, one of the EMS guys gives me "the bullet," the few pieces of relevant information when introducing a patient to a doctor: age, chief complaint, pertinent history. "This is Joshua Silver. Twenty-three. No significant medical history, no allergies, no meds. Also, he denies a psych history," he says archly, shooting me a look.

"And how'd he get to you guys? Who called 911?"

"NYPD called in an EDP." This is cop-talk for a psychiatric patient: emotionally disturbed person. "He'd taken off his clothes in Times Square and was parading around, barking like a dog. And growling," he adds.

This gets the patient's attention, and he interrupts the driver to clarify, "It was my way of showing them that I was not an animal. I am not a dog!"

Barking and growling to prove he is not a dog? His logic is lost on me, but at least he's stopped yelling and started communicating.

"You can talk to me," I say, turning my full attention toward him.

"See, there were some guys from Nation of Islam preaching on the corner, and they told a woman who was arguing with them that she was just a dog--God spelled backwards--to which I took offense." He then explains to me, as he did to them, that all people are art. " 'Thou art art,' I told them. 'Once you accept that all people, all objects, are art, you will live in heaven as I do.' "

"You know what, Joshua?" I ask, having decided it is time to move out of the triage area and into the locked area. "I think you and I should go talk about this inside." I want us to sit in an interview room so I can try to get some more history, and I don't feel like standing over him while he lies on a stretcher. I can already tell he's an admission and will need to be in the detainable area for patients awaiting beds upstairs.

I let EMS and NYPD know that they are free to leave, and I grab my new patient some hospital pajamas. I help him off the stretcher, wrapping his sheet around him, and walk him into the larger, locked part of the ER. As I escort him through the entrance, the door clicks definitively behind us, and I hope he doesn't notice that he is now locked in. Because he is naked, we can dispense with the contraband search, which is good. The search is often the point where people become uncooperative and agitated, ending up restrained and medicated.

Prior to entering the detainable area, a patient must remove his belt, shoelaces, rosary beads--anything that can be used to hang himself or choke a fellow patient. Inevitably, the patient will insist that he is not suicidal or dangerous, but it doesn't matter; these items are not allowed in the detainable area. Neither are cell phones, crack pipes, backpacks, knives, pens, wallets, and the list goes on. The patient has to give up just about everything along with his freedom.

Luckily, Joshua is oblivious. I show him to the bathroom where he puts on the pajamas quickly. I alternate between keeping an eye on him and setting up the interview room. There are several windowed rooms within the detainable area, each with a desk and two chairs. I put my chair closer...

 

 

"Weekends at Bellevue is a gem of a memoir. Holland takes us for a ride through the psych ER that is at once wild and poignant, a ride that leaves deep tracks in even the healthiest of minds."

 

"For anyone who has ever wondered what goes on in the mind of a psychiatrist, and what happens behind the walls of an institution like Bellevue, this is the book for you. An extraordinary insider's look at the typical days and nights of that most extraordinary place, written with a rare combination of toughness, tenderness, and outrageous humor, this book is a fast read that you will savor long after you have put it down."

 

"Equal parts affecting, jaw-dropping, and engrossing."

 

Julie Holland, M.D., is a psychiatrist specializing in psychopharmacology. An assistant professor of psychiatry at NYU 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, Slate, the Los Angeles Times, and The Wall Street Journal. Holland has appeared as a medical expert regarding mental illness and drug use on numerous television shows, including Today and Good Morning America. She runs a private practice in New York City and lives with her husband and two children in the Hudson Valley.

 

Weekends at Bellevue by Julie Holland
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