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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 | |
| --------------------------------------------------------- | |
| 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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