Annie was in the middle of a handstand pushup against the wall outside her room.  Balanced on her palms, her back and legs straight up, she pushed off without a sound.  A cropped tee fell to her bra line, exposed the bone marimba of her ribs.  Her tangle of auburn hair spilled to the floor and she had the translucent skin I associated with redheads; an appealing scatter of freckles dusted her nose.  She looked more like a gangly teen than the twenty-five-year-old I knew her to be.  

“Hey,” she called as I passed by.  She rose on thin, sinewy arms without missing a beat.

“Hey yourself.”  I bent and smiled at her upside down face.  She grinned.

“Could you help me?  I need to shave my legs but someone has to watch me, and” – she sniffed toward the clinical desk – “they’re all too busy.”  .

Her arms extended in the handstand revealed the black sutures that held together the separated edges of her flesh.  Her self-inflicted wounds were almost healed. 

“I’ll see how my morning looks and get back to you in a few minutes.  You must be Annie.”      

“You heard of me?” 

“You bet.”  I had just spent an hour reading her file.  “I’ll see you in a bit.”

I’d been a mental health nurse for three years, but Annie was a first for me:  The frequency of her hospital admissions and the severity of her illness were challenges I had never before faced. 3 East was a thirty-bed locked psychiatric ward on the third floor of Woodland Park, a community hospital on the east side of Portland’s Willamette River.  We admitted patients in the acute phase of their illness for assessment, stabilization and referral back into the community.  I worked back-to-back sixteen-hour shifts, Saturday and Sunday.  It was Saturday morning, the start of my workweek.   

The file I had been reading before I encountered Annie in the hall was seven inches thick, the clinical equivalent of hundreds of thousands of frequent flier miles.  I scanned the chart with information distilled from the records of her hospitalizations and outpatient treatment.  This was her first visit to Woodland Park Hospital.  It was hard to believe the upside-down in-person Annie could have burned as many bridges as hospital-chart Annie.   

Joanie, a newly minted MSW, was at the clinical desk watching the monitors that revealed areas unseen from the station and prevented elopements and assaults.  She was new to 3 East, working her way out of the deep hole of college-loan poverty.  We were a subset of a weekend team that included six therapists, five nurses, and five psychiatrists who rotated call.  We had each other’s backs in emergencies.   

“Any reason I shouldn’t help Annie shower and shave her legs?”

“Yeah.”  Apparently Alan, our second morning therapist, was busy facilitating a group – one that Annie, although invited, had refused to join.  Both Joanie and I were needed on the floor.  Several patients were still asleep in bed or just waking up. 

I checked my watch.  Breakfast had come and gone while I’d gotten caught up in Annie’s history. 

*

Annie had been admitted three days earlier, on Wednesday, on a Notice of Mental Illness – a psychiatric hold for patients who posed a danger to themselves or others – with a diagnosis of borderline personality disorder.  Because her illness had been well documented over its ten-year course, we knew what to expect, up to a point.  Her overly bright greeting, the strenuous exercise, her mood of the moment could swiftly devolve into something dark and irrational.  

The file showed that she could manipulate staff, hating then loving, going from zero to sixty in the time it took her heart to beat twice.  She would rage at those who were supposed to love her, who perhaps did love her once, until it got too hard.  She would rage equally at those who tried to hang onto her.  We could expect her to try anything to fill the emptiness that – like an organ not visible on a CT scan but with an anatomical location near the human heart – came with her disorder. 

Beyond genetics, we recognize people by their personality traits – the quirks and behaviors and emotional landscapes that make us different and distinct.  A personality disorder is a maladaptive response to situations established in childhood; sexual abuse, for example, is taken out on oneself and everyone else, rather than successfully treated in therapy.  A person diagnosed with a Borderline Personality Disorder like Annie suffers extremes of emotion and acts out in the form of suicidal gestures.  There are website for people like Annie that cater to self-cutters.  She shared creative nihilism the way friends shared clothing and secrets.     

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