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Although it’s common, the medical profession does patients a dehumanizing disservice when it defines anyone by diagnosis, particularly anyone diagnosed with a mental illness.  Of course, the “Gall Bladder in Room 3” will probably be just fine, whereas the “Borderline in Room 7” will likely be discharged with the same issues that brought her to the hospital in the first place.  But it’s not just the medical staff.  The patients define themselves by diagnosis too. You’re more likely to hear, ‘I’m a paranoid schizophrenic’ than, ‘I’m a college student and sometimes I hear voices.’  The already fragile psyche has stigmatized itself.

From her records I learned that Annie defiantly embraced her diagnosis.  On a limited playing field, she took pride in being the best at something where few sought a trophy.  It had its own perverse logic.  She derived her identity from being ‘a borderline’ and saw herself as a teacher of other borderlines. 

“I flunked DBT,” she bragged during intake.  DBT -- Dialectical Behavior Therapy – was the most effective treatment for someone as non-committal as Annie was to life’s infinitive, ‘to be.’  It taught basic skills, skills needed to stay alive, like how to walk step-by-step past disaster.  

Annie arrived on 3 East following several suicidal gestures, a smorgasbord of passive and aggressive attempts at self-destruction.  The serendipitous arrival of a friend usually thwarted her plan.  This last time, she upped the ante.  She swallowed barbiturates, then passed a razor across her left wrist.  When she changed her mind, she called 9-1-1 and left the phone line open as she spiraled into unconsciousness.   

*

Annie asked if she could talk to me.   

“Sure.  I have some time now.”

She invited me into her room and collapsed onto her bed.  I pulled a chair up close.  Annie’s features were distorted by crying and gaunt with weight loss.  Her chart indicated she was down six pounds from a week ago.  Her nightstand was a mess.  Sticky remains of last night’s juice smeared its surface.  Used tissues dried into stiff white clots.  An open composition notebook invited snooping.  She had a cotton ball taped to the antecubital space of her left arm from the morning’s blood draw. 

“How was your week?” I asked her.

“Just awful.  If I can’t get out of here, I don’t know what I’ll do.”

“Sounds like you feel pretty hopeless.  What’s going on?”

“Don’t talk to me like that,” she screamed, then started to sob.   

“Like what, Annie?”  I felt like I’d been slapped.

“Like a nurse or therapist, whatever.”

“I am a nurse.  How do you want me to talk to you?”

“Like a friend.”

“I care about you; I want to know what’s going on; that’s why I asked.”  How easily she walked over my carefully constructed boundaries.  “I don’t think you’re ready for discharge.  What would you do if you got out of here tomorrow?”

She stopped crying.  “They’d find me dead with a needle in my arm.”

“That sounds kind of dramatic.”

“I’m nothing if not dramatic.”

I laughed and she joined me.

“Okay, short of finding you dead with a needle in your arm, what do you want to do with your life?  What happens after here?”

“I want to write a book.”

“It looks like you’ve already started.”  I indicated her scrawled notes.     

“Like this.”  She pulled out a book she had tucked under her pillow and handed it to me.

It was worn copy of Girl Interrupted, the corners of pages tabbed down, passages that had special meaning for her underlined in pencil, doodles flamboyantly decorating the margins. This book was part of the body of literature in this field.   I flipped through it, read some of her notes. 

“I’m her,” Annie said.  

“You’re you.  This book’s already written.  You have your own story to tell.”  

“Will you read it after I write it?”

“Of course.  I’d like that.”

“Co-ol,” she said.  She studied my face, momentarily hopeful. 

I stood to go.   

“Evelyn…” 

“Yes?”

“Do you have to be so neutral?”

“Annie, you know the limits of our relationship.  Maybe a shower and some fresh clothes, clean up your mess.  It might help you feel…”

“Go to hell.”  There was something animal in her voice, growling, cold and hungry.

I kept walking.  Neutral?  When I thought of Annie I felt weary and sad.  I wanted to grab her by the shoulders and shake some sense into her; definitely not neutral.         

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