Weekends at Bellevue: Nine Years on the Night Shift of the Psych ER

Nursing Book Club

Weekends at Bellevue: Nine Years on the Night Shift of the Psych ER

An insane career move?

By Julie Holland, M.D. (Bantam Books, 2009)
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Reviewed By Christine Contillo, RN, BSN

I picked up Weekends at Bellevue by Julie Holland M.D. thinking that since this hospital catches just about every indigent in New York City, the stories might be outside my comfort zone and pretty entertaining. At least it might offer something useful to learn about mental illness.

What I found out confirmed my preconceptions about psychiatry. There’s something very special about the people who go into this field, and there is absolutely no predicting human behavior.

Personal Insight

Dr. Holland’s memoir goes beyond just stringing together essays about her patients. She gives a thoughtful rendering of her own past, from a tough motorcycle-riding broad in a rock group to becoming a young wife and mother. The change comes slowly over almost a decade and includes a therapist who helps her gain insight into her own behavior. What? A psychiatrist who needs a therapist? Another preconception confirmed.

The author begins her position as the 30-year-old weekend attending physician in charge of the Bellevue Psychiatric Emergency program working two 15-hour shifts each Saturday and Sunday. This is the oldest continuously working public hospital in the U.S., dating back to 1736 when it began as an almshouse. The pavilion dedicated to the insane opened in 1878. On the old police show Barney Miller, “Take him to Bellevue” was the order for anyone arrested with a severe mental problem. For the New York metro area, it’s where all the real crazies seem to end up, according to Holland.

Calling Central Casting

We follow Julie Holland as she begins her service with the locked wards and tough nurses, finds a mentor and learns to take a good patient history. We find out that even good attendings can have problems with the hospital administration, that policies no one likes are universal, and that nurses aren’t the only employees who think they are underpaid.

It’s clear to see, though, that people who have stressful jobs need to feel that they have some support, and we watch as that happens. Basically, we see Dr. Holland grow into her role. This would make a good television show if we added some character actors —
I can almost picture them now.

Trial by Fire

But don’t forget the patient stories! The author treats a man who believes he is God (a common delusion). She medicates bipolar patients, serial killers and trauma victims. She is working there during the 9/11 attack and sees the fallout for years. Her skills are called on not just for patients but also for traumatized families.

Many of the patients are brought in by law enforcement and we see her frustration in deciding if someone is competent enough to stand trial or needs to be hospitalized. It’s a tough job, determining the level of sanity, and we see just how tough it can be. City living is stressful, New York isn’t easy, she does a great job and we watch it all pull together.

Weekends at Bellevue is engaging and fast-moving. I was caught up with just how different the work in the Psych ER is from the cushy job I envisioned for psychiatrists. No couches, no plants, no expensive decor and tailored clothes, but through these nine years and thousands of patients we watch Dr. Holland work her psychiatric magic.

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Christine Contillo, RN, BSN is a public health nurse who suggests joining a book club as a reason to put down trashy magazines and look smart on the subway.

This article is from workingnurse.com.

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