“I need your shoes,” the nurse said.
I looked at my blue Converse sneakers, and back at him. “What?”
“Your shoes,” he repeated, more firmly this time. “You can’t have them here.”
I almost protested: I know what you’re thinking, but the laces are just decorative. I don’t even know how to remove them. Instead, I took off my shoes and handed them to the nurse, who put them in a clear plastic bag. I started to wonder when I’d get them back, but then realized that I couldn’t think too deeply about that, because I felt so fragile that any stray thought could crack me like an egg. That was when I realized that I’d made the right decision to check myself into the psych ward.
“Thank you,” the nurse said, handing me a pair of socks. After I put them on, he escorted me to my room. “Someone will open that door every 15 minutes to check on you,” he said, the fluorescent lights above us glinting off his glasses. He handed me a pair of dark blue pants and a shirt and suggested that I change. I went into the bathroom and took off the hospital gown I’d been given in the emergency room and put on these new clothes, which looked like a cross between surgical scrubs and pajamas.
The bathroom had towels, shampoo, body lotion, a plastic-wrapped toothbrush, and a travel-size tube of toothpaste stacked on the sink. There wasn’t a wall hook to hang a towel on; there was no mirror. I was in a place of smooth surfaces and rounded edges, a place where shoelaces could become weapons and doors were never completely closed.
When I came out, the nurse gave me a tour of the ward. It was nighttime, and the wide, clean halls were empty. We walked past a large day room with a television, a couch, and small tables and chairs, and into the therapy room, which was dominated by four long tables pushed into a rectangle.
“And this is the library,” the nurse said, showing me a well-stocked bookcase. I hadn’t been able to concentrate on anything outside of my own despairing and anxious thoughts for weeks, but before then, reading had been one of my greatest pleasures. Now I looked at the shelves with cautious interest. I had checked myself into the psych ward because I urgently needed to be under a psychiatrist’s care, but maybe now I would be calm enough to try reading again. After studying all the titles closely while the nurse stood patiently by my side, I selected Reviving Ophelia by Mary Pipher and My Story by Sarah Ferguson.
Then the nurse led me back to my room, my sock-clad feet moving softly over the linoleum floor, quiet as a whisper.
The next morning, I saw the psychiatrist, who was accompanied by several medical students and a resident, who spoke first.
“You were admitted through our emergency department?” he asked.
“I wasn’t sure where else to go,” I said, a little defensively. “I’d been trying to find a psychiatrist, but every place I called was full. Some of them had waitlists but they were long … ”
“The psychiatrist I saw in the ER yesterday said that I met the criteria for admission,” I added, scared they would tell me I didn’t really belong here, and then I’d have to start looking for help all over again.
“Why don’t you tell us what brought you here?” the resident suggested.
I closed my eyes, trying to organize my thoughts. I told him about how I’d been diagnosed with breast cancer the year before, and my bilateral mastectomy, reconstruction, and radiation. I swallowed and then continued, aware that I sounded like I was reciting from a script: “I have chronic pain in my nerves and joints, and the mastectomy was my 11th surgery. I thought I knew what to expect, pain-wise, but recovering from that operation was excruciating. Both the physical pain, and it also messed with me mentally.”
“How so?” he asked, running a hand through his curly, dark blond hair.
I told him I had been waking up every day feeling completely sad and hopeless, like I didn’t know how I’d make it through the day. I hurt a lot. I swallowed, remembering the sharp pain; it had felt like the underwire of a bra was under my skin, cupping my implants. I told him I couldn’t focus on anything. It was a major accomplishment if I had made it out of bed before my daughter got home from school.
“Had you felt that way before?” he asked, and I shook my head. I told him I was diagnosed with anxiety years ago and took medication for it, but the mastectomy and reconstruction were totally different.
“How were you during radiation?”
Better. It was grueling, but not as painful, and I didn’t have that same feeling of despair.
The resident nodded, clasping his hands in front of him. I saw the glint of his gold wedding band and began crying. “I’m sorry,” I said. “It’s just that today’s my 14th wedding anniversary.”
“It’s OK,” he said.
I wiped my cheeks with the backs of my hands. I brought my hand to my neck and lightly touched the 2-inch scar on the left side, and told him about the other surgery I had a few weeks ago, to replace a degenerating disc in my cervical spine with an artificial one. Within a couple of days, I had the same feelings as after the mastectomy—anxious and hopeless and depressed, but all the time.
“Were you able to talk to anyone about how you were feeling?” the resident asked.
Yes. My husband and close friends were supportive, and sometimes I’d feel better for a little while, but those feelings always came back. I lost my appetite and started waking up in the middle of the night and couldn’t get back to sleep. My mind would go in circles, thinking about stupid things I said years ago or a job I didn’t get. It was like I was stuck in this cycle where all I could think about was either how I’d already screwed up or how I was going to screw up, and I didn’t have energy for anything else.
The attending psychiatrist stepped forward, closer to my bed. “What do you think will help you feel better?” she asked.
My primary care doctor can’t diagnose mental problems, I explained. I keep coming back to the idea that maybe a different medication would help now. “But the waiting list for every psychiatrist office I called was so long,” I said, starting to explain myself again, “that I came in here.”
“That sounds reasonable,” she said, her dark eyes kind and tired. “We can help you find a psychiatrist you can see as an outpatient, and we’ll increase the dose of your anti-anxiety medication. I also want to start you on an antidepressant. How does that sound?”
“It sounds great,” I said, so relieved that I almost started crying again. “It sounds amazing.”
“Good,” she said. “If you tolerate the medications well, you can likely go home tomorrow.” She smiled and said, “We’ll be back to check on you later.”
After the team left, I picked up a folder that had been in my room the night before. Among other papers there was a self-assessment for patients to complete. I didn’t know if someone would come back and ask for it, so I decided to fill it out.
The top half was labeled “Strengths,” the bottom half “Weaknesses,” and the patient was supposed to check a box next to the ones that applied to them. I assumed I would tick all the “weakness” boxes—after all, I’d checked myself into a locked psych ward. But as I read it, I realized that I actually had almost all of the “strengths” listed: I was educated, with a fixed address and supportive family. I was financially stable and could communicate well, had a strong social network, and could afford to be employed part time. The only box in the “strengths” section that I didn’t check was for religion, because I only go to synagogue on the high holidays.
A dozen years earlier, I’d worked for a reproductive rights organization. One of my colleagues was fond of using the phrase “interlocking systems of oppression” for how what looked on the surface like a minor inconvenience could have far-reaching disruptions. For example, taking off work multiple days for required doctor’s appointments could lead to a woman losing her job. This checklist seemed less a way of assessing someone’s mental health and more a way of assessing their socioeconomic status. Except that the two were so closely connected: not having a stable home life, or supportive relationships, or reliable employment can all contribute to anxiety, depression, and other mental health conditions.
And I thought about how the “strengths” that I possessed were also linked. If I hadn’t gone to college, I wouldn’t have had the level of professional stability where I could check into a psych ward on short notice and not worry about losing my job. I met my husband through college friends; our combined incomes enabled us to buy a house in a safe neighborhood. The self-assessment brought home that while mental health problems can affect anyone, recovery hinges on a number of factors, not all of which are within the patient’s control.
I blinked, realizing just how long it had been since I’d been able to focus on an idea that took me outside of myself and made me think more deeply about an issue. It felt good, like the relentless cycle of despair and anxiety had slowed down enough to let me breathe and rediscover my ability to think and concentrate.
Later, a social worker in a pale pink sweater came in, and we chatted about setting up an outpatient psychiatry appointment. She asked if I could pay the cost of the appointments out of pocket, because if I could, that greatly increased my options. When I said I could, her eyebrows shot up before her face resumed its expression of pleasant neutrality. An hour later, I had an appointment for the following week.
By nighttime, I had finished both books and received assurances from the doctor, resident, and nurses that I would be discharged the next day. I took my first antidepressant before bed, the small pill sliding easily down my throat, and then turned off the light.
I didn’t fall asleep, though. Instead, I thought about how much calmer I felt knowing that I had a psychiatrist now, and medications and a treatment plan. The relief was dazzling, and I wanted to stay awake as long as I could to bask in it.
But then I thought about what I’d had to do to get that relief. I’d always assumed that being admitted to a psychiatric ward was something that only happened when you were suicidal or had a mental breakdown; even at my worst, my depression and anxiety hadn’t risen to those levels. I wasn’t ashamed of being in a psych ward, but I couldn’t ignore the fact that I’d had to step out of my life in order to get help. I had to “other” myself in a way that I’d never had to do to get help for my chronic pain or cancer: I’d had to deliberately leave my family and home to get treatment as quickly as possible. I’d had to accept that I didn’t know how long I’d be away, and I’d had to agree to be treated as someone whose mental health could cause her to harm herself or someone else. Checking into the ward had felt like crossing a line: On one side, I was a person who could be trusted with shoelaces, and on the other, I wasn’t. And it was on that side that I was beginning to come back to myself.