We’re worn down.  I’m worn down.  I dread my long weekends locked onto 3 East with A.  The staff meets weekly for debriefings and diagnose each other with compassion fatigue.  We veer between giving up on her and belief that she’s tough and will survive.  We’re horrified at our visceral responses to her – anger mainly – and surprised when our collective negative energy evaporates as she charms us with a joke or smile, some token of affection. 

She should be out having fun with friends, attending college, enjoying a loving family.  Instead she spends her time with us, binging, purging, cutting, committing desperate acts of near self-destruction, attention-grabbers.  Both victim and predator. 

In my better moments, I compare her to Tinkerbell; A. doesn’t stand a chance unless we believe in her.

She has a bad week.  She’s handcuffed and escorted by a Multnomah County sheriff’s deputy to court, where she’s civilly committed to 3 East for a period of six months.  An older man who fills the role of lover, who’s accustomed to their reciprocal use of each other, disappoints her by taking up with someone else, someone who isn’t hospitalized.  Her uncle doesn’t visit; her mother doesn’t call.  She’s been with us a month.  A commitment buys her – and us – some time.                  

One of the staff psychologists takes her for a walk on the quiet street in front of the hospital, for some fresh air and a smoke.  A. runs toward the busy intersection and darts out into traffic.  He runs after her and tackles her down; cars skid and slam on their brakes. 

That week I feel the prickly aftershocks of this incident.  The staff is vigilant but gives her space.  She’s off "constant."  I count the number of times she paces the length of the ward.  Seventeen laps equal one mile; she does twice that. 

My stomach muscles hurt, braced against threat.  The signs are there.  We take turns walking past her room.  I feel apprehension but not surprise when I hear the crash in A.’s room.    

She stands on a chair with a fragment of fluorescent light bulb that she’s broken out of its ceiling cage.  She slashes at her wrists.  Blood drips onto the floor.  I grab towels to apply pressure while two others take her down from the chair.  When we attempt to pry the glass from her hands, she puts the shards into her mouth and swallows.  A. slithers and writhes across a floor that glitters with fragments of glass.  Her mouth oozes blood; she bites at us.

"Code Green" echoes over the hospital speakers and trained staff arrives from all departments.  The emergency room nurses are there when A. loses consciousness and turns blue.  We have minor cuts and bruises and other deeper injuries that don’t show.

Closure is overrated, and in our line of work it’s elusive.  Sometimes I read about a former patient in the newspaper – usually bad news.  Or I see a photo of someone vaguely familiar poised on the Burnside Bridge.  Not knowing is my way of holding out hope.

A. is referred to the state hospital, but does not meet their criteria for admission. Her problem is behavioral; she isn’t psychotic.  She’s lucky; the state hospital is no place to get better.    

A. is discharged early at the end of May into a run of good weather.  She gets better. She gains weight; she hasn’t cut herself in a month; she discusses her behavior with seemingly mature insight.  I’m not sure her improvement has anything to do with us.  

In the next few months I hear rumors that A. is or has been in our emergency department after another suicide attempt.  I want to see her, but I don’t want her back on 3 East.  It’s another hospital’s turn.      

A year later I find a note taped to the clinical desk inviting us to A.’s memorial service.  There’s a phone number if we want additional information.  I don’t call.

Evelyn Sharenov