The cool quiet of my car is blessed solitude before my workday.  The drive to Portland begins in darkness and silence.  I don't turn on the radio — just listen to the roads and freeways.  Although it's still warm, day and night move toward the balance of September's equinox.  By the time I walk onto the ward, bright sunlight filters through the Lexan windows onto worn hospital carpet.

Which is to say that that September 11^th starts pretty much like any other September 11th.

Most of my patients are just coming to life.  By the time they venture from their beds and are marginally awake and dressed, I know the rudimentary facts.  In a series of coordinated suicide attacks, two jets have pierced the World Trade Center's Twin Towers in New York City, a third has crashed into the Pentagon, and a fourth is down in rural Pennsylvania.

I obey the human imperative and call family in New York, but the lines are down or busy or there's no one there to pick up.  A flat electronic voice politely tells me all lines are busy and suggests I place my call again later.  The ward manager wants to pray with me.  I'm not a believer, but this morning I need a binding ritual.    

In the usual scheme of things, a disheveled shuffling line of patients stops by the clinical desk to pick up their medications on their way to the community room; then breakfast and a morning news program, followed by the first group session of the day.  There's an eerie inevitability to what happens next.  In a moment someone will turn on the large-screen television.

In the course of eight hours, we — two nurses and three therapists — watch together as an endless loop of video crazily replays itself and the Twin Towers collapse and rise again and again in a bizarre demonstration of death and rebirth.  We're mesmerized by the spectacle, the upturned faces of New Yorkers, mouths open to receive burnt offerings — the ashes of family and friends.

The most delusional of our patients incorporate the television images into their illness; they smell burned flesh and hear screams that we refuse to imagine.  They watch without the filters we take for granted.         

A young man sits up close to the television, close enough to distort any coherent image.  "There, watch that body explode," he yells.  He's somewhere between terrified and excited.

The young man's hair winds into a dozen or so thick blond Rasta plaits.  Dark stubble sprouts like newly mown lawn on his drawn cheeks, and his arms and legs are dotted with old or healing needle marks. 

He's a literature and philosophy major at a small private college in Portland, the domain of the scions of educated well-to-do parents or talent large enough to earn a free pass.  His heroin use masks the paranoid delusions and auditory hallucinations of his psychosis.  He's on 3East in the middle of his first relapse — a month after he stops his medications. 

He'd felt fine.  He had a new girlfriend and wanted to lose the weight he gained from his meds.  He wanted to devour her, fuck her dusk to dawn.  Normal desires.  And the meds interfere with all of it, disrupt everything, not just his delusions. 

Now he's up all night and can't study.  He's restless and his approach has an edge — sometimes mean and off-putting.  His interpretation of reality differs from mine.  He's twenty and has embarked on what will probably be a lifelong struggle with schizoaffective disorder — a combined thought and mood disorder.

Another man, this one middle-aged, puts his arm around his college-aged peer.  His face falls into easy creases and jowls.  He's protective, coming through a vegetative depression — the kind of smothering mood disorder that holds you to your bed.  With the help of ECT — electroconvulsive therapy — and medication, he's fully awake.  His hairline retreats, the remainder grays, ambivalent on how to grow old, but he's clear eyed and animated.  His relentless depression, now lifted, provides new insight.  The two men share a room and are fast friends.  They sit together at meals and in groups.  The older man attempts to impart wisdom that's eluded him in his own life: you have to take your meds. 

Both men — in fact, most of the male patients — wear athletic shoes without shoelaces, ward policy.  During groups, a row of shoe tongues loll to the side like panting dogs.  This morning, no one leaves the community room to wash or dress; pajamas and bad breath are the order of the day.  Schizophrenia and major depression are untidy illnesses, and more so on September 11^th.

Part two next week.

Evelyn Sharenov