"How do we know the attacks are over?" a woman asks.

Her hospital stay was preceded by an overdose of opiates.  A double mastectomy, chemo, and radiation knocked out that part of her reptilian brain devoted to survival.  She’s in her fifties, with disheveled gray hair.  A bright purple blouse flutters to her waist like a deflated foil birthday balloon. Residual glue from electroconvulsive therapy electrodes sticks to her temples; tufts of hair stick to the glue.  This lends an unfortunate comic air to her otherwise forlorn appearance.  She huddles into a chair.  We’re supposed to help her feel safe. 

“What if they bomb us here?”

“How do we know this is real?”

“Yeah, what if they staged it?”

They look to us for answers.  While it seems unlikely that terrorists have much interest in Portland, Oregon, none of us feel safe.  We do, however, know it’s real and we have nothing to offer except words, soothing and hollow, words that don’t reflect our internal landscapes, our churning dread and apprehension.    

The attacks resonate with my own terror of being trapped on an airliner going down; my fears go back to my childhood.  In third grade we train to "take cover" during air raid drills.  It’s cold down there on the floor under our small desks, but not as cold as the Cold War.  The desks are barely wide enough to contain our length, scalp to feet.  We cover our heads with our arms and tuck our legs up under our bodies.  I’m young, but not so young as to believe that this will help if an atom bomb falls on us.  Depending on what we’re made of – brick, glass, flesh – and how far we are from ground zero, we’ll incinerate, liquefy, or vaporize.

Sometime that afternoon, my father calls.  I keep him in a nursing home in Portland, as if I own him and have that right.  In the twilight of our relationship, he’s hobbled by dementia and doesn’t remember how to use the remote control or how to end a phone conversation.  He’s a captive audience.  We weep about the city we know so well we can walk its streets in our dreams and never get lost.  I call the nursing station and ask them to hang up my father’s phone and turn off his television.  Other than that morning, he’s been doing well, the charge nurse informs me.

When I leave the ward that afternoon, a hunger overwhelms me.  I want to hold tight to something innocent, a void so young and pure it’s untouched by breath or fingertip; it has no history, no double helix, no DNA.  I visit my father.    

The next morning everyone is haggard.  The emergency room has filled and emptied and filled again during the night.  We have no empty beds.  Disturbed sleep and dark dreams prevail.  The hospital ramps up staffing as aftershocks shift our roots from shared foundations – the common expectation of safety on our own soil.  The first group on the first morning after 9-11 tallies nightmares – a Ground-Zero litany for the mentally ill:     

“My house crumbled with me in it.”

“I was burned alive.”

“A baby floated through the air toward me.  It had no arms or legs.”

“I jumped out of a window, but I woke up before I hit the ground.”  

In the big picture, I’m a bit player, an editor in the narrative version of their lives.  I enter in the middle of the story, do a brief cut-and-paste, and move on.  My tools are limited: medication and conversation, as much art as science.  I’m a conduit: the scalpel, the IV bag, the splint that holds the fractured psyche together until the crisis passes and the patient can stand on his own. 

There’s always the question: what separates us from them, staff from patients?  Any answer anchored in hard science is a long way off.  Other than that, there are different answers on different days.  On some days what separates us is a matter of degree.  Anyone who experiences an emotional toll – the loss of a child, a life-threatening illness, the turmoil of divorce – knows how fragile sanity seems at times, and rests well when the chill of danger passes.  One morning you wake up and understand you’ve averted disaster. 

I know it’s unlikely I’ll experience the horrors that bring men and women to the ward because whatever trigger, genetic marker, or errant DNA, whatever neurotransmitter in whatever area of the brain has done this to them has not done it to me.  Whether by luck or design, I remain upright.  

The emotional and physical boundaries that are essential on September 10th mean less on September 11th.  On September 10th, the physicians, nurses, and therapists on the ward have the power to say who’s mad.  It’s easy – anyone who sleeps on this thirty-bed ship of fools is mad.  What separates us on September 11th is just this: precious little.  For a brief period of time, shared disaster obliterates the biological and cultural contexts of mental illness.  What we have in common is greater than what distinguishes us from each other.  Jets crash into the familiar landscape of my childhood and carefully established roles change, patients and staff coalesce, one superimposed on the other.     

On September 10th sanity is a worldview, a consensus.  Madness requires witnesses. On September 11th we are all witnesses, sane or mad.

*

At this writing, seven September 11ths have come and gone.  Life moves on and away for those of us who shun the political drama and morally confused pageantry of what is now a more private sorrow.

On another brilliantly clear, splendidly warm day in Portland, in another clinical setting, it’s September 11th again.  A young man enters my office.  There are outward signs that he takes antipsychotic medication: tremors, fatigue, a broad abdomen, but vestiges of the handsome boy remain.  Although he’s making progress toward his goals, this morning he sweats profusely and he’s hypervigilant.  He startles when my phone rings.  He requests a prn – a medication dispensed as needed to treat transient symptoms of anxiety or agitation.

“It’s September 11th,” he says.  On the television in the day room, another group of patients watch the towers fall.    

Evelyn Sharenov