Weekends at Bellevue by Julie Holland

 Weekends at Bellevue: Nine years on the night shift at the psych ER

2009. Bantam. Hardcover. 312 pages.

From: the public library

Recommendation from: Maphead’s Book Blog

In a nutshell:

For nine years, Julie Holland worked the weekend shift as a physician at Bellevue Hospital’s Comprehensive Psychiatric Emergency Program – in other words, the psychiatric ER. Patients are sometimes prisoners, sometimes people recently arrested, sometimes injured people referred to the psych doctors from other hospital departments. There are also patients who walk in for help, or maybe to fake their way into getting a bed for the night. Dr. Holland’s job was mainly to perform a sort of mental health triage, trying to determine if a person should be admitted or discharged, or trying to determine if a person is fit to stand trial.

Weekends at Bellevue chronicles Holland’s experiences at Bellevue, with particular focus on her own behavior and attitude. Holland sports a brash attitude that at times compromises her professionalism, and she works with a therapist to get to the root of her own issues. A large part of the book details Holland’s friendship with one of her mentors, Lucy, who also works at Bellevue until breast cancer claims her life. Holland also has a combative relationship with another doctor, Daniel, who is close to Lucy as well, which adds complications.

Review:

I think I was expecting something else from Weekends at Bellevue, maybe a marshaling of anecdotes to paint a broader picture of mental illness in our time. And there are definitely plenty of anecdotes, but the overarching theme of the book is Dr. Holland’s personal journey as a person and a doctor. There is nothing wrong with that focus, but when you have a psych doctor chronicling her own state of mind, the anecdotes tend to come with a thick layer of self-analysis. This meant that many anecdotes about patients seemed to be less about the patient and more about how the patient affected Holland. Thus there was a flavor of self-absorption to the book, which is, granted, always a risk in the memoir genre.

I will give Holland plenty of credit though for being brutally honest about herself. She doesn’t gloss over her mistakes and failures. With patients and even colleagues, she can be too aggressive, too detached and too cavalier. Holland feels compelled to show others that she is tough and can take anything that is thrown at her, but finds there is a cost. The following is an excerpt from the book, shortly after Dr. Holland has heard from one of the residents, Desmond, that one of the neurology patients jumped out a hospital window and died.

[Desmond:] “There’s some controversy over whether he smashed the window with an IV pole or whether he just hurled his body against it. But the window looks just like a body went through it.”

“Like a cartoon?” I ask.

Desmond looks at me witheringly, pityingly, and walks away.

What the hell is the matter with me?

Desmond is the poster child for Karuna, the Buddhist concept of infinite compassion. We both want others’ suffering to cease, and yet we go about it in completely different ways. Should I be more like Desmond, with his limitless undying love? My patients would be better off if I could stay opened up and available, giving and understanding, yet my remoteness resurfaces routinely in my work at the hospital. It is my protection, like a hazmat suit, and it’s been effective, so it’s hard for me to move beyond it, even though I’m trying.

p. 187

The stories about patients were probably the best aspect of the book. Also, I liked the chapter where Holland discusses the issues she faces in her private practice as a psychopharmacologist.

It takes some getting used to, the idea that a little pill, swallowed daily, can provide such substantial belief. Some people adjust to this new fact of life, and others fight it. I encourage my patients to stay on their medications for at least six months, to get comfortable with being comfortable. Many people feel better than they’ve ever felt, and that feels awkward. Whether it’s okay to stay medicated or not is a thorny issue.

p. 244

I wouldn’t have minded reading more about Dr. Holland’s perspective on psychiatric medications, informed as she is by observations of her own patients.

Quite a bit of the middle chapters are devoted to the fraught interpersonal relations between Dr. Holland and her ailing mentor, Lucy, and her colleague/rival Daniel. No disrespect meant toward the people involved, but this was the least engaging part of the book for me. I never felt that I had a good handle on Lucy as a person. Holland told the reader how much Lucy meant to her, but I never really ‘felt’ this closeness or the eventual loss.

Excerpts from others’ reviews:

BookNAround – “Julie Holland seems to have had something to prove in writing this book and while I don’t know if she’s proved it to herself or her intended audience, this was ultimately an interesting read for those of us outside the psychiatric community.”

Caroline Bookbinder – “I found myself anxious for Dr. Holland’s safety at times, glad for her insights at others, and overall very happy to have been able to glimpse into a world I hope to never see even as a visitor, even if it was so thought-provoking that it was hard to go to sleep afterward.”

Maphead’s Book Blog – “Just as Dante had Virgil to serve as his guide to the hereafter, I had the luxury of Dr. Holland serving as my guide to that city’s world of the mentally ill. But perhaps more importantly, what impressed me the most by Holland’s memoir was her ability to learn and grow as a person.”