Suddenly she breaks out in gasping sobs and yelps, “I’m scared! I’m so scared!”
I ask her if she knows what she’s afraid of. “No,” she says, “I didn’t know I was scared until the words came out.”
I start to talk to her about fear and she aggressively says, “Is this about God?”
“No,” I say, and talk to her about epinephrine and cortisol, the adrenal glands, and fight or flight. It doesn’t matter; it isn’t on the right track for her.
She has bronchitis. “Do you smoke?” she asks me. There is the raw need to connect with someone, to know if anybody else is like her.
“I used to,” I say. I start to run the litany of things that could be making her feel so awful. “Are you taking any medicine?”
“I got the shot today. I get the shots, once a week, you know.” Yes, I know. The psych medication that is given by injection.
“Did you feel like this after the shot last week?”
“No.” She tells me she’s had bronchitis for three weeks. I suggest that being sick can make you feel emotionally crappy.
“No,” she says. She took the antibiotics for ten days, but that ended last week.
The other line rings. I excuse myself, put her on hold, and answer the other line. It is a young man, also someone who has called before, but not often and not recently. He starts to talk before I can properly greet him, telling me that the bad voices are telling him to hurt himself. “Oh, shit,” I think. Choose one: the lady or the tiger? The woman in despair or the guy going to hurt himself?
The woman has already gotten about fifteen minutes; maybe she can go it alone now. I cut back into her line and ask her if she could call back in a little while. We both know that they’re only supposed to call once each shift and this is special—me asking her to call back. She is dutiful, docile. After years of being beaten down by the system, she knows she is supposed to accept this, and she’s trying to. Then, suddenly, a blind, anguished wail and the words: “I have some pills!”
“I have some pills.”
Jesus, she’s going to kill herself! She’s scared of dying! She cannot endure the pain and if I cut out now, she will take an overdose. She simply cannot endure the pain.
This is the moment of horror. You know somebody’s life is in your hands and you have no idea what to do. You want to do what everybody else does: pass the buck. I don’t want this responsibility. You want to call 911, knowing they will send the first available emergency vehicle—police, fire rescue, ambulance, whatever—and “trained professionals” will take over. The problem is that trained professionals don’t like the “mentally ill” and treat them badly.
Trained professionals don’t care very much, and don’t want to be caught in the middle of this, and want to do it by the book: subdue the patient, restrain her and transport her to an emergency medical or psychiatric unit. Turn her over to another bunch of trained professionals who also don’t want to deal with her. They will isolate and seclude her, and then do their very best to ignore her. They want her to be somebody else’s problem, too, so they will triage and admit wherever they can find a bed. The facility she is admitted to will lock her down and drug her.
I cannot do this to her; cannot send her into the darkness of inpatient psychiatry.