When I first met her, she was wearing a hospital gown and sitting very still, cross-legged on her bed, with her hair draped across her face. She made no eye contact and said very few words in response to our questions.
My first thought is, "Man. This place would be rough for an 18 year old girl. I would be terrified if I were her." My second thought was, "Does she talk? Is she always like a statue?"
I gradually got to know her over the last 6 days. At first, it was just saying hi and hanging back after our team of white coats stopped hovering over her bed. I came by a few times a day and just said hi every time, and asked how she was doing and if there was anything she needed. She always said "No. I want to go home." And my heart broke for her every time. But I didn't know how to help her. She isolated herself from all other patients and took all her meals by herself in her room. She refused to even call her parents.
My first real breakthrough came over the weekend. The doctors and nursing staff had noted that she spent over 1 hour in the shower and were worried about that. I asked her about it, and she said, "My hair is thick. It took a long time to comb out. The brushes here are terrible." Well, of course. That makes sense.
So, I spent the morning trying to track down a different brush for her. I couldn't find a non-standard-issue one, because everything on this unit is basically contraband. But I tried. And I think it helped her feel like someone finally cared.
She whispered to me that she didn't think the nurses liked her. I asked her why, and she said, "They just seem exasperated." I told her that she could always ask for me, and that I would always come. She said, "I tried to ask to speak to someone once, and no one came." I told her I would come by more regularly when I could, and that if she had something to say at that time, she could tell me. If not, I would come by again later.
From that day on, I asked the team to wait outside and just one resident went in with me to check on her the mornings. She started looking me in the eye and talking with a normal volume. She said more than a few words at a time.
One morning, the nurses told her they would no longer bring her the laptop, and that she had to go to the nurses' station to get it herself. She said, "I guess I won't get it today." And I asked if we could walk to get it together, and she agreed. Walking together outside of her room felt like a victory to me.
We spent afternoons sitting in the TV room, half in comfortable silence and half in hushed chatting. She told me about her feelings about being here, and why she feels misunderstood. The hospitalization felt like too big a step to take when all she wanted was a regular outpatient psychiatrist to talk to.
She wanted to go back to normalcy, which for her, is a mostly-solitary existence and she prefers it that way. She prefers being alone, has few friends, few interests, and doesn't show her emotions much. By the book, she has classic schizoid personality traits. And that is her normal.
With every coming day, she brightened more and opened up to me more. I honestly felt like she would be better off at home and that she was not a danger to herself. I called her mother, father, and sister, and wrote extensively on our conversations. I was the only person on the team the patient would talk to, so I felt like I bore the burden of being the only one to feel like she shouldn't be hospitalized. The doctor team felt that a few days more with a change in medications would help. I didn't agree, but as the least important person on my team, I maintained neutrality and said vague things to her like, "Our team wants you to be safe and to see you doing well," which is true, but achieved in different ways.
She is a straight A student. We talked about college. Her main concern was that she couldn't afford it. My heart broke for her. To be 18 and worried about finances to the point where she was willing to work in a factory for the rest of her life was hard for me to hear, and made me check my own privilege. I told her that scholarships exist. That there are ways. There are resources. Please don't give up if that's what you want to do.
She asked me to be at her court hearing, so I walked with her and her supervising nurse down the locked unit. She wore her street clothes, looked at the judge, and stated the facts simply. She did not show any emotion and her face was flat. I wasn't sure which way the ruling would go.
I went to her room after, to ask her how she thought it went. She said it was an odd experience, to hear about yourself stated in that way. I took her down both paths: if you stayed, what would you do? If you went home, what would you do? She said, "If I stay, I might not talk as much anymore. It's nothing against you. I would just be upset. If that happens, I just want you to know that I appreciate you being here. Thank you. It's good to see young people with empathy." Which was entirely odd coming from a girl almost 10 years my junior.
In the end, the judge ruled that there wasn't clear and convincing evidence that she needed to stay any longer. Her hold was legally over. She could go home.
When I went to see her after the ruling decision, she smiled for the first time in a week. We talked about logistics of discharge, and other things I needed to cover with her. We set her up with outpatient psych appointments, gave her lots of resources, and made her promise to seek help if she felt hopeless or would hurt herself.
At the end, she walked over to me and opened her arms to give me a hug. She said, "I am glad to have met you. Thank you." I told her, "You are a bright girl. You have so much potential. Don't ever let anyone tell you otherwise. I hope you believe it, and I hope you do well. I hope to never see you again here."
....
My biggest fear (and fear of any psychiatrist) is that you let the people go who need help, and later find them to have committed suicide. That would be devastating. But in the end the judge ruled that she had the mental capacity and judgment to leave and make her own decisions. I guess one can never guarantee anything, and whatever choices she makes in the future are her own.
I wish there was some way I could keep in contact with her (and for it to be appropriate to do so) but there isn't really a good way. I hope she finds the support she needs to excel. I hope if even one thing I said to her encourages her in some way, then this entire week was for some good rather than the traumatizing, terrible hospital inpatient psych admission that I think it probably was. Experiences like these are why I like mentoring younger people, and why I hope to do it for as long as I can.
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