Louisville Medicine Volume 66, Issue 5 | Page 14

REVIEW
WEEKENDS AT BELLEVUE
Nine Years on the Night Shift
at the Psych ER
By Julie Holland, MD
© 2010 Bantam Books
Reviewed by
M. Saleem Seyal, MD, FACC, FACP
W
eekends at Bellevue is a
gripping tale of Dr. Julie
Holland’s memoir about
her medical education
and residency training,
but primarily as an attending psychiatrist
working at the iconic Bellevue Hospital in
New York for the weekend night shift for nine
years. Reading through this book is a wild, fast-paced romp with
high-spirited and honest prose with no-holds-barred pronounce-
ments. She very candidly describes her encounters with a multitude
of patients with various and sundry issues in the Psych ER. She
took extensive notes of her recollection of verbatim conversations
with patients “to exorcise the demons,” when she got home on
Monday mornings after two crazy days at work.
In the first chapter of the book, a patient encounter starts with a
bang when a manic patient, Joshua, is brought in by police. The story
is narrated with precise detail. Joshua is found completely naked in
Times Square, parading, growling and barking. In the detainable
area of the Psych ER, Joshua is “hyper-verbal, spewing non-sequi-
turs” and talking about grandiose religiosity. Getting any coherent
history in this psychotic-manic phase with rambling thoughts and
a flight of ideas is decidedly difficult. After much discussion and
listening to his being a “holy man,” his pronouncements and his
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supposed miracles, and to his considerable chagrin, she has to break
the ultimate news to him that he needs to be admitted in the psych
ward involuntarily. She continues with many other patients all with
different kinds of mental and emotional issues.
There are moments of tenderness, compassion, toughness and
humor throughout these remarkable tales. There are instances of
macho swagger but also regrets and shame about being tough and
harsh to patients.
Dr. Holland did her pre-med courses at Penn Med in the late
1980s and psychiatry residency at Mount Sinai Hospital in New
York City; after that she ended up at Bellevue Hospital. She loved
the experience, was “enthralled by insanity” and delighted in taking
care of the patient population who showed up there because she
wanted to “play with fire, to swim in the deep end.” Bellevue located
in Manhattan, New York, is the oldest hospital in the United States,
and opened as a six-bed infirmary in 1736 with an unalterable and
continuous tradition of “serving the underserved,” similar to Cook
County Hospital in Chicago, old General Hospital in Louisville
and many other institutions scattered across US cities. Bellevue
was used as an almshouse, a penal institution, and subsequently
an asylum for the insane was added in 1878. Bellevue hospital has
been a full-service hospital that holds the honor of having the first
ambulance service, maternity ward, emergency room and pediatric