462 First Avenue, New York, NY, 10016
I am aware of Bellevue's notoriety.
The thought of working in the country's oldest public hospital was at first not a particularly enthusiastic one. I was unnerved by its reputation and presence in the world of healthcare. I wasn't going to contribute to New York's Bedlam. I wasn't going to end up a doctor who didn't care.
The thing about searching for an externship (and - if I am honest - being a Sagittarius) is that sometimes original plans fall through, and sometimes a person is lucky for that. I'd pulled letters of recommendation together and wrote an enticing personal statement for another healthcare organization, mailing it in early November and dreaming about the experience I'd gain from working at a forensic psychiatric institute. A month of silence went by and I started calling, emailing - I nearly showed up to the building in search of an answer of why they didn't want me.
On December 21st, one solitary email appeared in my inbox.
"Your materials recently reached me. Unfortunately, we are not able to offer you an externship position here for the upcoming year. Best of luck in the future."*
Shit. I called the program advisor and asked her what to do next.
"Have you considered Bellevue?" she asked tentatively.
"Yes," I mumbled, scrolling through its Wikipedia page as she recited my future supervisor's email. I thanked her and modified my cover letter, sending it to him with a deep breath.
The call reached me an hour later. "I read your letter," the man who would become my supervisor told me in a deep, soothing voice. "When can you come in for an ID?"
"That's it?" I asked dumbly - surely there must be more to the process.
"It's not every day we get an email from someone with experience like yours, Anna. And you've clearly thought about this work. Can you be here next week?"
I say all of this not to revel in my supervisor's compliments, but to explain what a whirlwind of a process it was, and to comment on how quickly life can change - even when you're certain that you need something else. Bellevue was not part of the plan. Working at a hospital was supposed to come later in life - after I'd convinced myself that I could work with truly unwell people.
What my supervisor saw - what I couldn't see at the time - was that I was ready to do that work. I grew exponentially at Bellevue, but my foundation was strong. Earlier in my career I'd sat down with an advisor who told me that I'd better come up with a good story to explain why I'd spent so much time messing around in correctional facilities and syringe exchange programs, because it wasn't lab work and Ph.D. programs weren't looking for things that weren't lab work. I shudder to think of how intimidating the hospital would have been had I not been engaged in some sort of direct service already, especially with people who were living with substance use disorders, mental illness, and a history of incarceration.
Because of that, I can't in good faith say that everyone is well-suited to a treatment environment like a hospital. If I thought I'd experienced transference before, it paled in comparison to what I'd encountered working in the adolescent emergency room. I thought I'd had a good grip on mental illness until I started working with people with personality disorders - work that I'd absolutely loved, but was like nothing I'd ever experienced. Up until my first week at Bellevue, vicarious trauma was something I'd read about that other people experienced. I'd leave the hospital with lead in my lungs and I'd stare straight ahead on the subway, unwilling to make eye contact with anyone lest I learn another thing about a person's life.
"I'm so tired," I'd relayed to my mother halfway through that week. "It takes - it takes so much out of me."
"Are you going to be able to do this?" She'd asked, her voice tinny and small over the phone.
"I'm going to have to," I'd answered. "It's either figure this out or get into a new line of work."
It got easier with time. It always does. I quickly established myself as one of Bellevue's most trusted externs, cleaned out an office for myself, and secured a place in the hearts of the creative arts therapists who mentored me. I am forever grateful for their tutelage, and for believing in me even when I was hesitant myself.
Everyone always has an opinion on Bellevue. Mine shifted dramatically once I began doing the work, and shifted a bit more as I continued. Some people gave me an understandable amount of grief. "You must have some crazy stories," they'd say, as if they could skin me like a grape to get a glimpse of the presumed atrocities I'd witnessed. "Not really," I'd answer, effectively ending the conversation. I didn't want to rehash my patients' lives with voyeurs.
What was most surprising, though - and more satisfying than I could have ever imagined - was listening to the people who spoke to me with gratitude in their voices. "You all just do such good work," one woman told me with the utmost sincerity. "I had a niece who was there, and she just...you helped her so much."
That is what we do at Bellevue. That is what I did at Bellevue - I eased pain when I could. And while I don't agree with every practice there, many of the people I met were there for the right reasons. I walked in expecting the worst and walked out a better treatment provider. Above all, I learned to act in the best interest of the patient - even when it meant pushback; even when it meant summoning courage from deep in my stomach to do so.
Bellevue was exactly where I needed to be. The treatment teams - notorious though they may be - believe in the mission of treating everyone, regardless of who they are or where they came from (or what they did to get there). My patients changed weekly and my work wasn't limited to just one section of the hospital: one day I'd be working in palliative care; the next I'd be working with patients with traumatic brain injuries. I learned the languages of mental status examinations and compassion and did my best to integrate them both. I was very good at it.
Had I been placed in a forensic psychiatric unit, I wouldn't have been exposed to such an eclectic pool of people to work with. I wouldn't have seen court, adolescents, emergency rooms, or how to integrate the arts into my work. I would have been stifled by the limitations of another place. Bellevue never stifled, and Bellevue told me over and over that I was to act in the best interest of the patient. We saw everyone. I would treat everyone.
John Jay told me to become a fierce advocate for justice. Bellevue gave me the platform to do so. Someday I'll write about it all, but until then, I've written about a few moments I had experienced that sit just behind my teeth.
I don't subject my patients to voyeurism. But I understand the value in unstitching these stories from my palms. Remember the people in these stories are unwell. Remember that I am still incredibly new to this work.
I once told my therapist that I'd felt like I'd left my bones at Bellevue. That I was afraid of what would happen when I graduated because it meant that I couldn't come back to the hospital. "I scattered them everywhere," I told her. "I don't know how I'd go about picking them back up."
I appreciate a good metaphor and so did she. All I meant was that I felt so deeply attached to the work that I felt like I had to give a part of myself up to it.
"Could you not instead hold the experiences inside yourself?" She'd asked.
I considered what it would be like to hold memories underneath my ribs like snowglobes, and if they'd clink beside the bottles that held all my other feelings.
"I could try," I answered. She'd nodded approvingly and I set out to learn to take rather than to give.
I've lost those bones, but I won't lose more. So I write about the patients who are holding them. Maybe someday they'll give them back.
*They didn't take me because the person who was running the extern program had retired - not for anything I did or didn't do. Sometimes it really isn't about you.