I sat on the hard, gray plastic chairs under the fluorescent lights in the public, provincially run hospital.  People were bustling all around me: patients, nurses, doctors, family members, paramedics. I sat in a fog, but at the same time I was aware of everything around me.  I noticed the man, with his buddy, whose arm looked like it had been punched through a wall; they were collegially joking about it.  They were dressed in torn jeans, black t-shirts with some sort of beer ad or rock group on it and solid looking shoes.  There was an elderly lady whose left side of her face drooped, and she had a look on her face that was somewhere between terrified and vacant. She was stooping (yes, stooping, not sitting) in the chair next to her grandson in his early twenties.  He is terrified, fraught, unsure, and looking around furtively for a nurse. He did not look like he was old enough, had the experience, nor wisdom to advocate for help.  I wondered how much longer this woman had.  In a different lifetime or circumstance, I might have advocated for her and got the attention of the Emergency Department nurse, but today I was wearing a different hat. I was not a person in the place of power nor with the power. I was not a fourth-year nursing student. That identity had to be put on the shelf. Today, I was a young, queer, non-binary patient with several disabilities who sought a psychiatric admission for bipolar I disorder. To advocate for another person (even if they were having a stroke and decompensating right before my eyes) would not have helped my case as there is often the perception within the medical model that an acute mentally ill person is infirm or lacks coherent thought.  In that moment, I was a psych admit (or soon to be admit), and I had to choose every word and measure every action carefully.

As a psychiatric patient and person with disabilities, I had no power without the nursing title. I was not trusted nor trustworthy. The societal narrative was still such that I was a “burden”. The rhetoric of “mental health patients” and “addicts” (language I would never use) overflowing the emergency departments in my area was front and center in the daily news. On a body level, it went against every grain of my being, training, and humanity to not advocate for the elderly woman across from me, but if I did, I worried I would not receive help. As a person who has “high functioning bipolar”, I often get labeled as someone who is not actually sick. My abilities to have insight and advocate for myself work against me, work against me getting help, and work against people believing that I am as ill as I am.

When I am stressed or trying to contain myself, I turn to academics. I let my mind wander. I thought about Peggy McIntosh, Vikki Reynolds, and bell hooks and their writings about systemic oppression, positionality, and privilege: How one’s privilege in society and social situations shifts depending on location, context, and position. I could see my privilege floating away as I shifted roles: from healthy to ill (able-bodied/mind to disabled) and from practitioner to patient.

As I sat there, I reflected on the last twenty-four hours, my journey, and how I had come to find myself sitting in the ER.  Yesterday in her office, my doctor had certified me (as we both agreed upon) because my bipolar I disorder had gotten out of hand. This was a lengthy talk and a hard decision to come to because, in my jurisdiction, a psychiatric hold stripped one of almost all their rights only leaving them with three: 1) The right to know where you are (i.e., the name of hospital and unit); 2) The right to know why you have been certified; and 3) The right to request – after filling out paperwork – a Review Panel Hearing (which could take up to 14 days to assemble). I knew I was giving up almost all rights and freedoms, including my clothing, access to a phone, freedom of movement, access to a basic book to read, the ability to freely and privately access a toilet, and the right to refuse medication.  What was normally a manageable illness had blown up into a full flare that required acute psychiatric treatment.  My doctor and I had done this dance before: without certification, the hospital would not admit me. My doctor knew me well enough to trust that I would actually present myself to the hospital, so rather than calling the police to escort me from her office to the hospital, she gave me twenty-four hours to get my affairs in order: to pack a hospital bag for when I had regained some access, to make arrangements for my apartment, to contact professors. I had been hiding from my friends and support system so the severity of my illness could go undetected, but I also reached out to ensure a support system for the duration of the hospitalization – I thought it might be a long one.

After doing my dishes, I got dressed for the hospital. I chose an outfit that was not flashy, comfortable, and that fitted me well. I wasn’t dressing up, necessarily, but I also wanted to make sure I was wearing clean, well-kept attire. I knew from feminist theory on intersectionality, that perceived socio-economic status did matter. I was also partly following my granny’s advice to “dress well for the doctors”.  I walked the two blocks in the rain from my apartment to the Emergency Department. I felt a wave of relief wash over me: I no longer had to function. I knew that the exhaustion stemming from having to fully mask my illness would soon come to an end.

Despite my doctor “pink slipping” (certifying) me, the nurse at the hospital admissions desk did not have the paperwork. I knew it had been lost, but she appeared apathetic to its existence.  Panic had set in. When I agreed with my doctor to be certified, I became legally committed and powerless to the psychiatric system. The police are the ones who enforce mandatory psychiatric holds. The first thing I thought of was that if I left, the police would knock on my door and I would permanently have a record involving police, which as a person with a mental illness, episodically debilitating invisible disabilities, and a Muslim last name, I did not want in that moment. It could also mar my criminal record check for future employment; thus, ending my career before it started.  In that split second, I spiraled and wondered about the human rights aspect. But hey, I realized I was thinking of the future, a welcome change to the constant suicidal thoughts.  I caught myself and used all my energy to return focus to the task at hand.

I am someone who, despite being severely ill, can still put together sentences, give presentations, and have normal conversation (albeit for short periods of time).  I still am able to politely ask to check myself into the psych ward and state, in a calm and level tone, that I am severely suicidal and a risk to myself.  It throws off medical professionals because what is a protective factor in my professional and social life, became a liability: I said it as plainly as, “Hi, how’s it going?  Did you read the news yesterday?” but rather, “Hi, I’d like to be admitted as I have bipolar I with active rapid cycling, and I am severely depressed and suicidal. Could you please check me in?”  I don’t ever see the need to over dramatize it.  I don’t ever have a need for the attention.  I just needed the help.  This is very discordant with others’ beliefs of what mental illness looks like and, as a result, they often think I am trying to game the system or that I am not actually ill. 

So, I continued to politely insist that my psychiatrist had filled out the paperwork and that they were legally required to keep me. I lost touch with my surroundings, and I flashed back to the earlier fear that stemmed from the image of police coming after me. This nurse did not seem impressed.  They were busy.  Psychiatric patients were a lower priority than paper cuts when it comes to emergency room visits, in my area. At that time, it was on the news daily that the “mentally ill and addicts” were clogging up the emergency room and preventing “deserving people with real illnesses” from accessing emergency care. 

I held my ground.  Still polite.  Firm. 

“Can you check the fax machine?”

“Can you check the message board?”

“Can you call my psychiatrist through the switch board? She said she’d be available if there were problems.”

I tried not to let panic and urgency set into my voice. It would not help me if I became dysregulated as I would end up spending longer time in the padded rooms in the emergency psychiatric unit as they tried to ascertain how much of a risk I was.  It’s easier to reign it all in than fathom having my rights taken away for a longer period just to get the help that I know I need. Why is that even in a crisis I still had to coordinate my own care? I couldn’t use my status as a healthcare student because practitioners might be threatened by it (feeling insecure about my knowledge and unwilling to collaborate on my care;  recognizing their own vulnerability and lack of invincibility; and fearing that the systemic power imbalance between the patient and practitioner might be breached); however, I still needed the skills and training to get through the process of a hospital admission.  I felt so unwell before leaving my apartment, that I didn’t think I could tie my shoelaces; and yet here, I had to find strength and focus to troubleshoot for them and be a patient advocate for myself.

Finally, the paperwork was found.  I felt like I was a pariah.  I realized that no one likes to be told how to do their job, but I knew that if it hadn’t been found, then I would not have been admitted.  I got my hospital bracelet.  They took my blood pressure and other vitals. I was funneled back to the waiting room.  It was a Friday night, and a typical wait could be eight or more hours.  A sure way to elicit a manic or hypomanic episode in a patient with bipolar is sleep deprivation, and I knew I was not going to get any. I have always found the whole “wait in emergency” routine kind of ironic:  no medication is provided, and you cannot bring your own; there is no sleep in the chaos of a Friday night Emergency Department, and no food is provided.  After the lack of these basic necessities, comes the emotional stress of telling your whole history several times.  In a previous admission, I counted how many times I told my story from walking through the doors of the Emergency Department and receiving a bed on a psychiatric unit: It was 17 times in 36 hours.

I marveled at the cacophony around me.  There was the guy who put a nail through his hand.  He and his buddy still thought it was the funniest thing ever.  I was tempted to assess their level of sobriety, but his affect could have been due to the sheer amount of adrenaline. I use observations to circumvent emotions: This is how I survived.  I was not a nursing student. Then and there, I was a psychiatric patient.

As these thoughts went through my head, as if on cue, the nurse called my name.  I took a deep breath, albeit silently – I didn’t want to show any emotional overwhelm as it may have led to hostile treatment.  I passed through the doors to a curtained area.  The curtains were beige, the walls were white, the lights were fluorescent.  It was getting late – I’d been there for at least four hours – and the lights felt oppressive. I felt twitchy and like my agitation was taking further hold. It was becoming harder to contain it in the overstimulating environment.

The marathon of telling my story began. I recited my history to the psych nurse.  Just enough information so that she wouldn’t discharge me, but not enough to be completely depleted – after all, I’d have to tell my story to the medical student, the resident, the ER doc, and then the psychiatrist.  I wondered if I could just bring a written statement or a recording.  As we talked through my story, they asked what I did for work. I said I was a nursing student. I never know what disclosing this will bring. Sometimes it elicited compassion, sometimes disbelief coupled with disdain, maybe even sometimes fear as they might have seen parts of themselves in me. That night, with that nurse, it brought an ounce of compassion, but we continued. I was relieved.

In general, I felt like telling them that I was a nursing student was like a wild card. There is a saying “nurses eat their young”. In this scenario I was about one of the weakest nursing students possible. I was easy to eat up. Easy to erase from the profession of nursing. I was entering the hospital system not as one of them, but as a subject. I remembered back to the first week of nursing school when we were in the auditorium and our professor asked how many students had been in the hospital in the last ten years as a patient. Less than ten percent (about twelve to fifteen students) put their hands up. I felt empowered by my lived experience and knew that my capacity for compassion would help future patients; yet, I was also saddened and terrified for patients and the field as a whole, because others would not have this perspective. I almost cried that day. How are we training and educating health care professionals when there is little to no first-hand knowledge of how a hospital admission and stay feel: to have dignity stripped away, to lose autonomy, to become just another number in a revolving door of patients?  

When I finished my history, she gave me psychiatric pajamas to put on.  They were the same shape as scrubs I’d come to know and love over the last several years, except rather than blue or teal, they were a drab beige color.  They might have felt like scrubs, but they were not. These did not come with privilege and status. They were the opposite: they further stripped my identity away. I gave away my clothes. They get locked away. I did not know if it would be days or weeks before I saw my own clothing and shoes again.  I gave my privilege away. I gave away my civil rights in order to get treated for an illness.

I passed the first interview, and I officially became a psychiatric admit. I was taken to a calmer hallway to wait.  Yes, a hallway, not a room. The Emergency Department was overcrowded and, I sat in the hallway, in psychiatric garb for all to see.  Police officers passed and now looked at me differently.  I was not seen as a colleague but as a psych patient who could be “unstable” at any time.  I became a patient, on the opposite side. I sat there keenly aware that it was prudent and a survival instinct to fear security guards in my systemically disempowered position.  I had never had a run in with one, but the power imbalance was real and that any wrong move or overuse of emotion could land me in restraints and a padded room for up to 24 or 48 hours.

Now that I was in the quiet hallway but not yet admitted to the official emergency psychiatric unit, I still had been able to keep my belongings with me. I pulled out my laptop. I had planned to work on the paper that was due on Monday, but I just couldn’t. I switched tabs to Netflix and used my headset. Orange is the New Black came up in my feed, and I started watching it.  After about fifteen minutes, I was overwhelmed. Over the dialogue of the characters, the sounds of the Emergency Department flooded me: I could hear someone retching bile, IV alarms were blaring, blood pressure cuffs were inflating. At first, I could not understand why I felt so impacted by the overwhelm at that exact moment. I looked down at the beige.  I laughed out loud, but luckily nobody noticed.  I couldn’t believe it.  I realized that I was wearing the exact same pajamas as the women were wearing on the show. Had I become a convict in seeking psychiatric help? The moment felt so unreal that it took me a minute to ground myself.  How fitting was it that the standard issue prison uniform was the same as psychiatric pajamas.  I feared police and security guards for fear of being put in restraints or isolation. I couldn’t wear my own clothes. Soon, I would be locked in a padded 8x8ft room for the night with a toilet and a camera (for my “safety”). I would have no access to my phone, a phone, or any personal items. My rights were being stripped away, but I still had the right to know where I was, why I was there, and to request a review panel if I felt I was unjustly being held. If I did not play my cards right, I could be locked in that room for much longer than just over night. It could be days if I was deemed unpredictable. Seventy-two hours ago, I was a respected nursing student on a medical ward working with patients. Now, I had “voluntarily” given up my rights and freedoms in order to get treatment for an illness. If I had broken my leg or had cancer, I would not be treated like this. The medical system where I live continues to treat mental illness like criminals (in fact, sometimes people are arrested for dubious infractions in order to get more comprehensive care in the forensic psychiatric hospital than on a regular psychiatric unit).

Despite all this, I felt empowered by my decision to seek help. I knew that the hospital was the right place to be. My meds could no longer be adjusted as an outpatient. I needed to survive long enough for new meds to take effect. However, it was the system and the shift of privilege, the shift of the power dynamic, and the loss of rights that were disempowering. It was the social construct of mental illness and its treatment that created the feelings of loss. I had to erase who I was and risk everything to survive.

Didactics offers anonymous submissions. The author of this piece will remain anonymous, but has included a note and biography:

This piece’s author chose to remain anonymous due to ongoing discrimination in the field and the vulnerability that is written. They note that they are white, non-binary, queer settler in Canada with several invisible disabilities. On their mother’s side, the author is first-generation settler of Middle Eastern origin, and on their father’s side, they are several generations settler from England. In their academic research, they focuses on the intersectionality of queer and trans health, BIPOC, health equity, and social justice. They use their lived experience to break down barriers and stigma in the areas of mental health and disability.