Love and Drugs in the Psych ER

As a psychiatry resident and online dater, I’d become jaded

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ART BY DANIELLE CHUNG, MD

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When I sat at 4 AM in a crowded inner-city emergency room evaluating a poorly kempt woman who told me in one breath that she’d been prostituting herself to multiple men over the last few days on a crack cocaine binge, and in the next that she had a devoted scientist husband, I kept my gaze steady and my expression bland.  

I didn’t flinch because it seemed so clearly absurd. I had gotten to the point where I assumed everyone was lying to me. Patients vehemently deny doing drugs that come up positive on their urine screens and give me phone numbers for their families that connect me to gyms or hair salons or, most frequently, to disconnected lines.

The same was true with online dating. Men were inevitably older, balder, and shorter than their profiles. One forgot to mention his three small children. Another had a debilitating, fatal neurodegenerative disease that he mentioned in a lackluster way an hour before our date in a text message, as if warning me he had a cold. Men would profess desire, infatuation, even love and then disappear, never to be heard from again. Even a rabbi pulled this trick once. No one could be trusted.

“He always takes me back,” she told me, smiling through her tears, black makeup rolling down her cheeks. “Just call him, you’ll see. He’ll drive through the night and come save me again.”

She told me in detail about their beautiful house in the suburbs and her husband’s burning love for her that hadn’t wavered through the years despite her erratic behavior and intermittent disappearances. He took care of the children. He earned a handsome salary. They took ballroom dancing lessons together and played golf at the country club. He never lost his patience. There was even a white picket fence. It all seemed like a fairy tale.

I thought she was psychotic. This smacked of a romantic delusion. Considering the difficulty of finding such a man in the best of circumstances, without the complications of cocaine addiction or prostitution, how could this woman possibly maintain such a relationship?  I nodded blankly.

No man is going to save you!” I wanted to shout at her, “Not tonight or any other night.” Hadn’t she learned this by now? Wasn’t she too old not to have swallowed this hard lesson through disappointment? If fairy-tale endings exist at all, I felt confident that they didn’t happen in the middle of the night in the psych ER.

Of course, I didn’t say any of this. Diplomatically, I urged her to consider options for getting treatment for psychiatric issues and substance abuse. I tried to prime her that if she was not amenable to these options, she would likely end up in a homeless shelter, as many psychiatric patients do.

“No, honey. You don’t understand,” she told me. “The only way I’m leaving here is in the arms of my man.”

With great sadness, I dialed the number she provided, confident I would either reach an out-of-service message or a man who wanted nothing to do with her.  What happened next shook me to the depths of my soul.

He answered on the first ring, breathless. He’d been so worried, he said. She sometimes disappears, but never for this long.

I stammered … really? Was he willing to take her home? “Of course I will,” he said. “She’s sick and she needs me. I’m on my way.”

I hung up and sat stunned for a minute. I felt a flicker of hope. A smile crossed my face involuntarily. It was the first piece of good news I had heard all night amidst tales of chaos, violence, isolation, and desperation.  

I happily reported the news to the more experienced nurse and the crisis clinician assigned to the case with me. “No way,” they said. “That guy’s not showing.”

Am I a fool, I wondered? Was I “had” again? There was no time to think, though, because the police were bringing in a frantic patient on PCP who was trying to bite the nurses and needed to be restrained and sedated. This was true emergency psychiatry.  It was not the stuff of love.

I tried to put it out of my mind. They’re right, I told myself. He won’t show. Don’t be disappointed. But my optimism overpowered my cynicism that night, and I couldn’t help but hope that this man would be different.  

Around the crack of dawn, I got a call from security that some guy in a sweater vest wanted to see me.  Who is this guy in a sweater vest, they demanded? No one dresses like that in the middle of the night in the psych ER.  Immediately, I knew it was him.  

“He came for her!” I announced gleefully to the ER staff. No one cared.

Before I met with him, I watched them together on camera for a few minutes. In some ways, they looked like people who were not meant to be together: he really looked like a scientist in his wire-rimmed glasses and neat pleated pants and she like a prostitute with designer clothes dirty and tattered, hanging loosely around her. Still, it was obvious, watching them, that they were deeply in love.  

I watched him hold her as she cried and realized that this scene is at the heart of the vow “in sickness and in health.” It was a different, uglier way than I’d ever seen the sickness part illustrated. It’s a scenario no one imagines on his or her wedding day.

Against all odds, in the middle of the night, in a waiting room surrounded by people suffering from schizophrenia and unimaginable trauma, a moment of beauty had been created. It was improbable and in some ways unfathomable, but it was also unmistakable. It was love. The phones kept ringing and the patients kept shouting, but for a moment, I was mesmerized.

Was it true love? Was it healthy love? Was he really doing her a favor by “rescuing her” and thus enabling her to continue a dangerous, destructive pattern of behavior? These questions came and went from my mind. My feelings in the moment overwhelmed my rational, clinical, cynical nature, and I decided that it didn’t matter. All that mattered that night was that she was sick, and he would take care of her at her lowest moment.  

I discharged my patient home with her husband that night. He offered her something more powerful than any medication or placement I could have provided.  

At the end of my 14-hour overnight shift, I left the hospital haggard and weary-eyed and stumbled into the abrasive sunlight and crowds of well-dressed professionals. These moments are some of my darkest. I leave overnight shifts feeling the weight of the suffering that is simultaneously so pervasive and so invisible in our society, and that we devote such meager resources to treating. I look at people drinking lattes and playing on their cell phones and wonder if they have any idea what is going on around them, often in their own homes and families, or if they even want to know. That morning, though, I felt a little more hopeful.

Soon, I started dating again, and was less bothered by people misrepresenting themselves. I realized that love does not hinge on the truth, and often happens in improbable and unpredictable ways. I also learned a lesson that psychiatry continues to teach me: people will surprise you.

Lisa Jacobs, MD, MBA is a journalist and third year psychiatry resident at Penn who is the founder of this magazine.

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