Trigger warning – some mention of sexual assault. Please note that names and places have been changed to protect patient confidentiality.

My badge wouldn’t scan into the parking garage. Of course it wouldn’t… I was not supposed to be here. I found a random lot to park my car and ran into the hospital where once again, my badge did not work. Catching the glance of the security guard, I managed to explain that I’m an intern and that I’m supposed to be in the psychiatric ward in this hospital today. I left out the fact that I technically did not work at this particular hospital. He pointed me in the right direction, and I made my way to the top floor.

The elevator doors opened directly into a narrow hallway lined with yellow tile. Both ends were flanked by heavy doors that had, in giant red letters, the word “LOCKED” painted on them. I made the safe assumption that if my badge didn’t work to get me into the hospital, it probably wouldn’t work here either. I poked my head into a few rooms, and thankfully, someone walked me into the ward and pointed me toward the nurse’s station.

I introduced myself as an intern who was going to spend some time shadowing. I simultaneously overheard a nurse telling a psychiatrist that the frequent flyer is back in here. His response was, “God I’m surprised she made it out of the ED” to which another said something about wasting hospital resources. The nurse said, “I can’t believe she’s back here again. I’ll get Dr. H to cover her.”

That’s when I met Dr. H, a short older man with bright white hair resembling Santa. I excitedly stepped forward. “Hi, I’m an intern at the hospital downtown but my boss caught me zoning out a few times during meetings and we decided that I didn’t really like administrative medicine and she was nice enough to let me come explore and so I’m here because I think I like psychiatry. Can I shadow you today?” I exclaimed, all in one breath.

He smiled and told me he would be honored. The nurse told him that his next patient was in room four and that “it was an alcohol withdrawal”. Dr H spent a few minutes with her chart, then we headed into the room together. I sat in a chair at the corner, careful not to touch the table because it looked like it could give me tetanus. Dr H sat across from the patient and put his hands on the table. “How are you, Rachel?”

Without missing a beat, she said, “I don’t want to be here. I hate it here. I’ve been here before and I don’t like it.” Dr. H looked at her and didn’t say anything, then he pulled something called the CIWA-AR protocol from her chart and glanced at it. He replied calmly, “You’re here because you’re in withdrawal and it’s really hard to be in withdrawal when you’re on the street.”

Shifting gears, Doctor H asked her how long she had been on the street for.

He waited and it got so uncomfortable that I began to sweat.

He then asked her, “How old were you when you experienced your first trauma?”

At this, Rachel did not respond and put her head down on the table. Another uncomfortable silence ensued…until in muffled tones, Rachel began to share. We learned that her family grew up in an apartment complex in west Texas. That when she was twelve, she was sexually assaulted by one of the tenants in the complex. That the man took videotapes and threatened her. When she went back home, she was too scared to tell her mom. But over the course of the year, she began to self-medicate with whatever she could get her hands on. And finally, when she did tell her mom, her mom kicked her out of the house. She was thirteen years old when she began to live in the streets. She added, “Yeah, and basically that’s when it all started.”

Dr. H kept the difficult conversation going. We came to the end of the visit, and he let her know everything that she could expect – particularly that her CIWA score alongside her history of withdrawal seizures meant that she’d continue her course of benzodiazepines. She nodded dejectedly and said, “I know. I’ve been here before.”

I got ready to get up and leave but realized that Dr. H hadn’t moved. He asked Rachel if he could read her a poem. She cupped her face in her hands and nodded. Doctor H recited:

Dr. H looked at Rachel’s tear-stained face and said softly, “Now maybe is your time to weep but there will come a day when you can laugh.” At this, she laughed. He also laughed, and I smiled. Dr. H reassured her that we would be back that afternoon to check in on her.

We walked out of room four together, the room with the frequent-flyer-alcohol-withdrawal-who-barely-made-it-out-of-the-ED AKA Rachel. Rachel, whose dignity began to be trampled on when she was twelve and continued to be trampled on for the next decade. Whose dignity took yet another hit by the very people on the other side of the ward that were supposed to care for her. The ward seemed like a place where the cruelties of illness intersected with the cruelty of trauma. A place where people should know better. Dr. H seemed to and so maybe, just maybe, Rachel would finally begin to find her way.

Kayal Parthiban is a first-year medical student at UMass who graduated from Baylor University and completed a fellowship in Theology, Medicine, and Culture at Duke Divinity School. She is passionate about both medicine and writing, particularly in exploring the intersection of health and the medical humanities.