PRESENT DAY

Dear AMY BRENNER,

You have been assigned to overnight call tonight on our primary locked psychiatric unit, Ward D.

In preparation for your assigned shift, please observe the following guidelines:

You will be given a numerical code that can be used to leave Ward

D. Except in the case of an emergency, you MAY NOT exit the unit during your shift.

Do not divulge any personal information to your patients. This includes details about your personal life or your home address.

The following objects are prohibited on Ward D: alcohol,

flammable liquids, thumbtacks, pens, needles, staples, paper clips, safety pins, nail files, tweezers, nail clippers, tobacco products,

electronic cigarettes, plastic bags, razor blades, weapons, or any items that could be used as weapons.

Do not expect to sleep during your shift.

The on-call attending physician tonight is DR. BECK. Please report to the attending physician on arrival at Ward D.

Sincerely,

Pauline Walter

Administrative assistant to the Chief of Psychiatry.

Mrs. Pritchett can’t sleep.

Or at least, she couldn’t sleep the last time she was here at the psychiatry outpatient office where I have been doing a medical

school clerkship for the past two weeks. I am working with a psychiatrist named Dr. Silver, who I have nicknamed Dr. Sleepy (at least in my head) because eighty percent of the patients he sees are here for sleep problems. The medical school psychiatry rotation that I’m on is supposed to expose me to a general outpatient practice, with a mix of depression, anxiety, psychosis, etc., but it’s really just sleeping problems here. And I’m fine with that.

I still have the notes I took in my little spiral notebook from Mrs. Pritchett’s last visit. I hadn’t realized until this very second how illegible my handwriting has become. Aside from her age of sixty-four years old, I can only make out two sentences:

Can’t fall asleep.

And:

Cat

I underlined “cat” several times, so it must’ve been important, but I can’t read anything I wrote below that word. Something about cats, presumably. Maybe her cat was sitting on her face when she was attempting to fall asleep. That happened to me once.

Mrs. Pritchett is perched in the exam room, her chin-length gray hair combed into a neat bob, her big pink purse clutched in her lap. Unlike most exam rooms I have seen, this one doesn’t have an elevated examining table. It’s just a room with two wooden chairs in it. Mrs. Pritchett is sitting in one, I will sit in the other, and then when Dr. Sleepy comes in, he will take the second chair and I will stand, hovering over them awkwardly.

“Amy!” Mrs. Pritchett exclaims when I walk into the room. “I’m so happy to see you, dear!”

“Oh?” This is different from the usual bleary-eyed greeting I get from patients. “How are you sleeping?”

“So much better—thanks to you!”

“Really?” I try not to sound too astonished, but it’s hard not to blurt out,

But I did absolutely nothing.

“Yes!” She beams at me. “Everyone else just prescribed a bunch of sleep medications, but you actually talked to me. More importantly, you listened. And that’s how I realized the reason I couldn’t sleep was that I was missing Mr. Whiskers so much since he passed on six months ago.”

Oh, cat. Now it all makes sense. “I’m so glad I could help.”

She smiles tearfully. “And that’s why after talking to you, I went out and I got a brand new kitten. Ever since I took home Mr. Fluffy, I have been sleeping like a log. It’s all because of you. Because you took the time to listen.”

What can I say? As a medical student, I don’t have much knowledge, but I have lots of time to spend with patients. And it’s a good thing, because Mrs. Pritchett proceeds to show me about five billion Polaroid photos of her brand new kitten.

“Also,” she says when we finish looking at the photos, “I got you a thank-you gift!”

A thank-you gift? Seriously? Wow, this is the most exciting thing that’s happened to me in about two years.

However, some of my excitement wanes when Mrs. Pritchett stands up from her chair. And I would say it vanishes entirely when she grabs a giant painting that I hadn’t realized was in the back of the exam room. The picture had been turned to face away from us, but now I can see it clearly.

It’s a portrait of a cat.

And it is almost as big as I am.

“This is a painting I had commissioned of Mr. Whiskers,” Mrs. Pritchett says proudly. “And I would like you to have it.”

“Oh,” I say. “Um. Thank you!”

A black cat is prominently featured in the giant portrait. Clearly, this is larger than life, unless Mr. Whiskers was a bobcat or perhaps a small lion. And why does he look so angry in the painting?

“Doesn’t it look realistic?” Mrs. Pritchett says.

Yes. He truly looks like he is about to leap out of the painting and maul

me.

I lug the painting out of the exam room, unsure where I am going to put this thing in my tiny little apartment. For now, I leave it in the hallway.

Dr. Sleepy is working in the office next door to where I had been sitting with Mrs. Pritchett. This other office has a desk and a computer set up on top of it, and Dr. Sleepy is tapping away at the keys when I rap my fist against the open door. When he looks up at me, he pushes his half-moon reading glasses up the bridge of his nose and gives me one of his mild smiles.

“Hello, Amy.” Dr. Sleepy always speaks in a calm voice that is close to a monotone. I’m pretty sure he could lull most of his patients to sleep with just his voice. They probably leave the appointment and immediately drift off in their cars, possibly while driving. “Are you ready?”

“Yes,” I say.

“Well then. Tell me about Mrs. Pritchett.”

I go through the information about Mrs. Pritchett on my little notepad. Dr. Sleepy takes it all in quietly, making slight grunts at appropriate moments. I mention the cat portrait, hoping he might offer to take it off my hands, but no such luck.

“Anyway,” I say. “That’s all.”

Dr. Sleepy rubs his white goatee thoughtfully. “And how are you doing, Amy? You don’t look like you’ve been sleeping very well either.”

He’s right—I didn’t sleep well last night. I’m sure I have massive bags under my eyes. “I’m just a little nervous because I’m rotating on Ward D tonight.”

“Ah, that makes sense.” I’m not sure how disturbed to be by the fact that he thinks it’s normal that I have spent half the night awake worrying about my overnight call on the locked psych unit. “It can be challenging on Ward D. But I think you’ll learn a tremendous amount tonight. Who is your attending?”

“Dr. Beck.”

He nods in approval. “One of the finest psychiatrists I’ve known. And an excellent teacher. You’ll have a great experience tonight.”

I highly doubt that.

“There’s nothing to worry about,” he says in that calm, reassuring voice of his. “Remember, you will have the code to exit the unit. You can leave at any time.”

Right. There’s apparently a keypad with a six-digit code that controls the locked door to the psychiatric unit. But I can’t memorize a phone number, and that’s only one digit more. What if I forget the code and I’m trapped? What then?

He smiles soothingly. “You have done such a great job here the last two weeks, Amy. All the patients tell me you are a wonderful listener. A lot of students seem to forget that psychiatric patients are human beings, just like you and me. They just want to get better, and part of your duty as a physician will be to give them the best possible care.”

“I know.”

He cocks his head to the side and looks at me in the thoughtful way he often does. “What are you so worried about, Amy?”

“It just seems like it could be… dangerous.”

“You’ll be fine.” He levels his watery blue eyes at me. “All the patients are very well controlled on their medications. There’s nothing to worry about.”

That sounds like a lie. If they were well controlled, the unit wouldn’t have to be locked, would it?

But that’s not the real reason I am dreading my night on Ward D. I can’t tell Dr. Sleepy the real reason I was tossing and turning last night. I can’t tell anyone the real reason I’m desperately terrified of Ward D.

“Listen.” Dr. Sleepy glances down at the gold watch on his wrist. “Why don’t you let me finish up with Mrs. Pritchett, and you can take off early? Take a little Amy Time before you head over to Ward D.”

A little Amy Time sounds fantastic. I don’t get much of that anymore. “Thank you so much,” I say.

He winks at me. “No problem. And don’t worry. Once you get to Ward D, you’ll see it’s not so bad. I promise.”

I hold my tongue to keep from telling him the truth. The truth is, I’ve already seen Ward D. I visited it once before, nearly a decade ago.

Back when my best friend was a patient there.

I still remember her matted hair and wild eyes when I came to visit. She didn’t look like my best friend anymore—more like a wild animal closed up in a cage. But the thing that sticks with me most—the thing I will never forget—are the words she spit out at me just seconds before I ran out of the unit, swearing to myself I would never return ever again:

You should be the one locked up here, Amy.