by Maureen Hirthler

“If you don’t do something right now, I’m going to hurt my children.” Standing at the window of the police station, this is what you say. The policewoman comes out to get you, hand resting casually on the taser at her waist, and you follow her calmly to the room in the rear. The padding does not escape your notice, but that and the pat-down don’t upset you. Whatever is happening, all you know now is that your children are safe.

You can’t remember when your thoughts first ran fast and hot like a run-away truck down a hill. You accomplished so much—you had unlimited energy. You went back to school. Everything seemed possible, new and exciting. When did you start to think about killing your children? You don’t understand the compulsion that you feel when you see them. You are their mother; you love them. They need to lock you up.

The police call an ambulance to take you to the hospital for an evaluation. You remember the last time you were there, about three months ago. There was a woman doctor who saw you; you didn’t like her at all. She thought you needed to be sent away to a psychiatric hospital, all because your stupid husband complained that you talked too much and didn’t sleep more than a few hours, and brought you to the hospital instead of church. Why did he do that? You threatened to call the hospital C.E.O, your good friend, if the doctor wouldn’t let you go. Finally a male doctor came in and told you the woman wasn’t qualified to diagnose a mental illness, and that you could just call a local psychiatrist on Monday for an appointment. You never did that; it was a stupid idea.


You are standing outside the room, listening to the woman talk non-stop for ten minutes, watching the nurse squirming to get out of the room. Mania, you think, but why? There was no psychiatric history on the chart, no medications listed, just the chief complaint: “Husband states patient not acting right.”

“I just can’t believe how talented Jefferson was,” she says as you walk into the room. The nurse scurries out gratefully. “He invented so many things. Did you know he kept up a correspondence with John Adams? And they died on the same day? He owned slaves, you know, not Adams, Jefferson, and he had a black girlfriend…”

“Excuse me,” you say. “I’m Doctor Glass, and I’d like to talk to you for a minute. Do you know why you’re in the Emergency Department?”

“My husband thinks I talk to much, but he’s just a bore. I’m back in school and this history class is so interesting. I’m getting all A’s. We just finished the Revolutionary War and Declaration of Independence. I could get a Ph.D. It was signed in Philadelphia. You know, where the statue of Rocky is. Well, not right there, but by the Liberty Bell…”

“Slow down a bit, Mrs. Hill. How long have you been feeling like this?” You look at the husband and he mouths the words “two months.”

“Like what?” she says. “I feel great. I’m getting so much accomplished, did I tell you I’m back in college…”

You sigh and explain to her husband that you will order some tests and escape the room before she gets to the Constitution and Bill of Rights.

Mania it is. Flight of ideas, pressured speech, grandiosity. You speak to the husband privately. His wife is not sleeping, eating, or taking care of the children. She is obsessed with history. He denies any past episodes like this, but says she has been depressed at times. She doesn’t use drugs.

You explain that you will do tests to look for any illness that might cause mania, but that you suspect this is a psychiatric problem, and that his wife will need hospitalization. He agrees with this assessment. He is worried she might do “something crazy.”

When all the tests return normal, you call the psychiatrist to admit your patient. Unfortunately, there are no beds available at your hospital today, and your psychiatrists do not do consultations in the Emergency Department. You have to certify the patient is a danger to herself and others, then transfer her to another facility about two hours away. This is always a nightmare scenario.


“I am not going away to be admitted!” you say. This doctor has no idea about all you have to do. There is a paper due tomorrow, the kids have school, you thought you’d get a prescription and be out of here. You don’t understand all this talk about mania. You’re fine. You’re not about to kill yourself or anyone else.

“What do you mean I can’t leave? I have important friends. Do you know Dr. Ellison? I’m calling him right now to get me out of here. You can’t keep me against my will.”
The doctor explains that she does have the power to keep you, if she believes that you might hurt yourself without proper treatment. It will take you several months to be seen as an outpatient, and she is concerned about you. You don’t believe her, not one word. She’s on some kind of power trip, can’t your husband see that, well she’ll back down when Dr. Ellison gets on the phone.

Your husband agrees to take you home, but the doctor resists. She’s talking, but you don’t care. You just need to write that paper, the one about Ben Franklin. Or was it James Madison? Whatever, you’ll do both tonight.

The doctor leaves the room. She comes back a few minutes later with another doctor, a man this time. He listens to you, then asks your husband a few questions. He tells you that you can leave, that the woman doctor isn’t a psychiatrist and can’t diagnose mania. He knows you’re not a danger, and as long as your husband takes responsibility and you call a psychiatrist for an appointment, you can go home.

This was all such a waste of time. You have important things to do.


You recognize that this doctor-patient encounter is not going well. You can give in and discharge her and hope nothing bad happens, even though you are experienced enough to see where this is going, or you can restrain her, generating all sorts of complaints. Complaints are not what you need; you have been under scrutiny lately because you get too many of them.

There is one other option, and you grab at it like a drowning man grabs a life-line. You are working with your director today, the same director that is trying to fire you. You ask him for a consultation. Maybe he can sort this out without you ending up split between right and expedient, losing either way.

The director never worries about doing the right thing. You are not surprised when he tells the patient and her husband that you are not qualified to decide that she is mentally ill and needs to be admitted. He thinks that a follow-up appointment with a psychiatrist will be adequate. He doesn’t tell her that getting this appointment will take several months in our town. He apologizes for your ineptitude.

You discharge the patient, documenting carefully your opinion and the role played by your director. You hope you never see her again, that she gets help, that she gets better against the odds.


Three months later, your director says only,” Remember that woman you thought was manic? I admitted her last night. She said she was going to kill her children.”

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