December 4

Today I got out of rounds. Instead, someone (who?) was kind enough to surprisingly schedule supervision for me. I hate rounds. It's one of those remnants of European feudal societies, I figure, that help make sure we all know who's the boss and who's not. Not only the patients. It helps you remember which border lines are not meant for crossing.

Every morning the psychiatrists, psychologists, psychotherapists and members of the nursing staff follow the alpha female, Dr. A., from room to room and bed to bed. (In Austrian hospitals there are more than just 1 or 2 beds per room.). You greet the patient with a handshake and a firm "Guten Morgen" and ask him or her inane questions that get quite personal at times. In the course of all this many personal border lines get crossed ...

... with a whole slew of people listening in, including your roomies. Some patients choose to hide in the bathroom instead of making themselves available for rounds. In that case, one unfortunate member of the nursing staff gets to drag the equally unfortunate victim out of the shower, or wherever. More border lines get crossed. Don't you dare upset routines!

On Wednesdays, and only on Wednesdays, the psychiatrists, psychologists, psychotherapists and members of the nursing staff follow the alpha female, Dr. A., who follows the department head, Dr. F., "der Chef." It reminds me of roll call. The male patients must feel the same way because as a matter of course they get out of bed, barely suppressing an urge to stand at attendance.  Every morning I wait for someone to spontaneously salute. It never happens, though. And: Why no taps? Surely someone could play taps? This is Austria, after all, with the sound of music wherever you go ...

Another young adult came in during the night. E., age 25. She tried to kill her herself because the women's shelter won't keep her. The shelter is for abused women. Period. Not for abused women with a borderline personality disorder. And E. is "TOTALLY borderline", as my colleague C. says with a professional smirk. "The works."

After her suicide attempt the women's shelter sent E. right across the border to a mental hospital in Bavaria. She crossed the border line. Not funny. The Bavarians didn't want her because they are not equipped to handle suicidal patients. So they sent E. across the border line back into Austria to our hospital where she spent the night in the closed psychiatric ward.

Now she's with us at the suicide clinic. E. comes from a former communist country in the East. Her German is okay. We can communicate. Her father, a refugee, is not a nice man. Actually, he is physically and emotionally abusive. But now she wants to go back home. Across the border line. From a safe room in the hospital to her abusive father. That's very borderline.

E. is very pale. On top of that her complexion is unusually light and she looks surreal, almost translucent. You can't tell where her body ends and her Self begins.  Her responses are, well, borderline. Dr. F., the psychiatrist on duty, knows her from two former stays at the suicide clinic. He warns us. "You can't believe half the stuff she says."

We tell her she has to stay at least for a week. She needs meds to stabilize her, she needs therapy, and we have to get in touch with her parents and find an emergency solution for her where she can seek help and stay in case her father becomes abusive again. She has no way of living alone. Someone has to tell E. what to do. She needs a warm environment of care and love that will help keep her within certain boundaries so she can be safe. Structure. Lots of structure and routine. Structure and routine. Structure and routine. Structure and routine. No crossing border lines ...

Somewhere in the back of my head a trumpet is playing taps.