In this memoir Dr. Julie Holland describes her nine years as the weekend attending ER psychiatrist for in one of the most storied hospitals in the world. From her position the author struggles to diagnose and treat some of the most unfortunate people in the city. Along the way she learns a lot about herself, the world, life and death, and grace. 

Bellevue Hospital in Manhattan, NY is the oldest public hospital in the United States (founded in 1736). It is world renowned for many firsts in medicine, but it is best known for the large numbers of non paying patients it serves. The hospital specializes in Psychiatry and is the main safety net for the criminal and destitute mentally ill across greater Manhattan. Holland describes in poignant and sometimes lurid detail, what it is like to be a psychiatrist on the front lines of an inner city Psych center. The author grapples with her sense of how to help people and manage the sheer volume of patients with questionable mental status. The hospital receives a good number of people arrested and in need of immediate psychiatric assessment. As a result, Holland spends a lot of time trying to determine which of these patients are at risk of harming themselves or others (and thus can not be placed in the regular jail population), which are mentally stable enough to face arraignment, and which are simply malingering to escape jail and delay prosecution. The author shares her struggles with traumatic life events that shape her view of the world and her ability to see herself as doing enough to help her patients as well as her fellow workers and friends. Though she eventually starts a successful Psychopharmacology practice serving upper middle class patients, she continues to work at Bellevue for many years and, when she leaves, she has the distinction of having stayed longer than any Psychiatric attending physician in the modern history of the hospital. In a job that has a high burnout rate and rapid turnover, the author sticks with it and continues to try to do right by her constant stream of emotionally and psychologically distressed patients. Holland starts her career at Bellevue as an arrogant, top of her class, psychiatrist and leaves humbled, a little gentler, and with greater appreciation for life’s ups and downs.