I am 12. This is my doll.

She is smaller than most of the patients here, thin, and not as tall. The only concession her body has made to old age, aside from her white hair and wrinkles, is a rather large rear end. When she sits in a chair, she draws her knees up, or slings them over the chair arm. She eschews the hospital garb--except on days that she has ECT--and wears a knit light blue jacket, turtlenecks, and gingham pants. She always wants to wear the jacket, even when it is dirty.

She has lived in psychiatric hospitals most of her life. She has never had a house of her own. She has never had an apartment, paid bills, done the shopping. Yet she insists that she will, and the first day she met me, she pointed angrily. "Rebecca! You're going to take my apartment! Don't do it!" Then she burst into tears.

My name is not Rebecca.

She carries a doll with her most of the time. It is an incredibly realistic baby, about 1 month old, and if you're not paying attention it looks like a dead baby. Having recently worked on the pediatrics floor, this instantly activates "code brain"--take the baby to the treatment room, airway breathing circulation, call respiratory, do we have access, an IV, anything, what's the cause, respiratory failure, are we intubated yet, what's the rhythym--but it's just a doll. Sometimes she puts it in the basket of her walker and takes it around with her. In the middle of the week she left it in the dayroom for a long time. Today she cradles it like a real infant.

Sometimes she says she is not who she is. She says she is 12, or 14, or a boy. Her name is Andrew, or Jessica. She explains her white hair, her wrinkles, so quickly--I dyed my hair, I got too much sun. We are not sure why she does this, if she actually has dissociative identity disorder, or if she is interpreting her reality into what she knows--before she came to us, she was at the state hospital, surrounded by desperately sick teenagers. She was the only geriatric patient left, the only one the state couldn't get rid of.

She kept asking the nurse today how old she was.

"78," said the nurse.

"What YEAR is it?" she asked.

Her mouth opened and closed when she heard the answer, opened and closed with nothing to say.

The past few days she has cried every afternoon, in front of the nurse's station. She begs for $3, for a hot dog. Two days ago my attending took pity and gave her the money. She promptly lost it, and begged for it again the next day. She shrieks. She prefers injections, but will only sometimes allow them. Her right bicep is a hard lump from the years and years of injections. Calming medications, antipsychotic medications, any kind of medications.

Her speech is horribly jumbled and we don't know why. She just can't close her mouth around her words, as though she has a thousand marbles in there, fighting with the words. On days she hates us and wants us to leave, she's more clear, "Get out of here--go away" as she pushes us with her hands. When she feels better, her speech is less clear. Sometimes she will write her conversations with us.

How are you doing today?

I am 12. This is my doll.

He's a very nice doll.

It is a girl.

I'm sorry, my mistake. If you can keep from screaming and do what the nurses tell you today, you can go to the store (i.e. go to the cafeteria and get a hot dog.)

They are not nurses.

OK. Is there anything we can help you with today?

I am alright.

So we leave, move on, as she sits by the nurse's station, cradling the dead baby, and stalking us with her eyes. She will never get better. She will never have that apartment--I might as well have been Rebecca the apartment stealing girl. The state doesn't want her back, but we can't keep her here forever. No one wants her.

But our attending loves her. He sits with her, holds her hand, leans his head towards her. He figures out any way to communicate with her. He gives her the $3, the allowance, the hot dogs. She is thought about, time is taken for her, pleasures are devised for her. He wants her to be happy. He carries her with him, in his heart.

And maybe, for one day at least, that is enough.