Song of the Nightingale
Psychiatric nurse rewires Portland’s approach to mental health.
Sana Goldberg ’12 is on the front lines of the battle to change the way we treat our mentally ill. As a nurse at Portland’s new $40 million psychiatric emergency hospital, the Unity Center for Behavioral Health, she has made it her mission to address the inequities that pervade the field.
Unity opened in January and combines the psychiatric wards of four Portland hospitals under one roof with specialized staff, care, and facilities. Much of psychiatric care consists of managing patients’ environment, and Unity is designed to eliminate the sense of disarray and foreboding that permeates a standard emergency department.
“If you designed the very worst atmosphere for someone in a mental health crisis, it would probably be an emergency department,” she says. “There are staff in uniforms, patients are usually restrained because their behavior can’t be controlled, and there are other emergencies happening around them.”
The architects of Unity’s renovation ushered in sunshine as much as possible to eliminate the fluorescent pallor for which hospitals are infamous. Nurses bring patients to an open social area when they are first admitted rather than isolating them.
Caretakers at Unity also make a point of getting patients outside as much as possible. Elsewhere Goldberg has worked, some patients didn’t make it outdoors for months at a time. “What does that do to a person, physiologically?” she asks. “One of my patients asked one time for someone to bring him a flower. He just needed to have something natural.”
Little details are part of a larger strategy that Goldberg and her colleagues at Unity have adopted to tackle the societal impacts of mental illness.
There are three times as many seriously mentally ill Americans in jails and prisons as in hospitals. Police in the United States are 16 times more likely to shoot the seriously mentally ill than they are other civilians.
The issue rose to prominence in Portland this winter when Karen Batts, a 52-year-old woman suffering from schizophrenia, froze to death in a parking garage after being evicted from her apartment. She had been in and out of the hospital in the months before her death but did not receive coordinated care to support her once she was discharged.
“Unity can be successful in addressing the problem because we really focus on care coordination,” says Goldberg. It’s easy for psychiatric patients to fall through the cracks at typical hospitals, where imminently life-threatening conditions take priority.
At Unity, before one of Goldberg’s patients is discharged, she meets with their doctor, social worker, and, say, addiction specialist together in one room to discuss the care and support they will receive after they’ve left. Logistical interventions like these can have the biggest impact on a patient’s health and well-being in the long term.
But there are basic challenges that never go away. What do you do, for example, when your patient won’t take their medication? Do you try again later and work with them through their resistance, or resort to delivering medication via injection?
Thousands of nurses who work with the mentally ill have to answer that question every day. Goldberg’s solution? She does what any Reedie would—she sits down with her peers to talk about it.
Goldberg entered Reed planning to major in English, but it was an English professor who inadvertently sent her on a different path. Prof. Ellen Stauder [English 1983–2013], her adviser, insisted that she take a psychology class to round out her course load. She was hooked.
Her junior year, Goldberg took behavioral neuroscience with Prof. Paul Currie [psychology 2007–]. “Sana is a really good example of a student who truly excelled and hit the ground running,” Prof. Currie says.
In her thesis, Goldberg explored whether the “hunger hormone” ghrelin plays a role in addiction. She discovered not just that ghrelin plays a critical role in the pathways that drive drug addiction, but also that the hormone can drive mice addicted to cocaine to consume alcohol.
“Her thesis was the first report that cocaine could actually potentiate alcohol consumption. No one had demonstrated that before,” Currie says.
They published the results in Neuropharmacology, and Goldberg presented her findings at the annual meeting of the Society for Neuroscience.
“She stood there, held her own, and truly impressed a lot of my colleagues who thought in fact that she was a graduate student,” says Currie. “When I list the theses I’ve supervised over the last decade at Reed, this is one that truly, really did change not only her perspective in neuroscience, but my own. It changed the direction of my own research in a much more engaged way.”
Following graduation, Goldberg intended to go to grad school, but cooled on the idea after working in labs at OHSU. Then she did a stint as a social worker for people suffering from Alzheimer’s and dementia, where she got a ringside seat to witness nurses negotiate the tension between theory and practice, science and clinical care.
When she heard that Unity was going to open a few years down the line, she knew she wanted to work there. She applied to a one-year fast-track nursing program at OHSU, and has been working as a nurse in Portland psychiatric wards since.
When she isn’t caring for patients at Unity, Goldberg spends her time advocating for nursing as a means of political and social reform.
After the presidential election, she teamed up with three of her classmates from Reed—Arianna Rebolini ’12, Mamie Stevenson ’12, and Rebekah Volinsky ’12—to found the non-profit digital magazine Nightingale, which features writing from doctors, nurses, journalists, and artists, many of them Reedies.
Goldberg also writes for the Atlantic and is working on a book to help millennials navigate the healthcare system, tentatively titled How to Be a Patient, to be published by Harper Wave in 2018.
She still returns to Reed to do serious writing. “I’m so focused in the library,” she says. Her love for the Hauser Fun Dome is an apt metaphor for the relationship between nursing and the liberal arts she described in a TED talk at Harvard last year. “The liberal arts can be distilled to this canon of stories that, at their best, offer us renewal,” she said. “They tell us you don’t have to face your shadow side alone because we’ve done it as a species throughout time.”
Goldberg expects tens of thousands of Reedies and other liberal arts graduates to enter the nursing profession in the coming decades as hospitals and universities recognize their strengths and create specialized programs to educate and train them.
Perhaps then we will associate health care not with the chaotic blare of an ambulance siren, but with the call of the nightingale, so called because their song is a sonic beacon in the darkness of the night, when all other birds are silent.
Kieran Hanrahan ’15 works for a Reedie-run small business and is an occasional contributor to the magazine. He lives in Portland with his dog and two pet spiders.
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