I am frantically pacing around Dr. A’s office, talking so fast that she can hardly keep up with me. I am so agitated that I want to peel the skin off my body, but I keep digging my fingernails into my flesh instead. Even I know that I’m unraveling: For the last two weeks, I’ve lost my appetite and virtually stopped sleeping, and I’ve been unable to sit in one place for more than 30 seconds at a time.

“Manic,” Dr. A offers as her diagnosis. “You are having a severe bipolar episode and need to be hospitalized. I’m worried you might hurt yourself or do something crazy, like go out and buy a Corvette.”

She snatches the phone from the edge of her desk to find out if there are any beds left in her own hospital’s adult inpatient psychiatric unit. That way I can be in a safe place where nurses make sure I eat and sleep and choke down my mood stabilizers — even when I really, really don’t want to.

Before I know it, I am in a wheelchair, being swept through the locked doors of the inpatient psychiatric unit that is merely a few twists and turns from Dr. A’s office on the fourth floor of a sprawling hospital in suburban Chicago.

I am no stranger to mental illness, especially the bipolar disorder that has followed me across the country from Arizona to Chicago, where I moved to be closer to family. This is my first psychiatric hospitalization since I arrived a few months earlier. The first thing I notice is that this place looks nothing like any mental hospital I have ever been to. The unit is bright and airy, with comfortable rooms that have the best showers I’ve ever encountered in a hospital: The water gets hot fast instead of running cold for so long that strands of my hair turn to icicles that drip down the back of my neck.

This is the place I will come to call the Good Hospital. During my journey since then through the Chicago area’s mental health system, I will also come to realize that not all psych wards are created equal, and that the swing between extremes here is much greater than I found in Arizona. I would like to think that in a city like Chicago, there would be enough good options for everyone. But the truth is, there are not.

A few months later, I find myself in a small, locked room in the corner of an ER, in the midst of another mental health crisis. This time, I am not so lucky. I beg to be transferred back to the Good Hospital, even tugging on the crisis counselor’s sleeve as she stands up to leave. She doesn’t get too close to me, treating me like I have come down with a dread disease instead of a mental illness that is very treatable with the right combination of medications and therapy.

“Please, find a way to get me into the Good Hospital,” I say. “You have to!”

“Elizabeth, there aren’t any beds there. As much as I would like to, I can’t just create a bed for you out of thin air.”

And now that I have fessed up to my suicidal ruminations, there’s no way I can talk myself out of this one. The moment I tell that crisis counselor that I’m severely depressed, I know that she is obligated to find a bed for me somewhere, even if it is at a hospital that will make me feel even worse. Nobody cares that my outpatient doctor is one of the top physicians in Chicago or that I have excellent insurance.

If there are no beds, there are no beds. So I am brought to the place I’ll come to call the Bad Hospital, strapped down to an ambulance stretcher. Immediately I am met by an intake worker, who ignores my crying while proceeding to fill out several pages of forms. I have a sick feeling that this place is going to be the exact opposite of the Good Hospital.

I turn out to be right. At the Bad Hospital, it’s so dark and gloomy that I wonder if the electric company turned off the lights because the hospital’s administrators neglected to pay the bill. My room remains locked during the day, and the nurses tell me I can’t stay in there and rest, even though my body craves sleep — that staying out is a crucial part of my recovery from this out-of-control episode.

Dr. A constantly reminds me that having a manic episode is like setting your brain on fire. But the nurses at the Bad Hospital won’t help me extinguish the flames. They would rather I sit in the TV room all day, my chin bobbing up and down because I am so sedated. I feel like all the other patients are watching me, but after a while I decide that I don’t care what anyone thinks anymore, and I drift off in my stiff chair.

The Bad Hospital, also in the suburbs, smells worse than your average hospital, as if excrement may very well be seeping through the ceilings of every unit in the place. And the other patients scare me. They make me share a room with a woman who frightens me more than any other patient I’ve ever encountered. Sometimes, in the middle of the night, I jolt awake to see her leaning over me. She shouts things that make no sense when I just want to sleep. I am genuinely afraid that she might hurt me. The staff members make me feel like I’m crazy, and instead of talking me through my symptoms, they simply push medication on me. The Bad Hospital is a place where you just have to survive, knowing that each minute you get through is one minute closer to the day they will discharge you.

Upon leaving the Bad Hospital, I feel traumatized, like I have just been through a war, like I’ve been a prisoner rather than a patient. I can’t believe that a place like this exists in a metro area that has some of the best hospitals in the country. It is amazing that with the luck of the draw, you can end up at a place like the Good Hospital, built upon hardcore healing, or at a facility that will make you feel more depressed than you had been.

I’ve been to the Good Hospital four times since I moved to Chicago, and each time it feels like I am returning home. There is little staff turnover, and you can tell that the nurses and counselors enjoy their jobs, that they would rather be nowhere else: They like chatting with their patients and helping them discover solutions to the things that have been keeping them stuck. The employees at the Bad Hospital stare at their smartphones during their shifts.

The nurses at the Good Hospital hang out in the hallways and ask patients how they are doing several times during each shift. They offer me pills and talk whenever they think I’m slipping. They explain what each medication does and when I can expect some relief from the anxiety or agitation or whatever mental state is causing me distress.

When my bipolar illness became a runaway train of rapid-cycling manic and depressive episodes that my doctors couldn’t control with medication alone, two of the Good Hospital’s mental health counselors presided over my electroconvulsive therapy, or shock treatments. One of them held my hand as the anesthesiologist jabbed a needle into my vein to put me under. As I drifted off into my medically induced slumber, I felt gratitude wash over me. I knew that things would work out in the end, that I would find a way back to my life.

By the time I stumble into another suicidal depression a few years later, I know more about how to advocate for myself. I am in another suburban emergency department wearing yet another hospital gown. I feel so hopeless that I can hardly stand being in my own skin, and I know that I desperately need some help. A crisis social worker pulls up a chair next to my stretcher and turns to a new page on her clipboard.

“Will you check into a psychiatric hospital?” she asks me in a cheerful voice that is so kind that I actually feel a little embarrassed for being here.

I’ve quickly learned that these crisis workers play an instrumental role in where you eventually end up, as they are the ones who have to make the rounds of phone calls to all the psych wards in the Chicago area to see which ones have beds. There is no way to predict where you will be placed. While I am waiting to be medically cleared so that they can transfer me, I keep ruminating about what will happen to me if they have to send me back to the Bad Hospital. My life may very well be on the line.

This time, the crisis counselor basically lets me call the shots. I am now an informed consumer, having found out a little something about the various psych wards in the city and suburbs from my own experiences and those of friends who have been hospitalized. I’ve learned that certain units have a reputation for being on par with the Bad Hospital. I tell the counselor which ones to look into, even if they are on the other end of the metro area, and which ones to avoid. Through a sliding glass door, I watch her leave my room and plop down at one of the desks in the ER nurse’s station. She is checking to see if there are any beds at the Good Hospital, as promised.

Even if there aren’t, maybe she can find a place that will give me the help I need. I can only hope that I won’t have to go back to the Bad Hospital. I hold my breath.

“Elizabeth, it’s your lucky day,” she finally says, grinning. “The Good Hospital has some discharges planned. So, there’s room for you. I have arranged for an ambulance to transport you there sometime after lunch.” My heart swells.

At the Good Hospital, the paramedics lift me off the stretcher and put me in a small room where I am to wait for a nurse. One of the counselors, Evan, welcomes me back like we just had lunch the other day. Even though I’m so depressed that I can’t stop sobbing all over my hospital gown, I talk a little about how I am feeling: My sadness is so pervasive that I’m not sure I will ever get better. I haven’t seen this guy in several years, but he looks the same. And he’s still just as interested in my story. He slides a plastic hospital bracelet around the bones of my right wrist.

“We are going to help you, I promise,” he says. I’ve never felt so relieved.

Later on in my stay, my depression worsens and I languish in my bed through entire days that bleed into the darkness of the night. I come to when the nurses step into my room, turn on the lights, and start feeding me the capsules and tablets that are supposed to fix this, fix me. My meal tray sits on the table next to my bed, but I am too sad to even pick at my chicken Caesar salads or sip on the cranberry juice cocktail. I can’t remember the last time I showered, read a book, or had a conversation with someone who wasn’t a mental health professional.

Evan comes back to my room and pulls up a chair. “There is hope, you know,” he tells me. “I promise that you are not going to feel like this forever. I’ve seen you here before. And you always do get better.”

I keep crying and contorting my body into the fetal position on my bed. I feel myself choking on the combination of my own sour breath and the drool sliding down my chin from all the antipsychotic medications they are giving me to try to stabilize my mood. My eyelids are heavy, and I can feel my sweat sticking between the folds of my hospital gown.

Still, I am thrilled to be occupying one of the coveted beds at the Good Hospital for an entire week. During group therapy and meals, I commiserate with other patients who have spent time at the Bad Hospital. We all agree that it’s a terrible place.

“But the food is good there!” another patient says. I can’t help but laugh. This woman will eat anything, and I can hear her running through the hallway all day asking when it’s time for lunch or dinner.

Coming back to the Good Hospital is the first step in the right direction for me: for my sanity and my life. The nurses and counselors take care of me when I can’t do much of anything for myself. I might give them five reasons why I want to die, and they counter with at least 10 reasons why I should live. They cheer me on as I slowly get better. I’m starting to leave my bed, go to groups, and walk around the unit. The therapeutic routine slows down the chaos in my brain.

It unsettles me to think about what people do when they don’t have insurance, when they can’t afford to get a psychiatrist to manage their care. Then the emergency room becomes their only resort, and the cycle starts all over, with overflowing psych wards and the only available beds in the Bad Hospital.