Unsee

If you've ever had the unfortunate experience of watching The Silence of the Lambs, then you know the main character, played by Anthony Hopkins, is a brilliant psychiatrist, but also a dangerous psychopath with a penchant for cannibalism. Many years have thankfully passed since I saw it, but the unsavory scenes of one human eating another stay with most viewers.  In my younger days I liked a good scary movie,  but as an adult I've never much cared for them, which is ironic considering some of the horror shows I see when I go to work each day.  Most recently, I witnessed the aftermath of a patient who later brought the aforementioned movie to mind.  But sadly, this wasn't a movie.  Chewing from an open self-inflicted leg wound, my patient tore around seven inches of flesh from her body and spit it on the bed.  Her own blood covered her face and sheets as the nurse practitioner on call and three nurses worked quickly to stop the bleeding.  She had done this before.  The wound had grown so deep and so large that not enough skin remained to stitch it closed.  I had never seen anything like it and nurses on call that day said the same.  Standing to her side and trying not to cry for her,  I forced myself to hold it together and work to calm her while the ambulance for another hospital was called. As I looked into her eyes, I saw her desperation to die and with tears beginning to run down her cheeks, she asked me if she would live. When I softly told her that she would, her face fell in disappointment and she laid back in defeat.  Of the entire experience, that moment was more painful to see than the bleeding hole in her leg, blood stained sheets, and the pieces of flesh lying on the bed.  It was all too much, and as I fought back tears, I knew I could never unsee any of it.

In This Moment

As I walked into a patient's room recently, I wasn't surprised to see blood stains on the floor, bed sheets, walls, and her face. Only seconds earlier when her screams filled the hallway and nurse's station where I sat charting, I had taken a deep breath in to prepare for the complete breakdown that was commencing, and as I made my way over to intervene and stabilize her, I didn't have time to consider anything but the immediate crisis.  She was in there somewhere...the woman God created, but shouting back at me and the rest of the treatment staff was a person so incomprehensibly angry, scared, and reportedly desperate to die that I didn't know whether or not I could reach her in that moment.  So I prayed as I worked to calm her.  Our sessions up to this point had been as productive as her limited cognitive functioning allowed, but in the middle of a self-injurious rage, patients aren't always so easy to calm.  It's not my favorite part of being a therapist, but I had been in this setting before and the scene was all too familiar.  Several years ago I spent time working in a psychiatric hospital in Los Angeles, but when I left that position, I had no intention of ever working with the severely mentally ill or those with neurocognitive impairment again.  But there I was.  Working calmly and quickly to stabilize a bleeding patient screaming about wanting to die.  Again.  How did I get here was no longer the question running through my mind; I knew exactly how I got here, but the question had become Why am I staying here? To be honest, I'm still not sure, but what I do know is that in this moment, all is well.