Before, confronted with a difficult new patient, I sometimes felt like a stone falling down a well. The uncertainty felt sudden, total and overwhelming; it drowned me. The isolation felt like darkness closing. Sometimes I feel that now, but it’s rarer. Back then, a young woman, for example, might open her mouth and tell me that she was cutting herself, her wrists and her thighs, with a pencil sharpener, every night, and she would raise her sleeves and show me these thin, pink parallel stripes, and there I would be, falling down a deep well, thinking, “What can I possibly say to her that will help? What can I possibly do?” I feared that I would have nothing to offer, nothing at all, and that always seemed so terrible.
This morning Jodie, a patient, comes to see me again, angry as hell — always angry — saying that, because I tried to reduce the dose of her Valium, she had done this. And she yanks up her sleeve and thrusts her sliced forearms into my face, and asks what was I going to do? Jodie’s great-uncle is also her father. She has the ghost of a memory from her childhood that he might have been more than that, too. But her mother, who is dead now, would never talk about it (who would?) and she’s not speaking to her aunties or her sisters, so that leaves Jodie thrusting her wounds into her doctors’ faces, her own face twisted into a fuck you shriek. And I say to Jodie that there is nothing that I can do, because there isn’t, and that seems less terrible to me now, than it did, before.
Because I have seen hundreds of people who cut. Because I have seen so many cases, I have a mantra for people who cut. The same mantra I use for all my patients whose faces three views of a mountain carry that look, the patients who invoke from my depths the ghost of that same shriek.
Jodie looks at me through narrowed, angry eyes. Slowly, I breathe in my mantra; slowly I breathe it out:
✦ De-escalate. Reduce the emotional charge — mine and theirs. Be calm. Pause, breathe deeply. I don’t show desperation or impatience; I don’t show anger, with the world, or its victims. Suppress it all. I don’t glance at my watch. I don’t prescribe impulsively, I don’t refer impulsively, I don’t do anything that raises the emotional temperature. I’m calm. I’m present. I reassure.
✦ Be honest. Say it as it is: cutting is common. With calm and reassurance, with time, it usually passes. Your personality is as it is, and I can’t fix that, because it is you. This cutting is your thing, not mine, but I will try to help you to find a better way through. There isn’t a drug or a therapy or a person that will make you stop. Any cheap solution is a lie, and I won’t offer it. But I will try to help.
✦ Be there. I will be here for a long time. For as long as I am here, I will be happy to see you. I will try to be available; I will remember who you are, and I will still try hard to care. I will try to build a relationship with you even when no one else will. I hope to be the last person standing when everyone else is gone.
Now that I have seen how common it is, it doesn’t panic me so, when I discover that people cut themselves to deal with pain. Silent, I breathe in the mantra, breathe it out.
“Why did you cut yourself today, Jodie?”
Excerpted from The Human Kind: A Doctor’s Stories From The Heart Of Medicine by Dr. Peter Dorward. Copyright (c) 2018 by the author and reprinted by permission of Green Tree, a division of Bloomsbury Publishing.
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