I have a general rule about not touching patients. Perhaps I was unduly impressed by a lecture that focused on touching as "manipulation" (e.g. giving the message of "Please like me; don't hurt me"), perhaps I am overly-sensitive to professional "boundaries," and it certainly flies in the face of "auscultation, percussion, and palpation." Likewise, many of my colleagues emphasize that prisons, in general, are "filthy places," and the alcohol-gel hand cleaner is as common to them as a whistle. All of which is humorously ironic when a delusional patients says the same thing; one man told me he makes a "paste" of liquid handsoap & toothpaste, convinces the CO's to give him a pair of surgical gloves every Sunday evening, and by coating his hands for an hour he is "protected" from prison contamination for the week. Some colleagues use the "technique" of always having a pen or paper in hand, thereby discouraging touch. I emphasize that I am never rude - if a hand is extended, I will generally shake - but I am always cognizant of the level of violence & danger. But this is a post about innocence.
My young patient took a seat across from me, and the first thing I noticed were the long scars of self-mutilation on the top of his arms; easily a dozen on each arm. He had large doe-eyes that were locked on me, but he had little range of affect. He had fixed delusions, mainly of a judgmental. religious nature. Voices tormented him with deprecation of his past "evil life," which included his father who was murdered on the streets by gang members over drugs. A father with whom he learned to get high at age 14. Now, his father's voice scolded him as a "loser."
The first thing he said to me upon being seated was that he was not going to accept the disability "discount" the county gives for a monthly transit pass, because he was not "grateful enough" for being saved from death. He was so concrete that I found it necessary to be careful what I said, but when I asked what activities or hobbies he enjoyed, he said, "I love to fish, feed the birds, go to the mall," and very pointedly, I love girls." I spontaneously laughed, and for a moment his face was blank, wide-eyed, but just as spontaneously, he too began to laugh and extended his hand in a sort of "high-5" motion saying, "dude." Now, in prison inmates tap fists in greeting or dismissal, but staff never engage in the same manner with them. One CO even complained to me that a group of CO's had seen one of our staff exchanging "fists" with a patient. "What is he? One of their buddies?"
With a pen in my hand, I gently returned the hand motion. Why? In my heart, he was so sick, so disabled, so helpless, that he was an innocent. And as it turned out, he was a non-violent thief; stealing things from stores to sell for drug money, stealing from his family. I did not know this at the time. When we finished, walking him back to the CO's, he was grateful for my help, but he did not attempt to shake hands. But he did wait until I had gotten the next patient, and as I passed he waved good-bye.
This has only happened to me on one other occasion, and it was in the hospital at San Quentin. A man in his late-50's, who had served 24 years of a life-sentence for murder, much of it spent in the hospital, was now about to parole. He too was very ill, very gentle, very child-like. In fact, he could think of no positive reason to be leaving: his day was structured & predictable; he had his own cell with a window he could open to both see & experience the bay through bars; and he could feed the birds. His only concession was that he did want to see his elderly parents before they died, but he would gladly come back. As is typical, I interviewed him in a room barely large enough for the two chairs we sat upon. When we finished, we stood up, he thanked me, and suddenly and unexpectedly, he hugged me. It happened so fast that I didn't have time to feel either threatened or shocked. He then turned and went out the door. When I got into the hall, I told a female CO what had happened, and she literally gasped: "Oh. my God, are you OK?" When I got back to the office, my colleagues responded in exactly the same way, "You could have been killed." But he was an innocent.
This is the daily dilemma of working with the gravely impaired, dangerous, and violent. Walking a maze of professional behaviour, providing a level of care that approximates the community, acutely aware of your own safety, and the demands of your humanity. It's a bitch.