Dear patient,

I have two things to tell you.

You're fifteen. This should not have happened. This should not have happened to you. You should not have been dealt the hand you've been dealt.

Things will change. The way you feel will change. It will get better. It won't get fixed, it won't be all sunshine and roses, it won't ever be like it never happened, but you will, at some point, feel differently than you do right now.

Well, three things to tell you.

You don't deserve the pain you want to inflict on yourself. You didn't do anything wrong. The punishment you think you deserve is not, in fact, to be meted on you. You deserve to feel better than this.

Four things.

My job is to keep you safe from harm until you feel differently. To keep you safe from hurting yourself as long as you're under my care. Because at some point, I hope, you'll come to know what I know. That you don't deserve this pain. And there's no need for you to add to it.

Jesus. And five things.

And here is the thing I can only say here in this letter to you. Here is the thing I can barely keep myself from telling you when we talk. But I have to because I'm supposed to be the wise adult. The empathetic grown-up who can somehow, maybe, imagine where you're at.

Do you know how I can understand the desire, the drive, the compulsion to hurt yourself? I get that it's not about suicide. I get that it makes you feel better. I get that not doing it hurts almost as much as doing it. And do you know why I get that?

Because I fight it every day.

Little sister, I love you.

Constance

Dear patient,

I hope that you believe me when I say there's hope that you'll recover from your depression, even though you can't see it now. I hope you believe me when I tell you that you haven't done anything wrong, that it's not that you're a bad person, or that you just haven't tried hard enough. I hope that you can hear me when I talk about the disease that depression is, about how it robs you of perspective and hope and energy and strength and the ability to all those things you used to be able to do like show up for work, or be social, or wash your dirty dishes for weeks on end, or even shower. I hope that you can believe me when I tell you that it's your disease that's crippling you - not your character, or your mettle, or your will.

Because maybe if I can be convincing enough to you, I can convince myself.

xoxo

constance

p.s. When I hold your hand, you're holding mine.

Dear patient,

Ah, yes. The cocking of fists and throwing of chairs and yelling all night about how things are in the hood and the things you've done in jail... Yes, yes. Sure, sure. But when you tell me you own the place and can do what ever the hell you want because you think I'm scared of you? Yeah, no. Tonight this is MY house. And when I lose my patience with you trying to wake up everyone else on the unit and tell you to "Cut the shit, you little punk?"... You start to cry and call me "Ma." Oh honey. You're a scared little crazy little boy in there, huh. Yeah. You're still a punk, though. And I've seen worse than you.

HAPPYSUNSHINEFUNTIME!!!11!!one!!

Constance

Here's the thing. It's just one after another sad, sad story about the terrible, horrible things people do to each other. Things that have been done to you, things you've done to other people. And it's just a lot. And I haven't figured out what to do with those stories. I don't want to talk about them with my friends - they shouldn't have to hear and know these things. So they just sit here. And I become the sin eater.

I've been asked if I can't just ask the questions, write down the answers, and not get emotionally invested. But I know that all day long, in the emergency room, in the crisis evaluation, in the intake, you've been repeating your story to one after another person with a clipboard. Checking off the boxes for abuse, trauma, neglect, loss, depression, despair, and hopelessness. And I don't want to be another one of those people. I want you to know that I'm listening. I want to always mean it when I say "I'm sorry that happened to you."

But then I'm just sorry all the time. And sad that people can be so cruel to each other. And angry at the hand you've been dealt. And guilty that I have access to good, reliable, regular psychiatric care myself. Sorry that I can't do more for you.

And sometimes I feel so inadequate for being so affected by it all. Why can't I figure out how to be compassionate without being overwhelmed? There has to be a balance between caring and jadedness. Between empathy and indifference.

I know that there's a kind of spectrum of involvement. At one end there's complete emotional separation from those you care for. And at the other, there's the over-involvement of complete immersion and identification with patients. I also know that if I'm not going to find the space in the middle I would much rather be on the immersion side than the indifference side. And that's where I am. But I need to get closer to the middle of that spectrum than I am.

Because my life isn't just work. And things outside of work take time and attention and effort and caring and living and being and learning. So sometimes I don't have it all to give at the hospital. I would say I can't give what I don't have. But that doesn't seem to be true. I don't yet know how to do this job without caring so much and trying so hard and doing so much. But when my balance is low from the start I find I'm pulling the resources for all that doing out of thin air. I'm overdrawing on my emotional account, I guess. And then I need a bit of time to replenish. So I'm learning.

And that sucks. I'm mad about not being able to do it the way I want to, without any negative consequences. Maybe because I'm naive. Maybe because I'm too hard on myself. Maybe because I'm not hard enough.

But hey - I'm working on it. Making myself take "mental health days" when I need to. Asking for help from my friends. Writing here just to get it out of my head. And it's weird. And scary. This is not the way I'm used to handling what feels like failure. I don't know. Change is hard even when it's a change for the better.

Dear patients,

I just can't do it right now. I've learned the hard way now that if I don't take care of myself I can't take care of anyone else. So I can't take care of you the way I want to, the way I'm used to, until I'm ok again. And I'm kind of not ok. A little too much, a little too often, a little too deep, and a lot too sad and sorry. It takes its toll. So right now I'm just showing up and doing the job the way everyone else does. And that's ok. Right now I have to believe that's ok. I plan to be back. Maybe not like before, but more than I can be right now. Take care. And I'll help how I can.

Love,

Constance

Dear patient,

For just a second there, but a second that seemed to last a day, I thought you were already dead. The fixed stare, the not breathing... But your color was good and you had a good pulse. And so the moment passed. Maybe a seizure? Maybe a stroke? I mean, seriously, you're a hot mess medically, having come to us straight from the ICU. Later, in the emergency room, you told the doctor you were fully conscious the whole time we were running the code and that you were just hoping we'd leave you alone a let you die. So you held your breath. And stopped answering to your name. Well, I'm sorry I fucked that up for you. But it's kind of the opposite of what I do. I hope you can forgive all of us who've been keeping you alive these past few weeks since your suicide attempt. And I hope that soon I'll be able to forget the crushing dread of of that long moment of thinking I was already too late.

love,

constance

Revision

The more I think about this post, the less I think it's what I want to say. I mean, what a freakin platitude. "Just keep living! Just don't kill yourself!" With the implied "and everything will be ok." Everything's not going to be ok. I know that. He knows that. Of course he wants to kill himself. Who the fuck wouldn't. And how can I even begin to offer him solace at a time when, like I said, there's just so much wrong. With everything about the situation. With his life right now. Sad and broken and dope sick and lost and hopeless and angry and guilty and ashamed and lonely and scared...

So I'd like to revise what I said before.

Dear patient,

I can tell that you're hurting. I can only imagine how hard things must be for you right now. I'm so sorry. And I just want you to know that I'm here.

love,

Constance

Dear detox patients,

What's with all the Newports? Seriously, I've never seen a higher concentration of menthol smokers in any population. The old "if I smoke gross menthols no one will bum from me" theory? Won't work if you all smoke them. So what is it?

curiously,
contance

Dear Patient,

I am so, so sorry for your loss. To have lost a child, and to have missed the news, the wake, the funeral because you were on the streets using... I can only imagine. There is so much badness in all of that. I hope someday you come to forgive yourself. Please remember every day that not dying is the first and most important step.

love,
Constance

Dear patient,

No, I don't think you're stupid.  But I do think that, yeah, you don't know what's going on here.  I mean, I can see why what you seem to think might make a kind of internal sense.  Yep, I'm pricking your finger and getting access to your blood.  And yes, the test strip sucks up that blood so the glucometer can analyze it.  And sure, the a glucometer is computer, of a sort.  But it's only just the one drop of blood.  I'm not taking it all.  Though I really can see how it might look like that for just the one moment when there's a continuity of blood from your finger to the test strip to the glucometer. 

But here's what's going on here.  I am just trying to test your blood sugar.  The glucometer's not stealing all your blood to send it to the CIA.  Or the pope.

So yeah.  I don't think you're stupid but I do think you're wrong about what's going on here.  And hey - you got one thing right.  I am a crazy white bitch.