Friday, May 30, 2008

boundary transgressions

I found out for myself, again, the hard way, why 'professional boundaries' are so important.  Cardinal sin - I hugged a patient.  Should have thought twice, then twice again.  He was a thin wreck of a heroin junkie with wise sad gentle eyes behind scholarly horn-rims, sunken cheeks fuzzed with gray stubble, yellow horse-teeth in an occasional bitter laugh.

Strange how some patients leave me utterly cold, without a fig's worth of worry for whether they end up in the gutter or not.  Others take odd hold of me.  I remembered this man from a previous admission, after he'd driven his car into a tree - for the third time.  What was going on behind those sad gentle eyes that could make anyone wish to die so violently?  He spoke from between clenched yellow teeth, a mountain man trapped in a prison made of poppy stems.  Somehow he struck me.  

He was oddly, unexpectedly open in the interview.  He described unbidden his fear, loneliness, abandonment - until his eyes began to well and I quickly reassured him that he needn't speak of anything that would upset him so.  He drew back, but later returned to trying to explain. Finally he offered, "You ever just need a hug?"  He was staring frankly, a challenge perhaps?

Of course, I think that's pretty normal.
He described standing in the same room with his mother and brother and how desperately he'd wanted a hug, but had been completely unable to ask.  
Why not?
The expected cant about manliness, etc.  My heart rushed out to him.
You want a hug?
"Yeah, I do want a hug."  Testing me?  Wanting to see if I would be as good as my word?  Or, instead, if I would have the strength to resist?  I wasn't sure which option was the failing one.
I'll give you a hug.  No turning back now.  But you have to ask for it.  A psychiatrist's trick, or a weak attempt to give myself - or him - an out?  Regardless, he met my eyes.
"Could I have a hug?"
I hugged him, in my office, with the door closed, this man I'd just met; a long hard hug, rubbing his back as I would that of a sister or dear friend who was sobbing on my shoulder.  He smelled of cigarettes and pine bark.

Afterward I asked something inane, like How was that? or Was that helpful?
The former, I think.  He said he felt unsettled, almost nauseated.  I asked if he needed to throw up; he said no.  He said he hadn't had a hug in ten years.  Then he amended it: "Well, a hug from one of your buddies, that's something different.  But a nurturing hug..." He trailed off.  Then, "I haven't touched a woman in ten years."

Uh-oh.  Sirens, alarm bells.  How could I think such an act could stand independently of gender?  Fooling myself utterly.  But not innocently either - would I have done that for a patient I hadn't felt so drawn to?  Honestly, probably not.  Or, just - not.  Then how far could I fool myself to pretend I thought he would take it as such?

Let's get back to the interview.  I sought escape in a return to officialdom - pathetic and weak, as I'd abandoned that bulwark voluntarily already, showing it to be nothing but a sheet of tissue.  But he cooperated, bless him, returning also to the thin fiction of protocol.  

And later, of course, he avoided me entirely while others laughed and waved; as if we'd shared an intimacy far beyond what we had in deed.  That was when I realized the magnitude of my error.

Later I crafted fictions to forgive myself.  I wanted him to see that he could ask a small favor and have it granted.  I wanted to show him the possibilities that remained for human touch.  He needed it.  But all those were rationalizations.  True in ways perhaps, but at bottom I wanted to do it, wanted to pull close this scrawny middle-aged heroin junkie, this wasted scrap of human potential and make him feel warmed, supported, loved.  Why him and not others, I don't know.  Probably just because he had once been handsome, and because he spoke with such measured dignity and cocked his head so attentively to one's words.  Difficult to explain, of course.  Of course.

1 comment:

Penelope said...

Beautifully written post. Challenging situation. I remember once when I was in my internship, I was assigned to a client close to my age. I began to take a history and discuss what concerns had brought him in.

After about five minutes he stopped me and asked for another therapist, saying "I find you attractive and I want to impression you so I can't talk about the issue that I need help with". Fair enough. Not every therapist and client are a fit. Being fired for being too attractive..could be worse.

I appreciated his insightfulness and transferred him on. Fortunately, he did not ask me for a hug on the way out.