Posted by: Kate | September 30, 2008

A Boil on the Ass Cheek of Humanity

I’m a very patient woman.

I drive fast when no one is in my way, but am usually content to wait in line or at traffic lights as needed. I can re-explain things several times, several different ways, as needed. I have not yet throttled any of my immediate family for their continued inability to replace the toilet paper roll at the appropriate moment.

And, at work, I can ask a question and wait for an answer. Sometimes people are so wrapped up in their own misery that they can barely form words, much less push them out in a timely manner. There are times when I’ll ask a question and wait upwards of a minute before getting an answer. Don’t think that’s a long time? Try it. Ask a friend to hold a stopwatch and wait a full 60 seconds before answering a question such as, “How old were you when you had your first child?” and see just how endless that minute feels.

I can see the same client, for the same reasons, every week for months, and can repeat the interview as though something might possibly have changed since the last time. It could be argued that I’m just wasting my own time and theirs by bothering to give them a half-hour of my time, but I’m of the opinion that if they felt bad enough to come to the hospital and then stick around until I show up, then I’ll give them the benefit of the doubt. Even when I know they’ll never change, because there’s no incentive to change and their lifestyle, though it would be unbearable to me, is meeting some need for them. (For those in the field, what I’m saying is, I don’t have a problem working with someone with several Borderline Personality Disorder, because I know it’s not personal. I maintain good boundaries.)

I can argue with doctors, not kill coworkers with my coffee mug in the middle of staff meeting, and wait hours for a psychiatric hospital to come back with an answer about a potential admission. All with varying levels of grace and acceptance, but all patiently.

Of course, sometimes, I dislike clients, and sometimes I even lose respect for them. But even then, I’m able to remain patient with them, because I realize that their actions are not about me. They’re not focusing on me, trying to manipulate me; I’m just a casualty in their ongoing war against life. I get that.

But there’s this one woman.


She’s 30, and of a high enough functioning level that she holds down two long-term part-time jobs and carries her own private health insurance. But every year or so, not on a predictable anniversary but whenever she decides it’s time, she slides out of control. She decompensates completely and behaves exactly like a toddler – whining, tantrums, refusal to engage in rational discussion unless she’s getting her way. (So, to be clear, she’s like the worst kind of toddler on the worst day – my kids are far better-behaved, and always have been.)

If it was truly a slide into uncontrollable mental illness, I wouldn’t get so revved up about her. But I know her behavior is manipulative and deliberate, because I have watched her turn it on and off at will. She will sit and speak appropriately to me, describing complex symptoms and providing an accurate personal history, right up to the moment when I deviate from her script and say something like, “Well, I suppose you could consider that a suicide attempt, but six multivitamin pills is not a lethal dosage. You know this, because you work in the health field.” Then she will literally stand up and stomp her feet, pout, cross her arms, and glare at me, and will refuse to continue the conversation.

Unless, of course, I remind her that if she can’t convince me of her safety now, then her only option will be a commitment to the state hospital. She hates the state hospital, though no one is really sure why. Just because she can, I suspect. The first time I had to commit her (this is after 10 crisis assessments in 12 days, one voluntary hospitalization in which she left against medical advice, and on the recommendation of her treatment team), she attempted to leave the hospital room.

Wearing only a hospital gown, closed only at the neck.

She’s quite unattractive, though frankly I don’t care if you’re Angelina Jolie or Russell Crowe, I do not want to see your naked nether regions while you run down the hallway, gown floating behind you like the cape of the world’s worst superhero. Horrifying.

Last night, while I was talking with her, she got mad and did the tantrum thing, and so I stood up to leave. “Sorry, but I refuse to spend my time with someone who responds like that. I’ll go see another patient who is waiting patiently and behaving like an adult, and will return to your room and see if you’re ready to speak with me then.” When I returned, she cooperated for about 4 seconds and then started with the same routine, only this time she dropped her paper-hospital-provided drawers and started using the port-a-potty in her room. One might wonder if she had actually gone over the edge this time and truly regressed, except for the sneer and bright-eyed awareness on her face.

She just, ugh. I dislike her, I hold no respect for her, and I have no patience for her at all. I gave her appropriate treatment and followed proper protocol, crossed every T, dotted every I, did not thwack the patient upside the head with my clipboard. But I am already dreading the next day I have to spend time in her presence, and I know that day will come.


  1. I think, given your job, it’s remarkable that you only have one patient who drives you around the bend. That’s far better than I would be able to do. I’m sure I’d end up telling someone to grow the heck up at some point.

  2. OMG I laughed my arse off!!!!!!!!!!!!

    Nobody makes me miss my office job quite so much as you, Kate.

  3. Oh just thump her with theclipboard…P-P-P-PLEASE!!! 😉

  4. You’re a stronger woman than I. Yet another reason why I work with children.

  5. And you have just answered my question of why I don’t want to go back to work….to deal with those many people who drive me insane.

  6. Borderline? Sounds like it, I hear they are the most fun!

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