Mercifully, over the next few days, Dawn turned up on time and was able to talk about her experiences. I felt obliged to be transparent so I shared with her the results of the suicide/self-harm scale. Doing so actually helped her appreciate my obsessive questions about safety. Each day I reiterated our agreement, noting that we would need to consider a long-term approach to her therapy. Each day she merely nodded. On day three, she disclosed an interesting description of her suicidality: “I’ve been knocking on deaths door for years. I’ve been serving a commuted sentence…on trial for meditating murder, against myself. Everyday, for nineteen years.”
By Thursday, or day four, I reminded Dawn once again that we were approaching the end of our agreement. I asked “What can we do next?”
“You can’t leave me!” Dawn shrieked. Fear of abandonment was blared strong in people with her history.
“It never crossed my mind.” I lied. Then I realized I shouldn’t lie. “Well, to be honest it did cross my mind.” Her face grew stormy. “But hear me out…it only crossed my mind because I’m a crisis worker. My job is get people out of crisis and shifted over to someone who can give them what they need, for as long as they want it.” By the look of her, Dawn was not convinced. So I continued. “Mostly, I’ve been listening to you do the hard work of interpreting and re-framing your story. I’ve heard you say what happened to you was not right and that you weren’t to blame. Having said that doesn’t mean that you believe it – but having said it is a solid start. There are people who work in this field all the time who can push you where you need to be pushed and hold you back when you need holding back. Its not the job I’m best at…” I saw tears rim her eyes.
“Hey, I’m not giving up or turning my back on you but we do need to re-negotiate our next step.” I had her attention now. She sniffed back the tears but still said nothing. I let a full minute go by. “So, tonight, think about what you want to have happen next. Tomorrow when we get together I can share with you the names of some of the folks here at the hospital but also in the community who you can choose to support you in the long haul. There are support groups as well where you will meet other women who have had similar traumatic experiences to you and are at varying stages in their recovery. But I want you to know, I will continue to see you for the next while, just not everyday…” She calmed a bit with this piece of information. “Just a guess,” I added. “I expect tonight will be tough. I expect you will be angry with me. I expect you will be disappointed with me, you may even think I tricked you.” I knew giving her an I-told-you-so would not be productive. “Just remember, my wish for you is to continue to work on your wellness.” She needed to know I could withstand her intense emotions.
Dawn sat quietly, staring at her hands for at least two minutes. Finally she looked up. “Thanks.” She said clearly. “Thanks for believing in me.” As she stood to leave, she smiled and reported: “I’m ok. I’ll be safe. I’ll see you tomorrow.”
I made a quick run down to the emerg to finish up an assessment I couldn’t finish this morning on a fella who had overdosed and remained difficult to rouse. By the time I dashed in to see him he was much more alert and able to answer my questions. His level of depression concerned me and his promises that he wouldn’t harm himself were unconvincing. Because his blood levels were still wonky, he would stay in the medical unit overnight. After confirming with the duty doc, I requested a psychiatric consult in the interim. I let the new Team Leader Kim know what was going on, so she was in the loop. On my walk out the door, I continued to think about Dawn. How did people survive such histories? So much of the suffering was invisible, right until the moment it stopped being invisible. The statistics regarding the numbers of people who were admitted to psychiatric units who had also experienced sexual abuse should have signaled a public health epidemic but we shy away from these messy intrusions. Dawn’s story has been re-played again and again, and again, in our clinics and wards. It made me angry; it made me sad. Then is made me angry again.