Jenni continues her story, telling me about Ronnie tying her arm off with a rubber band because the belts they were using on their own arms were too big for her skinny adolescent body. As with so many other patients here, she tells me of becoming dependent on both heroin and Ronnie, and the tables turning after a while—Ronnie starting to demand something in return. Jenni has been desensitized to all this and retells the story as if she were reciting a grocery list. The word rape has lost its meaning, and she reports that sometimes her sister, Jackie, would step in and offer herself in place of Ronnie raping her twelve-year-old sister.
“Jenni, we are getting to the end of our time today, so I wanted to stop and thank you for being so brave and honest about all of this. I think I’m going to add you to a women’s group that we offer here, where survivors of sexual abuse can work together to manage what happened to them.” Jenni cheerfully nods along as I talk.
As she walks out the door, I look at the scabs on her scalp, I see the missing chunks of hair. I see the track marks on her arms and thank God alcohol leaves less of a trace. I think of Ronnie taking advantage of her, pushing her into a corner with heroin and then not letting her leave. I think of Lucas. I wonder if I can walk away with all of my hair.
Richard is still complaining about Devon and his jacket; he’s become obsessed, and he isn’t letting it go. He spent half the day today indicating that something must be done about this man and his jacket and his confetti. We didn’t have a session together, but he showed up at my door over and over again, demanding action. I’m going to Shirley’s office. Shirley is Devon’s counselor, so she must know something.
“Shirley, what’s the deal with Devon? The jacket? I have a patient who is completely disturbed by his jacket. Don’t ask me why.”
“What jacket?” Shirley is eating a fruit cup with a plastic spoon.
“Really? Shirley? The leather jacket he wears all day every day. The old, scrappy motorcycle jacket? You can’t tell me you haven’t noticed this. He wears it every day. And what’s up with the confetti he puts everywhere? Every time I have him in a group, he leaves these little brown scraps of paper or paint or something behind. Do you not notice this?” I’m looking at her chair, and it’s covered in the confetti. It’s covered in everything.
“Oh, the shit jacket.”
“What? The what?” I’ve never heard Shirley curse. It’s like Grandma taking a whiskey shot or smoking a blunt—what the hell is this? “Shirley!”
“He wears that jacket as a repellent.”
“A repellent from what? From who?”
“Whom. It’s a people repellent. It’s his shit jacket. He learned this while he was homeless. He was constantly getting harassed while sleeping on the streets. He needed to find a way of surviving out there, so he smeared shit all over the back of his jacket so he would stink and people would stay away from him.” She says this like she is telling me the turkey is done. She is nonchalant and unfazed by this information. I’m fascinated and repulsed.
“Oh, my God, Shirley! They’re shit flakes? You mean to tell me the confetti all over the unit is really a pile of dried shit flakes! Jesus Christ!”
I’m slamming her door; I’m barreling into the bathroom. I’m scrubbing my hands, I’m fuming. I’m shocked. How is it possible that we have all been handling shit flakes, and Shirley never bothered to tell us any of this? Jesus, no wonder Richard was disturbed by the jacket.
I sit down at my desk and compose three emails. One to Rachel to ask her to confiscate the shit jacket now that I know it’s a fucking biohazard. One to the head of the maintenance staff asking for a deep clean of the group rooms. And finally, one to the staff to let everyone know that the confetti they have been surrounded with is actually dried shit flakes, and in case we had forgotten, we are surrounded by insanity. With the pressure to keep myself sane—the need to ensure that something exists to keep a line between me and my patients—days like these help me believe that there really is a reason that I have keys and they don’t.
“Good morning, Rachel,” I say with a sunshiny voice as I saunter through Rachel’s door and sit in her patient chair.
“Morning, Sam. You’re very chipper today.” She clears away a corner of her desk for me to put my files down so we can begin our supervision session. Rachel does very minimal supervision of the staff because she doesn’t have the time, and she is forced to believe that everyone is able to take care of themselves. There’s been a recent influx of new patients, and Rachel is preoccupied with placement and intakes, so she’s been putting off traditional supervision and replacing it with encouragement to call her if we have questions or problems.
“Chipper every morning,” I lie, swallowing my hangover heartburn. I put on my reading glasses and pull out Richard’s incomplete file. “So, I figured since we only have a short time together this morning, I should jump right into business.” Rachel nods, sips her coffee and swivels her chair to face me. She crosses her giant calves and waves me along. “Richard McHugh and I have been meeting weekly on Tuesdays at 11:00 a.m. There was a lot of speculation that he was uncooperative, but he always shows up to our sessions, and he’s always punctual. He seems to like the structure. Now, that being said, he is extremely uncooperative during the sessions. He is absolutely unwilling to complete the psychological assessments and gets very defensive and cagey when I try to pull any information out of him.”
“Do you feel safe in sessions with him?” Rachel asks.
“Sure. He isn’t threatening or violent, he’s just very quiet and guarded. I don’t imagine that he would hurt me. He seems to be protecting himself by staying quiet. He doesn’t like to share his story.”
“Have you been able to determine why he was in prison?”
“No. This is actually one of the other issues with his chart; there isn’t a lot of stuff in his continuation-of-care section. I have the names of the halfway houses he attended, but no contact number or contact person there, no sponsor or mentor. I have the names of the prisons he was in, and the dates he was there, but no further information. It’s all very unclear. There are some xeroxed pages with huge swaths of the page blacked out. There is no information about the charges, so there’s no way to know what he did to end up in prison. And he certainly hasn’t made any effort to tell me.”
Rachel nods. “I was the one who did his intake, actually, and I found the same thing. There was very little information available to us, but he was strangely insistent on coming here. He didn’t tell me much of anything at all, but he was polite, if standoffish. It’s a complete question mark. I got in touch with the teams at Revelations and Horizon House, the halfway houses, but they didn’t have anything on him. The staff turnover at those places is ridiculous, and they don’t seem to keep proper records.” She’s reaching around her desk and pulling at scraps of paper poking out of various in-boxes and out-boxes. She’s looking for something.
“Have you had patients like this before? I’m not entirely sure how best to proceed. He’s a giant question mark, like you said, so I don’t know how to properly place him in groups, and I’m not sure how to draw out the information we need to help him.” Rachel loves it when I ask her for advice.
“I’m looking for his original intake stuff. I gave him a blank sheet to write on when he refused to fill out the intake materials. I asked him about his goals for treatment and that kind of thing. I know he scribbled something down, but I can’t remember what it said.” She pushes her chair around