She knew from past experience how nurses and doctors regard self-mutilators— as attention seekers and time wasters. Often they get stitched without anesthetic. “If you enjoy pain so much, have a little more,” is the attitude.
None of this changed Catherine’s behavior. When she bled she escaped the numbness. My notebooks repeat her words, “I feel alive. Soothed. In control.”
Dark brown flecks of chocolate are stuck between the pages. She would break off pieces and drop them on the page. She didn’t like me writing. She wanted me to listen.
To break the cycle of blood, I gave her alternative strategies. Instead of reaching for a blade I told her to squeeze a piece of ice in her hand, bite down on a hot chili or rub liniment on her genitals. This was pain without the scarring or the guilt. Once we broke into her thought loop, it was possible to find new coping mechanisms, less physical and violent.
A few days later Catherine found me in the oncology ward. She had a bundle of sheets in her arms and was looking anxiously from side to side. I saw something in her eyes that I couldn’t recognize.
She motioned me to follow her into an alcove and then dropped the sheets. It took me a few moments to notice the sleeves of her cardigan. They were stuffed with paper towels and tissues. Blood leaked through the layers of paper and fabric.
“Please don’t let them find out,” she said. “I’m so sorry.”
“You have to go to casualty.”
“No! Please! I need this job.”
A thousand voices inside my head were telling me what I should do. I ignored every one of them. I sent Catherine ahead to my office, while I collected sutures, needles and butterfly clips, bandages and antibiotic ointment. Behind drawn blinds and a locked door I stitched up her forearms.
“You’re good at this,” she said.
“I’ve had some practice.” I applied the antiseptic. “What happened?”
“I tried to feed the bears.”
I didn’t smile. She looked chastened. “I had a fight with someone. I don’t know who I wanted to punish.”
“Your boyfriend?”
She blinked back tears.
“What did you use?”
“A razor blade.”
“Was it clean?”
She shook her head.
“OK. From now on, if you insist on cutting yourself, you should use these.” I handed her a packet of disposable scalpels in a sterilized container. I also gave her bandages, Steri-Strips and sutures.
“These are my rules,” I told her. “If you insist on doing this, you must cut in one place… on the inside of your thigh.”
She nodded.
“I’m going to teach you how to suture yourself. If you find that you can’t do this, then you must go to a hospital.”
Her eyes were wide.
“I am not going to take the cutting option away from you, Catherine. Nor am I going to tell your superiors. But you must do everything in your power to control this. I am placing my trust in you. You can repay my faith by not harming yourself. If you weaken you must call me. If you fail to do this and cut yourself, then I am not going to blame you or think any less of you. At the same time, I will not run to you. If you harm yourself I will not see you for a week. This is not a punishment— it is a test.”
I could see her thinking hard about the ramifications. Her face still showed fear, but her shoulders betrayed her relief.
“From now on we set limits for your self-harm and you take responsibility for it,” I continued. “At the same time we’re going to find new ways for you to cope.”
I gave Catherine a quick sewing lesson using a pillow. She made a joke about me making someone a fine wife. As she rose to leave she put her arms around me. “Thank you.” Her body sank into mine and she clung to me so tightly I could feel her heart beating.
After she had gone I sat staring at the blood-soaked bandages in the wastebasket. I was trying to work out if I was completely insane. I could see the coroner, rigid with indignation, asking me why I had given scalpels to a young woman who enjoyed slicing herself open. He would ask me if I also favored handing matches to arsonists and heroin to junkies.
Yet I could see no other way to help Catherine. A zero-tolerance approach would simply reinforce her belief that other people controlled her life and decided things for her. That she was worthless and couldn’t be trusted.
I had given her the choice. Hopefully, before she took up the blade, she would think closely about her reasons and weigh the consequences. And she would also consider other ways that she might cope.
In the months that followed Catherine slipped up only once. Her forearms healed. My stitching job was remarkably neat for someone so out of practice.
The notes end there, but there’s more to the story. I still cringe in embarrassment when I remember the details because I should have seen it coming.
Catherine started taking a little extra care with her appearance. She made appointments to see me at the end of her shift and would have changed into civvies. She wore makeup and a splash of perfume. An extra button was undone on her blouse. Nothing too obvious— it was all very subtle. She asked what I did in my spare time. A friend had given her two tickets to the theater. Did I want to go with her?
There is an old joke about psychologists being the experts you pay to ask questions your spouse asks you for nothing. We listen to problems, read the subtexts and build up self-esteem, teaching people to like who they really are.
For someone like Catherine having a man really listen and care about her problems was enormously attractive, but sometimes it can be mistaken for something more intimate.
Her kiss came as a total surprise. We were in my office at the Marsden. I pushed her away too suddenly. She stumbled backward and tripped, landing on the floor. She thought it was part of a game. “You can hurt me if you want to,” she said.
“I don’t want to hurt you.”
“I’ve been a bad, bad girl.”
“You don’t understand.”
“Yes, I do.” She was unzipping her skirt.
“Catherine, you’re making a mistake. You’ve misread the signs.”
The harshness in my voice finally brought her around. She stood beside my desk, with her skirt at her ankles and her blouse undone. Panty hose hid the scars on her thighs.
It was embarrassing for both of us— but more so for her. She ran out with mascara leaking down her cheeks and her skirt clutched around her waist.
She quit her job and left the Marsden, but the ramifications of that day have plagued me ever since. Hell hath no fury like a woman scorned.
8
Saturday mornings and soggy sports fields seem to go together like acne and adolescence. That’s how I remember the winters of my childhood— standing ankle-deep in mud, freezing my bollocks off, playing for the school’s Second XV.
God’s-personal-physician-in-waiting had a bellow that rose above the howling wind. “Don’t just stand there like a cold bottle of piss,” he’d shout. “Call yourself a winger! I’ve seen continents drift faster than you.”
Thank goodness Charlie is a girl. She looks really cute in her soccer gear, with her hair pulled back and knee-length shorts. I don’t know how I managed to become coach. My knowledge of the game could fit on the back of a coaster, which is probably why the Tigers haven’t won a game all season.
You’re not supposed to count the score at this age, or keep a league table. It’s all about having fun and getting every child involved. Tell that to the parents.
Today we’re playing the Highgate Lions and each time they score the Tigers trudge back to halfway, debating who gets to kick off.