Knowing Your Limits

Knowing Your Limits

From Chicken Soup for the Nurse's Soul Second Dose

Knowing Your Limits

To oblige one grateful man, I will oblige a great many who are not so.

Lucius Annaeus Seneca

As a physician assistant, I spent the first two years after graduating at one of the largest correctional facilities in the New York City area, Rikers Island.

Staff members rotated through the various clinics, infirmary, and special housing units addressing the many medical needs of our inmates. It was in the women’s mental health unit that I met Renee.

Renee was a disheveled woman in her midtwenties, with long matted hair, dirty clothing, and a toothless smile. During my daily rounds to the unit, she stood in close proximity, grinning and drooling, and making bizarre gestures. She often attempted to communicate, but her speech was incoherent and tangential. Abused by family and most people who came in contact with her, Renee had a lifelong history of schizophrenia and depression. She had been in countless psychiatric programs and on various medications. Too often she became noncompliant and relapsed into a world of paranoia where she self-medicated with illicit drugs.

Now she was in jail for transporting cocaine. She was apprehended carrying a suitcase full while doing a “favor for a friend.” This was a most unfortunate incident because Renee was not capable of understanding her actions. Her medical condition prevented her from making sound judgments. She would have gladly carried a lit stick of dynamite had it been offered to her.

She’d been assessed by our mental health team and placed on multiple antipsychotic medications, but her condition never improved. Because our facility was overcrowded and our staff overburdened, we were unable to provide the intensive follow-up she desperately needed. After many weeks of treatment failure, she was transferred to an inpatient psychiatric hospital that was better equipped to assess and treat her. I felt so sad letting her go, and regretted that we were limited in doing more for her.

Several months later the time rolled around for me to rotate through the mental health ward again. One morning as I entered the unit, I was approached by a neatly dressed young woman with a coiffed brown bob, sparkling white teeth, and a pretty smile.

“Do you remember me?” she asked.

“No, I’m sorry, I don’t.”

“It’s me, Renee!”

Excitedly she told me about her stay at the psychiatric hospital where she had been thoroughly assessed and treated. With medication adjustments, her thought process and speech became coherent. Then the staff could focus on her physical well-being. She cut her hair, bathed, was fitted for dentures, and given new clothing. Now she functioned like an average person and was preparing for her trial with the competence she needed.

“Thank you,” she said, with confidence and poise.

“Thank you?” I asked, somewhat stunned. “I always regretted that we couldn’t do more for you—that we let you down.”

She smiled easily. “No. Your team admitted your boundaries and transferred me to a team of specialists who worked a miracle. Thank you.”

Frank Serigano

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