to casualty.”
“No! Please! I need this job.”
A thousand voices inside my head were tel ing me what I should do. I ignored every one of them. I sent Catherine ahead to my office, while I col ected 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 tel 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 cal 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 wil not run to you. If you harm yourself I wil 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 stil 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 pil ow. 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 control ed her life and decided things for her. That she was worthless and couldn’t be trusted.
I had given her the choice. Hopeful y, 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 fol owed 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 stil 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 al 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