Free The Naked Lady Who Stood on Her Head by Dr. Gary Small

though, could just mean he wants attention,” Will said.
    “He did get a lot of TLC in the E.R. from his mother and—”
    Will interrupted, “Do you think there’s a sexual component to this one-armed-man thing?” Will loved delving into possible sexual explanations when trying to understand and diagnose complicated cases.
    “I don’t think so,” I said. “But I didn’t really get a chance to go there. The two of them were arguing so much that I barely got them to agree to come back in again.”
    Will smiled. “So they still have feelings for each other.”
    “Yes,” I replied, “but this hand thing is too much for her to take. Also, her biological clock is ticking, and he’s reluctant to start a family.”
    “My guess is your patient’s hand obsession is just a distraction to keep them from dealing with the real problems between them. Try and get them to talk about their underlying issues. Also, ask him directly what he’d like to see happen with his hand.”
     
    THE FOLLOWING WEEK, KENNY AND I WERE waiting in my office for Lauren, who was late. He was jumpy and kept checking his watch. “I don’t think she’s going to show up,” he said angrily.
    “That’s okay. You and I can get started. How have you been feeling this week?”
    “Like crap,” he said. “I thought Lauren and I made a connection last week, but now she won’t return my calls. My parents are driving me crazy—I can’t live with them much longer…” As Kenny spoke he absently pulled his jacket downward to cover the sling on his arm.
    “You know, when you were in the emergency room, you asked the doctor about surgery. Why did you bring that up?” I asked.
    “I don’t know,” he said. “Sometimes they have to put in metal pins and stuff. They might even have to amputate for all I know.”
    Whoa. How did he get from a broken wrist to amputation? Was he kidding, or did he have some kind of unconscious wish to get his hand amputated? Maybe he was psychotic.
    “Don’t you think amputation is a little extreme for a wrist fracture?” I asked.
    “How the hell should I know?” he snapped. “I’m not a doctor. Besides, I can work just fine without my left hand. I’m right-handed, you know.”
    Maybe his amputation wish was not so unconscious after all. At that moment, his face seemed to shift from anger to sadness. It was so apparent that I thought I should comment.
    “You seem sad, Kenny.”
    He grunted and shrugged his shoulders.
    “Tell me what’s going on,” I said.
    He sighed. “I just feel alone. I always do. There’s nobody I can talk to.”
    “You can talk to me,” I replied. “Why don’t you tell me what you really want to happen with your hand.”
    Kenny looked up at me, worried. “If I told you, you wouldn’t understand. I don’t even get it.”
    “Try me.”
    Kenny stood up and walked to the window. He stared outside for a few moments and then said, “I’ve never told this to anyone before. It’s embarrassing, Dr. Small.”
    “Maybe you’d feel better if you told me,” I said.
    Kenny sat back down and said, “I get the craziest feelings sometimes. Like my hand isn’t supposed to be part of my body—like it doesn’t belong. I never told Lauren because she’d freak out, but she knows I have a secret and that drives her crazy.”
    Kenny’s secret feelings helped explain his bizarre behavior. He couldbe psychotic, but it sounded more like he had a rare form of distorted body image. Kenny’s feelings were similar to those of anorexics who starve themselves because their normal body size feels wrong to them. In Kenny’s case, instead of a skinny body, he wanted one less hand. I felt an urgency to learn more about this condition before Kenny actually found a surgeon who would agree to cut off his hand.
    “I can understand why it’s hard to talk about these feelings,” I said.
    “Lauren would never understand. She’d think I was some kind of freak.” Kenny got agitated again and kept