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

nervously pushing his left arm back, away from him. “Sometimes these urges get so intense that I’m afraid I might go down to my table saw and chop it off myself.”
    That comment changed the whole situation, and I was suddenly concerned that he was in danger. “What keeps you from doing it, Kenny?” I asked, trying to remain calm.
    “I always thought it would be safer if a surgeon did it. I don’t want to die, I just want to get rid of this stupid hand—it shouldn’t be there.” He looked down at the floor and continued, “But I don’t know. What does it matter? Lauren won’t accept me either way.”
    At this point I was worried that Kenny was at risk of seriously hurting himself, and I knew I would have to hospitalize him—whether he liked it or not. To keep him from bolting, my next move was crucial. While Kenny was staring at the floor, I used the old make-your-own-beeper-go-off trick and paged myself. Kenny looked up as I checked my pager and said, “Will you excuse me a second, Kenny? This is an emergency.” He shrugged and I left the office, shutting the door.
    I quickly told the clinic secretary to page security because I had to put my patient on a seventy-two-hour hold over at Lindemann. She said she’d buzz me on the intercom as soon as they were stationed outside my door.
    I went back into the office and sat down. “Sorry about that.”
    Kenny looked distracted and said, “Whatever. Look, Doc, I know I must sound crazy, but I’ve had these feelings a long time and I do just fine.”
    “You’re not concerned that you might act impulsively at some point,” I asked, “and maybe try it yourself?”
    “They’re just thoughts, Dr. Small, I haven’t done anything yet, have I?” he said with an edgy tone. To my relief, the intercom buzzed. I picked up the phone and asked them to wait.
    “But you’re having a tough time right now, Kenny,” I said. “Your marriage is in trouble, and living at home with your parents is driving you crazy. And you’re talking about possibly cutting off your own hand. I think you might be better off going into the hospital for a little while until we sort this out.”
    “You mean the loony bin?” he sputtered. “Not a chance in France.”
    One of the difficult decisions a psychiatrist is sometimes forced to make is whether to hospitalize patients against their will. There are essentially three reasons for involuntary commitment: a patient is acutely suicidal, homicidal, or perceived in some way to be a danger to himself or others. Often it’s a psychiatrist’s judgment call as to whether self-destructive thoughts or feelings pose an imminent danger. Some people might feel chronically suicidal and talk about those feelings constantly but never act on them. Others engage in chronic suicidal behavior, destroying themselves at a gradual pace through starvation, drugs, alcohol abuse, or smoking. However, these people are not perceived as acutely dangerous; they are rarely committed.
    Part of a psychiatrist’s training involves putting together what a patient says, his history, and his current behavior to make this critical decision. The methods for potential self-harm that patients discuss will influence the doctor’s decision. A man is more likely to shoot himself, whereas a woman would sooner opt for an overdose of pills. If a depressed and lonely woman mentions a large stash of sleeping pills at home, that would heighten a psychiatrist’s concern. And if a carpenter who’s obsessed with cutting off his hand mentions a table saw in his basement…
    “I’m sorry, Kenny, but at this point it’s not up to you,” I said. “I’m going to have to admit you for observation to make sure you don’t hurt yourself.”
    Kenny stood up suddenly. “No fucking way. I trusted you, you asshole.” He swung open the door and stepped out as two burly security guards grabbed his arms. “Hey, easy on my sling, you jerk,” he said.
     
    THE NEXT DAY, WILL BROWNING WAS