Jenny

Jenny

“I’ve been stalking you for 3 months. I know everywhere you go and when you go there.  I have spent all this time deciding when and where to kill you.  I have a gun.”

She talks in a monotone and her face is expressionless as she sits in the chair opposite me, her jacket on her lap.  I immediately question to myself whether the gun is hidden beneath, having entered the office behind her, my vision obstructed by the back of her chair.  I have an impulse to grab her knowing that I am bigger and stronger than she.  I think better of it.  With a false calm façade I inquire why she is so angry with me.  It turns out that she thinks and feels that I had abandoned her. Speculating that attempts to convince her otherwise in this moment would likely prove futile I appeal to her sense of the consequences like jail or prison that would follow this act.  She replies that her plan is to kill me and then kill herself.  After further conversation that remains a blank in my memory I tell her that she must admit herself to the hospital.  I also inform her that I will not be her doctor while she is there.  I tell her that I will be calling the hospital to alert the staff regarding her admission.  The hospital being a 10 minute walk away from my office, I tell her that I will call the police if she does not arrive there within 15 minutes after she leaves.

Jenny first became my patient when she no longer had insurance or private funds to pay her private psychiatrist.  She had been admitted to our psychiatric unit on a police detention after making suicidal threats following a breakup with her girlfriend and her case was assigned to me.  I had, seen in retrospect, made the mistake of agreeing to continue to care for her gratis after her discharge. She had been raised by a sexually and physically abusive father and I had apparently become the good father she had always desired and deserved. When she on a later occasion was again detained in the hospital because of suicidal threats she was penniless and without a place to live.  The county mental health team arranged for her to reside in a group home with the stipulation that she would need to see the psychiatrist on their treatment team rather than continue her contacts with me. This, I later found out, was what she had interpreted as my rejection and abandonment of her.

Over the years I had seen many patients who had the potential to harm themselves or others and on some occasions had had to call family or police to intervene for their safety or the safety of others. I was also aware that the practice of psychiatry carried with it a greater than average risk of being harmed. I had received indirect threats on some occasions.  For example over a period of about 3 months I had received daily anonymous notes sent to the hospital, office and my home saying things like, “Time to meet your Maker” and “You won’t be poisoning more people with your drugs.”  I never found out who had sent them.  There were times when I would be concerned about consequences when in the process of supporting a patient this could be misinterpreted.  For example, the wife of a paranoid, abusive husband once told me that she had confronted him by quoting me as saying, “Harry is a SOB.”  This is what she had told me and not what I had told her. I did consider the possibility that he might seek me out sometime and that the meeting would have the potential for turning ugly.

This was the first time, however, that my own safety was clearly and imminently at stake and the first time that my response was visceral.   I had always felt capable of experiencing empathy and would, for example, find myself beginning to tear up when listening to a depressed patient. This would clue me in to the fact that I should inquire about possible suicidal thoughts or intent.  I could feel for the anguish and fear experienced by the spouse of a threatening, paranoid partner.  But the intensity of these feelings for others was infinitesimal compared to that I now experienced when it was my own life being threatened along with the thought that over the past 3 months, that I could have been killed at any time, never suspecting that I had been in danger.

My symptoms were not unlike that of a Post Traumatic Stress Disorder.  I was frequently awakened with nightmares that had the common themes of being chased and attacked.  I often relived what had transpired during the ensuing days and weeks and worried that she would buy another gun after discharge from the hospital (the one she had at her apartment had been confiscated but this was the third one she had purchased from local gun shows) and pursue me once again. I sometimes questioned the competency of the therapist at the county clinic who had been assigned to her care and feared that she might not understand the gravity of my situation.   When leaving the office in the evening I might see something or someone as harmless as a little old lady in the distant periphery of my vision and that would be sufficient to startle me. I found myself closing the curtains on windows where I could be seen sitting in the house in the evening. 

Over the course of a few months my fears and preoccupations abated.  Jenny remained under the care of her therapist and psychiatrist at the county clinic and I heard nothing more about her until a few years later when she shot herself through her left eye.  I do not know the details surrounding this event.  I was told that she had recovered completely except for the loss of that eye. 

I didn’t see her again until after I had retired years later.  I was at a local restaurant attending the cocktail hour prior to our county medical society meeting.  She approached me wearing a black patch over her missing eye, greeted me with a smile and hugged me.  She then told me that she and her partner had bought a new home and that they were enjoying their life together, no longer having the disagreements that had plagued them in the past.  I awkwardly indicated I was glad her life had taken a turn for the better and we parted.

There was not even a hint of dangerousness in Jenny’s demeanor in that last meeting. I do wonder now what may have caused or contributed to her changes in attitude and behavior. Did this occur as result of her therapy?  Was this a result of what may have been a self inflicted frontal lobotomy by the bullet to her head?  Did it simply evolve as a natural event over the passage of time?  I’ll probably never know.

2006