I forget his name, nothing else. He was gorgeous, for starters. Tall, slim. Not too slim. Literally giving "heroin chic" meaning decades before it was...chic. Chiseled features, high cheekbones. Regally poised, but with an open, approachable smile, at least to me -- a vulnerability I didn't know if he intended. In the oldest, most beat-up ward at Yale New Haven Hospital, devoted to indigent patients and countless students. Hot and muggy, without AC. It was Second Summer and Ronnie -- we'll call him Ronnie -- sweated a lot. His long arms and legs gleamed, a buttery umber.
He smelled yummy, too. Of sebum and clean, shining hair, with a luster of the freshly showered. These were my first-ever clinical weeks as a baby nursing student. I was assigned to care for him a couple times, that's all, and I treated him...like a person.
I walked onto the ward in early autumn, the dull, puke-green walls and concrete floor assaulting, the flooring glossy with little flecks of black and white, satin-smooth from decades of wear. A white guy in a long white coat stopped me, abrupt. "3B won't let us do his bone marrow until you're in there!" he barked, startling me.
I was barely 21, in a little white wraparound nursing dress (soon to go the way of history; I forsook the white cap in protest) and intimidated by all things Yale-patina. A true West Coaster, even the bricks in the buildings were older, staider than anything I had known.
"OK!" I barked back, juddering and defensive, hijacking my path to review charts and scuttling off to Ronnie's room. So typical, these people, reducing a patient to a room number or disease, nameless, depersonalized.
Ronnie lay prone on his bed already, lines edging his eyes and mouth. He looked drawn, his lips clenched in dread. The thin, ancient slab of mattress sagged under his weight, his head on a scrawny pillow, his feet about to dangle from the base.
"Hey," I whispered. He opened his eyes, glancing up. His gaze proved my drug of choice in those days: the relief I saw wash over his features, the knowledge I could assuage someone's fear. The power of letting another human being know they are seen, known, worthy, simply by virtue of being alive. It's okay. I am with you.
I grasped the metal chair, scraping it close to his head, the scratch of metal against concrete startling us. I held his hand. His sculpted, lanky hand. Warm and strong. Clammy today. He was here due to bacterial endocarditis -- heart valves infected from injecting smack. It was the early '80s. No one had even heard of injecting anything else. Yet.
The attendings, residents, medical students, got to work unwrapping their biopsy kit on the opposite side of the bed, swiftly cleansing and draping Ronnie's right buttock, trading instructions between them like sacred incantations. The air hung acrid with Betadine, alcohol, the stiff starch of blue hospital drapes. Judgment and disregard were palpable as well. "Okay -- " I heard.
They were ready.
I leaned into the warmth of Ronnie's breath. He reeked of toothpaste and apprehension. "Breathe," I told him. "Squeeze my hand. Here," I clasped his hand firm, steady.
"Let's go," the men across the bed announced to no one in particular, the only warning they were about to insert a needle 2 millimeters wide -- huge, in needle terms -- into the small dark square showing through blue drapes. Ronnie's naked hip.
He sucked in a quick, sharp inhale as the needle hit, squinching in fear and pain. He held his breath as they dug in, crushing my hand.
"Deep breath out..." I reminded, watching his face go lax, let go.
The needle inserted, perhaps the worst had passed. I had never witnessed a bone marrow biopsy, or anything like it. Wetness bled, a seeping sheen around Ronnie's face on the frayed pillow; a worn, cotton-white witness to hundreds of patients before him, perhaps thousands.
"Now it's in, we just have to extract a biopsy," the white-coated cabal leader spoke to his minions. I looked at Ronnie, reminding him to breathe. This time his face showed pain, but not so much. Breathing, experience, helped.
"We're done, we got it!" I soon heard, as though someone had just completed a victory lap. Ronnie's entire body relaxed, loose. He sighed, recovering. The men ritually pulled away stiff blue drapes, wiping the needle site. Someone taped a simple band-aid on Ronnie's hip, strangely incongruous with the heft of the procedure. Finally, Ronnie opened his eyes. He smiled, a benison of honey and warmth. I drew in a deep inhale, abruptly aware I'd held my breath with his.
A few days later he was set for discharge, seated on his bed, looking even more striking in street clothes. My preceptor had insisted I beware -- Ronnie would do anything he could to manipulate me -- he was a drug addict, after all. I was woefully naïve, it's true. I had even spoken to him about giving up heroin. As if I, or anyone, had the power to make him quit. As if he would even have that power, without resources or help.
He asked for my address. Is he trying to game me? I worried, my professor's contempt invading my regard and trust. Is it even OK, to give my address? Ultimately, I handed him a slip of paper with my school address.
"I'm going to give it up," he told me. "And I'm going to write you." He nodded as he said this but worried the address slip back and forth between his fingers, staring at the side wall when he spoke. I believed him, or wanted to; I was sad and wistful when I never heard from him again.
When people mention trauma-informed care, my heart seeps with memories of Ronnie. Who knows what unknown, unfathomable trauma and abuse he survived? He didn't share it -- we didn't even know enough to ask back then -- and it was impossible to touch, let alone erase, in one brief hospital stay. How could anyone expunge a desperate need for drugs, the only reliable coping tool at hand to combat suffering and tragedy beyond what we knew?
Ronnie is probably long dead. And only because we failed. Because no one ever helped him work through and heal. Racial, societal, systemic, individual trauma, all piled up. Piled up so high we've barely begun to acknowledge -- let alone confront it -- some 40-odd years later. Suffering plenty enough to drive anyone to drugs.
I honor Ronnie and his memory with such gratitude -- for him and the deep, lifelong lessons he lovingly taught.
retired from psychiatry in Portland, Oregon to write narrative essays intersecting health, mental health, and well-being. She is an adjunct professor at Oregon Health & Sciences University and sits on the executive committee of the Oregon Wellness Program, offering free mental healthcare to healthcare professionals in Oregon. She is also a certified nurse-midwife.