It’s five-thirty and I’ve just finished the lovely sandwich my wife made for me when Hakim sticks his head in the break room.

“Can you do me a favor?” the young nurse asks.

“Sure.”

“You know that new patient in 308?”

“He’s been in bed all day.”

“He came in at three in the morning and the night shift didn’t check his belongings. Could you do it?”

Checking a patient’s belongings is the shittiest job on a psych ward. You have to count every stitch of their clothing, log it on a belongings sheet and then place anything remotely valuable into a special envelope and drop It off with the hospital cashier. Then you have to have the patient sign a receipt – no mean feat when they’re paranoid as hell.

I groan. “Does he have a lot of shit?”

“His suitcase is locked up in the utility closet.”

“Suitcase?”

“When he got picked up he said he was going to Denver.” Hakim says. “So yeah, it’s a lot of stuff.”

“Is he a hoarder?”

“Don’t know. I haven’t seen his bag.”

Nine times out of ten patients come in with only the clothing on their backs and some form of ID. If their family can’t supply clothes the patient can do laundry on-site or wear disposable clothes made of paper. But every once in a while we get a hoarder – usually a homeless person who, despite their lack of domicile, manages to carry the contents of a small apartment in their luggage. I’m sure that’s what I’m about to face.

“I’lll take care of it,” I tell Hakim. “But if I find moldy food in his bag I’m going to get even with you.”

Hakim smiles uneasily, not sure if I’m kidding, and leaves. A few years ago I had to go through a shopping cart filled with dripping wet possessions a homeless lady brought in. I found three pounds of moldy luncheon meat wrapped in her dirty underwear. I still have nightmares about it.

Sadly, it looks like I’m in for more of the same. The man’s suitcase is old dirty and bulging at the seams. To keep it from bursting he’s wrapped the whole thing up with surgical tape that’s taken on a lovely shade of brown. A walking cane hangs from the busted handle. Inventorying all this stuff will take forever.

I drag the suitcase to an empty therapy room, close the door, and then assemble all the items I need to perform a search – lots of latex gloves, patient belongings bags, garbage can, clear plastic bags, the requisite paperwork and a pen.

The charge nurse looks at my bundle of supplies and chuckles. “This going to take long?”

“I hope not.”

My hope are dashed the moment I open the outer pocket of the suitcase. Like most street hoarders the man’s wrapped all his items in napkins, paper-towels and then triple bagged them in supermarket plastic bags tied shut. Since I can’t see what’s in them I have to take them apart one by one. This will take hours.

I’m also on high alert. Homeless people often carry weapons. I’ve found razors and knives of every description doing this job – even a bullet. Never found a gun, though. That honor went to a co-worker some years ago who dug a .32 automatic out of a sock. I go slowly though the man’s possessions, careful not to cut or stick myself on anything that might be in there. I’m very happy I got the Hepatitis vaccine.

Just as I finish logging the contents of the first pocket the group room door swings open and a dirty and very large man walks in. “Who the fuck are you and what are you doing with my stuff?” he yells.

I forgot to lock the door. Stupid. The man rushes in and grabs his suitcase. “You’re gonna steal my stuff. Get the fuck out of here.”

I calmly stand my ground. “I have to check every thing that comes in here. I will make a record of everything I find.”

“Fuck that. I’m gonna watch you do it.”

“You can’t be here as I go through it.”

“Why the fuck not?”

“Because if there’s a weapon in your bag I don’t want you to use it on me.” I don’t say that, of course, and ask the man to leave the room.

“Fuck you asshole,” the patient says, pushing me aside.

I take a deep breath. I’m not going mano y mano with this guy. He’s very big and has got a mass of crude tattoos and scars. He’s been in the shit. He’s a street warrior. I hail a passing orderly and tell her to bring help.

The man grabs a pack of smokes out of his bag and tries to light them. Surprising myself I snatch the lighter out of his hand.

“Don’t touch me asshole,” he says.

“You can’t smoke in here,” I say. Actually I don’t care about his cigarettes. I’m worried about the lighter. Patients can and do start fires.

The man responds by snatching up his cane. Considering the confines of the room he’ll probably try and poke me in the gut instead of swinging. So I grab it.

“Give me the cane,” I say. “When you get a doctor’s order you can have it.”

The patient’s face flushes red and his body tenses. He’s going to go for it.

I’ve been trained how to defend myself against violent patients. Using a variety of holds, the object is to get the patient on the ground as safely as possible and wait for the calvary to arrive. But “therapeutic jujitsu” isn’t going to work here. The man’s too close, too big and I’m in a confined space. I’m in danger. Then the cold part of my brain tells me to deliver an elbow strike into the hinge of the man’s jaw.

I let the thought flicker in and out of my mind. Instead of breaking the patient’s jaw I hold up my free hand.

“Play it cool, brother,” I say. “I don’t want to tangle with you. I will not mess up your stuff.”

The man relents and lets go of the cane. Just then two security guards arrive.

“Any of you guys touch me and I’ll fuck you up,” the patient says, looking very scared.

The younger security guard is built like a light heavyweight and snorts. He’s not worried. The older guard, who’s even bigger, just shakes his head. “We’re just here to help you.”

“The guards at the other hospital beat me up!” the patient yells. “I have nothing to lose. Bring it.”

“No one’s going to beat you up,” I say. “We also don’t want you attacking us.”

“I just want to be left alone,” the patient says. “Let me out of here.”

Hakim arrives holding a hypodermic. “What’s that for?” the patient asks.

“Something to help you relax,” Hakim says.

“Fuck that.”

“You said you have nothing to lose,” I say. “What did you mean by that?”

“I got nothing,” the man says, his voice breaking. “My dog died five months ago.”

“What kind of dog?”

“A Jack Russell.”

“How old was he?”

“Eight.”

“You lost him to soon,” I say. “I have dogs. When my oldest one was sick I thought I’d have to put him down. I cried for hours.”

“So you know what it’s like, kinda.”

“Anyone who loves dogs isn’t all bad.”

“No. They aren’t.”

“Let us give you the shot,” I say. “You’ll feel better. Take a break from what’s eating you.”

The patient acquiesces and Hakim administers the shot. Within minutes the man is out cold. I go back to checking his stuff.

After two hours, in addition to clothes, food and a million pens, I find two knifes, a utility razor, screwdriver and two hundred Fentanyl patches that I could sell for a fortune on the street. No wonder the patient was so worried about his stuff.

When I get home I put my clothes in the hamper and take a long shower. Then I fix myself a dirty martini on the rocks and flop down on the couch. My wife comes out of the bedroom holding Natalie. She’s asleep.

“Sssshh,” my wife says and puts the baby in her crib. Then she tiptoes over and plants a kiss on my lips.

“How was your day?” she says. I tell her.

“Would you have hit that man?” she asks.

“If I had too,” I say. “I’m very glad I didn’t though.”

“But it bothers you that you thought about it.” My wife knows me very well.

“Yes.”

“You’ve never hit a patient,” she says. “Ever. You always manage to talk them down.”

“Not always.”

“True. But when you do put your hands on people you’re not brutal. You’re not violent.”

I nod. The martini is starting to have it’s effect.

“You got hurt recently,” my wife says. “Remember?”

Two weeks ago a guy went nuts and tried throwing a chair. I intercepted him and slapped him into a hold. But I didn’t roll him to the ground as per the manual because he had a preexisting head injury and I didn’t want to hurt him any further. As a result he managed to get a shot in and I ended up in the ER and out of work for five days.

“You got hurt so the patient wouldn’t,” my wife says. “Not everyone would do that.”

“I guess so.”

Annie kisses me again and goes to bed. She knows I have to be alone. I fix myself a second drink. I want to be in the bag. That’s a rare thing for me these days.

I watch television and let the vodka work its magic. When I finish my drink I look at the ice cubes and think about that cold part of my brain. It’s always been there. Ruthless. Calculating. An icy bastard. Today he peeked out of my unconcious and looked around.

Then I remember a line Lawrence Block once wrote. It’s something I tell new staff when they’re wrestling with the violent urges the patients sometimes incite within us.

‘Everyone has mean little spaces inside of themselves. It’s the ones who are not aware of them who fly off the handle.”

Quite drunk, I go to bed.