The Long-view of History
The physician describes the patient in his private notes:
Twenty-five year old male sex worker, arrived by ambulance, in the custody of police and emergency medical services status post intentional heroin overdose, per report. Pale, attired in blue paper scrubs furnished by the hospital. Denies current complaints. Musculature well-developed, hirsute. Black stubble, but scalp shaved. Well-healed longitudinal scar, one-inch, with loss of follicles over the right anterior mandible. Respirations non-labored, ambulates unassisted. The oral mucosa is moist, skin is not overly dry, and there are no active lesions on the face or trunk. Normo-cephalic without apparent trauma or signs of previous head injury. The mouth is full, jaw enviably square. Prominent vascularity in the extremities, track marks can be seen only unilaterally. Single visible tattoo between the scapulae, stated there is another over the pubis, showed to staff without request. "Helen". Piercings of the areolae with steel bars. Dysphoric-appearing, hypervigilant, but non-irritable, acquiesces to staff and other patients. Physically convalescing, has taken extended periods of sleep. Now attending to hygiene. Eating and toileting without difficulty. Denies abdominal pain or symptoms of withdrawal, mildly diaphoretic and tremulous at times. No obvious hallucinosis. There have been no paranoid or grandiose or morbid thoughts expressed to undersigned or nurse. Fluently masks guardedness, distrust. No self-injurious behavior or violence since admission. Has expressed in passing gratitude for unsuccessful suicide attempt. No expressed suicidal or homicidal ideation. Urine drug screen positive for fentanyl and cocaine, blood alcohol level 100 milligrams per deciliter on admission. Mildly elevated transaminases and macrocytic anemia. Vital signs within normal limits. Initial impressions: under-privileged, twenty-five-year-old male recovering from acute alcohol and opioid overdose, in mild withdrawal. Passively refusing care through denial of complaints. Appears at once older and younger than stated age, as if aged all at once then not at all; piercing blue eyes over an effortlessly masculine build. The world was generous to him with ways and gestures that are the objects of painful longing for other men, but which prove toxic in excess. Excess of attention from both sexes in youth, who would have found him desirable, and “hunted” him, deepening deficits in socialization and promoting promiscuity as form of intimacy. Suspect repeated occupational trauma, hypersensitivity to abandonment. Suspect altered empathic sensorium, with resultant functional impairment. Suspect limited experience of authenticity and altruism, relationships exclusively transactional or deeply co-dependent, expects and is comfortable with boundary crossings and anti-sociality. Maladjusted as a consequence of childhood physical, emotional, and likely sexual abuse. Prognosis limited by education and milieu, although there is normal intellectual functioning and general physical health, and hence theoretical potential for rehabilitation with total novelty—
