Content warning: >!Self harm!<
Being a social worker means seeing some of the worst that humanity has to offer. Albeit, I cannot overshadow the wonderful people I’ve met throughout my career. But the memory of one client haunts me. We might as well begin from day one: when we first met.
I was scheduled to meet with Julia once per week. She was on the first floor of the apartment complex. Her records indicated she was diagnosed with OCD and dermatillomania. This would become very adamant in the time to come. But for the time being, I was just focused on good first impressions.
My knocks on her front door were only met with a simple instruction from within. “Come in!” called a voice. With unexpected struggle, I had to push hard to open the damn thing. Inside was reasonably tidy. However, with the curtains closed and lights off, I almost didn’t even see Julia sitting on her couch enveloped in a nest of blankets. Only her head poked out the top of her cocoon. She looked like she hadn’t had a vegetable in a while. Age-wise, it was difficult to tell, but at least her records indicated her exact age to be 33.
The TV was on playing a game show I didn’t recognize. Brightness settings were definitely set to low. After introducing myself and complimenting the furnishing of the apartment, I found my seat at the opposite end of Julia’s couch. On the coffee table were scattered napkins and squares of toilet paper, stained with blotches of blood. Trying to ignore it, I directed the conversation about Julia’s treatment and services for her mental complications. To my surprise, she cut me off mid-sentence and asked me “Do you wanna see something gnarly?”
I hesitated, but humored her. Julia lifted her arms out from under the covers. Her left arm was sloppily bandaged in toilet paper. She began to remove it. I could tell it had been there for a decent amount of time because of the crinkling sound it made from being soaked with clotted plasma. “It’s fine…” Julia added. “I had to replace it anyway”. It’s difficult to describe what was underneath the wrappings. It took me too long to realize that it wasn’t a rash on the skin I was looking at, but rather the absence of skin. A large patch on the forearm was removed. Muscle and blood vessels were right out in the open. One vein had even been severed and hung freely.
The shock made it difficult, but I did my best to maintain professional. “Have you been given gauze bandages? It’s much better than toilet paper” I inquired. Julia shook her head. “They did give me the gauze stuff but I like the toilet paper. I’m used to it and I’m not switching”. She seemed stubbornly adamant about this. I tried diplomacy. “Well, if your injury were to get infected, that wouldn’t be very good right? It may mean a trip to the hospital”. She continued to reject the proposal, and began wrapping her arm in fresh toilet paper.
I changed the subject to discuss her OCD medication, and asked how she feels about its effects. “Well, obviously…” she answered holding her arm up. “… I’m still picking”. I inquired more about the picking by asking “What do you think causes you to pick?” Julia paused for a moment then answered. “I do it without realizing. When I’m just on autopilot around the home, it’s just what I do to keep my brain occupied with something I guess.” Julia spoke with grit teeth as she was biting into a hangnail on her thumb. She pulled so hard on it that it tore down to the thumb’s knuckle. She grabbed some napkins to wipe the blood from it. Couldn’t help but notice she swallowed the hangnail as well.
After some more small talk and discussions about her condition, I gave her a reminder that our next appointment would be next week. “Okay!” Julia replied eagerly. And with that, I made my exit. I knew even then that she was going to be my most challenging client. Not because of any attitudes toward me like some pervious clients. But because I could see she had dug herself into this very deep hole. The picking. I shuttered to think of how much it was consuming her life.
At this point in time, I thought I would be seeing Julia at our next appointment within a week. I was wrong, because our next meeting would be much sooner than that. Just days after our first meeting, I got a call while working. My manager was on the other end, and she requested I go to the hospital to see Julia. “Oh, did she get hurt?” I questioned with unease. My manager responded “Julia was administered from a self-harm injury. So expect her to be in some distress, but just do your best”. Haunting images of her forearm flooded my mind. I could only think to myself: What could she have done now?
After parking, I paced through the lobby of the hospital, heading to the room Julia was staying. Giving the door a couple knocks prompted a recognizable voice from within to respond. “Come in!”. Opening the door, I saw the same woman from the apartment before, only now in a hospital gown, and her non-dominant arm wrapped in bandages. And with the same arm, she gave me a wave as though to flaunt it, showing off the damage that was done to it. The arm was nearly gone. Bandages enveloped the wound and blanketed the stump which was just halfway between the elbow and wrist.
I could only muster one question. “Did you ever feel compelled to stop picking?” As I asked this, Julia gave a puzzled look. She asked “What you mean? Like when I did this?” She lifted up her stump. I nodded. Julia continued “Well, not really. Remember what I said? I do it without really realizing. It’s almost like tunnel vision how I just… keep going with it. So no, I don’t really think of stopping.”
I cross my arms, getting uncomfortable. Not like I wasn’t already uncomfortable once I walked into the room. “Do you think you should stop picking?” I asked her. She paused for a moment then said “I guess.” I knew that wasn’t going to stop her. She was too obsessed with it. “Oh,” Julia continued. “Could you grab me a bowl of soup from the cafeteria please?” I wanted any excuse to be out of that room, so I was more than happy to step out for a bit.
Walking through the hallways of the hospital, I was trying not to think of how bad Julia’s condition was going to take her. How much picking was she going to do? How could a person be compelled to pick away at their skin, scrape through muscle and tendons with their nails, down to the bone? I get the soup and a Coke for myself from the cafeteria, and begin making my way back to Julia’s room. She took the soup gratefully, and seemed comfortable with eating it now with a missing hand.
After giving Julia the soup, I continued with asking her questions about the medication, and additional treatments. Letting her know she’s supported. After our meeting was over, I prepared to leave the room. But just as I was leaving, Julia called out to me “It tasted good by the way.” I stopped in my tracks and looked back to her. “The soup?” I asked. Julia gave a little smirk. She just stared at me, unblinking. She chuckled, and simply said “heh-heh, sure!”
After making my leave, I drove home in silence. No music, windows up. Just wanting to sleep today off.
A few weeks later, Julia was let out of the hospital. Her stump was still bandaged tightly. Her antibiotics had to be taken daily to prevent infection. I personally think she should’ve stayed in the hospital longer, but alas. During her hospital stay, I took that time seeing other clients, and letting the nature of Julia’s condition truly sink in.
Then, after some time, I was scheduled to go check up on Julia at her apartment once more. I parked, walked to her front door, and gave it a hesitant knock. “Come in” I head Julia from within. With permission granted, I open the door. She’s not on the couch like last time. I call a timid “hello”, looking into the kitchen. And this image is what keeps me up at night. Julia lie on the kitchen floor. A pool of blood like a moat around her. Her chin covered with it as well. And her legs: gone. Parts of flesh lay strewn about, collected around her like some kind of charcuterie board. Her pelvis met my gaze as it stuck out from her lower abdomen. And what remained of her non-dominant arm had now been reduced down to the shoulder. She only had her dominant arm to pick, pull, scrape, and scoop.
I threw up in the sink immediately. I could only stare at the window outside, while shakingly getting my phone to dial for an ambulance. Before I could pull my phone from my pocket, I hear Julia call over to me. “Hey, would you mind helping me out?” she called, her voice sounding weak. I looked over to see she was chewing on one of the flesh bits. She stared at me. “There’s a saw in the closet. It would make this easier”.