Spending time on lock down

Excerpt #2 from Mental Health Journal

Yesterday was the most mentally intense day of my student nursing career thus far. I did not abide by the 15-minute rule and I suffered for it. I will admit that. My patient was a narcissist and had antisocial personality disorder. I had eyed his profile on the morning report sheet thinking he would provide me with an interesting day and a great starting point for my disorders analysis paper. The morning reporting nurse quoted him saying "I want to be a personal assassin and kill all the pedophiles, drug traffickers, wife-beaters, and gang members." Added to this list was a subset of individuals he wanted to take care of because of "personal" reasons; his 6 month old baby included.
So back to the 15-minute rule.
Hindsight is 20/20 and I think this rule is fabulous. It may have spared me quite a bit if I would have listened to it, including a very intense pounding headache which lasted for hours.
The day was fascinating. Communication is such a complex skill. The psych ward is filled with people whose greatest tool are their mouths; patients and providers. I can see myself watching, learning, soaking up techniques from every direction. I see the way a skilled doctor can readily release information from a person just through proper intonation. She asked him "Why?", the way a child asks a parent. This happened directly after he bragged about his marksmenship and the ex-girlfriend he was planning on killing.
I had sat with him earlier that day and heard the exact same story, told with less clarity and more anger. I didn't ask 'why'. I didn't even think of that as an option. We were probably on our 30th minute of the interview, 15 minutes gone too long for a student nurse. I didn't ask 'why' because I was working so hard on perfecting my mask-like appearance- the one that I wanted to so clearly portray as 'what-you-are-saying-is-not-affecting-me." Every look of disgust, appalling gasp, cringe, tear, or incredulous laugh I wanted to express got shoved down my throat deep deeper all the way down- away from the surface. It worked, so he continued, talking and talking about insane ideas he may one day make a reality.
But at the end of the interview, the one the doctors were conducting, a glimmer of hope sprung out of his mouth. They had asked him "We will make this very clear and we're sure you already know this. YOU ARE IN HERE FOR SAFETY REASONS."
He nodded.
"But," the male doctor continued through a very serious tone, "is there anything else you want to get out of being here?"
The patient said quietly and what appeared to be, genuinely: "Yes. I want to stop thinking like this."
It wasn't much, but it was enough hope for me to grab onto. I needed something. I am still grappling with the idea of these people who supposedly are born without souls. I don't get it. It doesn't fit very well into my idea of life, or my idea of God. It is too confusing, too big, too much for me to wrap my head around. When I was talking with the patient in the morning, when it was just him and I, he emitted a coldness that made me wonder. I listened to him explain the clothing he had picked out to assassin people in, meanwhile the thought sat heavy and motionless in my mind like a dark raincloud. Does this man have a soul?
During his afternoon interview with the doctors they were able to pull out more subjective information regarding his childhood.
Abusive deceased father- check.
Alcoholic mother- check.
Disruptive childhood and depression- check.
Cruel brothers - check.
Not many friends and a lifetime of being made fun of- check.
History of violence. none.
History of arrests. none.
Mainly, the theme that rang loudest in my ears, was his desperate desire to feel that he belonged somewhere and that he mattered. It wasn't something he was offering up; and it wasn't anything I was able to extract from him; but watching the doctors simmer down his anger and his grandiosity to a puddle of humanness was too much for me.
Again, the question haunts me. How does this happen? What are the factors involved here? Have I, in some way, contributed to someone elses state that may be similar to his? Has my meanness, my lack of insight, my insensitivity been a proponent of evil. Was the quiet homely girl in 6th grade that I teased and called "musty Misty" from a tribe similar to his? A tribe of the less fortunates. A tribe of the kicked dogs. A tribe of the silently enraged and plotting?
Wanting to kill your 6 month old baby in the gruesome way he detailed to me is a thought he will have to take 100% responsibility for. I understand this. In fact, his entire life is a life he will have to take 100% responsibility for. And for whatever genetic defects are present in him, the creator of those will handle that. That is not my business. But my business is healing, is offering the light, is suggesting the person climb up the mountain not off the cliff. I am learning. I am trying. But some days are harder than others.