Billy Holland was a tall, gangly 21-year-old guy from the inner city who was admitted frequently to our chronic ward at the state psychiatric hospital. He had a diagnosis of schizophrenia but even more tragic, he was often violent and aggressive. Whenever his behavior was violent, he would be restrained by two or three physically strong security guards. If the behavior was repeated frequently, he would be sent to the psychiatric prison down state, a facility for the criminally insane. Billy was terrified of this place and would cry and wail painfully when being transferred there. He reported abusive treatment by both guards and other inmates. When he was violent, the staff would often threaten him with being sent to the prison, but these threats did not influence his behavior even though he was afraid and intimidated by the place. He did not seem to be able to control his violence, even with the help of anti-psychotic medications.

Working as a psychiatric clinical nurse specialist on the unit, I was very distressed whenever Billy was sent to the down state psychiatric prison. He was such an appealing and friendly guy when he wasn’t violent and I liked him a lot. One day I decided to talk to him about controlling his violent behavior. I asked whether or not he could tell me ahead of time if he thought he could not control himself. He asked what would happen if he thought he could not control himself. I told him, “We’ll help you.”

“Are you strong, Jackie?” he asked.  I thought a minute and then said, “Yes.”   “Strong as a bull, right?” Again I hesitated and then nodded.

He squeezed my biceps muscle and then pronounced, “Yep, strong as a bull.”  I was more than a little embarrassed by my concurrence with this description, as I’ve never been known for my muscle strength or my size and I am actually a great deal smaller than Billy.

Every day when I came to work Billy would ask me if I was strong and every day he would squeeze my biceps and I would agree that I was strong as a bull. The ward lost its tension for a couple of weeks as Billy laughed and talked and helped out with other patients, occasionally shouting out “Are you strong, Jackie?” During this time he gave us the gift of his joy, his spirit and friendship.

I went away for 2 weeks and when I came back Billy had been sent down state again. We didn’t see him for months, and then a year passed. Finally, we heard that he had died while at the down state facility. His mother came later to pick up some of his things and she confirmed his death. She said he was troubled and afraid and “maybe it was for the best.”  She thought he died of heart failure. We all wondered and missed him in our lives.  I know I was able to influence him in his time with us; he has continued to influence me.

Jacquelyn H. Flaskerud, RN, PhD
UCLA School of Nursing

– excerpted from Touched By a Nurse©