Our Caregivers Are Not Your Acceptable Casualties

The key feels wrong. It's not a smooth, confident slide into the lock; it's a grinding protest of metal on metal, a conversation I have to force. My knuckles are white. I rehearsed this on the 35-minute drive over. If the yelling starts, I will place the client's file on the small table by the door. I will keep my voice at a specific, low octave. I will not mention the broken lamp from last Tuesday, the 15th. My bag, weighing maybe 5 pounds, feels like it's full of stones, pulling my shoulder down toward the peeling welcome mat.

From inside, the television is violently loud. A game show. Dissonant, cheerful bells mixed with a man's voice, a low rumble that vibrates through the cheap particleboard of the door. I turn the key the final quarter-inch. It clicks, a sound that feels both like a victory and a surrender.

The Abstract Anger of the Binder

They give you a binder. Mine has a coffee stain on the cover in the shape of a misshapen heart. Inside, there are 25 pages on 'Situational Awareness' and 'De-escalation Tactics.' There are cartoons of a smiling nurse holding her hands up in a placating gesture to an angry, red-faced stick figure. It's all so clean on paper. The stick figure's anger is abstract, a problem to be solved with the right combination of words. The smiling nurse is a vessel of pure, frictionless compassion. I used to believe in her. I really did. I thought that my empathy was a shield, that if I was kind enough, good enough at my job, I could gentle any storm.

That was my mistake. Believing that the intention of my presence was more powerful than the reality of it.

The reality is that I am a stranger walking into a private kingdom that might be in the middle of a civil war. My kindness is not a currency they accept here. My empathy is just a frequency they aren't tuned into. The binder, with its cheerful cartoons, is a lie. A well-intentioned, beautifully formatted, corporate-approved lie designed to make the people who send me here feel better. It does nothing for the person whose hand is on the doorknob, feeling the bass of a stranger's rage in her teeth.

Documenting the Contained Chaos

I saw a local news profile once on a man named Charlie N., a court sketch artist. I've thought about him a lot since. He sits on a hard wooden bench, just a few feet from people accused of terrible things, and he draws. The segment showed his hands, the deliberate, controlled movements. He uses a specific kind of compressed charcoal on paper with a heavy tooth, maybe 85-pound stock, so it grabs the pigment. He isn't capturing the event. He's capturing the aftermath, the heavily moderated, sterile echo of it inside a courtroom. The air in his workplace is controlled, the rules are absolute, and a man with a gun will remove anyone who breaks them. Charlie's job is to observe the contained chaos. He translates the human capacity for violence into something you can fold and put in a briefcase.

That's the tangent I always get stuck on when I'm driving between appointments. Charlie N. gets to document the drama from behind a barrier, protected by the very system judging it.

My courtroom is a living room that smells of stale smoke and boiled cabbage. The defendant might be a 235-pound man with an opioid addiction or a frail woman of 175 pounds whose dementia has turned a corner into terrifying paranoia.

There is no judge. There is no bailiff. There is just me and my binder of smiling cartoons, trying to sketch the reality of the situation fast enough to know when to run.

"Court"

"Home"

WE DON'T TALK ABOUT THIS

We talk about the nobility of the calling. The sacred trust. We put nurses and aides on billboards and call them heroes, a word that has been flattened into meaninglessness.

“A hero is someone you're willing to sacrifice.”

And the system is perfectly willing to sacrifice us. It is an acceptable operational cost. The corporate office will spend $575 per employee for a webinar on 'resilience' but deny a $45 request for a personal panic button with a GPS locator.

The message is clear: your mental fortitude is the only armor we are willing to provide. Handle it.

A Grand Canyon-Sized Gap

And so you learn to handle it yourself. You learn to park your car facing out for a quick exit. You learn the difference between the sound of a falling object and a thrown one. You start looking for your own solutions, because you realize no one is coming to help you. You find yourself up late at night, looking at things you never thought you'd need, browsing a site like the self defense mall or watching hours of videos on breakaway techniques, trying to backfill the Grand Canyon-sized gap in your official training.

You are completely and utterly on your own, and the sooner you accept that, the safer you might be.

I used to argue about this more. I'd bring it up in meetings, my voice shaking with a righteous anger that just made management uncomfortable. I'd point out the absurdity of our safety protocols. I think they saw me as hysterical. Now, I don't say much.

“This is the contradiction I live with: I see the profound, systemic failure with blinding clarity, and then I get up the next morning and walk right back into it. Why? Because a client needs his wound dressed. Because if I don't check on someone's mother, maybe no one will. The job's mission is still magnetic, even when the job's execution is terrifying.”

The game show applause blares as I push the door open. The air hits me first-thick and warm. I step inside, letting the door click shut behind me, the sound echoing that first, final turn of the key. I put on my professional smile, the one that doesn't quite reach my eyes. The conversation I rehearsed in the car is gone, replaced by the immediate, overwhelming need to read the room. To sketch the scene in my head, just like Charlie N., but my drawing has to predict the future. My drawing has to get me home.