*Caution: Please be advised that this writing contains depictions of child abuse and neglect which may be upsetting for some readers.

As he lay there exhausted, with his hands and feet restrained to the bed, he once again returned to being a sad, broken little child. In his rage, he fought long and hard earning a bite into one of the sitters, a small clump of blond hair from one of the nurses intertwined in his fingers, and five adults left out of breath. Now, he was reduced to the 10-year-old boy, who appeared much younger, whimpering like the small child he was never afforded the chance to be.

Matthew was born addicted to crack cocaine. His mother was unable to break her addiction while she was pregnant. The first week of Matthew’s life was spent in the NICU going through withdrawal from cocaine. Rarely was there a waking moment when Matthew was able to be consoled. At times he would have to be removed from the unit because his cries would upset the other infants.

Matthew was discharged twelve days after being born and his mother brought him to the flop house where she lived. She was unable to stop using cocaine though had the wherewithal to not breastfeed and instead gave Matthew whole milk (because formula would have been too expensive).

Matthew developed a flat spot of the back of his head from being left in his crib for extended periods of time.

Matthew spent the first four years of his life in a run-down house surrounded by active drug users. He and his older brother fought for food (as a form of entertainment for the mother and her friends). At age four, he witnessed a man being murdered over drugs. When the police arrived they took the children, who were bruised and had been living on white bread and ketchup packets, into protective custody.

The children’s aunt was able to adopt them both. She is a good, loving, kind Christian woman who has given the children a safe home. Sadly, both children are well known in several mental health facilities around town (including our own).

Matthew is 10. He is tough. During his last inpatient stay, it took four large security guards to restrain him. He is a master card player. He likely has a genius-level intellect, He, however has no ability to regulate his emotions or process experiences that don’t meet his expectations.

Today, Matthew was asked to leave group because he hit another child (who is autistic) for not sharing crayons. Matthew tried to apologize but because his behavior was unacceptable, he was not permitted to stay.

Matthew began walking up and down the hallway screaming obscenities. The head nurse asked him to sit down and to do some deep breathing. Matthew flopped down on the floor and started beating his head on the floor- so hard that I felt the reverberations through the concrete from my office some fifteen feet away.

I ran out as the nurses were lifting the inconsolable and raging Matthew and making their way down the hall. He bit one nurse on the arm and wrapped his tiny fingers into the hair of another. I wrapped my arms around his legs to stop him from kicking and keep him stabilized. We brought him into the isolation room and we was screaming, fighting, cussing, and begging us not to lock him in. But, we had to.

We all stepped away from the door and tried to make awkward jokes to help deflate our emotions. began processing. The head nurse examined the bite mark which fortunately had not penetrated the skin. One nurse stayed to monitor Matthew while the rest of us returned to our respective offices and stations.

After thirty minutes of screaming, banging his head on the soft rubber walls, and kicking the door (which echoed like thunder through the whole unit), Matthew began trying to strangle himself with his tattered shirt. The nurse who was monitoring him called for help and we altogether helped remove Matthew from the isolation room and place him on the restraint bed. He did not fight us but instead went almost limp. We followed protocol and placed the restraints on his tiny wrists and ankles.

Once he was safely restrained, we all knelt by the bedside. One nurse began stroking his hair. Another began softly speaking to him saying “it’s ok baby… you’re ok.” We all put our hands on him, patting him, and letting him know he was ok.  

In that instant, Matthew became the small child he was never afforded the chance to be and cried for his mommy.

*This story is based upon real events and real people. For the privacy of the patient, any potentially identifiable information has been excluded or modified.