Chapter 16
Hope
The ethics textbook is open on my kitchen table, spine cracked from too many readings.
I bought it five years ago for a graduate seminar I barely remember. Kept it because the professor wrote in the margins during office hours—red ink observations that felt important at the time. Now the pages are soft with handling and the coffee rings on the cover have faded to brown.
I've read this chapter four times since Tuesday. Not for work. For me.
The language is clinical, careful. Dual relationships. Power differentials. Transference and countertransference. Every paragraph describes the thing I'm supposed to be afraid of, the ethical lines I've been trained to see.
I turn to the section on self-assessment. The questions are meant to catch you before you fall.
Do you find yourself thinking about the client outside of professional contexts?
Yes.
Do you look forward to sessions in ways that extend beyond professional satisfaction?
Yes.
Have you engaged in physical contact not required by your role?
I close my eyes and feel his fingers inside me. Feel my body clenching around them while I pretended to read a checklist.
Yes.
The textbook expects these questions to produce shame. Name the transgression, trigger the alarm and the alarm makes you stop.
But there's no alarm.
I set my coffee down and stare at the page until the words blur. This is the part I've been circling for days—the honest audit I've been avoiding because I already know what I'll find.
The accident was seven years ago. Front-impact collision, traumatic brain injury, partial damage to my amygdala.
I understood the diagnosis when they gave it to me.
Understood it again in the rehabilitation sessions, the follow-up appointments, the concerned looks from specialists who wanted to make sure I grasped what had changed.
Your threat detection may be impaired. Your social norm processing may be affected. You may not experience fear responses in situations where fear would be appropriate.
I understood. I just stopped thinking about it.
You can't miss what you can't feel. That's what I told myself, and it held up well enough to live by. I walked into Greenridge on my first day and felt fine. Walked past maximum security patients and felt fine. Sat across from a man convicted of eighteen murders and felt interested, not afraid.
Everyone else burned out or requested transfers. I stayed because staying felt normal.
But this—Jude, what we're doing, what I want to keep doing—this isn't about threat detection. I'm not failing to notice danger. I'm failing to feel the shame that's supposed to stop me.
The textbook assumes shame is automatic. Cross a line, feel bad, correct course. The whole ethical framework depends on it—the constant pull toward acceptable behavior that you never have to think about, that just works.
Mine doesn't work.
I know what I did in that day room was wrong.
I can recite the violations: dual relationship, boundary crossing, sexual contact with a patient under my professional oversight.
I know the words and I know the consequences and I know that any licensing board would revoke my credentials if they saw the footage.
But when I try to access the feeling that's supposed to go with that knowledge—the hot flush of shame, the sick twist of guilt—there's nothing there.
Just the memory of his fingers and the low rough sound of his voice saying good girl and the way every nerve in my body fired at once, two words and I wanted him to say them again.
The dent in my brain doesn't make me want him. That's important. The wanting is real, mine, grown from months of conversations and observations and the way he looks at me when no one else is watching.
The dent just keeps the noise off while I do it.
I flip back to the chapter's opening paragraph. Ethical violations rarely begin with conscious intent. They emerge gradually, through accumulated rationalizations and the erosion of professional distance.
I haven't been rationalizing. I've been choosing. Clear-eyed, unashamed choices that would horrify the woman who bought this textbook seven years ago.
That woman had an intact amygdala and a normal fear response and she would never have let a patient's hand under her skirt.
But I'm not her anymore.
My phone buzzes. Aunt Kathy's name on the screen.
"I was just thinking about you," I say.
"Well, that's either very good or very troubling." Her voice is warm. I can hear wind in the background—she's probably in her garden, phone wedged between her shoulder and her ear while she does something complicated with her roses. "You missed Sunday dinner. Steve said you were working."
"Steve lies for me without being asked. It's one of his better qualities."
"So where were you really?"
I hesitate. The textbook is still open in front of me, Chapter 14 staring up at me.
"Thinking," I say. "About some things I probably should have thought about months ago."
"That sounds heavy. Hold on—" A rustling, a muffled curse, then she's back. "Fucking aphids. Every year. Anyway. What kind of things?"
"The kind you're better at than I am."
She doesn't answer right away. I hear her settle into what I know is the wrought-iron chair by the back fence, the one she drags to wherever the afternoon light falls best.
"This about your work? Or about a person?"
"Both. Neither. I don't know."
"Well, that narrows it down."
I laugh despite myself. "There's someone. At the facility. And I know all the reasons it's complicated, and I know what it looks like from the outside, but—"
"But it doesn't feel complicated from where you're standing."
"No."
"Hmm." More rustling. "Is he good to you?"
The question catches me off guard. Not is it appropriate or have you thought this through or any of the hundred concerned questions I've been bracing for.
"He is," I say. "In ways I didn't know I wanted."
"And you're telling me because you want someone to say it's okay, or because you want someone to talk you out of it?"
I think about the textbook. The self-assessment questions.
"I don't think I want to be talked out of it."
"Then don't let anyone try." Her voice is matter-of-fact, the way it always is when she's saying something that sounds simple and isn't. "You know what my mother told me when I introduced her to Dave and Neil?
She said, Kathy, the world is going to have opinions.
But they don't have to live your life. You do. "
"And you stopped listening."
"Thirty-two years ago. Still not listening." She pauses. "You're allowed to want things that don't fit what society expects of you, Hope. You just have to be honest with yourself about what you're choosing. The rest is other people's problem."
"What if there's more than one person?"
The silence on the line stretches.
"Then you stop pretending you have to choose," she says. "If they're all in, and you're all in, it works. It's everyone else who has trouble with it."
After we hang up, I sit at the kitchen table for a long time. The textbook is still open but I'm not looking at it anymore.
You just stop pretending you have to choose.
The next morning at Greenridge, Casey's in the Ward A corridor.
Standing between the checkpoint and the admin wing, hands in the pockets of his pants, facing the direction I come from.
"Hey, Hope"
"Hey, Casey." I slow down but don't stop. "How are you?"
"Good. Really good." He falls into step beside me. Walking with me, matching my pace, his shoulder close enough that I can smell him. "I wanted to talk to you about something."
"What's up?"
"I've been thinking a lot. About getting out." He says it easily, the way someone discusses weekend plans. "About what comes after."
"That's great, Casey. Have you talked to Dr. Kennedy about your treatment timeline?"
"Yeah, yeah. Kennedy." He waves that off. His eyes stay on me. "I mean after all of it. Where I'd go. What I'd do." A pause. "Who I'd be with."
I keep walking. Clipboard against my chest.
"I've been thinking about the mountains," he says. "You know that trail system up past Ridgeback? The one with the creek crossings?" He's close enough now that his arm brushes mine. "I think you'd love it up there. In the spring, when the wildflowers come in."
I stop walking.
He stops too. Turns to face me. His expression is open, earnest, and completely certain.
"Casey—"
"I know we can't talk about it in here." His hand comes up and wraps around my wrist—gentle, intimate. His thumb finds my pulse and strokes across it. "I get it. You have to be professional. But I want you to know I've thought about it. All of it. Where we'd go. How it would work."
I know what this is. Erotomanic delusion. Fixed, specific, grandiose. He's already decided this story is real, and every word out of his mouth has the weight of total conviction.
"Casey." I keep my voice even. "I need my hand back."
He blinks. Looks down at his grip on my wrist, and for half a second his fingers tighten before he lets go. Steps back. The pleasant expression returns, but his eyes don't change.
"Sorry," he says. Smiles. "Got ahead of myself."
"It's okay. I need to get to Ward B."
"Yeah, of course." He steps aside. "See you around, Hope."
I walk to the Ward B checkpoint without looking back. The guard buzzes me through and I go straight to the documentation room, pull a clinical concern form, and write it up before the encounter cools.
Patient Casey Robin, Ward A. Initiated unsolicited physical contact during corridor interaction (gripped monitor's wrist, sustained hold).
Described future plans involving this monitor in specific, familiar terms inconsistent with any existing relationship.
Presentation consistent with erotomanic delusional framework—fixed belief in reciprocal romantic attachment.
Intensity of focus notably elevated compared to previous interactions.
Recommend: (1) medication review, (2) reassessment of current movement privileges, (3) supervised corridor access only until clinical evaluation complete.