I'm angry and conflicted about a patient right now. Maybe talking about it will help.

[Aristus]

I've been treating, for a couple of years now, a patient with a history of deep-vein thrombosis. He comes in twice a month for his lab test and any necessary adjustment to his warfarin.

He's an okay guy, and our visits have been pleasant, even though I know he's been in and out of prison several times.

Yesterday during his visit, he confessed to me that he's going up on charges of felony possession of child pornography. Then he broke down and started crying. He's really afraid of doing hard time. Any affinity I might have had for him before instantly turned into disgust for this snivelling coward who is helping perpetuate a market for a horrible, horrible product.

I don't know how much longer he has before he has to begin his sentence. But I'm sure he'll be back for his regular visits. I'll make sure he gets good, proper medical care. I took an oath to that effect. But I just don't want to have anything more to do with him.

Thank you for listening.

[donkeypoofed]

1. He's crying cause of what's about to happen to him in prison

They absolutely luv and enjoy "skinners". I'd wish him luck but child porn is evil - so he has my thoughts and prayers (for all his victims).

[MicaelS]

14. WTF are "skinners"?

If you are going to use an obscure term, please explain. And no, I am not going to Google anything to do with child porn.

[mwooldri]

21. Urban Dictionary to the rescue...

https://www.urbandictionary.com/define.php?term=Skinner&amp=true&defid=3607519

Inmate slang for a paedophile.

[MicaelS]

33. Thank you.n/t

[zanana1]

57. His life and past are really not your business.

You're his physician, not his psychiatrist.

[sinkingfeeling]

2. Understandable.

[dlk]

3. I Can Understand How You Must Feel Conflicted

Learning something so awful about one of your patients you thought you knew must feel like a betrayal. All you can do is maintain your professionalism and it sounds like that’s what you are doing. Fortunately, he will move on to prison soon and out of your sphere. It’s difficult to ever really know someone and people with some of the worst secrets are highly skilled at keeping them.

[EarnestPutz]

4. Good for you. Your situation and your response to this patient...

...are part of why we admire health care workers so much. It's not just the oath, but your humanity that is at work here.

[NJCher]

5. I don't know what "going up on charges" means

does it mean he is facing a trial or he's already been convicted. From your other paragraph it sounds like he is awaiting sentencing.

Also, let's not assume--unless he admits it himself--that he got a fair trial. I investigate trials and I can tell you few of them are fair, especially if you don't have a ton of money. And even if you do, the system will still convict you and you have to spend even more money fighting on a post-conviction sentencing motion.

Our justice system is a mess. It cannot be depended on for fairness. I would in no way, shape, or form make a judgment on this person with the system being the way that it is. And I can tell you from firsthand knowledge as a legal activist that a guilty verdict doesn't necessarily mean anything.

[Aristus]

8. No, he pretty much admitted to doing it.

He even tried to put the blame on society at large: "Look at Brooke Shields! People were looking at her nude when she was twelve!"

I think his upcoming court date is a sentencing hearing, but I'm not sure. I didn't dwell on the details, for obvious reasons.

[cpamomfromtexas]

55. How would someone get a trial investigated in Texas. Know someone who was victim

Of tampered and forged evidence. Courts refuse to have hearing to void judgement or fetter out facts.

[TreasonousBastard]

6. There is nothing normal about an interest in kiddie porn so perhaps...

it's best looking at it as a disease, or condition, that should be treated, with punishment as a lesser option.

That's not so easy, but it may help.

[Phentex]

9. This is how I choose to see it...

I can't wrap my brain around anything else aside from the evil people who kill children after abusing them. *I* have to believe that this is some sort of disease or disorder/some mix-up of brain cells that drives some people to feel this way about children. I don't like it, any more than I like alcoholics or drug addicts who hurt people, but I try to remember that humans are flawed, some more than others.

[TexasBushwhacker]

12. If it matters

Many pedophiles were sexually abused as children themselves. But while they may desire children sexually, they know it's morally wrong and illegal to act on those desires.

[hlthe2b]

16. Most don't want to discuss this aspect, but we really don't know what causes this behavior

and as horrific as it is to the rest of us, there has to be a reason. Maybe it is a "disease". I suppose that is possible.

At any rate, it is true, that the only real answer we have is the criminal justice system. That doesn't mean there are no unanswered questions about it and its etiology. As a medical professional, I'd hang onto that if you can. I've never looked upon compassion as strictly contingent on certain factors, though clearly we are all human and it is difficult to not factor in such behavior and its horrific impacts on others.

Still, what if you were to find one day that this man had a brain tumor in the frontal cortex. There are at least a few rare examples where that was both documented and believed to have caused the disinhibition syndromes that lead to pedophilic acts (whether or not it explained the compulsion, I'm not really convinced). Still, food for thought, even if there is no evidence of something like this in this man. Decades from now we might find some other organic or neurotransmitter dysfunction that might explain...

Good luck. Not easy when inherent morality intersects with ethical responsibility.

[elleng]

7. Love you for all you do, Aristus.

[Ohiogal]

10. I don't know how you medical professionals

do the jobs that you do, especially when put in the position of treating some of the more odious members of our society.

Maybe with this guy, just try to keep in mind that he was caught and convicted so he won’t be able to perpetuate any more harm to innocent victims.

I guess addiction to porn is a disease ... albeit a repulsive one that harms innocent victims ... you sound like you are being professional as usual and doing your job, which is quite admirable. I don’t know if I could be as professional as you if I were in your shoes.

[Aristus]

39. I have a lot of patients who are ex-cons.

They get sent to the homeless clinic because living in a halfway house prior to release qualifies them as homeless, especially if they don't already have a home to go back to when their sentence is complete.

Most of them seem decent enough, and just want to get on with their lives. But I had another ex-con once who had been convicted of child molestation (although I forget exactly how I found this out). He was pretty skeevy from the beginning. I wan't surprised once I found out his crime, because he gave off all sorts of bad vibes (very unscientific, I know...) I think he only had about two visits, then I never saw him again, thank goodness.

I had one patient with whom I visited for several years, and now he gets his care at the mainstream clinic. Huge guy, just gigantic, with dreadlocks and a big beard. Fearsome-looking. But just the nicest, friendliest, most polite guy you'd ever want to meet. No skeevy vibes like the other guy. I always enjoyed our visits.

I got to talking about him with my assistant once. She told me: "Oh, you do not want to know what he was doing time for!" I never pressed her for an answer. I'm kind of glad I never found out. He was just a very personable guy whom I liked very much.

[blueinredohio]

11. I don't blame you Aristus. I would treat him because I'm supposed to

but I have nothing but contempt for anyone who would enjoy looking at child porn. I just don't get it and I don't want to get it. Thanks for being understanding.

[Freelancer]

13. Why the hell would he tell you shit like that?

Regardless of whether it's true, WTF? There can't be a good wiring arrangement in his head if he had a good thing going with you and blows it deliberately. Maybe he thought you were a "fellow traveler." Worse yet, maybe you're being investigated.

[nocoincidences]

17. Doctor patient privilege.

Sufficient to explain his revelation. He knows his doctor is bound by oath not to reveal what he is told.

[pbmus]

15. Addiction to pornography is very difficult to overcome..and

Child pornography is the most difficult.

No excuses..just fact

The psychological control issues are enormous.

The majority of perpetrators are abused as children or have been exposed to abuse very young.

I would suggest you try to hand off primary care duties to associate or nurse, and avoid any other contact, as your feelings will be detrimental to further caregiving, and patient will become aware of your feelings.

[captain queeg]

18. Addiction is hard to understand

Being addicted to alcohol or drugs is somewhat understandable, you put something into your body that has physiological effects. But things like gambling and sex really are addictions. I didn’t use to believe that myself. But one definition of addiction that I’ve heard that applies; if it ruins your life and you keep doing it. I’ve met people with gambling and sex addictions that fit the bill.

I’m not making excuses for them, some behaviors are unacceptable to society and if you do the crime you pay the price.

[The Velveteen Ocelot]

19. You might try to think of it the way criminal defense lawyers often have to think

about some of their more loathsome clients: they are upholding the standards of their profession by providing the client with the best defense to which the law entitles him. You are likewise upholding the standards of your profession by providing this guy with the best medical care you are obligated by those standards to give him. I used to do some appellate work for a lawyer who represented some pretty despicable characters, and although I seldom interacted with them directly, I was obligated to construct the best argument the law would support, and that could theoretically bust the creep out of prison or at least get him a new trial. We almost always lost because criminal convictions are rarely overturned on appeal, and all of these dirtbags were pretty clearly guilty.

Still, we had to put aside the fact that the client was a dirtbag and just do our jobs. It's probably harder for you because you have to interact with him directly. But of course your job is to offer him appropriate medical treatment and advice regardless, as you are doing, and you'll do that until he's hauled off to prison - where he'll probably be for a very long time, as he should be. (And he probably has a lawyer who doesn't like him any more than you do, and had the additional burden of having to look at the evidence.)

[wryter2000]

20. That's a tough problem

It does seem that he'll go away fairly soon, so maybe you won't have to interact with him much anymore. I'm sure you can maintain a professional demeanor toward him. Maybe try to limit conversation to his medical issues only and keep things as brief as possible.

It he seems to be trying to get you to act as his therapist, maybe you can refer him elsewhere. Or at least, tell him your expertise doesn't extend to helping him with psychological problems.

Good luck!

[kooth]

22. It must be very difficult ...

These are my feelings on this. First of all, thanks for your efforts in supporting your patients.

I have read that most addictions of this nature are caused by the patient's being abused in childhood. If this is the case with your patient, that might be a helpful way to think of it.

Perhaps you can use this as a teaching moment for you. Try to understand your patient's motivation for this addiction. Get more information on the patient's specific history, especially if you want to change your disgust into something more positive.

In any case, good luck.

[sagetea]

23. Porn addiction...

I'm a female. I was kidnapped by an older man. In my late 40's, lost my parents and by a stroke of luck, I was one of the first people to know when my captor died, their deaths happened within 10 mos. of each other. It propelled me to learn what my captor put me through. One of the ways I took to find out was through porn. And therapy....

What I found was I have sexual proclivity towards older men, because, that was what I knew, always. However, what I found on porn (besides what I learned about my past) was there is a huge, I mean HUGE section of 'age play' for both women and men. I guess what I am trying to say is, he didn't have to get child porn because there is women on internet porn who are into 'age play' In my opinion, men (and women) who go to the extreme like that, there is something fundamentally wrong with their head! Seriously!!

Long story short...I was on porn for three yrs. because what, for me, started out as wanting to understand my past, but it became an addiction to the attention I got from men. And I stopped it's been just over two yrs. and I still want to go! My husband knew and thankfully understood what I was going through...so, I'm not such a bad monster!

Some say that people that were abused become the abuser, maybe that is true in some cases, I think some are born like that. My captor molested his sister, when she was my age. He was never abused. I was the only child he took captive but, he molested others, one I almost lost my life trying to distract him. It worked, but the gun did not!! lol!!

I think I gave too much information...sorry about that! Perssonally, I think we need as a society talk about this stuff, just sayin'!

If I offended anybody, my apologies!


edited for misspelling 'their'.

A'ho

sage

[UniteFightBack]

24. Thank you for sharing your story. Addiction is a helluva thing. Glad to see you working through it

as well as your past...you are a strong person that I can say with certainty.

[MLAA]

30. You should never need to apologize about offending when Speaking the truth / from the heart.

We need to shine a lot on abuse and you are brave enough to help do that! You have nothing to apologize for! 😉💐🙂🌷🌞😊☺️🌷🌷

[UniteFightBack]

25. I wish someone like this can get help. After he comes out of prison he'll still be addicted to

child pornography. We need to figure out what is making these people tick...and that goes for all the other deviants too.

[The Velveteen Ocelot]

29. The typical sentence for child pornography offenses is 15-30 years.

Depending on the specifics of his crime and his age, he might never get out.

[guillaumeb]

26. I once represented an admitted pedophile.

While I found his conduct to be disgusting, my job was to ensure that is rights were secured.

But as part of the agreement, he could have no public conduct on the job.

[Snackshack]

27. Understandable.

IMO and as you mention you took the oath. You would regret more not being faithful to that then dealing with the visits.

Thank you for what you do!

[PJMcK]

28. You're a pro, Aristus

As you wrote, do your job and hold your contempt in check.

After all, if he's about to be sentenced, he won't be your patient much longer.

Find some peace. I, too, have had brushes with the "dark side" and it's horrific to look into the abyss. Those experiences have taught me to appreciate the contentment in life that I'm fortunate to have.

[still_one]

31. See if you can have another physician take over that case

[Aristus]

46. I'm the only provider at the homeless clinic.

The mainstream clinic is only a few blocks away. But I'm not going to fob him off on another provider.

[still_one]

48. You are a principled physican. +++++++++++++++++++++++++++++++

[Aristus]

49. Physician Assistant.

But thank you.

[still_one]

50. Regardless. we need more people like you

[Aristus]

52. Very nice, thank you.

If it helps, there are.

I often go to the university to address the incoming class of Physician Assistant students. I met a lot of smart, talented, motivated people, young and not-so-young (The PA profession has been called the best 'second career' in the nation right now. I was forty-one when I graduated and started in practice.) and I can tell they'll make good medical providers when they graduate. The core of the profession is providing medical care to the underserved and underinsured.

[Aristus]

34. I don't agree. If he is accessing these images, he is availing himself of a market for them.

And as long as that market exists, people will keep abusing and exploiting children to meet the despicable demand for it.

[lunasun]

36. Exactly . If he woke up and relayed he was crying for realizing the abuse he supported

and it was regret, it would be one thing, but self pity for participating in child exploitation and then for getting caught yuck

[Aristus]

38. Whatever the definition is, his actions meet it.

He wouldn't be going up the river if they didn't.

[Aristus]

45. And I disagree with your opinion.

If he likes to jog it with child images in mind ( eww, by the way), he can simply imagine it and no one would be the wiser. But if he is accessing tangible images, those images were created through abuse, exploitation, intimidation, and threats. All aimed at innocent children.

The creators aren't the only criminals here. The ones for whom they are produced are just as culpable, by creating a demand for such images.

[Skittles]

40. I hope you are urging this man to seek psychiatric treatment

and holding your contempt in check

[Aristus]

41. I encouraged him to talk to someone in our behavioral health department.

Mainly because he was so agitated and terrified of going to prison, I wondered if maybe he was considering suicide.

[Skittles]

42. getting to the root of why he indulges in child porn is what he (and society) needs

very often they were abused themselves

[cilla4progress]

53. Hi, Aristus.

I'm sorry for your inner conflict. I respect your resolution - to continue to serve him within your scope, but go no further...I encounter something like this from time to time in my legal practice.

Also, in the past couple years we learned the son of neighbors who our daughter grew up with was ousted from the Coast Guard and incarcerated for trafficking in child porn. I can see a thread in his upbringing that may have led to it, but distressing nonetheless.

[Lint Head]

54. I feel for you and encouraged that you have true integrity.

A human trait that seems to be lacking in our world today.

[smirkymonkey]

56. Aristus, you have a difficult job that I don't envy.

I don't know how you do it. I admire your courage and dedication. Just follow your instincts and I am sure that will serve you well. I wish you all the best.

[samnsara]

58. tough one for you..

..but easy decision to make. I did an internship at a mental hospital and during that time I came to know the patients quite well. One lonely old guy was just like any grandfather and it was easy to chat with him and in general be nice. TIL i found out he was in there for child molestation. I just started distancing myself from him.....

I still did my job...but just not so happily.

[Aristus]

59. That's pretty much the way it's going to be for me.

Thank you for sharing.

[JustABozoOnThisBus]

60. Remember Samuel Alexander Mudd

He served time for patching up the leg of John Wilkes Booth after that actor shot Lincoln and then broke a bone jumping from the theater box to the stage.

He did the right thing (fixing the bone), then got screwed.

So, yeah, just treat the person's condition and don't give him another thought.

[Tipperary]

61. You posted in another forum that you would not care if an inmate was murdered in prison.

It might be time for you to take a good hard look at yourself and your profession.

You are a medical professional, or so you say, and I find it frightening you would make a comment about prison murder. Especially since you (I would assume) have access to all kinds of meds.

That being said, I agree with your disgust toward a pedophile. However, this is not something that should have any impact on how you treat a patient.

[UTUSN]

62. . . .

[Aristus]

63. I'm pretty sure I pointed that out in my original post.

The guy who threw the kid off a third-floor walkway? Not a patient of mine. I don't owe him anything.

And I didn't say I wanted him murdered. Just that it's been known to happen in prison.

(Or so I say? What's that supposed to mean? I say I am a medical professional because I am. That didn't magically change just because I said something you dislike.)

[LuckyCharms]

64. He is a medical professional.

And he expressed an opinion about an individual who was not under his care.

I'm not sure why his access to meds has anything to with his opinion of that individual.

If your doubt about him being a professional is strong enough to post about it publicly, perhaps you should explain to everyone reading your post why you doubt his profession, rather than just throwing that out there like you did.

Or even better yet, maybe you should just apologize to him.

[akraven]

66. You are a gentleman.

He isn't.

Thank you for being you.

[Aristus]

67. Very nice. Thank you.