Caution: elopement risk

Our cat disappeared. He was an “indoor cat,” morbidly obese, with clipped claws and, apparently, no sense of direction. He got out of the house when we weren't looking.

Figure. Photo by: Art Explosion

When we chose our cat at the shelter, they told us that cats that don't go outside the house live longer than those that do. Cars don't hit them. Dogs don't kill them. Infections are avoided. We would be doing what was best for our cat if we kept him inside, behind closed doors.

Our cat never stopped trying to get out. He never forgot his pre-shelter days as a cat on the loose, in danger but free. He would hang around the door, watching for an opportunity to dart past us. He would sit, staring outside, occasionally mewing, sounding discontented and forlorn. We didn't waver, though. We knew we were acting in his best interest, but he wasn't convinced.

The same day that my cat escaped, I forgot my set of work keys at home.

I have nine keys that I need for work. Everywhere I go in the psychiatric hospital where I work, I have to use keys. To walk from my office to the secretary's office where I pick up my mail, I have to unlock two doors. To walk back to my office again, three. The door to the inpatient unit has to stay locked because of the large number of patients with dementia who could wander out if the door were open. Even with it locked, one still has to be careful: the door has a sign on it that reads, “Caution, elopement risk.” For their own safety, we keep the patients secure behind locked doors.

It's good to be reminded once in while what it is like to be without keys in our hospital. Keys are symbols in psychiatry. We talk about finding the key to a person's problems, or about unlocking the unconscious. But keys are more than symbols: they are instruments of freedom in a very practical sense. The day I left my keys at home, I spent the day asking to be let in and out of doors. I had to borrow keys from colleagues, who relinquished them reluctantly, looking me intently in the eye as they made me promise to bring them right back.

This loss of personal freedom is what many people fear about psychiatrists, that we will lock them up and not let them out. That we will throw away the key. Sometimes I forget that people could be worrying about this the first time they meet me. I think of myself as not only benevolent, but a great respecter of autonomy. I want to collaborate with my patients, as much as possible, even those whose memory and cognitive function are deteriorating. I want to keep them safe, as they cannot protect themselves. If my patients could truly process what it meant, would they still want to brave being out of the hospital?

Even now, when I look through the glass door into our backyard, I watch for a flash of white fur amongst the green and yellow. I feel guilty that we didn't watch our cat more closely, that he got out despite our best efforts to keep him safe. Is this what he really wanted — cold nights, no food, cars, dogs, danger? If his brain could truly process what it meant, would he still want to brave all these things just to be out of doors?