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On Orange Blossoms and Cypress Knees


It was my first day on a new rotation. He entered the room without a word. His eyes were cast downward toward his black tennis shoes with poorly constructed Velcro straps that loosely fit his feet. His palms were thickly calloused, and his nails were long. His hands read as a legacy of labor. His fingers were wrinkled yet strong, like the knees of a cypress tree. His years were beginning to show. After seven decades on this earth, his hair had turned white at his temples. Tufts of hair were emerging as white as orange blossoms. His eyes were sullen, sunken and hidden by thick bags of despair. His lips were surrounded by white stubble and pursed as he opened them to speak.

“Doctor, something isn’t right.”

His right leg jittered beneath his orange, prison-issued jumpsuit. The manacles across his wrists rattled with the chain connecting them to the cuffs around his ankles. His akathisia conducted an incarcerated symphony.

“Tell me more,” I probed.

As he continued in his slow, Southern timbre, his knee accelerated in tempo. His instruments of bondage were now competing in volume with the testament of his psychiatric interview.

“I’m just down, doctor. It comes back every now and then. I had been doing good for a while there.”

He had been in a maximum-security, forensic psychiatric hospital for more than five months. His charges were non-violent. As a victim of the perversions of flawed institutions of enforcement and sentencing, he was placed in the unit that I was servicing. He had relapsed medically despite a long treatment regimen.

I continued to follow him for the next four weeks. We would speak briefly every morning. He told me that he spoke with his daughter every week and wished to return to his family farm.

One may jump to a myriad of conclusions. As a patient in our unit, he may quickly be labeled by others as degenerate, violent, angry, unstable or dangerous. Some may assume that he is a repeat offender given his age or that he was serving a lengthy sentence for a single crime. All of these possibilities could be conceived only by his clothes and his cuffs.

He is more than his jumpsuit.

He is more than his handcuffs.

He is more than his charges.

As the days turned to weeks, we grew closer. With each conversation, I turned another page in his narrative by learning his passions, strengths, loves and losses. The more time we spent together, the less I was aware of the setting which consisted of a room housing only two chairs with the only door being open and monitored by a security guard standing at its entrance. In these moments, he felt outside of the walls and beyond the barbed wire fences. He seemed finally able to speak freely about his past, present and future. In our sessions he was able to feel human: respected, honored, dignified and whole.

By looking deeper than subjective labels, I was able to build an intimate relationship with him, uncover his story and optimize his care. This was a man who had made mistakes, but who was also working to rectify his wrongs and return to his place in society. This was a man who was working diligently to return to life as a normal citizen. This was a man who had toiled for decades only to spend large spans of precious time in confinement and away from his life and loved ones.

Regardless of his current criminal status, his health remained my primary concern. It was my aim to treat not only his psychiatric illness, but also his social life and well-being while in the unit. Once he lowered his guard and allowed others into his life, he became an integral part of the community by using his strengths to better the unit. These are the same skills that will make him an asset in his home and community upon his release.

I yearn for his freedom. Frequently, I imagine him seated in a rocking chair beside his wife on their front porch watching the squash and cabbage grow in their garden. If he was free, the unmistakable aroma of orange blossoms would welcome him home with each gentle breeze. The air would be filled with a concerto not comprised of a duet of shackles but rather an orchestra of cicadas. His slow, gentlemanly drawl would whisper sentiments of love to his partner of more than forty years. The love of his family would envelop him like a quilt that had been stitched over many generations.

He is safe.

He is home.

He is free.

Joe Burns Joe Burns (4 Posts)

Contributing Writer

Herbert Wertheim College of Medicine at Florida International University


Joseph Burns is a member of the Class of 2019 at the Herbert Wertheim College of Medicine at Florida International University in Miami, FL. He is a native of Orlando, FL and is an alumnus of Stetson University. He is passionate about the arts and community engagement, having served as the Art Director of the Mammography Art Initiative and the Community Service Chair for the Panther Learning Communities. His interests include congenital heart disease and American Indian Health. He hopes to pursue a career in pediatric cardiology.