You want to know what it means to be a pediatric psych nurse? Welcome to the Pediatric Evaluation Clinic of Boston, otherwise known as PECB. Our unit occupies the top floor of the larger Kirkland Medical Center. We like to believe we have some of the best views in Boston, which is only fair as we serve the toughest citizens.

Thursday night, I sat in the hallway of the pediatric ward observing our newest charge. Her name was Lucy and she’d been admitted this afternoon. We’d had only twenty-four hours to prepare for her arrival, which hadn’t been enough, but we did our best. Most of our kids shared a double room; Lucy had her own. Most of the rooms included two twin beds, bedside tables, and matching wardrobes. Lucy’s room had a mattress and a single blanket, that was it.

We’d learned the hard way that the shatterproof glass on our eighth-story windows didn’t always hold up to an enraged child armed with a twenty-pound nightstand.

Lucy was a primal child. That meant she’d been so severely and continuously abused that her humanity had been stripped from her. She didn’t wear clothes, use silverware, or tend to basic hygiene. She didn’t speak and had never been potty-trained. According to her file, she had spent most of her life in a disconnected freezer unit with bullet holes for ventilation. Her time out of the freezer had been worse than her time in. The result was a nine-year-old girl who existed like a wild animal. And if we weren’t careful, she’d train us to treat her like one.

First hour she was admitted, Lucy greeted our nurse manager by defecating into her own hand, then eating the feces. Twenty minutes later, a milieu counselor—MC—observed her ripping out the insides of her pillow and stuffing it into various orifices. The pillow was removed; Lucy wouldn’t allow us to tend to the stuffing. An hour after that, she scratched open her arm with a fingernail, then drew patterns on the wall with her blood.

First observation of our new charge: Any form of attention seemed to trigger a need to debase herself. If Lucy had an audience, she had to hurt.

By four in the afternoon, we agreed to confine Lucy to her room and assign one staff member to monitor her. Rather than the five-minute check system, where an MC accounts for every child’s whereabouts every five minutes, one staff member would observe Lucy as discreetly as possible, noting every twenty minutes.

Tonight, that was lucky me.