As James Close shook and shuddered through his arraignment on charges related to secretly videotaping unclothed patients, I momentarily pitied the guy.

He appeared via video (oh, the irony) on Tuesday from the Bucks County prison before District Judge Michael Burns, who detailed the charges against Close: Sexual abuse of children, criminal use of a communication facility, endangering the welfare of a child, and invasion of privacy.

There were 48 counts, and with each, Close – sallow in yellow prison garb – seemed to sink deeper into himself, rocking forward and back, rubbing his forehead, breathing rapidly.

When asked about his children – a son, 16, and daughter, 7 – I thought he would faint. The look in his eyes – shame, terror, both? – made my heart hurt.

How do you live with yourself knowing your perverted actions are wrecking not just your own life but the lives of your kids?

But then I thought of the 17-year-old Close allegedly videotaped while she was undressed during four visits to Penn Medicine Dermatology in Yardley, where Close worked as a licensed practical nurse. The teen was in a private light-therapy booth for treatment of a skin condition when she spotted Close's cellphone. In its screen, she saw the image of her naked body.

That poor girl was not Close's only alleged victim. Eighteen videos of seven additional female patients, ages 20 to 70, were found on his phone by Lower Makefield Township police.

And all I could imagine was the humiliation of that teen and those women as, one by one, they had to confirm for detectives that, yes, that was their exposed flesh caught on camera.

And suddenly Close's shaking and shuddering seemed just fine.

"These victims were horrified and embarrassed," says Lower Makefield Police Chief Ken Coluzzi. "Our officers are very upset and disturbed for them.  The thought that anyone would take advantage of someone seeking medical attention – frankly, it's disgusting."

It's also a horrendous betrayal of the privacy that patients expect their medical caretakers to respect.

"There's a very special, trusting relationship between clinicians and patients that is sacrosanct," says Dominic Sisti, director of the Scattergood Program for Applied Ethics of Behavioral Health Care at the University of Pennsylvania's Perelman Medical School.

"When it's violated, not only is the patient harmed but the institution of medicine in general is undermined. You start to wonder, am I going to trust this person? Are my kids going to be safe here? There's a whole house of cards built on a patient's privacy and expectation of confidentiality. When a bad actor violates that code of trust, it brings everyone down."

Remember Kathryn Knott, who did time for that 2014 assault of a Center City gay couple? She worked at Abington-Lansdale Hospital as an emergency-room technician; during the assault investigation, her cruel tweets about her patients came to light. (One gem: "Ended my night spreading a** cheeks to suture her hemorrhoids while they pulsated all over me #disgusting #arewekidding?") She got fired.

Then there was South Jersey orthopedic surgeon Steven Kirshner, who in 2008 "jokingly" applied a temporary tattoo below the bikini line of a sedated patient on whom he'd just performed back surgery. He thought she'd find it "funny" when she awoke. Mortified and enraged that he had touched her where he had no business being, she sued him.

Further south, a heartless Virginia anesthesiologist named Tiffany Ingham was sued for defamation and medical malpractice in 2015. A colonoscopy patient who used his smartphone to record audio during the procedure captured Ingham saying vicious things about him – his rash, his penis, his whining – as he slumbered. She even vowed to falsify his procedure records, just to bug him.

"After five minutes talking to you in pre-op," she sneered to the sedated patient, as colleagues chuckled, "I wanted to punch you in the face and man you up a little bit."

She got fired, too, and had to pay part of the $500,000 a jury awarded to her disrespected patient.

All this bad behavior pales in comparison to what Close allegedly did in that dermatology office. But it's all of a piece: a cowardly wielding of power over the medically vulnerable, who are too ill, sedated, or trusting to know they're being exploited.

It's the worst betrayal of the Hippocratic oath, whose promises include this one: "First, do no harm."

No wonder Close was shaking in his prison jumpsuit. It must be terrifying to see that harm boomeranging back to him, with the weight of the law behind it.