Saturday, September 25, 2010

Compassion Deficit

I think everyone has their type of patient that they just can't get over the feeling of wanting to kick. I've been a little surprised at myself lately at who it's been. I've always known that I can't deal with the entitled patients. I know why, and I've learned how to deal with them. But lately another sort of pet peeve- I hate to even call it that, because it's a little stronger than that- has crept over me for our addicts.
This may seem like a given to a lot of nurses, especially those that work in ER. But it sort of bothers me. I've always sort of felt deep inside that the reason I always end up with so many high drama psych patients is that God knows I know how to deal with them. I always thought that I would feel sort of a kinship or at least a deep empathy for addicts because of my own past. I was never a substance abuser, but I've dealt my whole life with a lot of unhealthy tendencies. When I was about 13 or 14, I started cutting myself. A couple years later, I also started dieting to a ridiculous degree even though I was already underweight. When I slipped up, I would make myself throw up. I didn't tell anyone. For a long time. When my family found out, and I realized how much it hurt them to see me this way, I worked very hard to stop. I had my setbacks, and I still have the tendency to do these things. I always will. The thoughts still run through my head, but I have it in me to stop myself because I think about how it hurts the people around me.
I think this is where I struggle. I hurt for our depressed patients. I hurt for the type of people who rely on some self destructive behavior to escape all the bad things they feel. But I hurt even more for their families.
I took care of a lady with liver failure and esophogeal varicies their other day. I remembered her face. I knew why she was here. Drank herself sick again. This time, though, her son was with her. I knew I would have remembered him. He was a big cherubic looking kid. Really quiet. Really young, about 21. He never asked us for a thing. He sat there and stroked his mom's hair and held her hand while we tried to start an IV on her scarred-up shit veins. I don't think she even really acknowledged his presence. She did demand Dilaudid from us while he sat outside the room and cried. He asked one of the nurses how much it would cost to get his mother a liver transplant. That was enough to make me cry, too.
And my patient last night. Came in via EMS for approximately the 50th time this year. Took 9 Vicodin at once for whatever bullshit pain complaint she made up at that particular moment. Her tooth...nope. Maybe her back. And/or neuropathy. Wherever the pain was, she wasn't trying to kill herself or get high. She was just trying to make the pain better. In fact, the pain was still there, could she get some more pain medicine? Yeah. No. So her husband came back. Apparently this was a pretty regular little routine for them. By the way, she'd also been popping Xanax all day like they were sweet tarts. She does the and passes out, he says, so he just calls the ambulance as soon as she does it. Take her meds away, we tell him. Nope. Can't do it. Supposedly if he takes her meds she throws boiling water on him. Why he stayed with her I have no clue. But he did. The whole night he hugged and kissed her while she drooled. He cleaned and changed her when she peed on herself. This is my wife, he said. I married her because I love her. The EMTs who ran on her knew her by name. They said he would run down the block and use the pay phone to call 911 because she got so irate and abusive when he did it, so he would call from outside the house and pretend it wasn't him. I felt so awful for him. He clearly loved his wife so much, and there was absolutely nothing he could do for her.
I looked into both of these people's faces trying to find what it was that made these people love them. I could not figure it out for the life of me. Who had they been? And what happened? I can understand trying and failing. But I cannot understand looking into the eyes of your loved one and seeing the desperation I saw in both of these men and not wanting to change at all. The selfishness in them made me sick. It didn't change the way I cared for them but it just felt... bad. Like there was an anger in me for them that I really felt uncomfortable with. Chances are that these women will both kill themselves with their behavior one of these days. An awful part of me felt like it would be better for their loved ones if they went ahead and did it.
Is this normal? Am I putting too much on them? And is it even fair for me to compare my problems with theirs? This job sneaks up on me so bad some days.


  1. I think your experiences with pain and brokenness make you uniquely able to care for your patients. I think it's a beautiful thing you feel for the family members the way you do. I think the fact that you cared for the patients regardless of their d-bag tendencies signifies your commitment to the universal hope behind working with the people that engage in such self-destructive behaviors: that maybe, just maybe this time they'll realize what they're doing, and stop.

    It's ok to be angry. It's definitely ok to be outraged for those that are vulnerable and being abused.

    Keep up the hard work, you're so very good at it.

  2. When you said you were trying to figure out what made these people love them. I wondered the same thing. I suffer from anorexia and self harm and I always wonder what makes people still love me. I have caused them so much pain and anger with my behaviors, yet they act just the same as you described above. I feel selfish and guilty for ruining my family's life, but they never seem to do anything about it. ... but neither do I. :/

  3. You can still identify with and feel something, anything, for your patients. That right there is a sign your job hasn't kicked your ass too hard yet. Thank you for not letting yourself turn into a brick wall of IV's and bedpans. Knowing many, many nurses in my life, it can be to easy to turn off our emotions and escape the suffering. Sometimes I wonder why some folks get into nursing in the first place, but I don't wonder that about you.

    Hopefully you have found someone other than us (your readers) with whom to share your experiences? Really dig into how this work makes you feel. It can be traumatizing work for both the professionals and patients, sometimes in very different ways.

    Keep it up, Hood. You've retained your humanity.

  4. I hear you, New Nurse.

    I work a Medical floor where we get the folks after ER stabilizes them. We get runs of patients like the ones you describe, sometimes not until after they've come out of ICU.

    I haven't had such an obvious enabler recently, though. It would be hard to be objective about that. I don't care that the guy calls 911 from a pay phone; he's still enabling her to be dysfunctional, and ruining his own life in the process. Why has the son of the liver-destroying patient not been told Mom is killing herself, and how? At least he'd understand why a transplant won't help her.

    Our patients are mild by comparison; usually they just go into hiding at home and create their own hell independently. We get them when they want a wider variety of pain meds or their chain-smoking causes their COPD to flare up.

    The ER is no place to have a talk about enabling behavior, but why does one not take place after admission to the floor? 21 yrs is old enough to have such a talk. It wouldn't be a bad idea to see the family gets info on support groups like NAMI or Al-Anon.

  5. Oh, Jess. They still love you because you're the type of person who actually cares what you're doing to them. I still remember wishing that someone would push me harder and give me an ultimatum, but looking back I think it just would have made things worse. It hurts you so much more to think this way when you're suffering from an illness that feeds on self loathing and guilt. I always wanted to hurt myself even more when I thought about how much I hurt others. But when I started thinking about the things they loved about me, I was able to use it as sort of an opposition to that hyper critical, bad narrative in my head all the time. I wish you the best. The fight doesn't stop, but it does get easier.
    Nurse Philosopher- I always assumed they were told but just didn't want to accept, particularly the husband. I did give him some info on Families Anonymous, although I really don't know how much it'll help him.

  6. I have to hand it to that husband. What a trooper! He took his wedding vows seriously! I would wonder too what he originally saw in this woman and what happened to her.

    I had to talk to a cutter a while back about her troubled existance. It was odd because she tried to make me see things from her perspective and I just couldn't. I tried to make her see it from mine and she just couldn't. I think it's all about inner strength and to me she had none or else she'd find another way to cope. She probably mistook my talking points as a lecture rather than advice.

  7. Those people, the mom and wife, gave up on living a long time ago. They're just existing now. It's not horrible of you to think this. It's normal.