Tough Love Can Be Tough

I’m used to patients being terrified of getting worse. But it took me awhile to realize that the main issue I was now dealing with was that this patient was terrified of getting better. I’m sure there are plenty of psychological publications and blog posts by some really smart people that have already covered this phenomenon, so I certainly don’t claim to be discovering anything new. But it was a new situation for me to find myself in, particularly as I had been with this patient for over a month and had a more intricate relationship with him than with patients that I have for only one or two days. There is an inherent emotional and psychological distance that you can keep from patients and families whom you care for for only a shift or two. But this changes, inevitably, when you are with them as their nurse for an extended period of time.

He had a physical disease process with some setbacks during his recovery, which sentenced him to a prolonged hospital stay. But he also had some psychological and emotional dysfunction that went even further back, which appeared to have gone unaddressed until now. He was intensely needy, refusing to let his primary caretaker from home rest, and fearfully reluctant to let go of various hospital treatments that had become his source of security over time. On the morning of my final shift with him, knowing that he would soon be transitioning out of the ICU, I started off the shift by saying, “Our big goal today is to work on boundaries.” His response: “What’s that?” Oh dear. Each step in this final push towards recovery meant that there would less of all the external support – less treatment, less comfort and coddling, less urgency of response for issues that were not true crises. The growing expectation on him to work through the uncomfortable changes and responsibilities of recovery was almost more than he could handle. I’m so used to my therapeutic nursing role being that of one who brings comfort and relief as much as possible. I wish someone had told me in nursing school that sometimes, the therapeutic nurse is also the one who will hold his or her ground with a firm ‘no’ when the patient is crying, pleading, throwing a tantrum, suffering (but not really suffering).

There is a big part of my ego that wanted him to love me as his primary nurse. I wanted him to thank me for everything I had helped him through. But my final shift with him involved me being a big source of his frustration and discomfort, perhaps some disappointment as well. There would be no thanks offered – just his desperate plea that I would somehow let him go back to the less healthy state that he was in before. It was at that point that I knew for certain I had truly given him the very best that I could as his nurse, and as his friend. Because more than wanting his thanks, I wanted him to get better.

I can see myself in him. It’s how I am sometimes too, towards life, towards others, and towards God. I have a deeper appreciation now for the times when God allows me to struggle. That is a wisdom and love that I still plead against. I kept asking my patient if he still trusted me. I think that is what my Father in Heaven asks me too.

close enough to change

He could not speak. His disease process barely allowed him to move any longer. But he was fully present, and he would smack his lips to get my attention. He could use his eyes and a slight nod or shake of the head to communicate his needs and desires. He was fully present, a little boy who had to face the span of life, the briefest childhood, and thoughts of death within too small a number of years. When his mom would leave the room, he would smack his lips. I looked up from my charting. His eyes would dart to the empty chair next to his bed. “You want me to come sit with you for awhile?” His head nodded yes. “You want to watch a movie?” A nod. “Toy Story 3?” Another nod. I walked over, took the seat next to him, and took his hand. “Alright buddy, let’s see what Woody is up to.” The movie started, and a big scene came on. The train was about to go over the cliff, and Woody was trying desperately to stop it in time. My little friend’s lips would smack. I looked over at him, and he was wide-eyed, looking at me, then looking up at the screen, as if to say, “Check out this scene!!” The train went over the cliff with a crash. A brief moment of silence. I looked at my friend, and his eyes were wide with anticipation. He smacked his lips again, looked up at the TV screen and slightly jerked his head up so that I’d look too and not miss the next scene. And suddenly Buzz Lightyear appears, train triumphantly lifted over his head. Buzz has saved the day! I look at my friend and we both have victory in our eyes. “Whoaaaa!! That was SO cool!!” My friend has a little smile, eyes still wide, and we share an exchange of glances celebrating a brief but precious moment when all is ok with the world again.

This is the first time in my young nursing career that I’ve asked to be a primary nurse for a patient, meaning that every time I go into work, I will be able to be this little guy’s nurse for as long as he is with us. The goal is to provide greater consistency of care for the patient, and hopefully as a result, greater quality of care.

I think, however, that it has to do with more than just having someone who is more familiar with his communication style and his preferences. Because I feel myself changing in deeper ways, in the ways I think about my patient. When patient assignments change after a shift or two, it is inherently easier to be less emotionally attached, less involved with the patients. Now that I am a primary nurse for this sweet boy, I find myself not only taking a stronger sense of ownership for him, but I find myself caring more deeply for him and for his family. I find myself thinking more about his journey, feeling more of his struggles and celebrating more of his joys. I go on that train ride with him to the edge of the cliff, and hope with him that maybe Buzz Lightyear will show up and bring some relief again to the fears.

When I asked our charge nurse if she could help arrange for me to be a primary for this patient, I told her, “I think he has so much potential to break my heart.” Nursing is a profession full of tensions and constant battles for balance. Not wanting to get too close or too emotionally involved to a point where it becomes unhealthy, yet wanting so deeply to be authentic, open, human in the best sense of the word, and a reflection of the heart of Christ in what I do as a nurse. Christ did not stay aloof. He got close enough to us to be broken so that love and healing could flow in ways that a careful distance would not otherwise allow.

God, grant me courage to get close enough to change, to be willing to be broken, to become more like You… so that my sweet little patient might know that You are Emmanuel, You are God with us.