Shortness of Breath | Is There a Certain Patient Population That Gets to You?

If you were to be completely honest with yourself…is there a certain patient population that causes you angst, disgust or fear, without really knowing why? I had some reflection exercises recently in my Senior Seminar class that have caused me to look inside of my thoughts and my reactions to those very situations.

A line in the sand...

Boundaries come into use for many different reasons…safety, security, independence.

The exercise that recently got my attention was that of boundaries. While reading that section in our text, many different thoughts were running through my mind. The boundaries I have set with my mother in order for us to have a relationship, actually ended our relationship all together because she was unable NOT to cross those boundaries over and over again without regard. At that point in my life was unwilling to loosen the lines of the boundaries I had made out of stubborn pride and need…maybe now.

Boundaries come into use for many different reasons…safety, security, independence. There are physical boundaries like fences and doors to keep people in or out. Rules of conduct and behavior are boundaries in civil codes of behaving. The boundaries I set with myself in my own behavior have been helpful, but I didn’t ever think of boundaries as being a place of meeting and coming together—like the shoreline and the ocean…both needing each other to make the perfect picture of co-dependence in a good way.

The words that made me stop and think the most in my reading of, Heal Thy Self, was that our roles as patients and practitioners are similar…that we are not just in a role…we are in a larger field of human connectedness, of shared humanness. Shared humanness…interesting.

I tried to keep this concept in the forefront of my mind at work this week and it helped. When one of our beloved female ER docs—who is scattered and slow but such a wonderful practitioner and patient advocate—was driving me crazy because she was sooooo behind and patients were stacking up. I thought, “We are in shared humanness right now and I will not get upset.” I instead re-organized her charts and kept her on task…she realized what I was doing and smiled at me with a nod and said, “Thank you…” Prior to this I would have re-organized her charts and made sure she realized I had done it, and done it with some ‘tude….

Yesterday I had another opportunity to realize my misunderstanding and my need for and about boundaries. We have a population of alcoholics that frequent our ER. There is one man that can drive my emotions to a red hot steam in 5 seconds flat. I know this and I try to not take that gentleman and typically swap another nurse’s patient (one she is having a time with). As I saw the name of the patient coming in via ambulance—the immediate reaction that typically rises from me occurred—disgust.

I have thought about this over time and realized that this one man reminds me of my childhood and feelings of anger, repulsion and fear surface with those feelings. It took me a while to recognize this…Just as quickly as the feelings surfaced, the thought about shared humanness surfaced. As I recognize that for the patient’s best interests and mine, letting another nurse take him is usually the right thing to do…

Yesterday I chose another option. I took the chart and went to prepare the room for him. I prayed. I asked God to show me how to care about this person as His child…in our shared humanness…I asked God to show me what boundaries to place on his behavior and mine in our ER today without any of my own emotion behind them. Typically and shamefully I would do the bare minimum with him and give nothing of myself while doing it…I asked to see the boundaries as shifting and moving as needed.

When the patient arrived in his usual state and with his usual rude, foul-mouthed demands I watched him…I listened to my thoughts and let them pass without judgment…I felt my breathing quicken with my heart rate, I felt my face start to show disgust, but I said to myself…”Shared humanness.” I let the paramedics get him off their stretcher and onto mine and for the first time I noticed something in me—fear.

I could be him…my disgust came from the PTSD-type recall of seeing my father drunk and acting in this way over and over again while growing up…My fear was no longer that I could be harmed—because I was in control here—I had the power to make strict boundaries on this man’s behavior! The fear that I recognized now was that I could have ended up like this man…it was in me, the compulsion to drink….he could be me…shared humanness….

I prayed continually as I assisted him to change, offered him a washcloth and soap to clean up…and tended to the carrying out of MD orders. I prayed while he flung insults and threats at me and I continued to pray while I set boundaries that were fair and not out of my need…but both our needs…shared humanness…

I noticed that during my interactions with him I felt nauseous at times, SOB, and irritated. I felt my pulse race and my stomach clench. I prayed for strength…so much of this patient and my guttural reactions were related not to him at all, but to my cellular memory of home…BUT despite this, yesterday I was able to be present and focus on the care of the patient despite my need to flee. I noticed my thoughts, and reflected on them. I noticed the reactions physically and applied lavender oil to my wrists and neck…I breathed deeply and continued. I will most likely continue to swap patients when he returns again…but I am thankful for the exercises in this book I am reading for class that are allowing me to slowly chip away at the protective layer that I have built over time and to understand why it is there…and flirt with the possibility of thinning it out!!

  • Jjjddcoyne

    This is your best one yet!I am proud of you!

    • Bobbi Mccarthy

      Thank you Denise… that means alot to me. 

  • Nurse19

    Bravo Bobbi. Really fine work–the writing and the introspection. What a contribution this is to your patients and all of us with whom you are sharing.

    • Bobbi Mccarthy

      Thank you so much Nurse19~  I’d love to hear about your practice.

  • http://www.facebook.com/profile.php?id=100000104597917 Holly Vogel-Engel

    Excellent post.  I have often thought of this exact concept.  My first reaction is the same as yours, the alcoholics, the drug addicts–but over the years I have learned to cope with them and even now feel sorry for them, I want to advocate for them more.  My biggest fear is a big surgery, a big abdominal surgery.  I think the reason is I am more a medical intensive care, cardiac nurse.  Give me a big heart attack any day right up to the arrest with every arrhythmia in the book, I can deal.  But surgeries, there is just so much more that can go wrong which is much harder at times to pick up on at an early stage.  Cardiac events–YES!!!

    • Bobbi Mccarthy

      Holly~  thank you so much for taking the time to post your own experience and thoughts. I agree with you… As an ER nurse at heart~  give me the MI, the trauma and the massive GI bleed…but the alcoholic/drug population sends me screaming.  I find the time spent trying to figure out my reaction to these patients has been helpful in helping me understand myself more… i may still want to run for the hills… but at least I know why!!