Monday, March 26, 2007

Walk the Line

About a million years ago, during the last semester of nursing school, we had to watch a video on ethics. The video was all about the tragic, fictionalized story of Judy, a pert, red-haired nurse with a turned-up nose, who got too chummy with a teenaged patient in the psych ward where she worked. After discharge, said patient showed up in her living room, having let himself into her house through the back window with a brick, and offered to take her away from her lousy life. We watched breathless as Judy got rid of Scary Teenaged Stalker-Boy, appeared before The Stone-Faced Commission Of Nursing, and finally Learned A Valuable Lesson about crossing ethical lines.

If only it were that easy. Truth is, there are moments in every work week when you wonder (unless you work, say, in the ER or a vent unit) if maybe a patient isn't getting a little too close for comfort.

Luckily, before you or a patient crosses a big line, there are lots of little lines. Keeping scary stalkers off your couch is a matter of figuring out how to redirect or contain weirdness early, before it gets out of control. Likewise, not every personal question or inappropriate remark is necessarily an ethical or privacy violation.

For example: If a little old lady tells me I'm pretty and I ought to meet her grandson, that's not something that's going to flip me out. For the same reason, a patient with a huge tumor in his frontal lobe can say nearly anything he wants without my throwing up walls. The converse of this is the neurologically-intact guy of about my own age who, while I'm starting an IV, asks if I have a boyfriend. *That* sort of thing, given who it's coming from and the situation, makes the alarm bells on a German submarine pale in comparison to what's going on in my head.

On the flip side, there's the problem of how personal to get with a patient. If I have a person who's dealing with sticky emotional issues in addition to a brain tumor, I might give them a very small detail about a similar situation in my own life and how I handled it. I *might*. It depends, again, on the person and on my gut feelings about them.

I have only a few hard-and-fast rules about personal relationships at work. One is that I don't date patients, doctors, or other people I work with. Another is that I won't allow inappropriate comments or questions to slide when they come from the neuro intact patients. The final and most important one is this: I always listen to my gut when it comes to those little lines.

I've only been wrong with the gut reaction once. My gut overreacted and the person it overreacted to was okay. Still, I'd rather overreact in a quiet, careful fashion to protect myself than end up with a friend I don't want.

So far, so good. I've not had any teenaged stalkers show up on my couch, and I've made one or two valuable friends out of past patients or family members. I've had to have the rare come-to-Jesus meeting with the rare pushy male, but that's only been two or three times in five years.

I still wonder about little fictionalized Judy. I mean, how dumb do you have to be to give a teenaged boy in a psych ward enough information about yourself so that he can find you later? Shouldn't the nursing board have cut her loose to be Darwinized by another patient down the line?


Anonymous said...

I spent a lot of time as a teenager on a particular adolescent psych ward. Over the years, I got to know many of the nurses and techs pretty well; some of the women were middle-aged, some in their early twenties. We chatted a lot about love and dating and school and jobs and families. I needed this sort of reciprocal therapeutic relationship -- through our conversations, I learned about and was later able to pattern "normal" behavior and normal relationships. Also, the simple act of having those conversations was an island of normalcy in a time when most of my life was in psychatric chaos. I am forever grateful for those ladies who treated me less like a crazy mental patient and more like a friend or daughter.

Maybe your patient who asked if you had a boyfriend was simply trying to make -what may have seemed to him- normal conversation?

Jo said...

Hannah, I wasn't trying to imply that every psych patient ought to be treated like a dangerous animal, really and truly. I used the overblown example of the overblown video as a starting point, kind of a "here's a really obvious example; here are some that are less obvious." Sorry if I implied anything different; I was kind of scattered when I wrote.

As for the date-asking guy, I wish he had just been trying to make normal conversation. *sigh* He'd said some things prior to that and then afterwards that prompted the Come-to-Jesus meeting we had later that week.

shrimplate said...

It's way easier to cut somebody off at the knees and then later backpedal like crazy (oops) if you find out you were wrong than to let something fester into a real problem.

They're patients. Not friends. But sometimes there's a risk they could actually be an enemy.


Anonymous said...

Ah, no worries. I figured that I hadn't gotten the whole episode when I asked the question in the first place. My rule of thumb is that there will always be inappropriate people, whether you end up as their nurse or sitting next to them at the bar. I don't work closely on a long-term basis with patients like you do (thank god! don't know how you do it, btw) but if something stands out as being inappropriate, I just smile, bite my tongue, and ask about the weather.

Anonymous said...

Your post is so true! I've seen many examples of healthcare professionals (nurses, dietitians, physical therapists) get way too close to their patient and it has ended in disaster almost every time. I also agree 100% with your comment on how you do not date coworkers. That seems so common in hospitals and it usually causes an uncomfortable work environment which is so unfortunate, especially with how stressful work is already.
By the way, this is my first comment but I have enjoyed your blog for a while now. Thanks for all your interesting perspectives on hospital life!