IMPRISONED WITHIN OURSELVES

Abstract

Looking back several years, I clearly remember a p tient whose care I found emotionally draining. I can see now that the stress I felt at the time was a direct result of a lack of communication among the nursing staff. Twenty-eight-year-old Ms. R had been admitted for a cesarean section. She had healthy twin boys, but hemorrhaged postoperatively, then developed fluid and electrolyte imbalance, hypertension, and septicemia. She was rushed to the ICU where she developed respiratory distress. Soon she was intubated, placed on a ventilator, and given pancuronium (Pavulon) to keep her from fighting the ventilator. She had a Swan-Ganz and multiple lines. Ms. R soon showed signs of postpartum psychosis. Each time the Pavulon wore off enough for her to open het eyes, her message seemed quite clear: I hate you. She was angry, frightened, and extremely frustrated. She couldn't speak, but each time I looked at her I could feel her eyes scream, Leave me alone! No more needles, tubes, machines, drugs! Let me die! Get away from me! I began to dread, in fact to fear, the time I had to spend with her. I avoided eye contact, so I would not feel her anger. My co-workers seemed to react the same way. We focused on the machinery. We checked equipment, monitored readings, studied X-ray reports and lab data, conferred to plan physical care. Losing ourselves in the technology, we avoided getting involved with the human being in front of But each of us suffered, not unlike Ms. R, because we were imprisoned within ourselves. Ms. R survived, as did my feelings. They made me look at my own patterns of nurse-to-nurse communication and move away from being a stoic rescuer. Moreover, I learned that depression is a communicable disease. Avoidance is a coping behavior. We know that. It is all too easy to run away from working at resolving the stress of difficult patientcare situations. But while we may succeed in avoiding confrontation, our feelings-anger, frustration, fear, powerlessness--lurk just under the surface of our polished efficiency and control. I'm sure that we can all recall times when we disregarded our feelings and maintained control. How many times have we, with tremendous effort, kept our feelings concealed? Have you ever wanted to cry with a dying patient but not permitted yourself to do so? We encourage our patients to express their thoughts and feelings, to be honest and open with us; we accept their strengths and weaknesses. But who will help nurses, if not other nurses? Take a good look at how you react when you see a colleague dare to get emotional with a patient. How do you feel when a colleague shows a weakness or makes a mistake? Do you offer empathy, respect, and sincere support as you would with patients? Or do you act as though your colleagues are far above such displays of emotion and incapable of error? Be careful. You might be building a glacier. Looking back on caring for Ms. R, I suspect that, in trying to maintain the highest standards of patient care, we set unrealistic standards for ourselves. Fighting the negative reactions we had to the situation-and to Ms. R-we avoided each other, Mr. R, and ourselves. We froze. So how do we help each other? Ralph Waldo Emerson once said, What lies behind us and what lies before us are tiny matters compared to what lies within us. Building on that, I suggest we stay alert for signs of wintry feelings, and fight them by moving closer to one another. If we do, we may find out that the colleague who dared to lose control or to make a mistake may indeed have enormous strength and courage. Instead of breaking a nursing norm, that colleague may have broken new ground-professionally and personally. We can offer our applause. And what do we receive? Escape from winter, into the spring of professional growth. [] Nancy C. Seddio, RN, PhD, CS, is a psychotherapist in private practice in Staten Island, NY. She specializes in counseling nurses and their families. w