Sometimes when I write my patient notes I actually have to pause in between them. On busy days when I do three intakes I likely still have three intake notes to finish late at night after the boys go to bed and it’s just me and the laptop. Intakes can range from easy to me curled up in a ball on my bed watching The Office trying to forget the horror I heard today.
I remember working in the emergency department and documenting abuse cases. I tried to write as little as possible, as I didn’t want there to be any conflictual information between my notes and the MD’s notes. And good lord I didn’t want to be subpoena’d.
I’ve had my charts subpoena’d now. It happens eventually in healthcare. I’ve been called on the phone by judges who just found my chart in the middle of a trial who demand to speak with me about a patient I saw four years ago and asking about a note I wrote and did I think they would actually harm some one.
I’ve spoken to district attorneys and defense attorneys and divorce attorneys and DCF workers. Inpatient I spoke with the Secret Service, the Federal Marshal’s Office, the FBI, and several police departments.
Working outpatient mental health now I generally can avoid the Secret Service and the FBI so that’s a plus.
But sometimes the hardest cases and the toughest stories are the ones who never were reported to law enforcement. Because I know and they know that they suffered and that no one stepped up and protected them. No one made the call for them.
Now here they are all those years later telling me their story. All I can do is listen, document it, and support them now in that moment. I’ve learned a hollow “I’m sorry” doesn’t cut it. They’ve heard that before.
My general response is a poker expression, so they keep talking, and/or if they are looking for some verbal confirmation that I’m listening, “That’s fucked up.” or “That’s horrible.” I’m sorry isn’t enough. But when you acknowledge that it was fucked up with a straight face that looks like maybe you would fuck a person up for this client for what they’ve been through. That had I been there all those years ago I would have called the police for you or DCF or both…that’s when they make eye contact and really see you.
They can really see that your heart breaks for them.
I always see articles about nursing being the most trusted profession. Then commentary on why it’s nurses and not MDs. I’m always thinking why would it be MDs? Why not nurses? Do people even know what nurses do every day?
I’ve had a long week. Hard week. I’m also approaching my first birthday without my Dad. That’s been weighing on me in the background.
But this week in between being yelled at, threatened, etc. by patients and former patients, I’ve had parents call and tell me “They wanted to fire you and I told them oh hell no because she’s the only one who gives a shit about you and your medications. She’s the only one that’s done a damn thing for you. So she was what? Brutally brutally honest with you?! Good. You freaking deserve to hear the truth and she’s too real to not tell it you. They are coming back to see you. Because I don’t trust any one else to see them.”
Some times I need to hear that.
There’s a Frasier episode when he starts private practice. His first day of course is a disaster. He starts by trying to welcome’s each client. By the end he says just come in a sit down. That’s how I felt by 3 PM Friday. Just get in here and sit down and let’s get through this.
But you can’t do that. I can’t do that. I had to be there. Present and accounted for. I did a lot of intakes this week. I kept thinking about how to welcome them into my practice. I find though that I’m an acquired taste.
I had a few clients disagree with me this week. What’s great is that they keep coming back. I teach through modeling that it’s okay to disagree. That I disagree without judging their opinion. That we can disagree about certain aspects to their diagnosis or treatment and still work together often by reaching a compromise and often by me working hard to understand and validate their point of view.
Psychiatry is hard. Nursing is hard. Because at the end of a week like this week I don’t want to spend time with my kids. I don’t want to be a wife. I want to curl up and watch The Office. Space out. Forget and not feel. But if I do that. If I numb out I don’t feel my heart aching for some of my clients. That would defeat the reason I became a nurse.
Instead of numbing out with tv or alcohol or anything else. I am writing my notes. Charting. In between my notes I’m writing this blog post. To feel. To process. To know it’s okay for my eyes to well up when I think of the experiences some people have lived through. It’s okay for me to feel something for my work for my people. Because if I didn’t feel that. If I lost my empathy then I’d be useless at my job.
That’s why nursing is the most trusted profession. We allow ourselves to be vulnerable with patients. We feel their pain we work ourselves to exhaustion trying to help people. It’s also why we have incredibly high burnout rates but…that’s a different blogpost.
Tonight my heart aches for people who were never helped by anyone but themselves.
Tonight my cheeks may be wet with tears as I chart notes from this week.
Yes tonight my heart breaks with the pain that I bear witness to each day in my office.
I don’t regret my job I don’t even hate it. I love it. Which I suppose makes me a bit of a masochist. But all the notes don’t make me cry. Just a few. There are many more that report “significant improvement in symptoms” and a call from a parent who had to tell me they would never trust anyone else with their child.