Friday, October 5, 2007


This week presented a challenge that I have never experienced before. As I was trying to get air out of one of my teenage patient’s IV line, I brought up the subject of his previous hospitalization- he had been hit by a car. Sensing that our rapport could handle some light teasing, I joking said “So, did you jump in front of it or something?” and he said yes. First, this made me think ‘oh crap now what am I going to say’. But luckily, my nursing-mode kicked in (apparently I have one!) and I firstly apologized for making that joke, and second asked him his thought process surrounding the incident. Apparently something inside him had told him to do it, and although he knew it was wrong, he still placed himself in front of the car. I asked him if he heard specific voices, which he denied. I also asked him if he had talked to someone or told someone that he had jumped in front of the car. He said that he hadn’t, that this was the first time he had ever said anything to anyone, and that “all they knew is that I got hit by a car”. I was saying that perhaps he should talk to someone, and was about to ask him questions about his risk for suicide now, when his dad arrived. This was ultimately a conversation shifter, as we never continued this conversation after Dad arrived. Unfortunately, I did not see my patient’s face when his Dad came in, or I would be better able to tell how the arrival of his Dad had affected him.

Once this admission happened and I had introduced myself to Dad, I left the room knowing I had to say something to the nurse that was supervising me. I pulled her aside and told her what my concerns were; that my patient was probably being discharged today yet he had mentioned these self-harmful things. I noted that this needed to be addressed somehow, and asked what we should do next. The staff nurse then told me that I needed to chart this, and that when the team came down to view his x-ray they needed to be told of the conversation, so they could decide about future treatment. I also told my clinical instructor, who helped me organize my thoughts and my observations about the interaction so I could chart it properly and effectively.

After charting this, I went back to visit my patient to chat and to spend time with him and his Dad. When Dad went to go get a drink downstairs, I seized my opportunity, played videogames with my patient, and tried to further develop our therapeutic relationship. I got more information out of him; his parents had divorced when he was young, and now his father was remarried and living in another town about 1.5hours away. He didn’t get to see his Dad much, but when he did, he enjoyed it a lot. He also mentioned that he and Mom moved around a lot. When asked where he had lived, he mentioned that he and his mom had lived in New Jersey, and that one day he was travelling into New York City when he saw the plane hit the World Trade Center. This struck me as odd: Two serious admissions in one day? Yet some of his facts checked out. I wondered, however, if his story was true, and how much of his comments were done in a self-attention manner. Overall though, these comments led to a picture of boy with some serious psychological assessment needed.

Before I entered nursing I thought I had a pretty open minded view on mental health; that it was an important aspect of health and that sometimes it needs medical attention, just like an infection or a chronic cough. I never truly realized, though, how much sometimes people need help to cope with life. I also forget that sometimes people don't want to admit that there is a problem. At first the above patient's mom was VERY upset with the idea that her son needed some sort of psychological consult. I don't blame her. This is sort of saying that something about her son's mental health is not necessarily ok, and bringing in that stereotype that her son was 'crazy'. Even though I can openly say that he needs someone to talk to to work out these issues, I'm somewhat of a hypocrite because I would feel weird to talk to someone if I was in a similar situation. I'd probably even think it was unnecessary, and make myself feel stupid for seeking help. Although I am currently working towards changing that within myself, I can have a better appreciation of the hesitancy some people feel about going to a mental health professional.

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