Thursday, February 16, 2006

In a Shoebox

"I feel like I'm trapped inside a shoebox", she said. She called me from "respite"---sort of a low-level psychiatric facility where a person in crisis can check themselves in for a short tune-up and escape from the world. She'd been there before. Seems she was all alone on her birthday and felt such strong suicidal feelings that she called 911. A good choice, and she was roundly praised for her decision to reach out for help.

A sweet woman, with a history of trauma that might have broken the spirit of a weaker psyche, I have done my best to provide the utmost in compassionate and nonjudgmental care. She counts me as a friend, and while I don't directly say "I'm not really your friend, I'm your nurse", I think she understands that our "friendship" is one which is active Monday through Friday from 9 to 5. That's the strange aspect of our work. We build these trusting relationships, we give of ourselves and foster hope and recovery, we blur those therapeutic boundaries to some extent, but that professional boundary must remain intact. Otherwise, this woman may have called me on her birthday---a Saturday---and shared her existential desperation. Instead, she decided to reach out to the place where help was available, and she received the succor and support that she so dearly needed.

The angst that I feel vis-a-vis my patients' suffering is real, though I try to temper it with a realistic view of the limits of my ability to assuage that suffering. A quote by Mother Teresa is attached to my email signature, and it sums it all up for me:

"I have found the paradox that if I love until it hurts, there is no hurt, only more love."

Make no mistake, sometimes that love manifests as anger, akin to the anger a parent feels towards the misbehaving child. The anger doesn't cancel out the underlying love; rather, it is a manifestation of caring, especially true if the anger is directed towards the person's behavior, not their essence as a person.

A case in point, I am angry with a patient of whom I am exceedingly fond. She has fallen into misguided behaviors again: school-age children playing unsupervised in the street rather than going to school; not taking crucial AIDS medications; not paying bills and losing electric and gas service; eschewing the supports and services that I have offered. Of course I care about her, but I especially ache for those beautiful children who are happy to skip school and stay home to play, but are being deprived of the benefit of a solid education which will allow them to rise above the subsistence mode of survival that their mother has achieved in her lifetime. My frustration has reached an apex, and my reaction is to retract and withdraw, allowing the chips to fall rather than swooping in to be the savior who fixes everything. Not an easy choice to make, but I choose not to disempower her by offering to right her wrongs. The local social service agency may remove the children from the home, and so be it. I'll help her pick up the pieces of her health, but first she must suffer some of the consequences of her actions, or lack thereof.

So, some individuals trapped in a shoebox will kick and scream and fight their way out, their desperation and spiritual angst fueling their desire for recovery and healing. Others will do their best to reinforce that box, sealing themselves ever more tightly within its confines. Neither choice illustrates that one is a "better" person than the other (although the current social and political climate in this country seems so quick to judge and condemn others for their errors). Perhaps one is momentarily stronger than the other, but we all end up in a box of some kind some day, and it's the process of how we get there that tells the story of our lives.
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