Saturday, January 12, 2008

The Long and Short of Therapeutic Relationships

For the last seven years, I have had the privileged opportunity to build solid therapeutic relationships with patients over the long term. Despite the frustrations and stressors therein, having the time and space to truly get to know patients over such a span of years has many benefits, both for the patient and for me, the provider of care. Long-term therapeutic relationships allow for trust to be built in such a way that I have been able to become, as it were, a part of people's lives.

Making periodic home visits to a considerable number of my patients has also engendered a considerable sense of intimacy and shared experience. Getting to know spouses, children, grandchildren and others during my visits, the web of human contact is strengthened and enlarged. Becoming somewhat of a fixture in someone's home---albeit a fixture who appears and disappears at will---creates a dynamic that simply cannot be equaled during any number of office visits. In terms of getting to know a patient and their life, there is nothing like sitting in their living room and directly experiencing their world by smelling the food cooking on the stove, seeing the room where they sleep, and getting a visceral sense of what this family's lifestyle is truly like. In my opinion, doctors should make house-calls to each of their patients at least once, if only to get a sense of how that person lives, information which is therapeutically priceless.

For myself personally, I have given my all to many of the relationships that I have nurtured with my patients over the years. Over time, that investment has paid dividends which cannot be measured, and I know that my presence has been beneficial to many. Now, as I prepare to take my leave, I can see the repercussions which the severing of those ties can have. For myself, I must process the guilt of leaving, of "abandoning" my patients (as several have described it to me as they react to the news of my departure). For them, they must accept my departure from their lives, and be receptive to a new provider and a new relationship which will have different dynamics and a entirely different feeling. For some, hopefully, that relationship will be equally or even more fulfilling for them. For others, things will just never be the same. But I remind myself that the only constant in the universe is change, and we are all experiencing that constant in this moment, whether we like it or not.

As I move into a new paradigm of work as a nurse, I will embrace the opportunity for more short-term relationships with patients. As a per diem visiting nurse, I may walk into a home for a brief interaction with a patient who I may never see again. With no history, no biases, and no preconceived notions, that moment is wide open for creative and compassionate interaction. As a per diem nurse in a small residential hospice, I may come to work one day and have a deeply emotional connection with a patient, only to return the following week to learn that that person has died. Thus, while a long-term investment is not an option in these relationships, it presents a golden opportunity to make each interaction count, holding nothing back and letting that moment be all that it can be.

While I am grieving the loss of many of the connections which I have nurtured over the years, I am simultaneously celebrating the relief that I feel as I relinquish the enormous responsibility that those long-terms relationships have brought to bear. Human interaction allows for depth and intimacy in many ways, and I plan to use my interpersonal skills in such a manner as to continue to satisfy my need for emotional intimacy with patients, even if those relationships are short-lived.

In this moment, as I write this missive, I feel a pain in my heart as the faces of patients I love pass over my mental movie screen. As I release my guilt and sense of responsibility, I shower each individual with compassion and understanding for their suffering, and wishes for healing and satisfaction with their lives, their health, and the relationships which they have with their medical providers. Even if I am no longer present in their daily lives, what we have shared is something which cannot be erased, and the value of those interactions---and the emotional and spiritual reverberations therein---can still be carried in our hearts.
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