Locked in for a month.

At the moment I'm thinking about VULNERABILITY.


I know. Light subject matter.


I'm fresh from a month of placement so that tends to get me thinking. I was on the hospital's only locked ward, Acute Medical (locked because some of the elderly patients have dementia thus  try to escape hospital grounds and get lost). Being exposed to different people with varying responses to the situations they find themselves in is really interesting to be a part of. It can also be exhausting. 


What I've found is that despite so many differences in patient's conditions, families and beliefs one thing can be said for all of them. When they're admitted to hospital, they are vulnerable. No doubt about it. Most of the power that may well usually be the patients' is in the hands of other people. Right down to when you have your dinner.


There tend to be three main responses to this loss of power by either the patients or those supporting them. 


Anger is one of them. People can often become very different versions of their usual selves when they're stuck in hospital, feeling like they've lost all control over what is happening to them. A great deal of the time, taking some time to listen to how the patient or the supporter is feeling takes a significant edge off the anger. It gives some of the power back. Being a student, asking the patient whether you can give them their IV drugs or their injection, and genuinely appreciating the opportunity to do so, can have the same effect. Because it is entirely their choice to let me do something to or for them, or to refuse. 
Relatives and friends can also be angry about the situation on behalf of the patient. Some become demanding, even abusive. Sometimes there isn't enough active listening, cups of coffee or extra linen that can satisfy the onlooker of the patient's comfortability. There are times when you have to do your job then walk away.           


Dependence is another. Some people can become attached to you and seem to perceive you as more of a friend. Some try to search for personal information to identify with. For the people you get along with it can be difficult not to talk to them like you've met on the street rather than when they're lying in a bed waiting for you to give them tablets. I get wary of telling patients and family too much, because at the end of the day I disappear back to my life and back to uni. They can't call me if they need me when they're discharged. Particularly those patients who are elderly and isolated, it feels almost cruel to let them like you too much, because that connection isn't going to be there for long. The relationship I have with them will end the second they exit the hospital.


This can be a challenge for both parties when you experience something very intimate with people. An example was when I was with a patient and her adult children when she died last week. The family were friendly, courteous people, who were a delight to have around the ward and had a very solid rapport with the nurses.  It was very difficult, hours later for the daughter to leave when her mother's body was being taken from the hospital, as there was tensions within the family. We had been her support base for two months. It had been my supervisor nurse and I who had answered her questions when it was clear that things were not looking good. When it was confirmed that her mother had indeed died, I was the one who held her and prevented her from falling to the floor overwhelmed by grief. It's a choice not to take that home with you, because I know however hard it is for me, it's harder for the people whose lives and deaths it is. I didn't go home and cry about it, which confused some people, even myself, because I didn't feel it like it was someone I was personally connected to. I felt some sadness but I didn't go through any grief, because she was my patient. A lovely lady, but my patient.


Optimism is the other. Not optimism to the point of denial, but the patients who are truly hopeful for the best realistic outcome for them, make up for the ugly sides you often see from people. The patients who are happy to have a student poke around with their medications, surgical site or just take their blood pressure. And then tell you how good a job they think you're doing gives you satisfaction makes the feelings of inadequacy from the negative experiences almost disappear. I admire these people, who  often have multiple chronic illnesses or serious diseases, manage to take the terrible things they are going through as a learning experience for them and me. The wife of a patient I met was recently diagnosed with leukaemia and was telling me how lucky she was. I don't know how these people don't become engulfed in the sympathy, sadness and the fear that surrounds them. But I certainly admire them. 


Because really, underneath any of these responses, is fear. Uncertainty and loss of control make fear in bucketloads. It can even give you insight into how you personally deal with being vulnerable. Learning how to help people who are dealing with situations where they have every right to be fearful, without making it personal, takes time. But now after a month of what felt like living at that hospital, I'm at least getting somewhere.        


It's going to be nice not to have to clean up any poo for a while either. Ha ha


K x