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End of Shift: Lonely Worlds

Monday April 4, 2011
Laurie Barkin, RN
Laurie Barkin, RN
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Nursing school and I were not a good fit. At 18, I loathed the conformity of the dress code, the constant need to consult the clock, the bickering among nurses, the charting — everything except listening to patients talk about their fears and concerns. But for that, there seemed to be little time.

During the summer between my junior and senior years, I called my parents and told them that a stained glass artist in the Berkshires had agreed to take me on as an apprentice. “Just get your degree,” they counseled. “Then you can do what you want.”

During the second semester of senior year, I was assigned to Boston State Hospital for my psychiatric rotation. Maureen, my onsite instructor, was a hard-boiled older woman with bleached-blond hair. She assigned me to work with Sean, a 19-year-old with depression and paranoia, who had threatened to jump off a building. The “precipitating event” was his brother’s suicide six months earlier.

Maureen told me the only way to circumvent paranoia was to “go for the affect,” meaning his emotions. She cautioned that this might be difficult since the patient came from an Irish-American family where both parents were alcoholics. “Kids who grow up in these families learn that feelings are dangerous,” she said.

I learned the same thing in my nonalcoholic Jewish family.

With Maureen’s coaching, I asked Sean about his relationship with his parents and his brother, going for the affect whenever the opportunity presented itself, but not having much luck. One day, weeks into my rotation, while we were walking on the grounds together, Sean told me about the night his brother destroyed their home while Sean hid in the basement.

“You must have been so scared,” I said

“Yeah,” he said. “I thought he might kill me.”

“That’s why you hid in the basement?”

“Yeah.”

Big silence. I was stuck. I was taught that my every utterance had to be “therapeutic,” not just conversational. We were sitting on a wooden bench under a maple tree. Above us, squirrels chattered and chased each other up and down the branches. When Sean looked up, his face suddenly clouded over.

“What is it?” I asked. “Sean, something just made you feel bad. I can see it on your face. You might feel better if you talk about it.”

After an interminable silence, he cleared his voice. “A long time after the noise stopped, I was still afraid to come out of the basement. Then there was banging on the door — the police.” Sean closed his eyes while his whole body trembled. “They found my brother hanging from a tree in the park.”

I was terrified of what Sean would do next. No one else was around. I sat there with him while his body heaved and shuddered and his voice made high-pitched choking sounds. When it was over and he was calm, we walked back to his unit. I knew that something important had happened and couldn’t wait to tell Maureen.

“OK,” she smiled. “Now that he’s in touch with his feelings, you need to help him identify them and manage the intensity of them. Reassure him that feelings don’t kill people and that putting them into words will make him feel better because he will have more control over his actions.”

Over the next few weeks, using the therapeutic communication techniques Maureen had taught us, I helped Sean talk about his guilt, shame and anger. On the last day of our rotation, during a meeting with students, patients and staff, Sean told the group that he felt “released.” He said that after crying for the first time in a long while, he felt “freed up” inside.

From that moment on, I was hooked. Knowing I helped someone made me feel better than I had ever felt in my whole life. Being with Sean in his suffering, witnessing and appreciating his pain, helped crack open the frightening and lonely world into which he had retreated. I wanted to know more about that world, and how to help people like Sean. As an added bonus, maybe I would learn more about myself in the process.

Laurie Barkin, RN, is a psychiatric nurse consultant for University of California San Francisco Department of Psychiatry.

Editor’s Note: This is an excerpt from Barkin’s book “The Comfort Garden: Tales from the Trauma Unit,” published in February by Fresh Pond Press.



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