Wednesday, August 16, 2006

Dismaying Story #34: Counting to Ten

Picture an L-shaped hospital corridor with patient rooms on one side and a nursing station and common area on the other. It was a few minutes after midnight so the lighting was subdued and the rooms all had their doors closed, with sleeping patients inside. I was walking quietly down this corridor, alone, opening one door after another and checking the patients, making sure they were breathing and doing fine.

Standard hospital procedure dictated that all patients had to be checked once an hour. This was many years ago and at the time I worked as an attendant on the psychiatric unit. The nurses checked their own patients during the day and evening shifts, but on the midnight to eight a.m. shift this responsibility fell to the attendant. On this particular night that happened to be me. I always started my graveyard shifts by taking care of this duty. It was a good way to get the pulse of the entire unit and put my mind at ease that all was well.

I was truly alone during this first "run" through the unit each night because the two nurses who shared the shift were in the office with the door closed "listening to report." This meant they were listening to the tape recorded comments of the nurses from the previous shift. We did this so incoming staff was always aware of what had happened with each patient during the preceding shift, including any potential issues. Someone had to watch the unit at all times so we took turns listening to the report. The nurses always went first on the late night shift, which left me in sole charge of the forty-bed unit for about half an hour. It also meant that I did my first tour of patient rooms before I listened to report. This turned out to be significant on this particular night.

I carried a flashlight with me whenever I did my hourly rounds during the night. I kept it turned off for the most part but the patient rooms were dark. Sometimes the dim light spilling from the open doorway was not enough to allow me to tell if someone was breathing. Whenever that happened I would put my hand over the business end of the flashlight, turn it on and then spread my fingers ever so slightly so a bit of light could escape, just enough for me to see their chest rising and falling.

I lacked a critical piece of information as I happily worked my way from room to room that night. Turns out a young woman had been admitted that evening, with paranoia as one of her primary symptoms. No doubt my nursing colleagues were learning at that very moment about the fear this young woman had expressed when she arrived. She noticed that the patient rooms had no locks on the doors and was afraid someone would come in and stab her during the night.

When I pushed open the door to her room, I stood in the doorway for a moment and looked at each of the beds, trying to see chests rising and falling in the darkness. All was still and quiet in the room. I had no way of knowing that this poor young woman was awake and trembling with fear in her bed.

Now I'm a big man, well over six feet tall. So from her point of view the door to her room opened unexpectedly in the middle of the night to reveal a hulking stranger, backlit by the dim light from the hallway, holding something in his hand that could very well have been a knife. It makes me cringe inside to think of the fright this must have produced for her. Her worst fear was coming true.

To make matters worse (you didn't think that was possible, did you?) her bed happened to be in a particularly dark corner of the room. I couldn't tell if she was breathing so, as I had done literally thousands of times before with other patients, I walked quietly to her bedside and leaned in for a closer look.

Now I will never know for certain if the next few seconds actually reduced my life expectancy. I think there's a good chance they did.

She sat bolt upright in bed -- which brought her face within inches of mine -- and screamed at the top of her lungs.

I was so startled I screamed right back at her.

Luckily I was not totally alone. The nurses heard the ruckus and came running. They shooed me out of the room so they could calm the unfortunate young lady down and explain to her who I really was. My understanding is that she recovered quite nicely from the incident (perhaps better than I did) and was discharged after only a relatively short hospital stay.

The extremely brief relationship between me and this patient is obviously in a different category than the relationships we normally discuss in this forum. There is a point to this story, though, beyond giving you a good chuckle over the collected bumblings of Dr. Andrew.

Here's the point. She did something completely unexpected, which caused me to react in an inappropriate way. This happens all the time in our other relationships, doesn't it? Let's say some contentious issue has been bugging your spouse for a while. The two of you are sitting watching TV one night and, as far as you are concerned, all is peaceful in the kingdom. When the show goes to commercial break, though, your significant other pops out with it.

"You know, it really bugs me when you do X."

Pow! A verbal left hook to the eyebrow, right out of nowhere. This type of unexpected bomb can startle us into an immediate response, which might go something like this:

"Oh yeah? Well it bugs me when you do Y but you don't see me complaining about it, do you?"

And off we go, with tensions rising and nerves jangling on both sides. This sort of thing is no fun, but what can we do about it? Plenty, as it turns out.

One lesson to learn is that you don't really want to surprise your partner with a verbal blow to the head. If you have an issue to discuss, announce that fact in as non-threatening a manner as you can, something like:

"Honey, there's something I've been meaning to talk to you about. It's no big deal, really, I just wanted to discuss it with you so we could figure it out together."

Notice the messages here. I don't expect this to be a big problem so there is no need for you to be stressed about the discussion. I'm not attacking you; I'm trying to be mindful of your feelings. I don't want to tell you what to do; I'm suggesting we work together, on the same side, to come up with a solution. With such an introduction, you have significantly reduced the chances that your spouse will shoot back with an immediate hurtful counterattack.

What if, on some other occasion, your spouse surprises you? You can make a difference here, as well, if you train yourself to react appropriately in that type of situation. Make up your mind how you would like to handle it if your spouse drops a contentious issue in your lap. Chances are they are stressed when they do it, so shooting back with anger is unlikely to get you very far. A better strategy is to take a few moments -- "count to ten" -- while you search for a way to defuse your partner's stress. Generally that means acknowledging their point, letting them know that you have heard and understood what they said. That doesn't necessarily mean you agree with them, just that you are willing to talk about it.

Once you have thought through this general strategy, you'll be amazed how quickly your mind can react to even complete surprises. Your thoughts can go immediately to, "Oh yes, I recognize this type of situation. I know what's going on and I already know what to do."

Using these approaches can reduce significantly the amount of tension in some homes.

All the best,

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  1. Counting to ten is a very good idea when you impulsively want to smack your spouse for being “stupid.” On rare occasions, I’ve been known to count out loud. It gives my husband the opportunity to reflect on his blunder, and time to run for his life. It also gives us something to laugh about later on, when we both come to your sense.

    Your story about your days working on a psych unit made me smile. I love a good hospital story.

  2. Excellent post. The same can certainly be true for dealing with children as well. Now that my kids are teens we've added all sorts of new ways for them to "test the limits" and freak me out. Often, my initial reaction is to freak out and start yelling. That is not effective in any way. When I can control myself and step back and think about the situation, my reaction is more focused and productive. We've had less "repeat offenses". The key is *I* have to learn how to control myself though in order to make that work and that's definetly the hard part.

    Also, since I've started blogging I've noticed that I'm slower to get worked up in a situation... I wonder if it's because I now see everything as a potential blog post. LOL Maybe blogging has become my "counting to ten"?

    Your story cracked me up. I worked 3rd shift in a psyciatric hospital as well. It was a long term care facility that I worked in and we learned VERY quickly which rooms you went in and silently checked and which rooms you stood outside hoping you could hear them snoring. hahaha

  3. I had the opportunity to tour the criminally insane ward with my roommate (who was an occupational therapist there). It was the scariest thing I have ever done in my life. (near Provo, Utah).

    And there are some good thoughts here.

  4. I did volunteer work on a locked ward years ago in San Francisco. I was scared and they sensed it.

    It's hard.

    Just checking out your blog. I'll be back and thanks again for the comment on mine. Come visit anytime.

    Ann (aka granny)

  5. I always try to say more postitive things to my loved ones than negative ones and when I do say something negative, I try to say it in a nice way.

    But you got me thinking about last night when hubby and I were watching the Brewer game and there was a break and I said, "Did you know I found THREE of your shirts in here today while I was cleaning?" (In all fairness, at the time he was taking off his shirt)

    He looked at me sheepishly and I said, "Love you, kissy kiss smoocheroo" and we went back to watching the game.

    Today there were no shirts but I expect this will only last a few days before they start showing up again.

    Anyway, thanks for stopping in and I would have freaked out about the woman screaming and I bet she felt empowered after you left knowing that she affected a big, you probably helped her deal with her fears in some way. (You did say she left shortly afterwards, right?)

  6. I admit to the commercial punch-throwing. who knew I wasn't alone?!

  7. Loved the story. It was hair-raising and funny at the same time. And your relationship advice is spot on.

    Thanks so much for visiting my blog, Andrew. Please do come again. :-D

  8. This is a great story. It is really hard to be aware of this kind of situations because most of the time we live unconscious. We live are lives reacting instead of responding. It is a great story to remind us that it is better to respond and be conscious than to react and live unconscious. Great advise: count to ten!!!!!!!!
    Thank you Andrew for helping us to live a conscious live.

  9. Thanks for your blog and your advice. I came careening out of left field towards my wife the other day. I hope this will work with both of us. I'm linking to you, so I can get your free advice all the time. ;)

  10. That is a great story and very well-written. Perhaps the young lady's stay in the unit was short because you in some way helped her face her paranoia head to head on!

  11. Good story Andrew, that poor girl was probably scared senseless and so were you! I would have screamed too!

  12. I'm glad I never worked a psych ward ---too much to learn. I dug the surgeries with all the teaching, the cardio floor with the cut and dried monitoring, but I loved maternity with the babies and the sudden surgeries--- kept my adrenalin working. I did my blog on perfectionism---don't know if it is any good ---but it explains things.

  13. Came across your blog through "mama" where you posted a comment.

    The story made me smile. I could picture you both screaming at each other at that moment.

    Very good analogy as well with relationships and catching your partner off guard and illiciting an inappropriate response.

  14. Andrew that story cracked me up - something very similar happened to my mother and I once. I had woken up from a nightmare and went to seek comfort from my mom. When I woke her, I startled her and she screamed. Poor little girl me, was already in terrors from a nightmare, I screamed right back and promptly burst into tears.

    You're completely correct though, sometimes our initial reactions are not appropriate. It takes a very emotionally healthy person to realize this and think about it. That's a worthy goal for us all!