A Nursing Veteran Replaces Judgment with Compassion

My name is Julie Twohig, RN. I’m the clinical coordinator of the Dissociative Disorders and Trauma Inpatient Program (Proctor II), a women’s unit specializing in dissociative disorders and trauma. I came into work on a Wednesday morning in November 2012 and was told that a patient who had made a suicide attempt on another McLean unit over the weekend had been admitted to our unit. The patient, Jane, had attempted to commit suicide by hanging.

I met Jane, an accomplished professional, that morning. For her safety, she was in a barebones “quiet room” with a one-to-one sitter—an MHS—and on five-minute checks. I remember being a little surprised that there were no ligature marks on her neck. She seemed very composed and pulled together. I introduced myself and told her I was the charge nurse on the unit and her nurse for the day.

Jane wasn’t confrontational, but she made it clear that she didn’t understand why we had implemented all of these restrictions. She did not want to remain in the quiet room. I asked her to tell me what had happened and how she had ended up on Proctor II. I wanted to hear her perceptions of what had happened. Articulate and polite, Jane denied being suicidal. She said she had no memory of the incident or what triggered it. But she presented so differently from what I would have expected. On her previous unit, staff had found her trying to bring in cigarettes, lighters and razor blades and at one point she told several people she was going to burn the hospital down.

To my surprise, I grew fond of her. She was a prolific reader and an amazing knitter. I liked her straightforwardness and always felt she was honest with me. She worked hard and was—with a few exceptions—a model patient, reconnecting with family and friends, researching aftercare programs and other resources for herself post-discharge and respecting the staff and rules of the unit.

After a month receiving treatment on our unit, it became clear the plan would be to transfer her to a unit at a state hospital because of ongoing concerns for her safety. I felt very badly for her. I had become her advocate and lobbied hard for her to be discharged to her own home, which was her preference.

When it came time for her commitment hearing, I was optimistic that the judge would see that she should not be sent to a state hospital and that we endorsed her return home. During the hearing, however, her lawyer was not successful and the judge’s verdict was that she should be committed. My jaw dropped. I was so shocked. I had thought the judge would see the situation differently. She was eventually transferred to Tewksbury Hospital, where she stayed for about a month.

I’ve been a nurse for almost 40 years, and it’s sometimes easy to fall into a “seen-it- all-done-it-all” mindset. Our patients with dissociative and borderline personality disorder can be difficult to develop relationships with. Relating and establishing alliances can be draining and exhausting.

Here was Jane—the object of a lot of negative transference—and I was able to connect with her in a genuine way. This surprised me because I was initially angry and resentful about having to take care of her. The fact that she was on the unit for so long and that I was her primary nurse five days a week also contributed to my ability to forge a real relationship with her.

The experience has reawakened some of my earlier enthusiasms around connectedness with patients. It was very rewarding to work with her: she had a good sense of humor and we had intelligent conversations about things that mattered.