I'm back after a nice break.
As you read this please remember these posts were written a few years ago.
I like the variety in my job and that one minute I might be chatting to someone in their 80’s and the next I might be with a teenager. There is one particular teenager that I have been heavily involved with and have quite a close relationship with. She has cystic fibrosis and is in and out of hospital on a regular basis. It changes the nature of the relationship when you have an on-going relationship that extends beyond one admission. This young woman is also very good at pushing the boundaries. One boundary that she has pushed, and I have allowed to be crossed, is that she has my mobile number. She uses it to text me. Young people communicate in very different ways. She knows that she can only text me on working days and that I won’t respond on my days off. It doesn’t stop her trying her luck though. She texts me when she wants me to take her out for lunch or to the shopping centre or if she just wants a hug.
She has a turbulent background and I think the hospital has become an extension of her family. This means that the usual family dynamics can be played out on the ward. She can be feisty and this can lead to the staff being parental and punishing her. She then resents this and becomes even more awkward. It’s a very difficult situation all around. She has learned to manipulate people through being so ill. It’s a survival strategy. The staff end up resenting that they have been manipulated and then there is even more tension. It’s an extremely complex situation and I find myself treading the fine line between the staff and the patient.
I’m trying to work with this young woman to help her to live and live well until she dies. She sees the world as a battleground and everyone as a potential adversary. She has a typical teenage relationship with her mum and they often don’t talk. It’s very sad because if she becomes acutely unwell and dies while her mum is not talking to her, I know her mum will never forgive herself. It is also possible that the mum might become acutely unwell, as she was also really ill last year. If she died I think the young patient would be traumatised for the rest of her life. I don’t know how to get her to the point where she can see it’s better to do something to work through the difficulties of a situation, rather than potentially live with regrets.
It feels like this young woman is becoming dependent on me. Recently she was very upset over someone letting her down and not being there when he had said he would always be there. She told me that I would let her down one day too, that everybody eventually walks away from her. I gently told her that I had never promised to always be there for her. All I could promise was that I was here right now and while I could, I’d be there. It was a tough conversation. It would have been easier to say “I’ll always be there” She evokes that kind of response, but do I really mean that? I might change jobs or move away, the same as any other professional in her life. What’s important is that I don’t promise her anything I can’t keep. That’s how she has been hurt in the past. People make promises but then their circumstances change. I think ongoing work needs to be done with health care professionals about boundaries. It should become part of regular mandatory training to think about these things. Instead what happens is they only get discussed when there is a problem. I think it’s a bit late then.
I hope I can continue to keep my boundaries despite this young woman’s pushing. My fervent hope though is that I can help her to live what life she has left to the best of her ability and to celebrate that life rather than see everything as difficult. It’s tough going because she does have a more difficult life to lead. It’s like the quote says “Life is only 10% of what happens to you. The other 90% is how you respond to it” I will continue to try and be there and help her respond differently.
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