On March 4, 2016 I had my final clinical experience at San Marcos Treatment Center. As always, our major objective was to look for opportunities to provide care to patients with complex mental health alterations. I also looked for opportunities to write a care plan, and took careful notes on patients for whom I might want to write a care plan. On this occasion I was assigned (along with Josh) to Springhill 1 Boys, a unit for low functioning boys between 7 and 11 years of age. Unexpectedly, I was able to spend more time with patients than on previous visits, and I was also able to closely read the files of boys I had observed. One boy, D, was present on the unit for almost the entire day. In the morning he was sweeping the hallway, since he has identified doing chores as one of the activities that helps him calm down after an outburst. After lunch, back on the unit, D had a sudden and inexplicable tantrum. He went into the common room by himself and proceeded to flip over every piece of furniture in the room, bang on the Plexiglass windows, and curse. When I glanced in the room he was sitting in between two toppled chairs punching one of them. The staff responded by simply keeping other people out of the room. After a bit of a delay, most of the boys returned to the school for the afternoon, but D and two other boys stayed on the unit. Later I had the chance to observe them and talk with them as they did schoolwork and then played with origami and paper airplanes. Finally, we observed group therapy on the unit.
Seeing these boys and reading through their histories pulled at my heartstrings. I know full well that D, for instance, is a very disturbed child who has spent about 4 of his 11 years in various psychiatric institutions. I know that he has been profoundly destructive, has set fires, and clearly has the potential for violence. Even so, I cannot help but find him endearing. When calm he seemed kind to younger boys on the unit and made origami gifts for staff members. I feel so sad for him, given his history of abuse and his long separation from his adopted family that lives out of state. I will need to be aware of how easily I can feel maternal impulses towards troubled children.
However, other events jarred with my emotional reaction to many of these boys as wounded and vulnerable kids in need of loving families. The afternoon group therapy focused on farewells to a cute and funny boy named C who is about to be discharged. C and the other boys were instructed to say what they had learned from each other and share their good wishes or advice for each other. C was small, funny, cute, and highly verbal. He was another child who initially presents as a normal, cuddly kid. However, D’s farewell to C was “I hope you have a good life” (something they all said to each other) and “I hope you don’t kill more animals because they’re adorable.” It could be very dangerous to confuse C’s normal surface appearance with the reality of his history and the challenges he will face in returning “home.” Even after discharge C will have to contend with a troubled family history including his parents’ loss of custody, his own history of killing animals, and the fact that he will be retuning to an non-permanent housing arrangement with an equally troubled brother (a former SMTC patient). Once again, I feel like I have a hard time approaching these patients empathetically and with an open mind, yet also needing to harden myself to anticipate dangerous behavior.
In choosing what area of nursing to go into I will need to be aware of the emotional cost as well as the potential for fulfillment. I think I would find it very rewarding to work with children, but the same emotional connection that would make such work meaningful would also make me more susceptible to feeling pain when things go wrong. If I were working with the boys on Springhill 1 on a long-term basis I would have to expect that, at some point, a patient I found sweet and endearing would lash out at me, or might inflict serious harm on himself or someone else, or would be returned to a family situation that didn’t seem altogether safe. It would be easy to get burned out. I guess that’s the beauty of nursing: that it’s easy enough to change from one type of work to another if you get burned out. I fully intend to enter a kind of a nursing that feels meaningful to me, but anticipate that sooner or later I will likely need to take a break and do some other type of nursing for a few years.