On Friday, April 1st we had our second clinical experience at at Methodist Transplant and Specialty Hospital. I was placed on the chemical dependency floor, as I had hoped. My primary goal for the day was to identify a patient who I could use for my care plan. I asked my assigned nurse, Deidre, for a recommendation of a patient who would be awake and might be willing to talk to me. She recommended C.G., who I did indeed use as the subject of my care plan.
I have been pleased with my experiences on the chemical dependency floor, especially because there are so many opportunities to converse with the patients. The other nursing students and I assisted with taking vital signs and followed the nurses as they checked on patients and passed out medications. We were able to sit in on recreation therapy, where I observed C.G. and his interactions with the other patients. I noticed that as he colored and seemed to concentrate, his tongue extruded from his mouth and moved from side to side. This appeared to be an unconscious behavior, and one that disappeared while he was speaking. I also observed that his hands—when not full with a coffee cup or a writing implement—constantly moved in a pill-rolling gesture. These reminded me of the extrapyramidal side effects that can occur with antipsychotic medications. I should have asked him or his nurse whether they were new side effects since this admission or if they were long-standing. After recreation therapy we joined the patients for a processing group. After lunch we returned to the dayroom and I felt privileged to have some very intense conversations with a couple of the patients. One patient had earlier said something about disliking AA, and I asked him (after first asking if he mind being asked about his alcohol use) why he was adverse to AA, specifically, whether he had trouble with their policy of total abstinence from alcohol. He admitted that he was very embarrassed to be a patient in the chemical dependency unit, but said he didn’t mind talking about his alcohol use and discussed some of his questions about abstinence from alcohol. I really enjoyed having this period of “free time” with the patients since it left an opening for patients to talk openly about whatever was on their mind.
The thing I did best today was reflective listening. N, a patient who is homeless and has struggled for 20 years with addiction to crack, opened a discussion by saying “it is so hard!” and bursting into tears. She sounded utterly overwhelmed by regret at her past and the prospect of radically transforming the remaining years of her life. I reflected back to her that she sounded overwhelmed and agreeing with her that it is “too much” when looking at her recovery in those terms. She seemed really struck by the idea that reframing her recovery in terms of smaller steps might be less overwhelming and anxiety producing. I also felt like this was a powerful encounter. I can’t imagine another context in which N and I would have been able to talk like that. I felt like it enabled me to develop a great deal more empathy for N. I’m now able to picture her relationship with her mother, as well as the social and emotional stumbling blocks that make it so easy for her to repeatedly relapse. It was also shocking to realize that N is only 6 years older than me, yet looks old enough to be my grandmother.
After this clinical experience I felt like I could imagine myself someday working in chemical dependency, or maybe doing volunteer work with that population. However, one thing that tamped down my enthusiasm was recalling the role of the nurses on that unit. The nurses were kind and didn’t do anything wrong, but they were kept busy with care planning, documentation, and other “office work” type activities. What I liked best about the clinical experience was talking with the patients, especially in the unstructured context of the day room. Unfortunately, the nurses I observed didn’t seem to have much time or opportunity for that.