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It never goes away

Carder, Jami, ADN, RN

doi: 10.1097/01.NURSE.0000531008.40342.1f
Feature: SHARING

At age 80, a patient is still haunted by an incident from her childhood.

Jami Carder is a nurse case manager at the Visiting Nurse Association of Cape Cod in Dennis, Mass.

The author has disclosed no financial relationships related to this article.

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THE BEST PART of transitioning from hospital nursing to home healthcare is the stronger connection I now make with my patients. Having more one-on-one time with no interruptions helps build rapport and trust.

Recently, I was assigned to an 80-year-old woman named “Sarah.” She spent her days alternating between a recliner and a hospital bed in her daughter's living room. Though she was receiving our services for wound care, Sarah had multiple chronic diagnoses, including depression.

At my first meeting with Sarah, I went about my visit, performing the skilled tasks I was assigned—assessment, patient education, medication review—all the while remembering her depression diagnosis. As I worked, we chatted. Getting to know my patients is my favorite part of the job. Having enough time to truly listen to them is so satisfying.

As time passed, our talks revealed many stressors. Her children were disputing how she should be cared for, and she often heard them arguing about it. They rarely asked her opinion, and a few of them seemed to have difficulty taking care of themselves. Sarah felt guilty for taking up their time and space. She felt more like a burden than a mother these days.

She told me she'd shared her ideas on how to fix things, such as moving into an assisted living facility to make life easier on her children, but she quickly realized she couldn't afford to do that. Her gaze shifted down, and she quietly mentioned a long-term-care facility. I could tell that wasn't where she wanted to live, but she could see no other solution. She felt powerless. As she spoke, her expression changed; she looked ashamed.

I sat on the bed next to her and took her hand. “Listen, Sarah,” I said. “It's okay to feel depressed about what's going on. You have a lot of stress right now. You have multiple illnesses that don't seem like they're going away. You can't eat the foods you want. You can't breathe easily. Your children are arguing over you, and no one seems to be listening to you. You want to fix things, because you're their mom, but you can't. You feel powerless. It makes perfect sense for you to feel depressed about this situation. Your emotions are real, and your feelings and concerns are justifiable. Those aren't things to feel guilty or ashamed about.”

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Unexpected revelation

She'd been staring right into my eyes as I spoke and turned away once I was done. I started to think she didn't connect with what I was saying, when she softly uttered, “You're right, I have a lot of problems.” She was staring at some faraway place, well beyond the walls of her home. “And it never goes away,” she added. “Being molested never goes away.”

I was not expecting that! I was there to change the dressing on her wound, but ended up on the other side of the world. I thought I was validating her feelings of guilt regarding her children being her caregivers, or her depression over her declining health and her children's difficult lives. Instead, I was giving her the validation she needed over 70 years ago.

I joined her in staring at that faraway place for a few moments. I knew she wasn't seeing the same place I was, though I knew they were close enough. I probably could have sat on that bed all day, looking at that place with her. I broke the silence.

“You're right. It never does go away. I know.” She turned and looked at me, with the wide eyes of a child who thought she was all alone in this world, only to suddenly find she wasn't. I nodded. Sitting in that tiny living room, side by side on a hospital bed, we became comrades—members of a club neither one of us wanted to join, but grateful to know someone else understood what it felt like to belong.

I asked her if she'd ever spoken to anyone about it. She shook her head. “No one ever talked about those things back then. You just kept your mouth shut. But, I'll never forget it. I remember every single detail.” Seventy years of holding on to that shame. I wondered if I hadn't talked about it with her, would she have taken those secrets, along with all her guilt and shame, to the grave?

I talked about therapy, and how even though therapy can't make it go away, it can “lighten the weight you're carrying around, lighten that feeling,” as I pointed to my chest. She nodded in understanding.

Most members of this club put their emotions, memories, and thoughts in a box and try to get through life without looking at them. Most don't have any control over it. The brain takes over as they go into preservation mode. Guilt and shame are almost always the result, as it's so much easier to blame yourself than to acknowledge the horror of what really happened.

I mentioned to Sarah that we have social workers who can come to her home and are experienced in listening to stories like hers. I asked her if she thought that might help her, and I saw her smile for the first time. “Oh yes, I think that might be nice,” she answered. I left that day feeling I'd accomplished something important.

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Sarah, empowered

A few weeks later, I visited Sarah again. I was looking forward to seeing how things went with her social work visit. Upon arrival, she seemed shut down. Another nurse was there, discussing her lack of interest in showering. So, I joined in, trying to get her to agree. “Hygiene is important to reduce infections and to keep your skin healthy,” I told her. I thought maybe she was afraid of falling, so I assured her a nursing assistant would come to help keep her safe. She listened to us without saying too much. She just sat quietly in that familiar, powerless way. Looking back, that's probably how she'd responded to her children, her parents, or anyone else for most of her life.

After a few minutes, though, she looked straight into my eyes, with a look of determination. “Okay, then. Let's talk about my childhood. That's why I don't want anyone touching me in the shower,” she said. After 70 long years, Sarah regained her power with one sentence. The room was silent. I looked at my coworker, and she understood. We stopped the showering talk. Sarah sat back in her chair, empowered. Her voice was heard loud and clear for possibly the first time in her life.

This experience has changed how I approach patient care. Important aspects of patient history aren't always found on a referral report. Some things may never come to a nurse's attention at all, but that doesn't mean they don't exist. It's up to us to realize that and not assume we know what's best when someone tells us, “No.” I don't ever want to be the reason someone puts painful feelings in a box.

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