Nurses and Trauma Bonding with their Patients

If you look online at how nurses talk about “never keeping in touch with a former patient” “because it’s wrong” or “a gray area” or a whatever self righteous reason, it’s a fact that many health care providers do, in fact, end up befriending a former patient eventually.

We meet so many people and take care of them sometimes for weeks or even months at a time. It’s not possible to remain emotionally distanced completely from all of them in every single case. Everyone I have worked with in health care has had at least one former patient that they absolutely had to keep in touch with. I’m not even talking about sexual relationships or even close friendships, just eventually we all meet a person or a few that we connect with and can’t just not ever follow up on in any way. That’s just the honest truth.

In my case, I worked briefly for an extremely chaotic and understaffed company that also had poor training. All of the staff was brand new and we were all extremely stressed out due to lack of experience, training and support.

For example, there was no typical day where I worked (short term detox). And it was never just an 8 hour shift. We all ended up staying late, sometimes for hours later to catch up on charting, finish other work or fix mistakes which we should never have made in the first place had we not been in a “sink or swim” situation.

One of my last days at this company, I came in to find two brand new nurses had worked the day shift and they had alot of left over tasks that they hadn’t been able to finish during their shift. And because I was new also, I couldn’t really answer their questions either. So there would be a frantic and rushed report on the patients (often with missing information) and some crisis that was ongoing and would need to be dealt with before getting out of hand.

That day, one of my patients was basically given too much medication on the day shift and was sick as a result. It was clearly at the point when I arrived that he should have been sent to the hospital earlier that day for treatment that our facility couldn’t provide. And of course, there had no been much training on this process of sending a patient out. So I winged it. Sent him in to the ER for an enema and IV fluids. And I’m glad I did. He returned later on my shift because the emergency room on a Saturday night in the city was actually LESS busy than my position (!)

So aside from having to take over an hour dealing with that emergency that should have been dealt with before I got there, I had several other patients with needs, also. These people were withdrawing from all kinds of substances and sometimes withdrawal can be extremely serious and even fatal if not managed correctly.

I managed to get through the rest of my shift with only one error that I was aware of- an error that was the result of the company’s terrible charting system. So a very preventable error. The nurse I was working with was also new and she could not handle half of her patients, so I ended up having to do some of her work, also. The patients knew that they weren’t going to get service anytime soon from this other nurse because 1. She was new 2. Had time management issues and 3. Did not know how to prioritize at all.

It was frustrating to me to have her constantly asking me questions because I had worked there exactly as long as she had- three days! She didn’t seem to be in any rush to get anything done and seemed to have no qualms staying hours past her shift. I was not willing or able to stay for that long past a shift. We already did not get breaks. At all. No lunch break, nothing.

Places I have worked before, there was time to actually double check that things were correct before doing them. Here, that was not possible and also new nurses were set up for failure because we did not have the resources or even a complete policy manual. Half of our time was spent trying to navigate the computers- and of course we had nobody to call for IT.

So ultimately, it was very difficult for me as a nurse who prioritizes safety and policy- but probably harder on the patients because they were not getting competent care. So many errors were made by everyone that it was viewed as part of the job. The nurse managers motto was “But did anyone die??”

Well, not yet. But statistically, eventually one or more of those errors would be a very serious one. I did not want to be there for that. I understand why this place is short staffed now. And why I was the third nurse that week to quit without notice.

I am pretty sure the company is concerned that I plan to report them. They should be concerned.

This is a medical detox center, not sure if I mentioned that. Somehow, the patients don’t stay longer than 5 days. The more I’ve thought about that, the more ridiculous it seems that someone is fully detoxed off of anything within 5 days. I actually think that’s when withdrawl symptoms tend to peak. So it’s no surprise that most patients return here frequently.

You meet alot of different people with turnover like that. Every week, it would be a new group of patients. I always enjoyed them to an extent- found them likable and felt empathetic towards them most the time. Some I would joke around with a bit and I enjoyed that too.

I couldn’t see how anyone would end up dating a former patient here until I locked eyes with a patient and was immediately struck dumb. My tongue was as tied and I knew I was blushing. I don’t believe in love at first sight, but I believe in spotting my type at first sight and I knew that’s what had happened.

And of course, he turned out to be my patient for the weekend. Among others, of course. To my horror, I continued to trip over my words and blush furiously whenever I interacted with him. And his personality was everything I expected based on my reaction to just seeing him. He was laid back, kind of rebellious, into science fiction and nerdy things (like myself- I mean I’m also into nerdy things) and just overall fun to talk to. What I noticed the most was that we had a shared sense of humor. We would chat and then laugh together for like 5 full minutes about something that nobody else understood.

I was pretty bummed out that after that weekend, it was unlikely that I would ever see him again. I was also bewildered by how dumbstruck I was around him. It was like he had a physical effect on me that I absolutely could not control and I don’t remember ever having felt that way before. I was tripping over my words, blushing uncontrollably and fidgety to the extreme.

One factor, that I couldn’t tell anyone, not at work, certainly not a patient, was that I had nearly run out of one of my prescription medications (one that causes pretty intense withdrawal) and that I had needed to cut my dose in half just to avoid full blown withdrawal symptoms. So I do kind of wonder if maybe some of my behavior was a result of the fact that while I was taking care of people in withdrawal, I was literally in physical withdrawal myself. The irony did not escape me.

I was sweating visibly on moment, then shaking the next. I was anxious, irritable, kind of in a daze and just feeling on edge. I could sense my heart rate was pretty high. I ignored these symptoms as best as I could. Looking back, I wonder how the patients would have reacted knowing that their nurse was suffering the same way that they were?

So, this patient who had such an effect on me. I managed to get past my tongue tied speaking and ended up chatting with him certainly more than I chatted with others. Because I enjoyed it. He made me laugh. Not just chuckle, belly laughs. I just plain enjoyed his company. He was interesting too and it seemed we had a lot of interests in common.

However, I knew then and now that it is extremely unlikely that there could be any sort of future between he and I. For one, he is addicted to fentanyl and other substances- which is well known as extremely difficult to quit and also extremely dangerous to use. Many people who use fentanyl end up dying from it. Much more than alcohol, which is a slower death. Fentanyl tends to kill younger people and very suddenly. I would be nervous to care for someone who had an active addiction to this because I would be constantly worrying for his safety. And I wouldn’t want to love someone who could die at any moment.

Also, I have children and more of a “grown up” lifestyle. I have a car, insurance, a house, I’m a full adult who is busy with a lot of adult responsibilities. That I take seriously. Especially my children. I never put them lower on a priority list for any reason. I

I don’t think a guy who lives in government housing, likely doesn’t drive or work and doesn’t have responsibilities like I do would be able to support me in fulfilling my obligations. I’m not saying I never want to have fun. Although it IS true that “fun” is not something I prioritize (but I should).

I did date a guy for a few months last year who also did not have many responsibilities. He didn’t work, didn’t have to care for children, didn’t have any bills to pay really. He had grown used to that lifestyle even though he was in his 30s and he spent his days mainly smoking weed and watching movies. I would see him on weekends when I didn’t have my kids. And sometimes I would still have errands to run or something to get done and it was very difficult to get anything done with this guy around.

I went to visit him in Duluth one actually. A couple hours away. He would drive to me on weekends but this weekend, I drove to him. On Sunday, the day I had to drive back, he tried really hard to convince me to stay longer- knowing full well that I needed to pick my daughter up that evening. He just didn’t get it. I couldn’t let my daughter down. That’s what ended our relationship eventually. His inability to be an adult and the fact that I was committed to being one.

So I think this ex-patient would be similar, although he did seem more sensitive than the guy I dated.

I was certain that this patient was going to ask me for a way to get in touch with me after he left. But I wasn’t taking any chances, so I ended up slipping him my phone number even though he didn’t ask for it. He seemed happy and said he would definitely follow up.

But he didn’t. He just didn’t. He did not contact me.

Finally, a month or so later and in a moment of weakness, after I had left this horrible job- I messaged him. I did not have his phone number but I found him on social media. He messaged back. And we had little conversations.

I will admit, I was not in the greatest place in my life at that moment. I was drinking every day, for one. I was overwhelmed by the number of hours I was working at the detox and also by how shoddily the place was run. I was constantly in fear for my license. Everyone there made big mistakes, left and right. It was terrifying. Plus there was that one nurse who bullied me.

So I left on a whim. Put my notice in by email.

I was very disappointed that this position hadn’t worked out. Very much so. The pay was great, I really enjoyed the population and I felt like I had learned a great deal and had a natural talent for this. BUT the management kept finding ways to make the environment intolerable. Once I learned one thing and felt comfortable with it, they introduced something nobody was trained on, thus putting our entire department into a new tailspin.

I couldn’t take it anymore the day they suddenly started accepting patients on methadone. There was no protocol in the books for it, none of us has been trained on it, I was the only one who knew how serious methadone is because of my previous work in rehab. I wasn’t even sure if we were legally allowed to administer it or have it in the facility. Our doctor on call didn’t know either!

That combined with the bullying nurse who was on top of her bully game that evening ended it for me. I just refused to come back and work with her. I wasn’t sure if I was willing to come back at all.

So it was quite a disappointment that it didn’t work out but I don’t see how I could have done things differently.

So back to the ex patient. He and I kept up a halfhearted conversation by messaging every few days but I was so paranoid that I would get in trouble for it, I was very guarded in what I said. And I’m positive he relapsed right away. I could just tell the difference in his attitude. He changed as a person. He wasn’t the same person that I had taken care of in detox and laughed and chatted with. He was now someone who seemed ambivalent about everything and uninterested in human contact, from what I could tell. That made me feel sad also. I really wanted to say something about it but again, I didn’t want my license to be in jeopardy over this so I kept my end of the messaging very superficial.

I am thinking once a year has passed since he was in my care, I can be more up front with him. Just be honest about the fact that I couldn’t be much of a friend at the time and also tell him straight out that I can’t be a friend any of the time if he’s using.

I am not sure what went on between he and I at the detox. If it was kindred souls meeting, two people who were vulnerable and made a connection or if he was just bored and toying with me. It still bugs me that I don’t know. But I’m not risking my license over it.

I did do alot of research on keeping in touch with former patients and the opinions are very mixed. With some stating that it’s absolutely unethical regardless of whether it’s as friends or acquaintances or what. But also based on what I’ve read, I think a lot of people who work in the medical field will face this dilemma at some time. Whether or not to keep in touch with a patient. While I agree that it’s improper to have a sexual relationship, I am not sure that I agree that it’s improper to not have a platonic friendship.