Yesterday, in the hall of the outpatient clinic where I practice as a psychiatric nurse practitioner, my patient politely took my extended hand at the end of our session and then quickly hit the button on the wall sanitizer. The wall sanitizer had been my first impulse as well, but I refrained, worried as to the message I might give if I immediately cleansed my hand after we touched.
I was quickly reminded of all the conflicts this moment might represent. Long ago, training at a large, prestigious teaching hospital during a group supervision session with an esteemed forensic psychiatrist, I was dressed down in front of my colleagues for being the only one willing to admit I had hugged a patient. Even a handshake, the forensic psychiatrist vigorously warned, could be the beginning of a slippery slope.
I wrote of it much later in an essay for a Creative Non Fiction anthology on nursing, having matured into the professional for whom boundaries are an easy combination of the compassion and objectivity that others speak of in recent Intima articles. I wrote:
“In Psych, even a handshake threatened to be indicative of a boundary violation. One of my best friends during my days as an artist, a photographer who hand-tinted her portraits, once told me, "I have to fall in love with each of my models as I work. It's part of my process. Then I can get their lips and their eyes just right.” Soon thereafter, in my new world [as a psychiatric practitioner], I would have to draw a hard dark line through the word love. As if a most basic human emotion needed to be censored. And I understand that. My compassion might be my patient's undoing. If I care too much, my decision might be cloudy. And this is life and death.” 1 I don’t think this was the slippery slope the forensic psychiatrist had meant. I believe he was speaking of darker impulses, impulses on our parts that I fortunately have never experienced. Nor do I look back on the moment that I write about in my recent piece for Intima, the moment that I exaggerated a young, pregnant crack addict’s alcohol use in order to get her into rehab a violation. It was life and death.
“My voice cracked and I was overtaken by both her grace and her gratitude,” Vik Reddy writes of a patient to whom he had just given bad news, in his Crossroads blog, When the Medical Mask Slips: The Contradictions of Care. I am certain that the very human moment where our competence includes allowing our masks to slip is what makes illness bearable for our patients. Hugh Silk describes the conflicts in The Power of a Handshake. “I am offering it to an inmate even though we were instructed repeatedly during our orientation to avoid shaking hands with inmates.” Silk goes on to say that the act of a handshake not only functions as one of the first observational tools we have in assessing a patient, but how that “simple gesture” can convey respect and “set a tone of partnership and friendliness.” I most appreciate how he acknowledges that the act to a great degree alters the uni-directional flow of respect between practitioner and patient.
I did hit the sanitizer button right after my patient yesterday, our eyes met and we both smiled. How human of us both to worry simultaneously about flu germs, nasty cold bugs, whatever else flies about a clinic hallway. And I felt a relief in the kinship of these other writers, these other practitioners, sharing their experiences with the vagaries of compassion.
© 2015 Intima: A Journal of Narrative Medicine
Nina Gaby is a writer, visual artist and psychiatric nurse practitioner. She has contributed to many anthologies and periodicals, and is both editor and contributor to the recently published anthology "Dumped: Women Unfriending Women.” Her sculptural porcelain is in the national collection of the Renwick Gallery of the Smithsonian, and she has been exhibiting her newly concieved three-dimensional mixed media sculpture vessels. Gaby is currently a psychiatric nurse practitioner in the University of Vermont Health Network and has been on faculty at several university schools of nursing. Her piece, "The Baby on the Bus" appeared in the Spring 2015 Intima.