Building Trust Slowly With a Longtime Patient

My name is Sandra Feehan. I have worked at McLean for 15 years and feel very fortunate to have a job I look forward to every day. I work primarily in the Neurotherapeutics department with patients undergoing electroconvulsive therapy (ECT) for disorders such as chronic depression, mania, catatonia, and schizophrenia. I also work on a per diem basis in the Clinical Evaluation Center. I am privileged to work with dedicated, empathic colleagues who support and challenge me every day. I have also learned a lot from the patients I encounter in both of my work settings.

This brings me to a particular patient who has made a huge impact on me and my approach to nursing. “Sophia” came to McLean for treatment 18 years ago, following the birth of her first child. Initially, she was diagnosed with postpartum depression, but over time this was changed to bipolar and personality disorder. Over the years, she has had numerous medication trials—with mixed results—so after an initial trial of ECT at another hospital, she came to McLean in the mid 1990s to begin ECT.

I met Sophia, when she had an exacerbation of her illness about 11 years ago. She is a petite, warm and intelligent woman who worked as a professional before becoming ill. She is married to a man who has been a constant and supportive partner over the years and they have two teenaged daughters. When her disease worsens, she exhibits self-harming behavior, often hitting or pinching herself. Sophia and I have developed a close relationship over the years. She is comfortable sharing with me the details of her anguish and I am very honored that we have this trust. Many of her symptoms are precipitated by personal stressors she feels are beyond her control or a reflection of her inadequacies. Sophia feels tremendous guilt about the effect her mental illness has had on her family over the years.

It’s sometimes challenging to develop deep relationships with patients because of the nature of ECT treatment. The outpatient visits last around two hours, including prep, the treatment itself and recovery. Much of the time the patient is either asleep, recovering from the general anesthesia or resting in the recovery lounge, which is a separate area. My relationship with Sophia has developed gradually over the years, partly because of how much contact she has had with our service: she has undergone nearly 200 ECT treatments. But I do think that it is possible to be a compassionate caregiver—and to forge a trusting relationship with a patient—even if your interactions are fairly quick, as ours are on the ECT service. I have come to know Sophia so well that I can quickly tell when she is depressed: she doesn’t make eye contact, becomes reticent and takes on a pale look, as if the vitality has been sapped from her.

She’s had a number of crises over the years, and I am thankful I have been able to play a positive role on a few occasions. One incident occurred several years ago. Sophia stopped by the ECT clinic at the end of the day, after seeing her McLean therapist. She was evasive about her reason for stopping by. I asked her what was going on and she admitted that she had taken an unknown quantity of Klonopin. I called a medical doctor to examine her and he sent her to the emergency room because it was unclear how much she had taken. The incident strengthened our bond even further.

Sophia and I have developed certain rituals during her visits. When she’s feeling relatively well, we’ll chat about her family, her activities and music—a passion of hers. As the anesthesia is being administered intravenously, I stand next to her gurney and hold her hand, which she finds very soothing. She always gives me and other staff a hug as she leaves the unit. She shows her gratitude in other ways, including dropping off bouquets of flowers. If she’s feeling depressed, she’ll scurry away to avoid chatting.

My bond with Sophia is the closest I’ve ever had with a patient. She has helped me become a better listener and to carefully observe demeanor and mood. I feel honored that she trusts me enough to reach out when she feels at her most vulnerable and fortunate that we have the facilities and resources to provide her with the best care possible.