Sunday, March 16, 2014

Walking on Eggshells

I've been working a lot with idiot nurse.  We'll call her Helen.  I think she has Borderline Personality Disorder (BPD).  I was not sure at first, thinking it was a language barrier.  I also expected to see two extremes in her treatment of me:  The "You are the Greatest" as well as "I hate you and will destroy you."  The two versions I see from Helen are "Despondent" and "I Hate You and will destroy you."

Helen is the nurse who invented a reason to yell at and accuse me in front of an audience, supposedly based on a rumor she heard that I bad-mouthed her.  That was extreme and is typical of the fragile stability seen in someone with BPD.

When I returned from lunch the other day, a patient asked me to call her social worker.  I do not do this because every patient asks constantly to call their social worker to ask when they are being discharged.  If you have not been told that you are being discharged, then you are not being discharged any time soon.  This particular patient was supposed to be discharged within the week.  So as to not besiege the social worker with identical phonecalls, I asked Helen if she had already called the social worker for the patient.

Helen lost it.  "You don't know what I do when you are not here!  You act like I do nothing.  That is not true.  You know what your problem is?  Your tone.  I don't want to hear you."

I tried to keep it professional.  "No, I don't know what happened while I was at lunch, so that is why I am asking you if you reached out to the social worker or not, so we don't both call him."

Helen grew angrier.  "I have so much work to do and you act like I don't do any work.  You need to change your tone."

Now I was done.  "I don't care for your tone, either, Helen," I answered back sternly.  "I asked you a simple 'yes' or 'no' question and you started ranting.  I'll just call the social worker myself."

Helen wasn't backing down.  "I already called the social worker.  This is what I am talking about.  I do something and you say it's not good enough and you do it over."

Doesn't she hear herself and lack of sense?

Later the clerk told me that when Helen covers the ward when I am off, she is a mess and usually calls out if she knows in advance that I am off.

I thought to myself:  If she needs me so badly to handle the ward, why does she treat me like garbage?

Then it occurred to me that she was exhibiting another typical BPD trait:  extreme anger over perceived abandonment.  When I go to lunch or am off for the day, she sees this as abandonment.  Most of these tiffs are when I return from lunch.  If she works the ward on my day off, the next time we work together she constantly mentions things that went wrong "because you weren't here."  It's not said as a compliment.  Her tone implies, "You were supposed to be here and played primadonna and did not show up, and so things went wrong because you designed the place to fail without you."  When I was focusing my attention on New Nurse, Helen felt she had been abandoned and went to the supervisor to regain my attention.

Another way of detecting BPD in someone is by noticing your own thoughts and feelings when around this person.  If you feel as if you are walking on eggshells and the person can go off on you at any moment for any little thing, you could be dealing with someone who has BPD.

How to deal with BPD?  Not easy.  Setting firm boundaries is necessary.  When I work with a good nurse, it's more symbiotic with both of us grabbing whatever work pops up, finishing it, and then grabbing the next item without declaring, "That's not my job, it's yours."  When I work with Helen, she constantly calls me to help her with everything from finding a chart to assessing a patient that she is standing next to.  She drags me into every task she does, which is inefficient and obnoxious.  In contrast, if I tell her that I'm inundated, she'll answer, "That's your job, not mine," and continue sitting and swinging her feet.  Her explanation for any undone work is, "I told Enid to do it."  She runs out the door five minutes before the end of the shift, leaving me to give the useless report she wrote to the incoming shift.  The problem with trying to draw boundaries with her is that she complains to the supervisor that I won't help her.  She won't help me, but that is not relevant to the supervisor.  Helen doesn't have to help me because I don't get along with her; I am to start demonstrating my willingness to work well with others by doing Helen's work for her whenever she demands and not putting my own work onto others.

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