It was around 5:00 p.m. on a Friday afternoon when I “should” have been going home when I got a call to see a patient in the neurological intensive care unit. As a psychiatric liaison nurse, I am called to see “problem patients” who have emotional as well as physical problems. Sometimes, it is not the patient who has the problem, but the staff. It was not unusual for me to get frantic consultations on a Friday afternoon, so I cancelled my evening plans and walked up a flight of stairs to the Neuro ICU. When I entered the unit, I hear a female voice groaning and distinctly saying, “I can’t believe it. They say that they love you and they shoot you in the head.” Hearing someone speaking other than the staff is a strange experience in the Neuro ICU since most of the patients who enter here have a brain injury or are paralyzed, making talking impossible. Therefore, I was curious as to who was speaking and why.
The nursing staff saw me enter the unit and motion me to a secluded corner. The nurse asks me to see Chrissy “over there in the corner; the one who is talking”. She continues to tell me Chrissy’s history of what brought her to the hospital. Chrissy is a 21-year-old woman who works as a waitress and was shot in the left side of her brain by her ex-boyfriend. Her ex-boyfriend shot Chrissy and then shot himself. He died on top of her and when she awoke, she had to crawl out from under him and walk to the neighbor’s trailer for help. The nursing staff’s dilemma was that Chrissy kept repeating the story over and over again. Chrissy was unaware that she was saying the same thing again and again and again. What I noticed almost immediately was that most of the nursing staff in this unit were young, (in their mid twenties) and unmarried themselves. Hearing Chrissy reveal how her boyfriend professed his love and then shot her was too much for the staff to bear. In the meantime, Chrissy is having difficulty believing this horrible incident has happened to her.
When I approached Chrissy, I was struck with how small she was. Her head was all wrapped in a large white bandage, her dark brown eyes were filled with sadness and disbelief. I asked her how she was doing today. Her voice was shrill and defensive as she spoke, “How would you be feeling if your boyfriend shot you in the head?” All I could think to say was, “I would be sad and scared if something like that happened to me.” She immediately calmed and said, “Yeah… I can’t believe he did it. He told me that he loved me and then he shoots me in the head. You’re not supposed to do that to someone you love. Are you?” I asked her if she could remember what had happened that night and she told me the story. I sat there a long time that night listening to her repeat her story until she fell asleep. The nursing staff were so relieved to have another person (me) talking to her so they would not have to listen to the terrible details of betrayal from someone whom you have loved.
With Chrissy’s particular gun shot wound to the left temporal lobe, she was unbelievably alert and could recall the events leading up to her hospitalization. She knew who she was, how old she was, what year it was, and that she was in the hospital. However, she could not remember that it had been three days since the shooting and that she kept repeating herself to the nursing staff, telling them the same story over and over and over. Her repetition of the story was wearing the staff’s defenses down; they wondered privately if the same thing could happen to them. At the time that I saw Chrissy, she was not depressed; she was in a state of shock and suffered from delirium from the swelling in the brain caused by the gunshot wound. Both the staff and Chrissy needed me to talk and listen to Chrissy as she retold her story in an effort to resolve her trauma.
I worked with Chrissy throughout her hospitalization and afterwards when she went home to live with her parents. Chrissy met with me on a weekly basis for three months in an effort to restore her life. During the first month after discharge from the hospital, Chrissy looked at me and said, “You know, what happened to me was the pits. I still can’t believe it. But, you know, I don’t think that I would ever be able to go on if you hadn’t been there for me. I know that I don’t always say much and that I repeat myself over and over, but I got to do it over and over right now. None of my friends and my parents want to hear it any more. I think that it scares people too much.” I thought to myself that she indeed needs to continue to talk about her trauma and how perceptive she had become. Chrissy did recover significantly from her gunshot wound. She went to a local community college and took accounting courses. Math was never her best subject; however, since the shooting, she was able to better grasp the concepts.
Jane Bryant (Neese), RN, MS, CS