Dear patient,

The helpful answers I have to your questions about your medications? Like what your target dose might be, possible side effects, and why your doctor may have chosen one over another? Yeah, I didn't learn that from books. It's how my psychiatrist explained it to me.

I wish I could tell you we're taking the same drugs. You might not feel so broken and alone.

Dear patient,

From what I've seen both in life and in here, drinking yourself to death always takes way longer than you expect. And is way more gruesome, painful, dirty and just plain squalid. Sure, it's like Leaving Las Vegas. But with twenty times more vomit and piss. In the bed you can't get out of. And at a certain point you're just too weak to stay on top of poisoning yourself and your body starts to heal. Or your friends force soup down your throat. Or the police come.

From an email to a friend

It occurred to me today that there's something about the difference between "I care about you" and "I care for you." I can't fully care about everyone I care for. But I'll always care about caring for them. I'm not sure I could explain it more than that.

Dear patient,

I really don't know what to say. I'm sorry. I'm hurt. I'm angry. And I feel so guilty. I'm sorry you feel so bad. I'm sorry I don't really like you and think you're a loud mouthed "funny guy" jerk. I'm sorry you wanted to kill yourself. I am. But I'm really hurt. I'm really hurt that you tried at the hospital. And now that you were found in time to save your life I don't know what to say to you. Maybe you "just" wanted attention. Maybe you really needed attention you weren't getting. I'm sorry. But I'm not going to apologize to you nor am I going to pretend it didn't happen. I don't want to make you feel worse but I don't want you to think it's ok either. What if he hadn't found you hanging by a sheet from your door? What if you had died? What would that have done to all of us? And yes, I feel guilty for feeling that way. But what the fuck. Just because I'm a nurse doesn't mean I'm not fucking human. I am really so sorry that you feel so bad. I really am. But I'm really hurt too. I'm hurt that you didn't come talk to us - to someone. I know I'm not the only one who cried over you today. And I wasn't even on the unit last night. So fuck you. And I care about you. And I'm sorry. And I feel guilty. And I feel angry. I really don't know what to say.

Love,
Constance

Dear patient,

I know you don't like the arm splints. I don't like them either. And I'm sorry they make you cry. But you bit off your own finger and that's just not OK.

Dear patient,

This is a psych hospital. I'm not going to just hand over a razor so you can go shave five minutes after you get here. I know you're not a five year old but I also know you just told the ER you were going to kill yourself. Not on my shift, buddy. Give us a day or two to assess your safety, OK? OK.

Dear detox patient,

This is a psych hospital. We're not going to freak out and think you're "OMG, CRAZY!" if you tell us you're having hallucinations. It sometimes happens with alcohol detox and if we know then we can help you. And, you know, keep you from having the seizure that comes next. kthnxbai!

Dear (other) patient,

It must be incredibly scary to hear the voice constantly telling you to do horrible, violent things to the people around you. But you're not a bad person and, no, I don't hate you. The fact that you came to tell me it was getting hard to resist the voice shows what a kind, brave, and yes, sane person you are.

Dear patient,

I'm sorry things suck so much. Until you can again, let me carry your hope for you. And when you're ready you can have your share back but I'll keep ahold of mine. Hope works like that.

The first status update

Constance is sometimes hard pressed not to give as good as she gets. You wanna cuss? 'Cause she can cuss. Just, you know, not when she's clocked in. Yay! Lucky you!

Hello.

I'm a psychiatric nurse working in an inpatient setting. I can't and won't say where. I often find there are things I wish I could say to my patients. Thoughts that find words while I'm driving home after a shift.

I don't know how to explain it. In the nurse-patient relationship, especially in a psych setting, there's a need for boundaries. Patients want and need to feel that I've a handle on things. That they're not burdening me. That I'm not quite a whole real person. And that's OK. I don't want them to worry about me - they've got enough to worry about already. So sometimes, these things that I wish I could say, they're just not appropriate in reality. So I'll say them here.

These all started as facebook status updates. The response was such that I decided to move it all here.

Patient confidentiality is a priority for me. If you do know who I am or where I work, please don't let on. If you think I'm getting close to violating HIPAA regulations or inadvertently sharing identifiable information, please let me know. I welcome feedback on how best to go about this.