I have a new patient who happens to be staying in a house very close to where I live. When I drive out in the morning, I can actually see the window of the room where she lies, and I cannot help but think of her. This is one thing on a work day, when I am immersed in thinking about my patients anyway. But I have found it is quite a different thing on weekend days, when I am rolling out on my bike. Or in the early evening when I’m driving off to Fairfax Lumber to compulsively buy more deerproof plants for the deer to snack upon in my garden that night.
This has highlighted for me how I actually drive about the county of Marin in two very different frames of mind, and how the same world looks strangely like two entirely different worlds, depending on whether I’m at work or not. As a hospice nurse visiting patients where they live, I drive around the community all day from Monday to Friday. Evenings and weekends I drive around those same roads and neighborhoods but I feel that they are different.
Let me try to explain. When I am at work, as soon as I log in each morning at 8:30 and clip on my hospice badge, my world shrinks down to the worlds of my patients and their caregivers. I do see the rest of life as I drive around but it’s oddly irrelevant, almost as though I am viewing it through glass. I may stop at a local cafe to pick up a coffee, or drop quickly by the post-office, but if I’m in my work clothes, wearing my hospice nurse badge, and between patients, the world is sort of walled off from me and I feel that I cannot fully interact with it. My mind is busy with medication orders, concerns about a patient’s new symptoms, or the endless To Do list that comprises my day as a nurse. The time gets chewed up at a very constant and much faster pace than on a weekend day when I might meander from thing to thing with no rigid agenda.
Sometimes I take my daughter to the mall where, during the week, I often stop at a cafe between patient visits to chart. The mall looks distinctly different, depending on whether I’m at work or with Jessie shopping. It’s the same mall, clearly, but I’m engaging with it differently. At work, my focus is intense. The mall is really just a coffee delivery system, a place where I can sit in a booth and chart, make calls, and get med orders sent through. I barely notice the people around me, and two hours can go by like ten minutes as I try to get through the endless To Do list. Shopping there with Jessie on a Saturday, the pace of everything is slower. It’s like the mall, the people in it, the whole world has slowed down and opened out, because I’m not rushing to do thirty things in the next half hour, and because I can fully interact with everything that’s going on around me.
There has now been a blurring of the boundary between the world I’m actively engaged in (evenings, weekends) and that glassed-off-world feeling as I motor around the county as a hospice nurse. As I drove off to the gym after work this evening, I could not help glancing up at my patient’s window as I passed and wondering how she was, and how I will find her on my visit tomorrow. Did I order enough wound care supplies? How can we best support her friends as they care for her? And is she really on the best pain regimen going forward?
It’s fine for the boundary to be blurred, really. It’s not as though my boundaries are terribly strong to begin with. [Note to self: strengthen boundaries]. I check my work phone way too often nights and weekends when a patient is close to death. I sometimes take calls and answer emails after hours (strictly discouraged, you did not hear it from me). But the proximity of this patient to my home has made me realize the odd parallel existence of my two worlds and how I move between them almost without noticing. Now I’m noticing. And honestly, when I’m driving away from my house at 5:50pm on a Wednesday, I don’t want to be thinking about wound care supplies. I just want to be focussing on how Fairfax Lumber is closing soon and I only have 10 minutes to buy more deerproof plants for the deer to snack on.
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