Debriefing

I’ve always been reluctant to record things about my work in writing due to the risk of identifying patients or clients, and also because most people don’t want to hear it due to the sadness associated with the type of work I do. I’ve noticed that when health professionals of any sort get together, they seem to speak about work far more than any other occupation. I enjoy those conversations but have also been privy to friends of other professions complaining about either the gruesomeness of the talk, or a lack of understanding about why anyone would want to talk about work outside of work, especially when it excludes others trying to participate in a social event (!)

I spoke to a friend and workmate from Melbourne last night and it made me yearn for my job there. An unexpected response considering how much my enjoyment of the job varied. It’s fairly easy to say that I loved the type of work, and mostly enjoyed the day-day activity, especially when I felt like I or ‘we’ as a team had made a difference for someone. Not so enjoyable when people are hurt, angry, frustrated, abusing me or blaming me personally for rules my employer or the government instigated, or the occasional times when I felt unsupported by my employer in what was a fairly autonomous role.
Talking about work with colleagues is enormously important when working in the health profession – particularly in those environments where interaction with clients is ongoing and/or traumatic events occur. In case management and nursing where I’ve worked, there are terms that float around like ‘supervision’ and ‘debriefing’ and ‘reflection’ that can all refer to formal or informal conversations about work situations. They give professionals an opportunity to discuss events, emotions, conversations, expectations, abuse, praise, grief and frustration. I know some of those terms may seem to fit into the broader-meaning words I’ve included, but I purposefully separated them.
My frustration was frequent while working for an insurance scheme. Believing someone ought to be entitled to something but being unable to provide it / pay for it due to policy or legislation was difficult. It wasn’t simply because the client was frustrated or angry at me for saying No, but because I often genuinely agreed with them that the item / service should be provided. The line that I crossed telling the client or family that I personally agreed with them that the decision was unfair was a fine one. It can be viewed as disloyalty to my employer. It’s can also open a door for a discussion with the family in which I’m expected to justify the employer or governments’ stance. Or I hope that it can it be seen as empathy towards a person’s situation and honesty from an employee without disobeying the rules.

Sometimes I tried to ease my frustration by noting that there were far more unreasonable requests and expectations than reasonable ones we had to deny, but I couldn’t honestly compare them. The reasons for what I felt were unreasonable requests varied. Sometimes clients had a sense of entitlement to more than could be provided under legislation, for example, expecting that everything they ever needed would be paid for irrespective of whether they would have paid for it if they hadn’t had an accident. Sometimes a request seemed to be a means to vent anger and frustration at their circumstances. Sometimes it reflected financial hardship of the client or family. Occasionally requests reflected the encouragement of a professional who didn’t know the policies governing such decisions. Some families would request things that they knew should be denied with a glimmer of hope that it might be received by someone who didn’t know the rules. Sometimes requests were ridiculous.
My frustration as a professional is not at all comparable with the ongoing frustration and grief suffered by those who have an illness or injury that prevents them from maintaining their usual lifestyle. Loss of or changes in ability, independence, communication, mobility, skill, relationship, cognition, emotions, employment, self-esteem, appearance and respect can all be outcomes of accident injuries. Some changes are temporary and others permanent. Others improve or deteriorate over time. The vulnerability of not knowing if or how something might improve can be excruciating. Minor improvements can mean a lot but sometimes lead to hope that is never fulfilled.

I’m working with a man who has a brain injury. He lives with his parents and requires 24h care. For the first 18 months after the injury, he could only move his big toe. That big toe movement was incredibly important as he could communicate yes or no responses. A number of years later, he can now walk with a lot of assistance. His ability to communicate, even yes or no, is inconsistent. The injuries and disability affect his family enormously. They’re responsible for all of his care, for decisions about his health, for staying awake overnight when there’s no staff, for maintaining their family unit including the other children during all highs and lows, for juggling the 24h staff rosters and filling in when there’s none, for maintaining financial stability despite the necessary cessation or reduction in employment and the inevitable additional expenses.
His parents are hopeful of recovery. I think that they genuinely believe he will speak clearly and consistently again, that he’ll walk independently and that he’ll live the life they expected him to. With ongoing small improvements, how do you know when his current status might be as able as he gets? At what point should one be concerned about the hope that the parents hold onto so tightly, especially if the hope is the only thing keeping them going in such a changed world?