25
Jan
12

Right Church, Wrong Pew

Liz wanted to be a nurse. And so she went to college, got her degree, then earned a Masters degree in Nursing at a prestigious university.  She graduated with a 3.95 GPA, with honors and everyone’s applause.

Finding immediate employment at a world-renowned hospital, she soon started to become depressed and anxious, disenchanted with the job though she loved working with other professionals and the patients. But the demoralization continued  and she sought therapy. The therapist referred her to me for evaluation. “Something doesn’t make sense,” the therapist said. “Liz is very bright, she’s  had a stable upbringing, has lots of friends, no trauma, no evidence of familial disposition to mood disorders. But she keeps complaining about the work, how nervous she gets. Maybe you can help clear up this matter.  She’s on medication, an antidepressant, but that’s not making much of a difference.  I’m at a loss.”

And so, a few days later, Liz entered my office.  Congenial, cheery, sophisticated and very mature in her ways, despite her youthfulness (she was 24), Liz seemed the epitome of all that makes up a competent and sensitive human being.  And she was hard-working, intent on doing her best on each task I presented her.  Her IQ reached into the 90th%ile+,  superior.  It would have been higher had she not obtained two remarkably lower scores. One was on a subtest called Digit Span, another on a subtest called “Arithmetic” .

Both are very sensitive to attention span. The possibility that an Attention Disorder was related to her depression soon occurred to me.  But more evidence was needed. So I asked some questions like the following;

1. Do you ever have to re-read something you’ve just read.

“All the time, even in high school and always in college.  I’d spend hours on homework!  I mean, I could read just one paragraph and then realize at the end of it that I was thinking of something else.  And then I’d have to re-read.  But that was OK. I never minded working hard.  I’m not really very smart if you want to know the truth.  I just work hard.”

2.  Do you make little mistakes, like forgetting to write some words in a sentence or miscalculate in math?

“Well, yeah. But they were never really a problem because  I’d double-check my work.  But I always hated math because no matter how many times I checked, an error would show up anyway, always a careless error, dumb, stupid. “

3.  How about lecture note-takng in college?

“I was OK if the professor didn’t talk real fast.  And I became a really FAST writer. I never participated in class because I was so focused on getting the notes that I couldn’t concentrate on WHAT the teacher was talking about.  Same thing with foreign language; I had to try really hard to remember what was said in French so I could translate it.  But I’d keep forgetting, and so my translations sucked.  I HATED French!”

I asked her about her nursing job.  I LOVE nursing, but… I…it’s getting to me, getting me down.”

And then the tears began, pained sorts, robbing her of the dignity and  self-possession she’d worked so hard to project.

” I have to give out all these medications, different dosages, sometimes three or more for some patients.  And I’d keep forgetting who got what.  And I’d study and study the dosage charts and names and still catch myself making dumb mistakes,  forgetting this or that. I’d spend hours reading and re-reading the charts.  But I was taking too much time, and the supervisors were getting on me because I was not giving enough attention to my patients.”

I was afraid I was going to hurt  somebody! “

Liz did have an Attention Disorder, quite severe.  It corrupted her ability to remember “little”  things, data, details, numbers and the like.  It compromised her efforts to monitor her work for “dumb” mistakes because those errors came so quickly, she didn’t know she’d made them; they were INvoluntary and so she could not know where her mistakes were.

Liz, at my encouragement, sought another position in Nursing, one that required far less charting and record-keeping, one where she had time to do her job well and with pride and satisfaction. Her depression lifted; it has not returned. She has become the very competent, sensitive and compassionate nurse she always wanted to be, that in truth she always had been.  In a Psychiatric position, she excels in her understanding of the human condition, of struggle and suffering, and her great empathy for her patients.  She found her calling.

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