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Cowboy Hat

His mom was suffering from her own mental health disorders, but my god was she trying so hard to get things in order for herself and this boy. He was my very first admission as a brand new nurse. Those are things you’ll never forget. People say nurses change lives, but I’m promising you, my patients have changed mine. I made sure I was prepared as this was my first admission I was doing on my own after my orientation period. I wanted to be sure to get it right. I had my paperwork sitting on the table with my purple pen that I always used as this nine-year-old boy walked into the nursing office with his mom.

She was probably in her thirties but could have passed for fifty something. You could tell that she was not given the easiest life but she smiled and shook my hand as her and her son sat down at the table across from me.

He was short but slightly chubby with the cutest round cheeks. He sat with his hands folded on the table and a cowboy hat on his head. I introduced myself to them both and he reached to shake my hand and said, “I’m going to just keep this hat on, okay?” I smiled and said that that was okay and that I liked the hat. He said that he wears it everywhere he goes and that it made him feel brave. I did not want to take that away from him. Being brought into a residential facility knowing that your mom was going to leave you there had to be terrifying. I wanted him to hold on to every once of brave that he had left.

Everyone is a product of their environment. What you see as a child, what you grow up watching others do, whether we like it or not, it becomes part of who we are. This was another sweet boy with a shitty trauma history. Not only was his dad an abusive piece of shit, but his mom was bipolar and trying so hard to stay clean for him.

This boy was scared. He had seen a lot of domestic violence and was afraid of most men he came in contact with. He walked with his head held high though and an attitude arose every time fear crept into his tiny little mind. He tried to compensate by acting tough and like nothing bothered him. If he felt like a male staff member was looking at him the wrong way, he would yell and scream and threaten them. He would try to hit and kick and bite. He also would get into arguments with the other kids on his unit who would get on his nerves or say things that triggered his mind into a fear response.

I spent a lot of time with this boy, mostly because he was in restraints nearly every one of my shifts. After the first week or so he finally realized that I was there to help him and would ask for me every time he started to go into crisis. Every restraint he was placed in, I would help to talk him out of. I would sit beside him sometimes for over an hour, to talk about what he was feeling and why and what he could do different.

It’s easy to get attached to your patients, but it’s even easier when you are with them all shift, every shift, for months at a time.

There was another boy on the unit who was very aggressive towards animals and one night decided to kill some birds. Don’t worry. We will talk more about him later. When sweet little cowboy hat boy saw this, he went into the worst crisis I had seen him in. It broke my heart because prior to this incident he was doing so well. It had been almost a whole month without a restraint.

He started crying and screaming and fell to the ground, having a fake seizure. Yes, it was really fake. He’d done this before when he was really upset and needed a way to receive attention that he wasn’t sure how to obtain. It was freezing cold that night and I had been outside with the other kid who was killing the birds for almost an hour trying to get him to calm down, but as soon as little cowboy started needing attention, I was right by his side. My hands were numb from being so cold, but as he continued his fake seizure, I sat down on the cold ground beside him and grabbed his hand. As soon as I did, he stopped forcing himself to shake and started smiling. He sat up and was able to walk himself inside without a restraint, which was rare for him to do. He started crying saying that he didn’t want to go back to his unit because he was afraid of the “bird killer.” I didn’t blame him; it was awful.

After about an hour, he was calmed down enough to go back to his unit and go to sleep.

It’s weird what fear will make people do. I’ve seen it make people cower; hide in a corner and cry. I’ve seen it make people hurt others. I’ve seen it make people hurt themselves. He was scared; that’s it, right? If only it were that simple to get over and move on from what’s scaring you. It’s not that easy. The brain is a complex organ that we will never fully understand and although as providers we want to fix everything about everyone, we just simply can’t.

So while little cowboy spent his months in residential he learned to cope with his traumatic history, deal with his fear, and learned coping skills to help him in the real world. When he discharged from the facility, I cried but not because I knew I was going to miss him but because I had seen such a huge improvement in his behavior and his mood. I had seen him go from crying and being afraid to being afraid and hurting people to hardly being afraid at all. I seen him go from angry to happy. I seen him go from shy to outgoing and making friends on the unit. I like to think that I had a part in that. That when he looks back on his stay in residential that he’ll remember the nurse who was there for him no matter what.

Keep him in mind. We are going to come back to him later.

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