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Professional or friend? The strange encounter with Mr C

I had been seeing Mr C weekly for the past six weeks. Having found his blood pressure to be raised during his annual hypertensive review I had brought him back the following week, then to the doctor for his medication to be changed. The doctor had asked him to have weekly blood pressure checks then return for review and possible dose adjustment in a month. He had always seen me, as he preferred to come in after work on Thursdays and I am the only nurse available at that time; usually he would have seen our healthcare assistant, but it gave me the opportunity to reinforce the health promotion advice I had given at his monitoring review.
Mr C is in his late fifties, and works as an office administrator. He is overweight, does not smoke but drinks alcohol every night - admitting to three or four units of spirits to help him sleep. He finds his work stressful and does little physical exercise. There was plenty of scope for health promotion, and over the weeks I would ask how he was progressing with the lifestyle advice I had offered - whether he was managing to have two or three alcohol-free days, was fitting some cardiovascular exercise into his daily routine, whether he was making dietary changes involving eating little and often from high-soluble fibre and low-saturated fat choices, and I would suggest various relaxation techniques and hobbies to provide relief and distraction from his workday stress. He seemed interested and agreed to give the advice a go.

On the same level
His blood pressure reduced only marginally, but he did not seem to be having any side-effects, so it seemed likely that the doctor would increase his medication - I had advised him of this. I tended to lean away from Mr C in order to avoid his halitosis (possibly he did not have a chance to drink much water during his afternoon at work), so I only really made contact with him when I took his blood pressure, and usually did this towards the end of the appointment to allow him to have relaxed. This time, as I applied the cuff,
Mr C took my hand and said, "When I come to see you I get the impression that however many times we meet we'll always interact at the same level." I quickly extricated my hand while I continued with the business of taking the blood pressure. Quite honestly, I was a bit confused as to what he meant, but decided to take it as a compliment and replied that I hoped my care was always consistent.
He went on to say: "But I get the impression we'll never be closer friends like this." I was now feeling uncomfortable and was suddenly very aware of the silence emanating from the rest of the surgery as everyone was winding down and going home. I told him that was exactly the impression I wanted him to get - close friendship was not on offer, simply healthcare.
I felt embarrassed. I am - as writer Colin Dexter would put it - a woman of some 50 summers. Having worked at the same surgery for 15 years I know many of the patients very well, some also know my husband. I have several hobbies and lots of interests, and share these with some patients, but I have long since forgotten about being "chatted up" by any of them. Indeed, apart from the usual playful banter from elderly men, usually in the presence of their wives, I find the whole "sexy nurse" image insulting, and hope that the professional care I give is completely irrelevant to my gender or sexuality.
To my astonishment Mr C had now started to cry, saying that meeting for a drink after work couldn't do any harm, he wanted to be my friend and now feared that he had "blown it". He sobbed that he had increasingly thought of me as a friend over the past weeks as we had discussed his problems, and had imagined us growing closer, feeling he knew me well enough now to "move it on a stage further".

Meeting a "close friend"
I was now starting to feel resentment that the healthcare advice I had given had been perceived as personal interest and perhaps even encouragement to fantasise about me. There had been no suggestion of his hidden agenda in previous appointments, but now it seemed as if he was diminishing my role, reducing my past career and the whole nursing profession into an opportunity to meet a "close friend". As I looked at him he seemed ridiculous, crying there.
Almost immediately afterwards I felt guilty. In my professional role I should surely be feeling empathy and compassion for a distressed patient - worse, it had all probably been my fault! Perhaps I had encouraged him in some way! Here was I, taking the moral high ground of professionalism, while my reactions were anything but professional. Perhaps I was overreacting; after all he had only held my hand. I had held the hand of hundreds of patients, but what I couldn't escape from was the sensation of feeling threatened, of flesh-creeping "wrongness".

Manipulated feelings
In transactional analysis, when an unexpected twist in a transaction leads to wondering what happened to cause it, the chances are high that it was a "gimmick", the result of a "game" played to manipulate the other person's feelings to produce a desired result. I wondered whether I was being manipulated into feeling sorry for him now. The whole scenario had been unexpected but the tears seemed inappropriate.
Mr C was, as usual, my last appointment of the day. I passed him some tissues and said I would book his appointment with the doctor the following week, to save him going to the reception desk. At this he wept more, asking whether that meant I wouldn't see him any more. I told him it was exactly as the doctor had requested, and gave him the appointment card. Thankfully, it had needed no negotiation since I knew he would want the following Thursday evening. I stood up and reminded him it was time to go. At first he made no move, but I said nothing more and continued to stand, so eventually he gathered up his tissues and his jacket and left.
I closed the door and sat down again with enormous relief but utter confusion. I was too embarrassed to speak to the doctor, suspecting he might think I was overreacting and/or menopausal, both of which could be valid. I didn't want to go out to the car park until I had given Mr C a chance to leave, so I stayed there self-analysing for a while.
The following day I was still concerned that the situation felt irksome. I rang the Suzy Lamplugh Trust and spoke to an adviser - they deal with issues of personal safety, and I was keen to know whether I was exaggerating the unease I had felt. They are unfailingly helpful and restored my sanity by affirming that abuse and threat are entirely subjective - if I felt threatened then it had been a threatening situation. This gave me the confidence to speak to the doctor, who didn't laugh or dismiss me as menopausal. Mr C had apparently had counselling to help him communicate with his third wife and his daughter, complaining that he found it difficult to interact with women. I could vouch for that. It seemed there was no history of abuse or violence.
The experience will stay with me, though. I don't know whether it will change the way I discuss lifestyle, but I will be aware that some may see the apparent interest as more than identification of risk factors.

Resource:

The Suzy Lamplugh Trust
W: www.suzylamplugh.org
E: sltrust@ukonline.co.uk 
T: 02070 910014