Start of shift, 6:43 a.m.
The coffee is still too hot, the night was too short, and during the handover, someone says something that sticks with me:
“It was tough today.”
That could mean anything.
Someone was screaming half the night.
Someone wanted to leave.
Someone wanted to die.
I set my bag down, glance at the morning shift’s to-do list, and head to Room 12 first.
The door is half open.
He’s sitting on the bed, not looking up when I walk in.
His shoulders hunched forward, as if he wants to disappear.
I say his name.
No reaction.
I'm staying anyway.
Sometimes, care begins right here.
Not in communication tools.
Not in treatment pathways.
But in those moments when nothing seems to be happening.
I'm going to sit down.
Not too close.
Not too far away.
A distance that is renegotiated every day.
Voices in the hallway.
A phone.
A doorbell is ringing somewhere.
After a while, he says:
“I can’t take it anymore.”
Quietly. Almost casually.
As if that sentence had drained his last ounce of strength.
I nod.
That's all for now.
Not a good sentence.
No intervention.
No solution.
And that’s exactly what you rarely learn.
How to prepare medications.
How to assess risks.
How to document.
How to de-escalate.
There are standards, guidelines, and training programs for all of this.
But no one really shows you how to deal with your own helplessness when you’re sitting across from someone whose pain can neither be relieved nor hastened.
Later, I'll go back outside.
Document.
Prepare medications.
Make phone calls.
Coordinate beds.
In the progress report, this will later appear as follows:
The patient appears depressed.
Consultation conducted.
No risk to self reported.
Three sentences.
None of them describe what despair sounds like when even crying has become too exhausting.
Psychiatric nursing often operates precisely in these gray areas—where no quick fix exists and simply being present becomes the most important intervention.
We support patients through crises that cannot be squeezed into standardized procedures, often performing emotional labor that goes unnoticed.
Maybe we should talk about that more often.
Nadine Schuster works in psychiatric nursing, is a member of the AFG Psychiatric Nursing Association, and writes literary pieces about everyday life in the clinic. Her book *A Dance on a Tightrope: On Dignity, Abysses, and the Quiet Work of Psychiatric Nursing* was published in 2025.