For a Living

It's hard for me to make sense of what I do "for a living." Those quotation marks denote sarcasm, in this case. I went to university for greater than four years to learn a set of skills and knowledge that would prepare me to blur the boundaries between your life and mine for 12 hours out of the day.

Sometimes I see the bad news before you do, and I let myself go cry in the bathroom so you can have a solid presence when you learn it yourself. I hold your hand. I hold your spouse. I hold your family in my heart for the rest of my days.

I let you lie to me, over and over again, so I can keep you in the hospital long enough to heal your sickness - knowing full well your addictions will swallow you whole when you leave the safe space I'm desperately carving out for you.

Sometimes, I have to let you leave, when it's not time. I have to let you be the grown up in your own life, even though I know that grown up is headed toward an unnecessary death. I tell you I honor your choice, even as I screw up the courage to confront you with the reality of what it means for you.

I'm funny for the you in this room, because that's what makes you feel loved and safe and seen. I'm somber with the you in this room for the same exact reasons. I give a little of me to every single one of you, and your presence and person smudge all over me - changing me forever.

While all this lovely emotional work is happening, I'm using my sharp mind, skilled hands, and years of experience to tend to your body. I'm recognizing when your respirations dip toward death, and giving you medication to pull you back from that brink. Or, I'm noticing when your body is no longer tolerating what we do to keep it living, and teaching your family how to love you in the letting go. I'm watching your vital signs for subtle shifts that will be missed by your physicians (remember, I think about you and know you for hours and days at a time) to recognize when you're sliding toward deathly illness, and put a stop to it.

And, I'm really, really proud, and really, really tired to be this Registered Nurse. Because, all this was yesterday, or days ago, or years ago, and I'm still wearing you. I'm still loving you. I'm still grateful that, even for the abusers and liars, and of course for the helpers and growers, the world got you in it. That for a time, I got to reach deep into your life, and regardless of how you lived it outside the walls of the hospital, I loved you. I honored you, your body, your person.

This is a "living" in a much deeper sense of the word. It's my chosen mode of living - my ethics, my faith, my heartbreak, my hope.
#registerednurse #nursing #healthcare

What Matters (when you can't take care of you)

Some of us will make it within spitting distance of 100. Most of us will some day depend on other bodies to care for our body. I have the privilege of providing that care right now, and observing what matters in these years. For instance: 

You taught your children self-sufficiency. You gave them full awareness of their own personhood. When it is time for someone to represent the voice you no longer have, they aren’t still striving to maintain a falsehood of needing you with them. With great loss, and tremendous courage, they advocate on behalf of your body and soul.

You built love with a partner based in truth, compassion, and passion. It helps if you laughed a lot, because when this partner has to face tending to your most undignified needs, you’ll want them to get you so tickled you toot in the bathtub. And, this partner knows you too well to cling to a shell of you.

You opened borders and created community. A walled off life is a secluded one, in health and sickness. The crowd at your bedside get smaller as the years go by, unless you created a legacy that parents shared with their children, and that got soaked up by grands and great grands of the genetic, adopted or spiritual varieties. A little diversity here is extra special.

You let others sit with you in your suffering. You let them see a few warts. They grew to admire your courage and generosity all the more because of them, and won’t be afraid to face the diminished you.

You took terrifying leaps of fun and adventure. You drift away from full physical strength, and toward death with a heap of memories; and no regrets about forgetting to stray from the American dream, and the Protestant work ethic in favor of a day at the park, or a journey abroad, or deeps acts of charity.

You tended to your body. At this point, how little or much your thighs jiggled in youth won't matter. This isn’t about bringing sexy back. Rather, about priming your body for the years when other bodies bear the burden of moving you, and supporting you. You’ll live longer, and enjoy the waning years more with moderate attention to tune ups.

Modern medicine gives us so many extra years, but we forgot to prepare along the way for what comes at the end. The grace, courage, and love you infuse into your world now, will follow you all the days of your life.

"I want to go home. It's so very cold here."

Yesterday, a patient, shaking, naked, and bereft of the control over his body that he's had since toddler years told me, "I want to be normal. I want to be me again. I want to go home. It's so very cold here." The extent of conversation he'd had to that point was caregivers instructing him to get back in his bed, because he's too weak to be up. We are right.

And wrong.

Right to recognize the limitation of his body, when his mind can't. Wrong to not explore the capacity of his mind and body. Wrong to not fight for a more humane approach to his health, lack of health, and inevitable death.

Last week, in a similar situation, I asked an oncologist why we weren't having a conversation with the family about hospice. He replied, "I'm not ready to write him off yet." In fairness, this is a very compassionate doctor. I looked him in the eye and said, "I'm not writing him off either. I'm facing all the potential directions his illness can go, and wanting to keep an open mind to all the possibilities for how we treat him. He will die. How will we treat him until he does?" An hour later, the family came to me in tears - adjusting to the conversation the physician decided to have with them, and determined to bring meaning and comfort to whatever days they had with their dear one.

We stand over our patients, literally and figuratively. We address them with the same tone we do our children. Dismissive. Concerned. Coaxing them back into clothes, into bed, into the masks and tubes and lines they "need" to maintain the numbers we want to see from them. We neglect to find the strength in their weaknesses.

I crouched below this fellow human, and told him, "you're so very sick. And, you're in the hospital. Please tell me what you want." He looked into my eyes, and expressed the thoughts above. He talked to me of his "most wonderful wife."
When I swung into his room, just ten minutes before, trying to catch him from falling, and simultaneously direct his body back into the bed, he struck out with his hands and arms. Disoriented. Disrupted.

There's something here, on a grand scale about how we treat all humans. How we let every person maximize what they have. How we sit in silence, waiting for someone to reveal their pain, their wants, their needs.

There's also something very direct here. Talk to your loves. Learn what they want in the waning years. Tell them what makes life so livable and meaningful for you.

As for me: don't chase the numbers. Keep me close to the lives that bring me purpose and joy. Love me with presence, not interventions. And, listen to me. Ask me questions, and wait long enough for a disorganized mind to gather a response. That's living, now, and always, for me.

Hello you. You're lovely.

This is the fifth and final part in a series on self-care for care-givers. Physicians, nurses, mommas, pastors, teachers and unsung care-givers of every stripe I hope you find something restorative here. Post 1, Caregiver, Love Thyself, Post 2, Thick Line in the Sand, Part 1, Post 3, Thick Line in the Sand, Part 2, Post 4, But...The Lord Told Me To, Post 5, Tapped Out.

As we wrap up this series, I want to pose a few questions all caregivers need to face. The answers to these questions help you know/see yourself more fully, and that makes your work most meaningful and fulfilling.

Question 1: Why do I want to be a _________?
Knowing why you're a caregiver is critical to how you do that work. In counseling school they made us write out our answer to "why do you want to be a counselor." I think every caregiving profession should make this a requisite. The truth is, an honest assessment of yourself will reveal some altruistic motives, and some deep personal needs. You need to know both. Unacknowledged needs drive us. They take over our actions. It's no crime. It's entirely human to be helping others for personal reasons. However, when we have no way of owning that truth, and understanding those motivators, they undermine us and put an unfair pressure on the recipient of our care to perform in ways they can't know, and we may not even be able to articulate.

Owning the truth of our needs helps us put an emotional check in place when we see ourselves place those demands on others. All of us have places that need healing. Sometimes we use our work to keep from confronting that pain.  

Tapped Out -- Compassion Fatigue

This post is the fourth part in a series on self-care for care-givers. Physicians, nurses, mommas, pastors, teachers and unsung care-givers of every stripe I hope you find something restorative here. Post 1, Caregiver, Love Thyself, Post 2, Thick Line in the Sand, Part 1, Post 3, Thick Line in the Sand, Part 2, Post 4, But...The Lord Told Me To.


This post most closely fits those of you working in caregiving fields. Any work placing you frequently in the middle of others' traumas and problems puts you at risk for something called Compassion Fatigue (CF). Essentially, compassion fatigue is the caregiver's version of burn out. While many caring for children or aging parents experience elements of exhaustion related to that work, this syndrome particularly strikes caregivers who repeatedly encounter others, often at the hardest moments of their lives. Nurses, physicians, pastors & chaplains, counselors, I hope to reach you.

A story
I drove up on a fatal accident this Labor Day. Medical help not yet arrived, I jumped out of the car and approached a red Honda in the center of the road. The man inside needed no medical help. He was dead. I panned the four corners of the intersection, each littered with bystanders, looking for victims. The man's wife was covered in blood, crying in the grass. A quick assessment showed she had no external injuries. The blood was his. She called out for him. I could do absolutely nothing but crawl behind her on the hillside, hold her, and whisper things I don't remember in her ear. When medical services arrived, they took the same path as me. By the car -- help not possible; see bloody victim, approach. And then, as she screamed and cried out information about herself and her fears they yelled, "Ma'am, I need you to calm down." Over and over with this asinine phrase.

I understand the need in chaotic situations to create a presence of assuredness and authority. But this medical professional's response to the tragedy did not create calm. She exuded a detachment beyond that needed to perform her job safely. She demonstrated a need to protect herself from the gory mess on that roadside.

My guess is, she's encountered lots of tragedies that confront her with the fragility and mortality of our species, and the depth of our capacity to ache and grieve. She entered the medical field ready to pour compassion into these circumstances, and having poured it all out long ago, is now going through the motions of a job.

But... The Lord Told Me To

This post is the third in a series on self-care for care-givers. Physicians, nurses, mommas, pastors, teachers and unsung care-givers of every stripe I hope you find something restorative here. Post 1, Caregiver, Love Thyself, Post 2, Thick Line in the Sand, Part 1, Post 3, Thick Line in the Sand, Part 2.
 

Ironic timing: I'm preparing a series of posts on how religion reinforces a lack of boundaries and self-care and my teenage sister sends me a meme saying: "Always remember God added another day in your life... not because you need it, but because someone else needs you."

I'm tempted to drop the mic... er... keyboard, and walk away.

This thinking typifies the unhealthy Other focus that religion can propagate. Your life isn't about you. It's about Others. Burn out for God, for The Lost, for a Dying World. Words like these make too much sense to caregivers. They fit our default position of other-centeredness, and we run with them.

Housekeeping
My only religious background is Christianity, so I'll address that perspective.  Also, I'm still a Christian. The form of that identity has changed over the years, but essentially, I believe the radical love of Jesus Christ is the greatest model and hope for humans. This post is about spiritual misguidedness and abuse, not a call to end religion.

Moving On
I experienced mishandled religion perpetuating broken boundaries and broken people in several ways. I learned a poor theology of the person that corroded my ability to see the need to care for myself. I learned to distrust pleasure and rest. I absorbed an ethos of disproportionate focus on others, among other things. I saw basic human limitations labeled as sin and "heart issues."    

Thick Line in the Sand (Part 1)

This post is the second in a series on self-care for care-givers. Physicians, nurses, mommas, pastors, teachers and unsung care-givers of every stripe, I hope you find something restorative here. Post 1, Caregiver, Love Thyself. 

The guy was dying in agony. An ill-informed physician and his lengthy drug history added up to inadequate pain medication. He'd scream and curse and spread filth everywhere. Some days his wife was sober. Some days she wove down the hall like someone slowly dodging bullets.

I became one with this family. I was the only nurse who would care for them repeatedly. Shift in, shift out. I read his wife's mood changes fairly well (although she yelled at me plenty). I spent all the patience I had at his bedside, tending the wounds he made worse.

I called to check on them after my shift, asking the current nurse about labs, or subtle changes. And nightmares -- I heard his screams in my sleep. I dreaded caring for them, and feeling guilty for that, tried harder and harder to be more and more, until his wife yelled at me for addressing her intoxication and kicked me out of the room. I realized I was in too deep and with tears streaming down my face, and great gasps for air, informed my manager I could not care for them any more.

He died several days later. I never worked far enough away to not hear his screams.

I wish I could talk to that young, passionate, and utterly broken nurse and tell her leaving this family in other hands was just that -- letting other people do their job. It wasn't a moral failing. And it was utterly brave to do something so counter to her culture.

Caregiver, Love Thyself

Self is a stranger to many people who never met a stranger in their life -- people who sense another's needs across the airport, but have no understanding of their own inner struggles.

These people are experts in the Other. They bore secrets, tended wounds, and ran to rescue starting in childhood. They gravitate toward helping professions like nursing, teaching, pastoring, counseling, mothering etc. So, obviously, I'm one of the people I'm talking about.

I coached a group of nurses on self-care yesterday. I always open the session asking "Why nursing?" so we hear why each chose this profession. Invariably, someone tells how they started caring for others as a kid. This time, to make the group aware of that common bond, I asked them to raise their hands if they had been secret-bearer, soother, bandage-applier, or other caregiver in childhood. Twenty-three nurses in the room -- 18 hands raised (mine too).

When you start doing something as early as childhood, your identity gets all wrapped up in it. Many caregivers don't know themselves without other people to care for. I didn't know who I was, because I built my identity to suit the needs of others.  It seemed natural to go into a profession where my daily work turns on expressions of compassion.

Not knowing myself, I couldn't create boundaries around my identity, capacity, and responsibilities. I never responded "no." I never turned off.

It still hurts to look back at how deeply this type of living wounded me and impacted my family. 

Hello's and Such

I guess I finally got around to making a blog. I hereby promise to be inconsistent in posting and wide-ranging in subject matter. You see, I haven't yet fully decided what I wanna be when I grow up. Let's review, shall we?

1990-something (or maybe 80-something): A young Jessica reads a book about nurses, and decides this sounds like an amazing career opportunity.

2000-She starts college to get this degree, takes a detour a couple of years in for a minor in journalism, and graduates in 2005.

2005-Registered Nurse!

2007-Decides to get a master's in counseling--graduates 2010. Detours through theology on the way. Oh, and a marriage license in 2008 (Shout out to Jason! [That's my husband...not some random guy name]).

2011-It's time for a master's in nursing. Anticipated graduation: December 2012.

That's all the boring stuff. Just mile markers. The real story hides behind. The girl who grows up desperately wanting to help people have better lives. The hope of starting a new career and finding out that the hardest thing is wanting to help people when sometimes you're just a body filling a time slot--under-resourced for the task. Oh, and sometimes people don't wanna be helped. The disillusioning experience of going to seminary, and finding out you no longer connect with the judgments or the platitudes you hear all around you.

So, currently, I specialize in pain management nursing. When I can, I do palliative care nursing. Most recently, I discovered that I am ready to try church again. Maybe. I wife. Now, I'm not great at that last bit, but it's my very favorite thing about me. Mostly 'cause my husband rocks. And, for fun, I shop in my closet, my husband's closet, and resale stores to come up with amazing outfits. Don't judge. I look at it like clothes are paint. Painters get respect for being all deep and creative. So, fashion can be too (I feel like a kid sticking their tongue out with that last bit).

So, if you drop by; hello! Welcome. You can expect to read bits of all that stuff, and whatever pops into my crazy head.

chesha 

P.S. I'm all kinds of computer illiterate, so the the first 5 or 6 dozen of these (my, I'm ambitious!) may be ugly. Sorry. This much (---).

P.P.S. I have a long standing love affair with commas, and, they, show, up, everywhere.,, Don't judge. Grammar nuts might want to avert their eyes.