A Spirit of Compassion

If you ask my friends to describe me they would not use words like "less than pleasant", "sour", a "drill sergeant", "mean", or an expletive of choice. Amazing how in twelve hours at work I can be called all of these on any given day by patients. The verbal abuse that takes place from patients towards nurses on a daily basis is incredible and unacceptable. When you walk in to an ER you are asking providers to take care of an emergent medical condition and assist in your healing. The providers and nurses don't go in to healthcare to make people miserable, rather to make a difference and help others on a day to day basis. It is rewarding to soothe one's pain, hold his or her hand, and be present in difficult times of life. No one comes to work looking to pick a fight or make someone's life miserable.

Today I left feeling a little defeated for no good reason. I enjoy my  role in leadership, and one of my jobs in this role is to deescalate difficult patients and enforce boundaries that are made to keep staff safe and keep the department running. It's hard to enter an argument seeing in the patient's eyes you will not win, and they will do everything in their power to emotionally break you in the process. Reasonable people can be reasoned with and a compromise can typically be reached. Mentally unwell patients do not have this ability. It's like trying to reason with a drunk person...you can't. There is no capacity for reason. Therefore, no matter how hard I tried, I managed to anger two patients in one shift. One wanted to sleep all morning and was refusing to leave while the other prolonged a workup from 30 minutes to four hours by falling asleep, demanding a hot meal, and refusing to provide a urine sample in hopes of spending the night. The first was in tears and told me I was rude and inconsiderate for making her leave after she had been cleared and discharged thirty minutes prior. She avoided eye contact, teared up, and passive-aggressively fired back comments about how she didn't feel cared for. I knew she would not be satisfied even though I tried for 15 minutes to re-explain her situation, medications, and how there was nothing more the ER could do for her at that time. I'm sure she felt alone and just wanted to feel secure in one aspect of her life. She accused me of being mean and basically heartless. I wished there was something more that could have been done to ease her mind and her pain, but there was no medical reason to keep her in the ER and she had all the tools she needed to be comfortable at home.

The other patient was flat out mean. He was prolonging his stay on purpose, manipulating staff to see how much food he could gather, and then yelled and threatened when he realized he was not able to board in the ER overnight. I went in to set boundaries and lay out a time frame for discharge to stop his abuse of the system and of staff. Recognizing this, the patient became even more upset. He yelled, tried to leave, and then was finally escorted out by security for his aggression towards staff, but not before he chose to leave the urine sample, which he swore he couldn't give, all over his room floor.

I asked for a coworker to walk to my car with me that evening actually fearful of what he might do if I ran in to him on my way to my car. I should not be afraid after work, nor should I feel defeated. I knew there was nothing I could have done different to make those patients happy, but it made me sad that they felt the need to take out their aggression on people who were simply trying to help. I wish I could let every homeless person sleep and have shelter each day, but this is not an appropriate use of the ER, and without boundaries we would have no rooms for the critical patients we need to treat.

I can't imagine what it's like to feel like your mind is overwhelmed by something else. I can't imagine what it's like to not know where you're going to sleep each night. My heart hurts for these people, but that doesn't give them the right to take out their anger on me. It is exhausting to be verbally shot down throughout the day and to encounter someone who refuses to acknowledge that you genuinely care. This is balanced by those who are appreciative and those who recognize that you are doing your best to help them feel better, but some days those tough cases overwhelm the compassion you are trying to give.  

So I go home, breathe, and wake up with tomorrow as a new day. I will remember that these people are not in a place to be kind. They don't have the capacity to see beyond themselves. This doesn't make it right, but it is the reality of broken people and a broken mental health system. I challenge myself each day to find the good in these people, to grant them every compassion possible, and to walk away knowing I will not win every battle, but in the process will be kind. There is no patient that should walk away with the victory of breaking my spirit of compassion.

Resolving to Care

I started off my New Year at work determined to start new habits. The glorious New Year's resolution plan. I even made a poster to encourage the thought process of self care as a goal for a resolution. What did I do today? Naturally didn't follow through with the promises I had made to myself, and they were little things like to put something in my mouth as a snack at least every three hours and fill up/drink my water bottle just as often. Self care is a hard concept to grasp and be okay with in a profession that specializes in putting others first. In my current state it carries much more weight when I realize I am not just caring for myself, but also the little human I am growing inside me. Then it feels selfish to not practice good habits. 

But why does it take having a baby to influence how I care for myself? I should be prioritizing basic human needs like food and water and bathroom breaks on the regular, and as nurses I think these little things are the first to give when we are focused on caring for everything our patient's need all day long. I'm not talking about long breaks, just simply the respect to myself to prioritize those needs as I prioritize everything else in a shift. 

"You can't care for others well until you have taken time to care for yourself". There is so much truth to the wise words of my mother. As long as no one is actively dying, taking 5 minutes to eat a snack to avoid being hangry is in my best interest in addition to the interest of those around me. Even such small acts of self care take practice. It's not something one can be good at unless you practice it regularly. It's like working out. You don't stay in good shape unless you keep up with your weekly regiment...and we all know the crazy crowds at the gym die down by the end of January when the New Year's pledge of consistent workouts tends to wear off...

So how do I resolve to care for myself? This year I resolve to listen to my body, to acknowledge how I'm feeling physically and mentally and process my days and learn from them. This is packing snacks so I don't hit a "hangry"low and take it out on those around me. This is checking in with myself and acknowledging my feelings so my emotional well-being is also assessed. This is acknowledging the feelings and basic needs of those around me and encouraging my coworkers to also advocate for themselves. 

I resolve to prioritize my health as part of a daily practice that strives for resilience. I resolve to care for myself so I that I know when I have hit my limits and can then take a step back and catch fatigue and burnout before they take over. I resolve to smile and take each day one at a time. I resolve to reconnect to my purpose and remember why I nurse and remember the privilege it is to care for those around me. 

I will not be perfect, but this year I resolve to continually strive for these things. Here's to a resilient year.