It drives me crazy sometimes that I really don’t have control over anything.
I see this everyday as a nurse and it often makes me feel powerless. I can hang all the antibiotics in the world but I cannot cure someone of ARDS. I can hope that this patient doesn’t have to go back for more surgeries but nobody, not even the surgeon, can say 100% that it won’t happen. One inch to the right and the bullet would’ve killed him. One inch to the left and he would’ve lived. I can do everything in my power to help save someone and they can still not make it. I can tell a patient a million times over to limit alcohol consumption but they can refuse. And then they could die in a week or live to be ninety, who knows? For all the miraculous interventions that we’ve come up with in medicine, many, many aspects are still out of our control. And while we all intuitively know this, we ignore it most of the time. We want to be the masters of our own fates, and our patient’s fates as well.
The randomness can be terrifying, the fact that we have no control over the majority of things that happen. This man was just walking down the street and someone shot him. This lady was minding her own business and someone stabbed her. This child was living a healthy life and now has cancer. This can breed fear like wildfire in your life if you let it, if you don’t find some way to combat these thoughts. You have to find a balance, the line between defiance and acceptance. Resignation and initiative.
I’ve recently gotten a taste of this lack of control in my own life. A week before Christmas my NP preceptor for January informed me that she was leaving her practice and basically wished me luck in finding a new one. Being only a few weeks before the start of my semester, you can imagine how I felt about this news. I threw a big fit (not to her), if I’m being honest. So now I’m going to have to defer the start of my semester and I’m scrambling to find a new preceptor on such short notice. It’s frustrating and discouraging and I hate that there’s a big hole in my perfect plan now.
I have absolutely no control over the fact that my preceptor decided to leave me with no options. I can’t fix the fact that I have to wait six more weeks to start my clinical semester. I can blame everybody and everything in the world but that won’t change the outcome. It’s out of my hands. But as maddening as that is, I’m starting to accept that this is how life works. Plans don’t work out. People get unexpectedly sick or laid off. Storms hit and car wrecks happen and pregnancies don’t make it. This is the reason why hospitals exist! I can fight against this and I often do, but it’s futile. I exert very little control over anything in life and yet I still try very hard.
To be fair, sometimes the uncontrollable turns out to be good news. A positive pregnancy test or an unexpected promotion or an accident that turned out to be a fender-bender when it should’ve been worse. Just as many bad things are out of our control, many good things are too. And there’s hope in that. Without that juxtaposition, I think we’d all give up and live meaningless lives. This is the reason why we hope for remissions and good lab results and why people work in labor and delivery. Sometimes life unexpectedly throws you something joyful.
There are a million insidious questions that I believe every healthcare provider has to face at some point. Questions like: Why do bad things happen? Why did this person die and not this one? Why is everything so out of our hands? How much impact can we really make as healthcare professionals? How much should I push and how much should I leave it be?
Obviously we believe that our words and actions carry some weight otherwise we wouldn’t show up for work in the morning. I can’t make someone get a screening colonoscopy or a mammogram but I can inform them of the benefits and risks, try to convince them that it would be good for their health. I can rejoice when someone decides to quit smoking at my advice. But sometimes I will also have to lament when someone refuses to take their insulin and ends up with an amputation, despite my admonitions. I will never give up advocating for wise choices because it’s not all up to genes or luck. We are still responsible, while not being in full control. We have to become comfortable with this oxymoron, as frustrating as it is.
Control will often fail us for another reason. People are allowed to make their own choices, even bad ones. They’re allowed to sign out AMA and ignore medical advice. They’re entitled to refuse that surgery or to keep doing IV drugs. They don’t have to listen to and follow your advice. People are not black and white and neither are their motives, choices and responses. You can’t control the heart and as healthcare providers, that should never be our aim, even when you see the train coming full speed down the tracks for someone.
For me, it comes down to humility. I have to accept that many things are out of my control. I don’t control the universe. I don’t control my patients. I can’t control many aspects in my own life! I can kick and scream about all of it or I can resign myself to do the best that I can- promoting smoking cessation and praying for that sick ICU patient and hoping for a good outcome. But then I have to leave it. I can’t live my life in paralyzing fear of the unknown but I also can’t think that I can control every outcome.
The only thing I can do is decide not to carry that weight on my shoulders.
I don’t know the answers to the questions. I don’t know why this person was allowed to live and this person’s life was cut short. I will never know why this person smoked for forty years and never got cancer while this child died of leukemia at two years-old. I don’t know the answers, but I think it’s still worth struggling with the questions. Even if we don’t find answers, we find out something about ourselves. We discover why we get out of bed at the crack of dawn and go to work day after day. We remember why we spend hours in surgery. We realize why we always, without fail, mention smoking cessation at every visit. We don’t limit our tears when someone close passes away. We learn to embrace everything that comes, in full measure, the whole spectrum.
We learn to live in an unpredictable world- to rejoice over the good and mourn over the bad and appreciate what is in front of us. We learn to embrace both joy and pain, exaltation along with sorrow. We learn what it means to live openly and humbly. We learn not to fear tomorrow no matter what it holds. We learn how to truly love, even with no guarantees.
We learn what it means to be human, the full messy whole of it.
And that is the best thing we can do for our patients, and ourselves.