I believe there is a plague that exists within healthcare, something that I would say is worse than burnout, more devastating than compassion fatigue, and more debilitating than job dissatisfaction. This plague is insidious, internal, individual and communal, and often goes unaddressed for far too long. It has affected me personally, changing the way that I view not only my job but also my own life, seeping into every arena of my mind, contaminating my ability to deal with suffering. I often hear people discussing a host of other issues as they try to determine the problems that our healthcare system faces but I don’t hear many people talking about the plague that I deal with on a daily basis. Maybe someone out there has a solution or a way to deal with it but in my nine years in nursing I have barely heard a whisper about it.
I’m writing today in hopes that I’m not the only one who has been infected.
I heard a speaker the other day talking about trauma. I was expecting the lecture to be about patient trauma, aka the trials that they encounter in life before coming to the hospital. At my facility most of the patients are disadvantaged, economically strained and have had to face dramatic challenges in life. The speaker did briefly address this topic but then she took the conversation in a direction that surprised me. She expanded the definition of “vicarious trauma” to apply to those of us who witness horrific things everyday at the bedside and then have to figure out how to structure our lives around it. Basically she asked the question that I’ve struggled with for years- how do we come back to work day after day, shift after shift, after seeing such potent suffering and death?
To put it lightly, her words struck a nerve with me. I’ve fought to put words to this concept for years now- the idea that I am forever changed because of what I’ve experienced as an ICU nurse. And I’m justified in wanting answers to these questions, of wanting to deal with this plague, because the horrors I’ve gone through are not insignificant.
I’ve watched fathers bleed to death in front of their children. I’ve seen young men become quadraplegic after hanging Christmas lights on their own suburban houses. I’ve watched young mothers hemorrhage to death after a catastrophic childbirth. I’ve held the hands of parents as they let their adult children go after they attempted to blow their heads off with firearms. I’ve seen more attempted suicides than I ever even thought possible. I’ve watched helplessly as we’ve adhered to family wishes and coded little old ladies, cracking their ribs as they flailed like ragdolls on the bed, knowing we would never get them back. And this is not specific to the intensive care unit. No matter what area of healthcare you work in everyone has a story that they would classify as “the worst thing I’ve ever heard.” I’ve seen things that I can never forget and gone through emotions that I wish did not exist.
And yet we go on because that’s what we do in healthcare. But then we’re left to figure out how to categorize and deal with these traumatic experiences on our own. We’re left to figure out our own answer to “how do I come back to work tomorrow?”
I’m not saying that facilities and organizations are not trying to help healthcare providers work through these issues. I know there are support groups and free counseling and a host of other options. But, speaking as a nurse, I also know that nurses are probably not going to be too apt to take advantage of these resources because we pride ourselves on being able to do the job with a straight face and come back the next day as if nothing had happened. We develop callouses of the heart, probably to keep up from getting infected in the first place. I know this because that is how I’ve operated for years.
So why did I start to face this plague in the first place? Because I hit a wall. The experiences I had gone through had shaped me, whether I realized it or not, and I could no longer ignore the behemoth in front of me. I had seen so many horrible things that I started to assume that everything was worst-case scenario. In my mind, nothing could ever be a minor accident, only an accident that led to death, dismemberment or paralysis. I had no middle ground anymore, no rationality, and a very-present fear of something terrible happening to me or my family. I realized I needed to deal with my issues. I also realized that I needed to find the root cause if I had any chance of coming up with a solution to my vast and overwhelming problem.
You might be thinking that I’m just one of those people who is prone to feel anxious, prone to worry. And you would be right. But you can’t attribute this entire plague to personal tendencies. I know men, women, new nurses, veteran nurses, physicians, respiratory therapists….and the list could go on. And they all have felt this way at some point. At some point everyone wonders why in the world we keep coming back to work.
So we’ve narrowed down the major question but finding an answer is a much more difficult task. How do we process these experiences in a helpful way? Do I just live in fear of something horrible happening? Do I try to rationalize my emotions and keep telling myself that I’m overreacting? Do I quit healthcare altogether?
I don’t have the answer, even after years of searching, but I can tell you what I’ve learned along the way:
The first thing I had to do was realize that the world is full of suffering and there’s no way around that. Ironically, I learned this lesson as an adult through both my own experiences and the experiences of others. Unfortunately many people learn that the world is a bad place at a very young age and they grow up with an understanding of this truth. Mine was acquired and left me feeling like I had been lied to all of my comfortable life.
Another thing I had to accept is that the world isn’t fair. I wanted life to operate in some predictable manner. For example, I adhere to the rules, I play nice, I strive for honesty and integrity and things will work out. Seems plausible, right? Only to someone who hasn’t lived in the real world. The nicest people get fatal cancer and the most horrid people in society recover without a scratch. That’s just the way it is sometimes.
So the world is full of pain and suffering and it is by no means equitable. I accept that life is fragile and I have only a miniscule amount of control over it. Well now I’m just depressed and left with a nihilistic viewpoint that robs me of any motivation.
That might be true except here’s another thing about nurses- it’s hard to keep them down. When they hear something impossible, they want to do whatever it takes to turn the situation upside down. They don’t give up. They don’t back down. Nurses are the definition of making lemonade out of lemons. Healthcare providers sacrifice their own time, their own lunchbreaks, and even their own health sometimes to make sure that others are taken care of.
If there is a plague, then there are people fighting against it. When there is trial, individuals always rise to the task. And so I decided I had to do the same. I had to find a way to fight back against the sorrow, the heartbreak, the unfairness of it all. I came to terms with these realities and then decided that my only method of fighting back was to do my job to the best of my ability and to push back the darkness one kind word or one hug or one smart clinical decision after another. I decided to face my fears, knowing that I would still be impacted by the trauma of others but that I was actually trying to turn the equation in a positive direction. What else can I do? I can’t change what has already happened to people but I can change how it goes from here.
This is my working thesis and it is still very much in progress. I don’t have the answers and I still have days when I feel an overwhelming amount of pain for the people I’ve taken care of that day. But I know I’m not the only one who has had to make a real, all-encompassing effort to deal with the things they’ve seen. We all have and we need to see the good we’re doing in the midst of all the sadness.
For every tragic story, there is a family member who leaned on you to get through it and they will never forget your kindness. For every unfair circumstance, you have made a good call that benefited your patient. For every time you’ve wanted to cry at work in the supply room, well, you’re justified in letting out that emotion. Your job is not in vain, although it seems like it sometimes. And there is a reason to come back tomorrow. The darkness is real and weighty and potent but it does not have to win.
We won’t let it.