It's 8:30, I woke up and drove to stretch class which I thought was at 8:00, turns out it's at 9:00. So here I am with this hour to relax and wait. I just finished this article written by Joan Halifax. The article puts words to a lot of my experience in my work. This in particular relates to the struggles I often have:
"(...) let us look at five core challenges that affect caregiver well-being, including burnout (cumulative work demands and stress), secondary trauma (dysfunction from prolonged exposure to the pain and suffering of others), moral distress (caregiver knows what is right to do; cannot act on it), horizontal hostility (behavior that controls, devalues, disrespects, or diminishes another peer or group), and structural violence (systemic discrimination against an individual or group).
In the case of those who work with the dying, these five core challenges are compounded by the possible denial of death; the angst around pain, suffering, and death; the inability to discuss interventions and death; the inability to communicate about stresses in caregiving; workaholism, self-neglect, and perfectionism; guilt for avoiding or abandoning the dying individual; engaging in negative cognitive appraisal; and moral conflicts and distress. Caregivers also can experience a sense of futility that arises from patient demands, institutional demands, clinical errors, feelings of inadequacy, and interventions not benefiting patients."
YES! These are my very own wounds she is talking about! "The angst around pain, suffering, and death" (particularly by family members of the dying patient.) "Self neglect, perfectionism" "clinical errors, feelings of inadequacy, and interventions not benefiting patients" Yep, yep and more yep. These have been the hardest parts of nursing for me all the way along! I can't believe how much this article speaks to my experience and also offers an antidote to the pain, basically spiritual practice, we'll get to that part later on.
Then later in the article:
"In Buddhism, there are so-called near and far enemies of compassion. The far enemy is cruelty. This enemy is easy to detect. But the near enemies of compassion are often difficult to recognize. They include fear, grief, pity, anxiety, and righteous anger, all expressions of personal distress. The so-called ‘‘near enemies’’ can drain or destroy us. Thus, we must look truthfully at our own experience and see if our response to suffering is healthy; we then evaluate our choice in how we are responding and let go of blame and judgment" Joan Halifax, PhD.
I see myself here in my desire to alleviate suffering, I get caught in these feelings, particularly guilt and righteous anger. When I see poor care in facilities or group homes, I am sometimes overwhelmed to the point of paralysis or worse yet, responding with anger in ways that might not ultimately serve the patient. On good days I can watch these feelings rise and fall and not get swept away by them. I can listen inside myself and then do what needs to be done to serve and protect my patients. But there are also times when I am struck by others' apathy and cruelty, and my old riot grrl flames get fanned and I seriously want to fight it out. Now the triggers are not gender inequality but a different inequality that is new to me since entering the nursing profession.
Man, there sure is a lot to be pissed about. I try every day to be mindful, to take it slow enough to act out of love, not anger or fear, and it is so damn hard. I try to remember that there will always be a zillion things to be pissed about and that it is my choice to do what I can to make the journey a little gentler and that is best done with gentleness. It is also my choice to focus on the inequality or keep my eyes on what can be done about it, specifically what I can do about it. Also there is a treasure trove of deep meaning to be found here as well and it is up to me to savor the sweetness and try to not hold on to the painful aspects.
Joan Halifax is a Zen teacher, writer and anthropologist, who for many years has been teaching healthcare professionals to care for the dying and at the same time care for themselves on a spiritual level. Every year she and a few doctors, nurses, and others in related work come together to teach an eight day course on this subject at the Upaya Zen Center in Santa Fe, New Mexico. My hope is to attend the program in 2013. She also wrote a really good book called Being With Dying that's well worth reading. Here is a link to the training I would like to do next year: http://www.upaya.org/bwd/programs.php.
So would a richer spiritual life really help me to take better care of my patients and myself? I wonder. Actually, I wonder this all the time. All spring I meditated every day and it frequently felt like I was hitting my head against a wall. For awhile I sat trying to focus on my breathing. I also spent a lot of time practicing both metta and tonglen (For more info on these practices, read Loving Kindness by Sharon Salzberg and The Places that Scare You by Pema Chodron.) I found that practicing metta/lovingkindness meditation is easiest when I am running. I repeat the phrases over and over in my head: May all beings be happy, may all beings be safe, may all beings be healthy, may all beings be peaceful, may all beings be free from suffering. It was easier to stay focused running than while I was sitting, maybe because running is such hard work in itself? Tonglen is easier for me to focus on while sitting because I was using my imagination visualizing peace/happiness/etc for all beings (including YOU!)
Every day I make an effort to be mindful in the big and little moments, the flavor of tea, the softness of Clover's ears, holding hands with my patients, laughing with my friends, and while listening. At the same time it's really difficult not to get swept up into rushing and stress. It's hard to savor each moment when I have eight hours to get the job done and I really need ten or eleven. I don't want to miss out on anything yet it takes monumental effort to slow down and catch my breath. I guess this gets back to the article when it talks about perfectionism being problematic. I have a very high standard for the care I provide and that can be so time consuming. I want every patient interaction to not only meet their medical needs but also leave them feeling cared for and really SEEN. I want the patients' families to have as much support as I can possibly provide them, even though in the end I know that so much of our suffering must be done alone.
Okay, it's afternoon now. Stretch class was lovely. I really want to get back to reading other Joan Halifax articles and maybe start reading a novel, so I'll end here. May you be happy.
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