Recently a Facebook friend asked me how I manage to avoid burnout in nursing, and how is it that I am able to say "I love all my patients, even the ones I can't stand."
An interesting thing happened the day I was planning to write this: I got sick. I live alone. I am often reminded I am a senior citizen, to which of course I reply with a crotch-grab, "I got your senior citizen right here." It is not denial. It is a Dorian Gray thing, I suspect. At any rate, getting sick while living alone delayed my writing, but it also put a finer point on the issue of the questions. I'm glad I live alone when something like that happens. My house is a shambles after 36 hours of chills, fever, nausea, splitting headaches, etc. Yeah, a "man cold." I'm glad there was no one here to pick up after me. That would be more than wrong.
In the morning I will rent a bulldozer.
But I digress: The burnout factor is something I live with and have lived with ever since this second career found its roots in my 30 years of fire/EMS service, when I saw the same thing happen to, first, "aid men," then ambulance corpsmen, and finally EMTs and paramedics. A lot of them, like a lot of nurses, seem to go cold after a while, to just be going through the motions, or worse, to resent the very people for whom they are caring.
I am reminded of the night a car came screeching up onto the apron of my fire station. A young woman in the passenger seat was gasping desprately for air, doing what we call "posturing", screaming and sobbing that she couldn't breathe. A classic first panic attack. Our ambulance, as it often was then, was out of service again, so we called for a medic unit since it was technically a "trouble breathing." I began talking to the young woman, talking her down (I've done this countless times, and they first look at me like I'm insane, but eventually they catch on and start to calm down). Medic unit arrives, paramedic goes to patient side of car, recognizes what's going on, and begins to berate and shame the patient for being "hysterical." I tapped him on the arm, nodded for him to follow me to the other side of the medic unit (where I'm sure he thought I would tell him this was a frequent flyer), grabbed him, slammed him against the ambulance, and said "Motherfucker, you're at my house now, and if you ever speak to one of may patients that way again you will be getting flown to the trauma center."
Which one of us was burned out?
But again, it is digression, because what really guides me now, even with all those years of preparation, all that time regarding those patients as "mine" as in "my sister," or "my mother," etc., I wind up working at a hospital that contains the Gladys Spellman Specialty Care Unit. This is a very large wing with 90% of the patients on ventilators, either hopelessly mired in end-of-life issues or having sustained permanent brain damage. Sometimes it's someone from a nursing home who caught pneumonia and is now living in an unattractive sort of mechanical homeostasis.
I am a critical care technician. My home base is intermediate medical care (IMC), the best place probably to work in my hospital (yes, I am aware I speak of all these things in possessive terms. That is not an accident), though I really prefer the ER. But I have a sweet deal here as a PRN ("as needed" or per diem) worker; I make my own schedule. The quid pro quo is I don't know what unit I'll be working on a given day. And at least once a month all us PRNers have to do a turn in the Spellman unit. It is the name of that unit that makes my approach to caregiving the opposite of burnout. I've said, and I believe, I couldn't do that every day. But when it's time, I go and do it anyway, and I love those patients too, who cannot speak to me, at least verbally, or who may even lack awareness. Hope does spring eternal. Sometimes it pays off, too. Statistically not very often, but they are still people, people lying in their own waste, people sometimes physically falling apart, bedsores, sloughing skin, unseeing eyes - or as often those eyes that see in such a panetrating way that I am locked into them, and we converse in a way that defies words, just as the suffering of being trapped inside one's body must be the most horrific sort of nightmare, and yet I can come and join them in the experience for a while, and I do. I don't look away, I look in. This prevents burnout. The conventional wisdom is "don't get emotionally involved." My acquired wisdom is that the only way to avoid burnout is to join your patient, no matter what's going on, whether he or she in in a hospial bed, ER cubicle, lying on a sidewalk, trapped in a wrecked car, at the t0p of an antenna tower...
Or a politician working the crowd at the mall here in Laurel in 1980. Gladys Noon Spellman was one of the most loved, respected and accomplished Democratic Senators ever. She was talking with constituents, hugging people, shaking hands, making the rounds, one of those typical political moments, when the Sword of Damocles fell and her heart stopped beating. No reason. She just hit the floor.
The local rescue squad arrived, performed CPR, delivered her to what is now "my" hospital, but while her heart resumed beating, her brain did not wake up. She was transferred to the flagship hospital of the county system, back in the town where she'd lived, raised a family, taught in the local elementary school, become an advocate for educators and education, ran successfully for the County Council, was appointed by President Lyndon Johnson to the Advisory Committee on Intergovernmental Relations in 1967 and was awarded the highest honor that could be bestowed by county officials nationwide when she became the first woman elected president of the National Association of Counties in 1972.
Former Happy Acres Elementary school, where Ms. Spellman taught.
When it became clear Ms. Spellman was unlikely to come out of her coma, other patients with similar problems were placed in the same area. Gladys Spellman died eight years after that ordinary night in 1980. By then a unit had formally been created at the big hospital to care for people who, for the most part, weren't going to come back, who were stuck in limbo. Steny Hoyer won Ms. Spellman's seat when it was finally declared vacant in 1981. Two years ago the unit was moved to my hospital, because there was an underused wing.
Gladys Spellman was just an ordinary person who did extraordinary things. She walked among us, she fell among us, she was rescued - or perhaps not - by fire-EMS personnel on the floor of the now-moribund Laurel Mall, she was treated in the intensive care unit of the big hospital, and now the unit is at my hospital and that wing of the 4th floor bears her name.
It also bears her legacy. Every one of those people, in fact every person who comes through the doors, usually beginning with the ER, is an ordinary person with a story. Most of them get better and go home. Some do not. Some linger for months or years. Even those who go back where they came from are sometimes bitter. Wouldn't you be if you were 80, as a recent patient of mine, and knew when you were well enough you'd be returned to the nursing home you'd been living in prior to the hospital's god-awful atmosphere? (And I say that having spent some time in hospital beds as a patient - it is not the greatest place for a sick person to be). This gentleman was difficult. None of the med-surg staff (where I wind up more than half the time normally because of a shortage of help) liked him. He was very insistent about one thing in particular: that his door be open far enough to allow air to circulate (the 4th floor is hot year 'round. I do not know why) but closed enough that he could sit on the edge of his bed and use the urinal without being exposed to passers-by. He had, in his mind, the perfect alignment of that door, and he had been cursing people for several days for not placing it just so.
I also once failed to get it right, and he yelled at me and cursed me. I apologized, moved it slowly, saying "Tell me when it's right, okay?" which he did. A while later I came back and he was sitting on the edge of his bed. He said "I'm sorry I cussed you" in a very contrite tone. I told him it was okay, I understood. He raised his voice then, saying "No it isn't! It's not okay! I was wrong. Don't tell me it's okay. I know better than to act that way!' I stood, silent, for a moment, thinking what, if anything, might be the right thing to say.
"I'm sorry," he said again, in a soft voice.
"Thank you, sir. Apology accepted."
Then one of those things happened that I cannot explain and almost never mention to anyone: I felt something; a physical touch on my shoulder, and a sense of voice where there was no audible voice, saying "We get a little testy sometimes."
I knew that touch from more than 30 years ago. I knew that voice that only existed inside my head.
Ordinary men and women, every one. From the crazy drunk to the drug seeker to the needy and demanding sickle cell crisis patient, to the frightened one with chest pains who is feeling that sense of imminent doom, to the panicky patient who will be talked down eventually, to incredibly demanding to those who seem to have given up and those beyond having given up. On giving report to my relief at midnight in the Spellman unit: "Everybody alive and breathing? Good."
They are all mine when I am there, and Gladys Spellman walks those halls with me, and in the words of Dan Fogelberg, "Death is there to keep us honest and to constantly remind us we are free."