The Future of Caring

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How we care for ourselves in our practice
reflects upon how we care for our patients.

 

In the field of healthcare I have always been transfixed with our process of learning in clinical patient care settings. Fresh out of school, hands on, here you go! You are on your own! A fresh caregiver thrown to the wolves and we know there will be two possible outcomes. They will quickly learn how to use their resources, reflect on mistakes, debrief with co-workers to adapt and succeed just enough to propel them forward. Or, they will make mistakes that are incredibly stressful and discouraging, flounder in their ability to redirect critical thinking concepts, feel incredible responsibility for their actions and shut-down emotionally due to shame and fear. Fly or fall. Trial by fire. The attempted creation of one who must care often performed by those who do not have enough experience to support them or have lost connection with our current system.

Stress can create the opportunity for an incredible mirror, but here’s the key part…we cannot learn about that which we have accommodated to. There is no perspective for reflection. There is no outside opinion to create dialogue. There is no vision for improvement, only a drive to continue on as we are, surviving. We do the work and walk away at the end of the day. Defend ourselves with a wall between our patients and us in order to cover our fears. When we are in the thick of the work of daily life, we do not allow time to review each moment in our practice to learn about ourselves, how we relate and how we can grow.

Current caring culture often potentiates failure, exhaustion and attrition. We are slammed from the moment we show up. Pulled into documentation and process and policy, we strain to ensure our patients feel cared for. Attempts to make healthcare safe and consistent while reducing liability must be balanced with the art of caring both physically and emotionally for our patients. All the while we must be looking ahead in time, critically examining the possible outcomes of our actions. A healthcare system in which care is provided reactively finds parallel in the way its workforce is trained. Prevention needs to override as the dominant message in our field. Prevention of disease and prevention of mental illness for those we care for but also prevention of trauma, despair and loss of our workforce among those who are doing the caring.

If you are lucky, as a new clinical practitioner you may be given a mentor, with whom you may strike a relationship that feels safe to discuss your work. This allows decompression, emotional release and growth in practice. However, few are are afforded this luxury. If you have excellent leadership, you have frequent opportunity to practice and reflect,  continuously debriefing, evolving your practice and establishing new professional goals. We have excellent evidence in health care now to support debriefing after intense or stressful patient care events. The benefits of learning and improvements in care practices are irrefutable. Now, we just have to figure out how to incorporate debriefing discussions into our daily care, consistently and with priority as the practice requires global commitment throughout an organization.

As we care for ourselves as ‘grown’ or established practitioners, we will model behaviours of holistic healthcare throughout public healthcare systems for practitioners in training, for fresh graduates and for our patients. We must walk the walk: performing, examining, discussing, relating, planning and repeating. Healthy cycles of health care that are connected and creative in order to provide solutions to ever changing human populations, their needs and their goals. Fly or fall is no longer sustainable when the majority are falling. Our success will rely on those who bravely come forward to support, empower and continuously reflect on their own progress as leaders and teachers; Those that understand that how we care for our caring workforce is paramount to the future of caring.

-CB

Deconstructing fear

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Deconstructing fear

mlk-fear-quoteIt has been exactly one year and 12 days since my very first (and only) ever anxiety attack. There it is. Out there. Yep. I lost it, big time! You may judge away, but there is something big to be gained by the universe slapping its hand across your cheek so profoundly saying “Snap the F*%k out of it! This is not where you need to be.” Yet now, even 377 days into the recovery of my body and mind, I am left with the sense that once you cross the line of exposing your body to extreme stress, it is very, very difficult to get yourself entirely back across again.

It was awesome (powerful awesome, not good-time awesome). I recall gasping like a fish out of water with no ability to take a full, deep tidal breath. I know breathing. It’s my career. This was overpowering and all-consuming with cardiac impact and a sweet shot of adrenalin to shake me through the aftermath. My dear colleague talked me through it, asking if we needed to walk the 50 metres down the hallway to the ER. I refused to be seen by co-workers in a state of complete lack of control. I remember a dear voice across the room saying out loud “Christy, this is insane. You need to walk away from this.” Sometimes, the challenge is not the work in front of us, but in the walking away and letting go. Seated on a comfy, reflective couch 2 months later I found the causation explanation I was so desperate for. Sometimes our deepest fears pop up like whack -a-moles in our daily lives. The foundation of our coping is shattered by a side-impact, unexpected.

But this story is not about cause, it is about affect…because that is how I am left. Affected. Where I once felt great satisfaction in accomplishing multiple tasks on a busy afternoon between racing to taxi around small family members, I am now unexpectedly left fluttering, nauseous and distracted. There is a new baseline. A new me. More reflective yet more fragile. More wise, yet more wary. There is no way of going back.

Involuntary change is challenging regardless of the intensity and impact to our lives. Change casts the shadow of our underlying fears. Fear of loss, fear of failure, fear of being unworthy. So much fear underlying so many of our everyday actions and always, always hidden in our words. There are so many things to be afraid of and we learn of many of them very young. Born bold, resilient and spontaneous, we learn hesitation, humiliation and loss as they pound us and shape our bodies into our adult forms. What we may not fully realize is that these sculptures of self are still pliable after all these long years. Call it personal growth, call it neuroplasticity, call it a mid-life crisis if you will. We know that there is more to do and more to be because we feel in our core that glimmer of radiant light that is wonder. We remember bold. We remember feeling so light and unencumbered.

My steel tight grasp on my path through life has been wrenched free, leaving a void where there was once surety. I have a new normal and weave this into my family’s everyday lives as best I can with the skills of grounding, calm, meditation, and self-preservation. Some days, that is enough. This week, I struggle to breathe…to cope and move forward without collapsing into a teary mess.  I continue to unearth and deconstruct my fears as I struggle to accept that there really is no version of me that I will get back. There is only the me that I will become.

CB

Snow and ice

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I have been so intensely disappointed with how we live our daily lives lately. Likely potentiated by Christmas, a season I used to revel in for its abundance and over-the-top attempts at spreading love and cheer. We never really accomplish this en masse. The experience always falls short of my expectations. I walk around this year feeling slightly numb. Observing toys and gifts and junk and stuff and plastic and I feel almost sick. I don’t want any of it. I want it to go away. Where there always had been snow for me at Christmas, now there is only ice.

The challenge to growth and change comes when you are faced with beating familiar habit back with a bat. Hand to hand combat with who I think I should be. How I should interact with the world around me. How I should work. How I should play. How I should exist. This last year has brought many internal battles, some lost in shock and others won in the throes of sobs of understanding. I find myself conflicted in feeling both release for shirking old weighted expectations and loss for what is familiar and gratifying. How do I reshape what I know, who I am and be content? The puzzle pieces fit together, yet the picture doesn’t make any sense.

I have a different yearning this winter season for revelation and simplicity. For purity and clean. My heart feels a bit broken and no one seems to have the right glue stocked on their shelves. I’m superficially hoping this could just be some form of seasonal affective disorder. SAD would be fitting… the rain in Vancouver has been oppressive this year. Yet this haunting feeling resounds deeper than that and I will need to dig deep and wide to find a way out. Feathers need to be rustled, boundaries need to be broken and I will have to force the solution into existence.

It’s so easy just to expect the world to change around us. So careless. So childish. I am tired of hate. I am tired of apathy. I am so very exhausted by greed.

I need more to sustain me. It all just feels like total bullshit and I see right through it this year. Throw some more glitter and varnish on it if you like, it will be all in vain. I’m not buying.

So, if anyone has any ideas, I am all ears. My feelers are out, I am on the lookout for love. I am frantic for some shred of hope because I decided to have children and I am desperate for a way to look them in the eyes and say “This is a good place and I am proud to show you around.” and do so with sincerity. For the joy and love in their hearts is still bright. Their eyes glimmering as if they play out their days inside a glittering snow globe. Floating. Light, soft and pure.

CB

Picking up the Pieces

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Sometimes, you just aren’t ready for the lessons that life has in store for you. Head down, focused on your daily struggles or eyes focused on a prize that is not meant for you…and BAM! The universe reveals itself, huge palm to your face, and says “Hello there Blondie, don’t go this way! ” My lesson came swift and smothering, like a slap and then a pillow to the face. No time to scream, kick or flail. Inner trauma requiring a complete halt of everything I knew to be me. This lesson will change my life course dramatically. But isn’t that what lessons are about? Isn’t that why we are here? To experience pain, joy, love, fear and discover, through these events, who we are at our core. To reveal our essence. To break and then re-build, with love.

I am a health care worker, to be specific, a Respiratory Therapist. Or, at least I thought that was who I was. My work had become my identity, the vibrance and force behind my vitality. Then, for reasons I cannot disclose, my work was taken away from me.  My sustenance withdrawn, a struggle ensued. It was messy, it was exhausting. Mud flew and I fell to my knees in exhaustion. I believe that I only survived because of my support system and because I found an amazing guide to help me make sense of this unfairness, this trauma, this… lesson. My guide broke me down into 4 pieces. My body, my Ego, my spirit and my soul. (If you had met my Ego, you would understand why he gets capitalized!) In complete disharmony, my work was to reveal these pieces, understand them, find them balance and set them free.

How can a helper and healer survive if she cannot help? The love that I felt for and from my patients, their families and my co-workers was a connection to my purpose and fuelled my soul (Well, hello Ego!). This energy was a force for my survival. So taken away,  I found myself adrift and utterly lost. My Ego was horrified, scrambling to find me some source of love and vitality. So I went deeper, found my soul and saw…the light within. This light was deep buried and like hauling an iron bucket up from the deepest of wells, I work daily to keep it in sight. My soul resides in this well, with walls built thick and dark and wet around it. My life’s work is to break down these walls brick by brick and lift this bucket up for all to see.

I see now that caring for others is not my destiny. It is my destiny to love. But first, I must love myself. I had lost all respect for my body, running it to exhaustion until my heart literally warned me of the danger of this path. Respect for the body, the mind and the soul must come before all else. Only then can we turn this love outward and be free.

Four hard months of caring for and healing my body, revealing my Ego, discovering my spirit and reveling in the light and clarity of my soul. These are the gifts of this life lesson.

I will tell you what I have learned, but know that each of us is on a unique journey and no one story is the same. Your answers will come on your own time. (Have you ever found a book at exactly the right time for reading it? Not made sense of something the first time you experience it but then had a wicked ‘A-ha’ moment at a later date?) I know that every day we can either make decisions – rational thoughts weighing in on pros and cons – or we can make choices. Choices come from our soul, our heart and often feel like intuition. In the words of my favorite guide, “Analysis is paralysis.” To experience your path, you need to feel your way through it. Close your eyes to reason and use your heart to know the answer.

“If experience is viewed in a certain way, it presents nothing but doorways into the domain of the soul.” – Jon Kabat-Zinn

It is our perception of every person, place or thing that determines our reaction. We ourselves make meaning in every interaction. A person full of hate can remain so in your mind and be justified, or they can become understood as a fearful child who trusts no one…not even themselves… so resulting in the need to control everything around them and being terrified of human connection. This perception shift requires empathy and as such is challenging for most as it places our own nature under the microscope for review. (What… me? But I’m perfect!)

I am unbelievably grateful for the circumstances that caused me so much pain and confusion…resulting in growth, creation and love. In this, I found forgiveness. The pieces of me that fell shattered, once put back together, no longer form the same person. New boundaries around self care and family have been set. New priorities revealed. A new lens through which I witness sources of love and joy that have been there all along, patiently waiting for me to find them.

Will I remain in health care? Yes, in some form or another, as I have a passion for education and healing. The context is irrelevant. In today’s acute health care, there are limitations that my morals and values will never agree with. (Putting it politely!) My heart speaks to driving change but not at the sacrifice of self-care. My patients deserve the best. Caring at all levels – emotional, mental and spiritual as well as medical. Care without love is not healing, regardless of how much we would like it to be so. To love in our care is much harder work…but as I now know, the work of love gives back 100 times more, letting the pieces come together. Letting our stories weave together. A tapestry of hope, joy and peace.

-CB

 

 

In the Mouth of Madness – The Work of a Respiratory Therapist

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Respiratory Therapy

Every day that you breathe comfortably is a gift. This, I say with absolute surety, after 14 years as a critical care Respiratory Therapist.  Every hour you live is a chance to learn something; not a fact or a skill, because these are too tangible, too easy to grasp. No, every day is a chance to learn one more thing about human connection and an opportunity to explore the boundaries set for us by our limitations and our fears.

Flash back 10 years ago to the critical care bedside of a tiny infant, connected to my life-supporting equipment. It is my job, on this day, to be in this room, at this moment and to press that button; Yes, THAT button. The button that turns off a machine that made it look like this baby was taking its own breaths. I’m not alone. On this day there is a doctor with me and a nurse nearby outside the door. But it feels like I am alone because no one is making eye contact. No one is saying out loud what I am screaming inside, “Dear God, this is breaking my heart.”  But really, I am glad it is me. This way, I can be so absolutely gentle and kind, yet swift when I remove the tube from her mouth. This way, I get to say goodbye as well before I quietly leave the room.

Nothing could have prepared us for this. There was no didactic course on terminal weaning babies or palliative withdrawal of life support on patients that look and sound exactly like my grandmother. And so, we learn as we go, pushing the boundaries of our fears and sending out ‘feelers’ into our psyche to probe a dark emotion that we were never trained to recognize. We can sustain life beyond expectations but were not taught to embrace death.

As I sat with an elderly gentlemen in an ER at 4am a few years ago, I finally started to unravel this tangle of emotions that reared its head repeatedly.  I withdrew a BiPAP mask and then watched caregivers duck back away behind curtains. Pieces of the puzzle fell into place. We are healers. We fix people. We pride ourselves in this ability, boastful and resounding. Death is to be overcome! We shall not surrender… but if we do…when we do, we lose purpose. We feel weak. We feel shame. The dark and tangled emotions of failure, fear, vulnerability and shame all blended opaque and smeared across our vision. We can no longer see the person we were caring for without reminder that we were not enough.

So I became enough. Slowly at first but with steady purpose, when there was no family, I became the family. When hands reached out in fear of the unknown, I shrugged off my hesitation and held onto those hands. Fear was overcome by the strength of human connection. In these moments, my practice changed forever and so did I. My rusted old personal boundaries flexed and were broken. Relationships blossomed and life just made more sense. Everything became more real. I have never looked back.

The work of a Respiratory Therapist or any other critical care practitioner is incredibly stressful and exhausting. Finishing a set of 12 hours days and nights, its all we can do to not run out the hospital doors laughing maniacally on our way home screaming ” No one died…it was a great night!” But on those nights when one of our patients does pass away, we can learn so much in reflection. What if we stepped right around our fears and walked boastfully up to death saying “It’s ok that you are here. Let me help you take them kindly”.  Knowing we are enough. Knowing we did our best.

CB

All grown up…?

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Harness more life energy: Boost your EQ!  Photo: www.ppswest.com/blog/

Harness more life energy: Boost your EQ!
Photo: http://www.ppswest.com/blog/

Just wanted to share this great article recently posted by another website.

Emotional Intelligence has profoundly shifted to the forefront of my awareness over the past decade and this article gives a great recap of what ‘EQ’ entails (i.e. what we are striving for).

The real work lies in getting from where you are now ‘in your head’ to where you want to be. Unleashing more EQ. Prepare for emotional blood, sweat and tears because this is the real work of life. Shifting through the thoughts in your head and your reactions to people and events to trace back to the base human emotions that were evoked. What do you fear the most? What causes you shame? Where do you search for love and acceptance? Emotional intelligence effects your search for love, your joy in life and your everyday behaviour. It allows you to have empathy and truly connect to other people.

Realizing your potential, your joy and passions as well as the same features in everyone around you are some of the rewards of an improved emotional intelligence! Don’t wait. This is some of the most important work you will ever do.

No ‘Eggs-cuses’ anymore.

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Living it up…chicken style! Which means fresh air, green grass and the strength to stand.

A co-worker of mine brings farm fresh eggs into work on a weekly basis. He sells them for an amazing price at $3.50 a dozen. Last week someone popped their head into the department and whispered loudly, “Have you got any eggs?”. “Why are we whispering?” I retorted. Oddly enough, I have noticed that it is quite common for people to side-step over to me at work and speak out of the corner of their mouths whilst asking if our fridge has any eggs in it presently. I didn’t really acknowledge the odd behaviour until this week.

Is this some sort of clandestine egg exchange? A black-market grocery op? Should I be trying to manipulate who gets the goods and who doesn’t in exchange for preferential treatment if I ever require an MRI or gastroscopy? (I work at a hospital). Maybe I’m just witnessing the people ‘in-the-know’ trying to keep the amazing deal on farm-fresh, free-range, organic, grass-fed eggies on the down-low? I think the chance to get local, healthy food options is rare and thus, maybe SHOULD be treated as an opportunity.

So it got me thinking about food and how my family eats. Then, as in all things, what you think about – you bring about. So I found myself finding and watching a few documentaries on Netflix about what we shove in our mouths daily in North America. I found information about cows steeped in feces with stomachs full of a strain of super E.coli. I found myself watching chickens that could not walk more than 3-4 steps without collapsing because their bones could not support their massive growth from genetic manipulation and forced growth. I found out that a chemical company that developed Agent Orange, now controls over 90% of soybean production in North America by using fear and  patent legislation. I found out that the ideal diet for optimal health and weight loss is one that encourages massive amounts of fruits and vegetables, beans and legumes with meat only twice a week max and rarely ever milk or milk products.

So, I am horrified. More due to the fact that I thought we were already eating healthy and making decent choices. I choose to eat organic and always avoid the ‘dirty dozen’ fruits and veggies. I occasionally buy organic meats as a treat. I am celiac and thus already making invested, learned choices about what goes in my shopping cart. I am mostly horrified by the thought of undoing the damage to my children as they have grown to accept their diet of boxed cereals (Whole Grain!), noodles with fake cheese (Organic with Real Cheese!) and sugar-laden granola bars (High Fiber -Low Fat!). I see now, more than I ever have, that food marketing is a joke, with no entitlement to honesty felt by any major food company.

So, as a consumer, what choice do I have? How can I impact the industry? Where do I go from here other than crawling under my fluffy duvet and crying out “I give up! What the hell are we supposed to eat?” You can bet your juicy July BBQ steak that I am not going back to the person I was before viewing these atrocities against animal and man on film.

So I decided to take control of my own eating habits. I will make slow changes for my family, but for myself, I am going for it.  Here is my plan:

  • First: Hit the market – local if possible – for some Organic fruits and veggies. Feeling as though I would need the fiber, I chose not to juice but to purchase a Nutribullet instead. I started blending up some chlorophyll-filled goodness on Monday. Kale, strawberry, flax, apple, carrot, walnuts, pineapple, cucumber, lemon and almonds have never tasted so good. I blended 3-4 times per day. I ate no meat, only beans and legumes. By Wednesday I had amazing amounts of energy and I no longer craved coffee, bread, sweets or milk. In fact, all of these things that I usually love to indulge in because they give me comfort almost made me nauseous to look at. By Sunday, I had lost 4 lbs.
  • Second: Yoga, yoga, yoga – Perhaps this is the true source of all my healthy thinking and awareness lately. 3 weeks ago I started practicing yoga 3-5 nights per week. I am stronger, more calm and I feel more in control of my body than when I began. Look out crow pose – I got you! The physical benefits are awesome but there is no denying the mindfulness that yoga brings. I remember one instructor asking us to recognize the differences in how our bodies felt, left side vs. right side. Acknowledging, but not judging. Experiencing, but not shaming. Wonderful life lessons.
  • Third: Protect my family – I am lucky enough to have a lot of options here in the suburbs around Vancouver. I can access organic, grass-fed meats online for my carnivorous husband to enjoy, allowing my family to benefit from my knowledge but not forcing them to change. (All in good time). I can drive 5 minutes and visit a family owned farm selling vegetables that grew up from the ground looking very normal and imperfect. My kids don’t like the texture of my revved-up ‘smoothies’ and so I will have to consider starting them off with juicing. This will be a financial investment..but we are always better off paying now for what we put into our bodies instead of paying with our health later (trust me on this one).
  • Fourth: Never forget – The strain on our food system has created where we are today. Chemically treated meat, genetically modified food, and fast-food that is killing us on every corner. How do we walk away from all the convenience? Easily done when we look at how sick people have become. Type 2 diabetes is rampant, cancer is always right next-door, auto-immune diseases are common (so-says the  Celiac) and we are all desperate for more! More energy, more distractions, more everything!!! I propose less. Less toxins, less rush, less waste, less apathy.
  • Lastly: Get growing – Last year I managed to grow some yummy lettuce and carrots in a planter in my backyard. We live in a townhouse, so I will need to be more creative this year.  I hope to conquer vertical gardening this year and start taking control of my food supply, even if only for small additions to each meal. It’s a start that I need my children to see.

So, feel free to observe my journey. Feel free to make one of your own. Maybe you start with a quick decision to pull over at the beat-up sign at the end of the long driveway and buy those farm-fresh eggs. Maybe you go full-out and buy a $500 juicer! To each his own… but always remember that we are all, very much, in this together.

CB

Documentaries that forced my changes:

Fat, Sick and Nearly Dead

Hungry for Change

Food, Inc.

 

Portrait of Lotte

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A time-lapsed video of one man’s daughter from birth to Age 14 – all in only 4 minutes. As parents, we don’t need a reminder that changes in our children happen fast. Very often, far too fast. I thought this was a beautiful video and its existence is a testament to one father’s great love for his child. The importance and relevance of her development and evolution shines through. Well done!

Paying it Back, in Kind

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I am having a bad day. You know, the kind where you wake up annoyed and just can’t seem to snap out of it? Today, I feel like the weight above me is just heavy enough to override the wind beneath me. In other words, I feel down. What’s got me in this funk? Who really knows, but at my best guess, I think I have taken too much on again. I feel like my ‘to-do’ lists are growing wings, levitating off the kitchen island and taking flight for the sole purpose of flapping around my head all day. Like a murder of crows after a chunk of fine flesh, these lists will consume me piece by piece. My mind is always with them, ever-buzzing, never at peace. Today, these lists make me sad. Sad that I cannot seem to muster up enough empathy for myself to just let them die a quiet, pulpy death. If I could only grant myself as much kindness as I could any friend or acquaintance in a tough spot, each day would be that much more free.

Think about the last time you sat with a friend who was hurting or upset. Did you lower your voice? Speak softly to be sure they were really hearing you? Did you use empathy and really try to understand their situation so that you could give an honest outlook? Were you caring and sympathetic? So what if we could use this same kind and consoling manner with ourselves? What if today, I just took 10 minutes to create some compassion for myself, acknowledging my daily struggles and recognizing that I have some choices to make. As any good friend would, I can note that I am doing the very best that I can. I could suggest that I am being a little too hard on myself and expecting too much. Perhaps, expecting more than anyone else ever would.

Self-compassion and empathy would likely allow me to again remember that I am enough. To acknowledge my worth and my value – without all the unnecessary trimmings. I could speak softly and gently, kindly guiding the way. Then, I could let the lists rest like paper should, in a pile, waiting its turn to be dealt with. There are more important things to be done. Like tickling my children to entice their laughter, holding my husband’s hand just to feel his warmth, and twirling around the kitchen to my favorite song. All things guaranteed to lift me up above this hazy fog to clear skies and brighter days.

CB