You are Already Enough

At the end of a long 12 hours at the hospital. Strangely, after a full day of urine dipsticks, gowning and un-gowning, call lights, pumps, shots, meds, and more pee, all I want to write about is how much I've learned from my clinical instructor, F. She has a pretty amazing depth of hands on, nitty gritty 'how to give that drug' 'how to assess this kiddo' 'how to chart that crazy thing that just went down' knowledge to share, and she shares generously. She's nice, too. She build us up my confidence and passion, instead of making me feel like incompetent jerk, going home every night wondering why on Earth I thought this was what I wanted to do. But the two biggest things I've learned from her are nothing to do with drugs, pumps, lines, or machines that go ping. The two things are 1) Our patients are human and 2) We are human too, and that is a good thing.

You might be thinking "But Caren, you're a doula and a future midwife-you know you have to act in loving kindness, honoring the human experience." I do, it's true. I know it's important. I also have to tell you that it's a lot easier to do that when I have no real doubt that this will be a happy ending, an experience I will overall be glad I was present for and that I know is healthy and normal-not something that will break my heart and make me want to hide under a rock. Instead of being happy to engage in a joyful family process, I am scared to get pulled into the current of a terrifying, tragic, draining time in a family and child's life. Also, I was good at my job as a doula, and didn't have to think that hard about what I was doing at every moment. I was unlikely to kill anyone if I made a mistake. That made it easy to focus on the experience and the people. When I'm all thumbs and nervous as hell that I'll screw up bad enough to hurt someone, I get tunnel vision to what my hands are doing and which tasks need to be completed. So, although I have the values in place, F. has deepened my understanding of them and challenged me to live my values in more difficult times.

On the first point, that our patients are humans, you'll think "yeah, duh." But people in hospitals are dehumanized, for many reasons and in many ways. I think staff dehumanize patients in an effort to protect themselves from heartbreak and burnout (although I'm unconvinced that it's an effective strategy). For some professionals who do very high risk things (like surgery) it might take a certain amount of dehumanization to do their job without abject terror.

We are educated in a way that dehumanizes patients-we are shown gruesome pictures of terrible injuries and diseases, with only the diseased body part shown or the eyes blacked out. There is never a caption on these pictures that says, "This diabetic foot belongs to Mr. Jones, who is the proud grandfather of 3 boys and a girl, the husband of 65 years to Mrs. Jones, and an avid hobby train enthusiast." Mr. Jones is reduced to just a disembodied gangrenous foot. We memorize standard symptoms, pathologies, and treatments, and not how it feels to be a 17 year old girl who is incontinent, and has no hair on her head, but a full beard from her medicine.

Perhaps most importantly, we never see these patients-these people- in their "real" lives. When we see them they are afraid for their lives, surrounded by equipment, with lines and drains coming out of any or all orifices and out of unnatural holes we've made in their arms and chests. They are living under literal microscopes that tell us every detail of every body fluid and cavity, but also under figurative microscopes that are constantly observing how they parent, how they behave towards their parents, if they're 'compliant', if the parents' marriage is 'healthy', if they're 'in denial' or 'high needs.' For God's sake, do you know that your neighbor had an affair? Do you know how much they drink? Do you know they flipped out and yelled at their kid yesterday? No. You aren't given the opportunity. We have the opportunity to observe and pathologize and dehumanize at every moment of these kids' and families' existence. All of it adds up to make people into patients.

And yet, what we see in the hospital room is not them. It's not their real life. It's a little piece of something they're doing so that they can live their real life. For example, I was reading a blog today from Harvard's Center on Women's Mental Health that referred to pregnancy as a disruption to a woman's treatment for bipolar disorder. A year ago I wouldn't have thought twice about that statement. After this quarter with F. and the families on my unit I think, "No!" The treatment is a disruption of this woman's life course which includes pregnancy, not the other way around. The treatment is meant to enable her to have that life that she chooses, not to become her life. So, F. is teaching my to cut through the dehumanization and see a 2 month old and his parents for who they are, not for what the diagnosis is and what equipment he's hooked up to, and what the social work note says. She's teaching me to do the harder thing, to see my human patients, my fellow humans, our thus to see our shared human fallibility.

This brings us to the second point: we are humans, and that is a good thing. This is a hard one for me. Like most people, I pull back reflexively from things that hurt me to see or do. I do mean things to people sometimes. Shots, dressing changes, meds that make kids barf or cry. It's hard to be human when I'm doing sort of inhuman things, even when I know it's for the patient's health. F. pushes me to be uncomfortable and be in the moment with uncomfortable people. You may wonder what could be more uncomfortable than 40 hours of labor (which I happily and quite comfortably am present for), and I can tell you that acute illness of the kind seen at acute care hospitals is much, much more uncomfortable, undignified, and scary. Labor is normal, healthy pain with a joyful purpose, while diseases causes suffering with no purpose. But, just like women in labor, people in the hospital be they a kid with cancer or an adult with a broken pelvis need me to be human, be present, do everything possible to prevent suffering- but also not flee when I can't prevent it. F. said today, in response to a question about what we should know to say and do at the end of a patient's life, "It's ok. You are already enough. You are a human, just be human." So simple, so hard, and so true.