Tuesday, March 28, 2006

Lofty Goals, Harsh Realities

I was just re-reading my previous post , realizing how portions of those ancient Buddhist vows are so apropos to my feelings about my work on this earth. For instance, "as long as diseases afflict living beings, may I be the doctor, the medicine, and also the nurse who restores them to health." For obvious reasons, this stanza speaks to my current vocation and my desire to be of service in this world. As grandiose as it may sound, it is really simply a wish, a desire to be a conduit of healing.

These types of prayers/vows reflect, in my mind, a kind of spiritual "best case scenario" in which the person making the prayer is setting his or her sights on the loftiest possible goal. These statements are intentions, set by the individual with full knowledge that none of us mere mortals can be at our very healing best at every moment of every day. My experience has taught me that even the best intentions and deep-seated love can often fall short in the heat of human drama and the frailty of emotions.

A good case in point would be my ongoing relationship with a very loveable patient with a history of substance abuse. I have written about this case before, and throughout 2005 was beaming with pride and the flush of success as this individual's kids stayed in school, chronic diseases under control, and the patient's general lifestyle stabilizing. Sadly, over the last months, the bottom has fallen out and a relapse into cocaine abuse and manipulative behavior has consumed this person's life, the kids missing school and the authorities stepping in vis-a-vis the welfare of the schoolage children. Many red flags have been raised, as has my level of ire as the situation devolves into chaos.

Details aside, my exasperation has been getting in the way of my ability to really be there for this person, and I have found myself avoiding calling the patient and making myself available. That said, in such situations, I have often found it quite useful to step back, take a break, and allow my broken compassion meter some time for maintenance, so that my subsequent visits can be focused on the person, not the aberrant behavior being demonstrated. Herein must enter compassion and its cousin patience.

At times, disappointment in my ability to maintain my composure in the face of my patients' failures to live up to my expectations can cloud my vision of who they are, of their own unfolding process. My cynical "social-worker self" sees addiction, cycles of neglect and poor judgement, seemingly avoidable mistakes and missteps. These perceived errors are easy for me to see, of course, and my agenda--- no matter how well meaning---cannot permanently get in the way of truly seeing with clarity and non-judgement, or else my powers as a stabilizing force for healing and growth are lost.

On Thursday I will visit this individual whose process it is a priviledge to be a part of, despite the moments of anger, disappointment and unmet expectations which can dull my desire to be of service. Withdrawing for a time is often a good therapeutic tool, allowing the client space to solve their own dilemmas and stew in their own juices, so to speak. And then, when the time is ripe, the time comes for stepping back into the fray, leaning in once again, and hoping that, on another day in the not too distant future, more functional and intelligent choices will be made. Until then, compassion and patience must hold sway, and when they are not attainable, a healthy distance can allow those batteries of compassion to recharge. Sadly, there are some individuals who we eventually learn must implode on their own, beyond the reach of our assistance. At that time, compassion can still be front and central, even as the person's certain denouement looms on the approaching shore.

Harsh realities? Oh yes. Lofty goals? Even still. Desire to continue on? No other place to be. For now. Keep oiling that compassion meter.


Jeffrey said...

Addicts especially, I would think, must be hard to tend to over the long run. (he says, knowing some things about addicts, knowing many and being one, recovering for 3+ years) Lack of consistency in behavior, back to whatever drug on seemingly invisible triggers, anything from a heady giddiness that makes one forget reasons not to, to an anguished desperation driving one to escape, and many more mundane things in between. Most addicts cannot be helped until they're ready. And if there are other diseases, the pains, perceived futility, indignity, inconvenience can provide a big handful of additional excuses ...

So, do you do anything differently with your addicted patients than with your non-addicted patients?

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Different? Hmmm. I try to understand the triggers of their relapses, and also to have some comprehension of the original wounds and traumas that brought them there. I also try to connect them with services that will provide that extra layer of support that they need to overcome the addiction while dealing with their psychosocial and medical problems. I also try to treat them with respect and dignity.

Kim said...

Reading this post made me realize that we all have our own gifts that we bring to nursing.

I could never do the ongoing case management that you do, because I don't have that ability to deal with chronic issues and keep my judgement/emotions/compassion balance.

But I can take that same lice-ridden homeless person or an addict or alcoholic who present to the ER for help and I can treat them with dignity and respect them as an individual, helping them get through the first painful steps of the emotional and physical manifestations of detox. Without judging.

Maybe because I don't see the results of the behavior, it is easier for me to deal with the acute illness than the chronic manifestations.

I recently wrote on another blogger's comment section the paraphrased verse where Jesus says "...that which you have done for the least of my brethren, you have done for Me."

That sort of puts it in perspective for me.

(Oh, and I appreciate the "oil" provided for my compassion meter in your last post! High quality stuff you're dishin' out there! : ) )

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Kim, we need people like you in the ER, too, y'know. Thanks for doing that difficult work, and keep that compassion meter well-tended!