Friday, November 02, 2007

Taking Leave: Exit Stage Left

Today saw the beginning of my leave of absence. "Taking leave"---an interesting concept to digest. Add to the notion of leave-taking the additional concept of "absence". But will the heart grow fonder? Only time will tell.

Divesting myself of my work responsibilities (and my attachment to caring for my patients), I extricate myself from the melee and enter a period of intentional self-care. What will become of me as I venture into these less travelled waters? Will I veer off course? Will I become lost in a maze of doubt and guilt? Or will I rise to the occasion, embracing this sense of freedom, allowing the emergence of a new feeling of expansion and openness to self-renewal? I think my old friend time will also tell me this story as well.

Just yesterday, in a moment of absolute serendipity and Jungian synchronicity, I attended---along with my wife and several colleagues---"Behavioral Health Grand Rounds" at a local medical center, wherein a world-famous doctoral psychologist lectured on the concept of "Vicarious Traumatization".

Also known as "V.T.", Vicarious Traumatization is the concept that a professional caregiver/therapist comes into contact with a traumatized individual as well as that individual's trauma material, consequently becoming retraumatized him- or herself in the course of that therapeutic relationship. It is well-known that a vast majority of clinicians who choose to work with trauma survivors have experienced significant traumas in their own lives, thus creating a dynamic in which an empathic and sensitive professional is repeatedly exposed to clients' trauma, and in the professional's commitment to providing therapeutic care, harm is actually done to the caregiver in the course of that relationship. Also known as "secondary trauma", V.T. is indeed a direct cousin to PTSD (Post-Traumatic Stress Disorder).

For better or worse, I am no stranger to PTSD myself, having been diagnosed in 2001 following the murder of my best friend by police in an unfortunate (and wholly avoidable) tragic set of circumstances which I have previously mentioned here on Digital Doorway. With this personal history, it is extremely clear to me that a number of my patients---whose lives are chaotic and rife with the effects of trauma---have begun to trigger my own trauma history as I go about the business of my work as a nurse.

Working in an ambulatory setting and caring for patients over years of close relationship and involvement in my patients' lives, the boundaries between myself and my clients are, by definition, more fluid than those practiced by many other health professionals. While these less rigid boundaries do indeed lead to more intimate therapeutic alliances with patients and their families, the cumulative effect on my psyche has certainly begun to be noticeable vis-a-vis the deleterious effects of such closeness in regards to my mental, spiritual and physical health.

There are those of us who consciously choose to work with members of society who have long suffered from the effects of abuse, neglect, poverty, and societal disenfranchisement. When one decides to immerse one's self in such an environment of lack and struggle against long odds, one must expect to pay a price for such involvement, especially if one is what I will deem "an empath". Being an empath is, in my book, a laudable occupation of spirit, yet the toll one pays for such a gift is often paid for dearly with stress-related illness.

So, exit The Nurse Protagonist to Stage Left, the curtain drawing temporarily on the well-furnished set of vicarious trauma, burnout, and compassion fatigue. As said Nurse Protagonist goes about reclaiming his sense of self and new-found (but temporary?) occupational freedom, we will be keen to discover along with him what new pathways of self-care and renewal will be embarked upon.

Is it difficult for our Nurse Protagonist to relinquish his sense of commitment and responsibility? Mais oui, monsieur (sings the Greek Chorus at Stage Right).

Can he embrace the challenge of enhanced selfishness, taking full advantage of this golden opportunity for renewal? Perhaps (says the orchestra conductor from the pit below).

Will he emerge from this time of self-reflection a changed man, a healthier man? We certainly pray for his deliverance from the throes of personal trauma (shout those who love and care about him from the bleachers).

Lastly, will he return to his place of work in five weeks, only to begin the traumatization process anew? (His patients and colleagues, friends---and psychotherapist---all wait with baited breath in the lobby.)

Stay tuned as the weeks unfold, as our traumatized Nurse Protagonist makes his way along this long ignored path of self-care and renewal. Admission is free. And the outcome? Certain to entertain.
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