The Prospects for More Meaningful Work

Sometimes things just happen. Yesterday I received an email from the person who serves as the Public Health Nurse for the little college town where I live (population: 20,000 residents + 25,000 students, more or less). She's stepping down from her post and the town is looking for an interim part-time nurse (10 hours per week +/-) to organize, plan, and implement the town's flu clinics for the season, as well as track the handful of TB cases and other reportable diseases in the area.

A few emails and a phone call later, and a meeting has been set up for me to discuss the position with the Powers that Be. No muss, no fuss. Perhaps not even a formal interview. (One confounding factor: I have tickets to fly to Brussels to visit old friends and will be gone November 4th-12th. Deal breaker? We'll see.)

Meanwhile, I await a call for an interview in the local inpatient psych unit.

More meaningful and remunerative work may be just around the corner.

The New World

What a difference a week makes. From one week to the next, my life has shifted from a eleven-year history of full-time employment to a new paradigm of self-directed part-time employment which is still somewhat puzzling to my reeling brain and mind.

How does one arrange one's days when they aren't built around the 9 to 5 framework? What parameters does one set in order to get things done, balanced with time to not do anything at all? Does one think, "Don't just sit there, do something!" or "Don't just do something, sit there!"?

What does it mean to not have one job that defines one's place in the working world? When someone asks the ubiquitous question, "What do you do?", what becomes your new ten-second elevator speech?

"Well, you see, I'm a newly-minted under-employed nurse slacker, waxing poetic---latte in hand---at a cafe with Wifi near you!" Or perhaps, "I'm a burnt-out nurse with more per diem jobs than I can count."

However one defines it, I know this first week has seen me working a few hospice shifts, attending my new Tai Chi/Qi Gong class and my new writers' workshop, and---dammit---crying uncontrollably during a matinee showing of The Kite Runner. My slacker cup runneth over.

I embrace this new life, even as I must accept not commuting with Mary every day, letting go of my beloved work family, and allowing the uncertain fickleness of this new paradigm to overrun my life. Gaining control of these new reins, I have no doubt that a kinder, gentler work-life will emerge, seeded with challenge yet relatively free of the trappings which so efficiently burnt me to a crispy shadow of my former self.

Here's a toast to newness and all its inherent uncertainty.

Back to the Drawing Board, Wherein the Heart and Mind Discuss the Future

Back to the subject of my (currently non-existent) work-life, although the job-share position was ostensibly approved by the powers that be, the nurse practitioner with whom I was planning to share said job has accepted another position. Thus, the job-share is now defunct, and a vast blank drawing board appears on my horizon. Yikes.

So, when faced with a blank drawing board, what does one do? At first, nothing. The blank space is kind of nice, isn't it? See how the light reflects? Notice how that blank space is one upon which any number of potential futures can be projected? Why don't we enjoy it for a while?

But then the Mind in all its glory jumps in, grabs some (thankfully erasable) markers, and goes to town.

"So," the Mind says. "We have Option 1: return to full-time job as planned, and decide to stick it out for another 6-12 months. See all of the gains and stress reduction from the leave of absence erased in a matter of weeks. Hmmm. Maybe not such a good choice." The Mind looks puzzled.

"Well, then," says the Mind. "Option 2 seems better: return to work for the required 30 days, close up shop, say our goodbyes, terminate with patients and colleagues, and skedaddle asap, no looking back. Not a bad scenario, if I do say so myself." Some skeptical interest is perceived.

"Or how about Option 3, perhaps?" asks the Mind hopefully. "Offer to work per diem for old employer after fulfilling 30-days of full-time work in order to fulfill leave-of-absence obligations. String together several other per diem positions---one of which is quite close to home, actually---and have a renewed sense of professional invigoration? Let "The Mrs." carry the health insurance benefits, and take this golden opportunity to cut loose from the 40-hour grind! Work when you want to---some weeks will be extra heavy, others can be quite light. What freedom! What a concept!" The mind smiles.

Then the Heart steps up to the plate, chiming in. "Oh, God! All of those patients with whom we have cultivated intimate working relationships for seven years! How would we say goodbye? How would we terminate? What would it do to them? To my colleagues? To the workplace? How can I handle so many goodbyes?" The Heart wrings its hands.

The Mind rests a reassuring hand on the Heart's virtual shoulder. "Look here, cousin. Don't get so worked up. People leave jobs all the time, even ones in which long-term therapeutic relationships have been nurtured." The mind smiles reassuringly as the Heart looks dubious.

"We all have to say goodbye and move on at some point," the Mind continues. "Patients know that clinicians come and go. It's part of the process. Perhaps your leave-taking will cause some of them to become more self-sufficient, more empowered. Just imagine the relief you would experience when you released yourself from the responsibility you feel for those eighty people and their well-being!"

The Mind and the Heart sit in silence for a while.

"Y'know," says the Heart. I need some time to consider these scenarios. It's just too much to process today."

"I understand," says the Mind. "Change is always hard. Take your time, enjoy the rest of your leave-of-absence, and know that this is all happening for good reasons. Remember that drawing board? We can leave it blank for a while."

"Thanks," says the Heart. "I can only take in so much change at one time. It was enough to accept a six-week leave-of-absence. Let's clean the basement, then we can make dinner and watch a movie."

"It's a deal," says the Mind. "We'll put the drawing board in the corner for now. Let's tackle that basement."

Of Heroes, Parity, and Economics

Last night's post only scratched the surface of the culturally accepted norm dictating that mental health is not on par with physical health when it comes to one's needs for rest and rejuvenation---especially where work is concerned.

Work is, for better or worse, part and parcel of our lives, a veritable necessity for putting food on the table and clothes on our backs. As we moved out of an agricultural society into an industrial---and eventually technological---society, it obviously became necessary for an astronomical number of individuals to become workers who performed duties under the auspices of companies and corporations which held our livelihoods in their hands. Granted, an agrarian society is no panacea---share-cropping and slavery are excellent examples of that scheme's miserable failings---yet the industrial age brought with it abuses and restrictions on individual freedom which, while not necessarily slavery in name, certainly have kept many segments of society in quite similar and dire economic straits.

So, when one has chosen to enter a field of work in which the vagaries of the economy and the edicts of one's employer shape one's destiny, there is a certain amount of freedom that is abdicated. That said, even the self-employed feel that they too must abdicate some freedoms in the face of restrictive tax codes and the high cost of health insurance and healthcare.

For myself, I have chosen to enter the "Medical Industrial Complex", to riff on a phrase originally popularized by Dwight D. Eisenhower in 1961. Within said Medical Industrial Complex, a hierarchy exists, similar to the hierarchies within other disciplines and professional societies. The members of such systems are rewarded for their work based upon algorithms which take into account such notions as experience, education, applicable skills, and other factors which make one a candidate for the assignment of various tasks and responsibilities.

As I stated in yesterday's post, certain segments of society are held in higher esteem than others, earning astronomically higher salaries and benefits than those of us who slog away in blue-collar, "pink-collar" and even many white-collar positions. Most of us would agree that celebrities---including many actors, some entertainers, as well as many professional athletes---receive remuneration for their efforts which far seems to outstrip the relative value and social import of their (cultural and economic) contributions to society. CEOs are another story, and the scale of their remuneration is also sorely out of balance (think Ken Lay, may his soul never rest).

I stated yesterday that the hypothetical baseball player who experiences occupational stress could be pretty certain that his salary---often in the millions, or at least hundreds of thousands---would not suffer in the face of a leave of absence for reasons related to stress.

In my post, I compared myself to that stressed-out baseball player. Let's imagine that I was a nurse who was experiencing incredible levels of stress and burnout by caring for the destitute, chronically ill, and elderly who live in that baseball player's hometown. Maybe several members of his extended family---saddled with substance abuse, mental illness, or other disabling medical conditions---were actually on my caseload. When I decide that I need to take a leave of absence due to stress related to my work, why is it that I---a person providing essential services related to the health, well-being and survival of members of that baseball player's family and community---must do so without pay and with risk of economic hardship, while the baseball player (who essentially swings a piece of wood at a leather ball and catches balls hit by others with the same piece of wood) rests on his laurels and fat bank account, taking a break from his on-the-job stress on Maui? What is wrong with this picture?

Teachers, nurses, police officers, EMTs, substance abuse counselors, social workers, senior center directors, outreach workers, AIDS workers, hospice counselors, homeless advocates, housekeepers, medical assistants, home health aides, daycare workers, laborers----we all experience on-the-job stress, yet it seems only the rich and famous can have respite without negative economic consequences. The families of people in the military live on food stamps in decrepit barracks for the enlisted, yet we say we "support the troops". Again, what is wrong with this picture?

Our measure of "heroes" is askew. Who truly are the heroes? Who should be celebrities? Where are the trading cards of famous nurses and home health aides? When will substance abuse outreach workers have their day? Something is wrong in a culture wherein those who care for the dying must themselves struggle to survive. This is an emergency of priorities, one for which parity and balance seem far beyond reach.

In essence, the true heroes go unsung, and the make-believe heroes take home the prize.

What Lunch Hour?

As I begin to plan for a five-week unpaid leave from the rat race, I feel particularly sensitive to messages, both implicit and explicit, that communicate that overworking is a culturally accepted practice.

In the last few days, I have begun to notice an ad campaign by Dunkin' Donuts (I refuse to link to their website, just to spite them) that truly speaks to what drives me to take a break from work altogether. This ubiquitous American purveyor of non-organic, non-free-trade coffee and fatty, sugary treats is now propagating billboards which promote a lifestyle unfriendly to slowness and thoughtfulness. "Eat on the Run!" screams one billboard, while another colorfully suggests that I "Work Through Lunch!". What have we come to? How did I become another victim of American workforce culture?

A recent study in the UK cites data showing that fewer and fewer Brits stop working in order to eat the midday meal. An article on Monster.com urges workers to take lunch breaks, and article after article cites the shrinking lunch hour and lengthening workday. In my own office, the majority of us eat lunch at our desks as we finish notes, check emails, and answer calls. And when five o'clock rolls around, so many of us seem to simply keep working since there seems to be no end to the work we need to do. No wonder we're all exhausted. The Japanese even have a word for death from overwork: Karoshi. At least it's not a purely American phenomenon.

So, those billboards that cajole us to work through lunch and eat on the run? Why not boycott Dunkin' Donuts, instead?

Post-Traumatic Workday Syndrome

It was in many ways a typical day following a three-day weekend. My voicemail was teeming with messages by the time I sat down at my desk at 9:15am. Emails were summarily ignored until the afternoon. The phone rang as if it had a mind of its own, and patients---whether scheduled to see me or not---seemed to be in the waiting room of the clinic every time I passed through. At one point, as I walked through the waiting room to find a patient for a scheduled visit, I was literally accosted by three other patients who "just happened" to be lying in wait nearby. I was like a zebra trying to skirt around the edges of the oasis and not be seen by the predators in the grass. But, like the zebra, I am all too noticeable in my environment, and surreptitiousness is next to impossible.

By noon, my head was swimming, and I heard a small voice in my head calling for nutrition---anything to keep the engine going. Buried in paperwork and charts and partially completed tasks, I skipped the microwave and ate my leftovers at room temperature (a common practice, and probably healthier, if you believe the rumors about the dangers of microwaved food). Luckily, a patient scheduled to see me in the clinic at noon was a no-show, since I had double-booked myself for a home visit to another patient at the same time. As I force-fed myself my lunch, I called patient #2 and said I'd be 30 minutes late. (He may be unemployed and disabled, but his time is valuable, too.)

Three o'clock, and the pace slackened only briefly before starting up again just before 4, and it was all I could do to get out the door to pick up Mary down the street at the Senior Center by 5:15, knowing I had a meeting at home for the Medical Reserve Corps of my town for which I volunteer my services. Leaving the office, I knew full well that there were more than fifteen unfinished visit notes in my bag, a number which will only be further increased as soon as I hit the tarmac tomorrow. Will I finish those notes tonight before bed or tomorrow at breakfast? It's possible, but the trauma of the day may only lend itself to a swim, a snack, and retirement to the oh-so-needed bed. (Did someone say "retirement"?)

That said, the remaining business of the day will need to simply fade to the background, or my unfinished work will only interrupt and short-circuit my need for restful sleep. How to turn it off? That is a life's work in and of itself, and tonight is a good opportunity to practice letting go.

Violation

We arrived to this scenario yesterday morning. After months of partially smashed windows, we finally had our first office break-in. The intruders made off with a computer. They didn't have much time once they tripped the alarm.

Last year, a colleague at a neighboring agency was shot in the shoulder when she was caught in gang-related crossfire.

As one of my Latina colleagues quipped, "That's life in The Ghetto, people. Get over it."

Friday, Friday

Yesterday, at the first staff meeting since my new boss took the helm of our unwieldy ship of nurses, she unceremoniously---and rather spontaneously, I think---announced that we will be closing the office at 4:00pm for the summer, in order to encourage self-care and reduce stress. The phones are supposed to be turned off, the answering service engaged one hour early, and the on-call Nurse Practitioners ready to begin their weekend of call one hour sooner. The announcement was met with great enthusiasm, as well as a modicum of cynicism that this directive would actually get anyone out the door before 5:00 when the proverbial whistle blows. In an office of chronic overachievers, leaving early is not always on everyone's to-do list, although I manage to do it a few times each week, myself.

So today, the first Friday that the new early closure was in place, I looked up at the clock as I raced through the office for the umpteenth time to notice that it was 4:20pm. I noticed that the administrative staff were still at their desks answering phones. I turned to their supervisor and asked, "So, I thought we were turning off the phones at 4:00?" She looked at me and replied, "Well, honey, nobody seems to be leaving, so we're here until you do."

Turning the corner, I ran into our new boss and explained the situation. Her reaction was clear. "I want the administrative staff to get out of here at 4 on Fridays. They work hard enough. The nurses can stay and torture themselves if they want to, but everyone is free to take off. Period."

We smiled at each other, and agreed that next Friday would be better. Maybe an offer of free beer on Fridays would help these chronic nose-grinders relinquish their death-grip on the phone and mouse? Whatever it takes, next Friday we'll try to make sure that the office is dark at 4, and that the denizens of our overcrowded establishment shake loose their shackles and begin their weekend just a little bit earlier.

Finally Friday

For those of us who work a traditional five-day week, Friday brings the welcome denouement of our five days of travail. Add to that a Monday holiday (like the upcoming Memorial Day here in the U.S.), and a very lovely triad of days off beckons like a siren to a wayward ship.

My personal vessel feels rather happily tired tonight. I started the day with a very useful and growthful hour of good ol' psychotherapy. Next was a consult with my new gastroenterologist (see this post for the run-down of my own healthcare cast of characters). Five hours of work felt amazingly like eight, and then the sleepy drive home delivered me for a delicious hour's nap in the hammock. Sixteen laps in the pool at the nearby health club roused me from my torpor, and now as bedtime nears, my body is readying for sleep. How lucky am I?

There are many blessings to count in the preceding paragraphs. First, I have gainful employment with weekends off. Second, I have the absolute blessing of health insurance, allowing me the relative luxury of psychotherapy and gastroenterology for the asking. I have a reliable car to get me to and from these activities, and a home where a comfy hammock awaits my weary body. Toss in the health club and a quiet place to sleep, and there you have a person who has a better standard of living than probably 90% of the world's population (at least). That is not a notion to take lightly.

So, I am happy that it's Friday and that there are three blissfully long days to fill with as little or as much activity as I like. If I was disabled, poor, infirm, or living in a war zone, all of the above undertakings would seem like something one could only dream about.

Speaking of dreams, I ran into a doctor yesterday at the clinic who only comes to see patients for surgical consults every two weeks. "David!" I said. "How are you?" He shook my hand and replied, "So, are you living the dream?" I thought for a second, caught off guard, and said, "Yeah. I guess I am."

The dream is what we make it, apparently. No one put me here. No one forced my hand. To paraphrase (and contradict) David Byrne, I would say, "This is my beautiful house. This is my beautiful wife." And then, if I were smart, I'd get down on my knees and thank my lucky stars for my very own embarrassment of riches.

Worthy Wednesday

Continuing along the same vein of daily titular alliteration, today was a Wednesday worthy of the moniker "Hump Day". Wednesday, that day which symbolizes "the day of maximum hope that maybe, you might make it out of this week alive" (Urban Dictionary). The German word for Wednesday---Mittwoch---says it all: "mid-week"; and that notion of "middle" can mean only one thing---that the end is only around the corner.

So today was one of those mid-week days, not overly busy, but busy enough that the sweetness of the coming three-day weekend can be tasted on the tongue like a long anticipated and justifiable dessert.

This week has seen its share of difficulty and strife: a patient reporting that he is the victim of domestic violence; a patient's granddaughter in state custody due to an unstable mother and substandard home environment; illnesses and losses of varying levels of seriousness and magnitude.

As Thursday and Friday rise on the horizon, I realize that relief and rest are around the corner. Does everyone get the rest they deserve? Sadly, no. Are some lives simply rife with trauma, rarely seeing a glimpse of relief? Unfortunately. But for the working person, that golden glow of a weekend is just what the nurse ordered for rejuvenation of the mind and soul. Without that recovery time, the refractory period following the stressors of the week, this particular nurse would simply be yet another member of the "walking wounded", and my ability to serve anyone's greater good would be severely compromised. So, nose will be dutifully applied to proverbial grindstone for two more days, and then that nose will rest on the luxurious pillow of the holiday weekend before it resumes its grinding once more.