SELF MAINTENANCE

Imagine, a city under siege.  The enemy has completely surrounded this city and cut it off from all attempts to bring in food.  There is a breach in the wall and every day, the enemy charges through the heavy rain of razor-sharp arrows and clashes with those filling the gap, defending the city.  Normally, in such a situation, the soldiers defending the city would get the largest portion of weevil eaten bread and maybe even a little meat from a slow pigeon or rat.  But imagine that in this situation, these battle-hardened soldiers, desiring to feed the many starving people within the walls, begin to cut off a small portion of themselves, and throw it in the communal pot.  Every day, before the onslaught, they cut off another piece, toss it in the pot, and rush to hold the gap another day.  Crazy?  Why would you call them crazy, when you do it every day?  Working in this field, we as constantly sacrificing ourselves to help others.  

Taking care of oneself seems to be a chore for most.  But in this line of work, any miss-step in self-maintenance can begin a decline in our ability to help.  An untreated injury, not updating your prescription glasses, or wearing shoes that don't fit well can erode our performance. Even skipping a meal or nap or time with friends and family all collide to impede one's ability to do the right thing at the right time.  When I worked as an EMT, I would work 24-hour shifts without a break.  I would work 12 out of 14 days and/or nights in a row, picking up extra to help my friends at work.  I would eat the garbage food I could remember to buy at the gas station or load up on large blended coffee drinks to keep going.  It seemed so easy because it was.  Hard work is a core tenant of what makes us Americans, and certainly what makes health care what it is.  We fuel ourselves with garbage because we are too busy to take care of ourselves.  But how effective can we be if we don’t take care of ourselves?  And the worst of it is, I’m cutting a piece of myself every day hoping that sacrificing myself today will somehow make tomorrow better.  And every day my patient reminds me that there is no bigger lie.

My excuse? After working with a psychologist for a while, I don’t take care of myself because, at the core of my being, I struggle to value myself. What I want, and what I need are not as important as what other people want and need.  I learned this from my mom and dad, who were always willing to help others.  I learned early on that being “selfish” was bad and being “helpful” was good.  I can remember countless times when I would have to go to the bathroom or felt hungry or tired, and I was asked to just keep going.  I was thanked and encouraged for being willing to “take one for the team”, first in tee-ball then well into my 30’s as a critical care nurse.  The one who will shoulder the load for another person is revered in stories and movies.  It is this characteristic that makes someone a hero.  What we don’t talk about is how very hard it is to have that strength.  The strength of mind, of body, of will, to be the hero by doing your job perfectly when it really matters.  How can you remember all the steps of a procedure if you haven’t eaten in 10 hours?  How can you sit and cry with family members when your bladder is about to explode? How clear is your vision and thinking on 18 hours of hard work when at the end of the shift the really bad trauma comes in? It is impossible for anyone of us in healthcare to truly be at our best if we don’t take care of ourselves.  The real problem is that as everyday heroes, we feel that we need to “take it for the team” in every aspect of our life.

We in healthcare, (well, except for doctors and pre-hospital folks….wink*) are nurturers more than anything else.  After compassion comes our love of science, the human body, public health, financial stability for our family, community and a strong peer group.  We want to make someone else better.  Thank God for people like us, as we are the salt in a world filled with selfish, self-centered, myopic, obtuse and downright cruel people.  And like everyone else, we have an Achilles heel. Even if care for others comes naturally, care for ourselves is often very difficult.  To make it more insidious, consequences often do not show up until later. Our relationship failures are the stuff of legends, and there are not many nurses who can pride themselves on their personal health.  As the country and society has become more health aware, so have we in healthcare. But doing something with our new understanding has proven plenty difficult. 

Precision takes far more preparation than the time of execution. In drag racing, a car travels 1/4 mile in less than 4 seconds, and the engine is completely rebuilt, which could take weeks, after every single race. In healthcare, we do the equivalent of running a drag race, then driving through the mud, then parking in the rain, then letting the children borrow the car for a beach trip, hoping there will be enough gas for the next race. We snack before, during, and after work on whatever we can find.  One-third of us work at night, which, after 14 years I can attest is not something you get into or out of easily. Sleep is a luxury, sitting down to eat is a luxury. I don’t know a single provider in my 14 years who did not pick up an extra shift at least once a month, most of us do an extra shift or more a week.

At home, do you get to relax, or do you spend your time stressing about other problems? Do you take the time to eat healthy food, or grab something quick because there isn’t any time? Do you prioritize sleep, or do you get sucked into another social event or Netflix series you can’t say no to, just to unwind?  Not a single one of you reading are thinking when you get home, “What a day! I should have water now and save the alcohol for going out next week.” When our job is to be the hero, we use up all our reserves to do incredible things.  We stand with someone in their tragedy and make it ok. We navigate the most mind-bending social dynamics to find a place to stay, get prescriptions, and even start a road to recovery.  Our community, our neighbors, and friends in humanity, land in our already over-filled departments with needs beyond our capacity and we still find a way to make it happen.  Our Emergency Departments around the country are everyday examples of how Jesus fed 5,000 with a few fish and a loaf of bread. But this does not come easy.  Not easy at all.

It’s time to start building into your own life a plan for sustainability.  Each of us will be on the other side of the gurney one day.  You know what kind of patient you want to be.  The one with good veins, tolerating PT and OT, with working kidneys and a healthy liver and a strong heart that can tolerate the horrific electrolyte and fluid shifts of  a bad 2 weeks in ICU. . That doesn’t happen the day of your emergency, that happens over the years before.  Quit slicing off bits of yourself. The 5 minutes here and 30 minutes there often do not make any difference to the people you are trying to save. Because they each only get such a small amount of you. But it all comes from the same source. No one will respect the cost more than you, and no one else will have to pay the price of your sacrifice.  Take care of yourself, you are the only YOU that you’ve got!

by Eric Hodson with Caleb Sunderland