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Being Good to Ourselves 

Being Good to Ourselves
Chapter:
Being Good to Ourselves
Author(s):

Mark Lazenby

DOI:
10.1093/med/9780199364541.003.0009
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date: 22 September 2020

When I have a hard day at work and I share my difficulties with colleagues, invariably one of them will tell me to be good to myself. When I hear this, I often picture a white sandy beach and an azure sea lapping the shore directly in front of a chaise lounge I find myself reclining on in the warm sun. As wonderful as this fantasy is, it is not what my colleagues mean when they tell me to be good to myself.

It can be difficult to be good to ourselves. A beach vacation may give us rest and take our minds off work for a week or two. A good foot massage will offer rest and relaxation, until the next twelve-hour shift. We can—and should—eat well and exercise, and we can take refuge in hobbies or in the confidence of good friends. All these are good and important strategies for self-care, which is part of what my colleagues mean when they tell me to be good to myself. However, it is not all of what they mean when they tell me this, for at the end of the day, there is no actual single thing we can do that will undo the myriad difficulties we face as nurses. A vacation, a spa experience, a good book, or collapsing in the arms of our loved ones do not prevent our patients from dying, being diagnosed with life-limiting disease, showing up in our emergency room having just been raped, or having births go wrong. Nor does self-care alone undo the exhaustion we face from our hard work. What my colleagues mean when they encourage me to be good to myself is, quite literally, to be ethical toward myself. They mean that I should recharacterize my life as a nurse in such a way that brings justice to the difficulties I experience on the job.

The power of stories in making sense of difficulties hit me most when my son was a little boy. When he had encountered difficulties during the day, he would often lie awake at night and dwell upon them. On these nights, he sometimes would ask me to come into his room, sit on the side of his bed, and tell him a story about when something similar had happened to me. Typically, before I was finished telling my story, he would drift off to sleep. Either my voice was soporific or he was reassured that he would be all right, just as I was all right in the story I told him about myself. Of course, with my long view, I had faith that he would make it through the difficulty at hand. But eventually I came to realize that something more was going on in my telling the stories of my surviving my childhood difficulties: I benefited from telling these stories as much as my son did, perhaps even more. Of course, I remembered the injuries of my childhood—the embarrassing moments, the painful moments, the moments I encountered bullies on the playground, the moments of betrayal by people I thought were my friends. I began the stories with these injuries, but somehow, unconsciously, I ended the stories with justice. Sometimes I ended them with the justice brought about by others on my behalf, sometimes by how I overcame my injuries by tenacity and hard work and, when my injuries were at the hand of another person, by forgiveness. Even when the injuries were at my own hand (my dog, after all, did not eat the homework I forgot to do), I ended the story by forgiveness. Eventually, I came to see that telling our stories reminds us that when we are injured, justice heals.

We may experience injury when people place unjust demands on us. I was a new nurse working on a team in which the physician on fellowship (also known as the “fellow”) on the team had a lot of latitude to tell others what to do. A patient needed to have a peripherally inserted central catheter (PICC line) removed. Even though it was a simple procedure, the hospital required nurses to be trained and certified in the procedure before performing it. I was not. The trained and certified nurse was busy; she would not be able to remove the patient’s PICC line for about an hour. The patient would have to wait. The fellow grew irritated at me and, in front of the patient, “ordered” me to do it. I refused, giving my reason of not being certified. There were possible complications, some life-threatening, if the line was not removed according to procedure. My refusal strained my relationship with the fellow, and for the next several months, he treated me unkindly.

At first, it was hard for me to find justice in the story. The fellow had made my clinical life difficult. However, after telling this story over and over to my colleagues, I realized that it was justice that, when she arrived, the trained and certified nurse who took out the patient’s PICC line defended my refusal to do so to the patient. It was justice that the patient was not subjected to undue risk of complication. After the tensions between the fellow and me did not abate over the several intervening months, my nurse manager confronted him about his behavior; this, too, was justice. Later, as the patient was preparing to leave the care of the team and proceed to hospice for end-of-life care, the patient and I had an exchange in which he thanked me for the care I had given him. The patient himself said that he was glad I had said no to the fellow. The patient gave me a gift when he told me this; it was, perhaps, the greatest justice for the injury of being ordered to perform unsafe practice. As I tell this story now, I am healed anew by the justice with which others salved my injury, especially the patient; they saw me as beautiful, a person who, by virtue of my humanity, is worthy of justice. But more so, I am healed by the fact that the injustice was not allowed to injure the beauty of the patient.

The more I retell this and other nursing stories, the more I understand the meaning of justice in my nursing practice. Justice is that which is right, both in the sense of the right way to practice and in the sense of righting wrongs, that is, making injustices right. In the situation with the fellow, I had practiced rightly by not removing the PICC line, and my community of nurses had set right the wrong of the fellow’s behavior. Justice is also fairness. It was fair to the patient that I did not perform a procedure I was not trained and certified to do. It was also fair to myself, for had I performed the procedure, I would have put myself in jeopardy. Justice is that which is right and fair, and that which is right and fair is beautiful. Justice not only restores beauty when it has been injured, acts of restoring rightness and fairness to someone are good acts, acts that restore beauty. There was goodness in the acts of the people involved in this situation, which I only uncovered by telling and retelling the story, a story that began with an injury that was painful for me for a long time but ended with rightness and fairness, that is, with beauty being restored. We are good to ourselves when, in telling the stories of injuries committed against us, we search for and find justice, for justice restores beauty.

I have over the years tried to understand the fellow’s actions. Perhaps his actions were motivated by wanting the best for his patient, insofar as he did not want his patient to wait. Perhaps he felt insecure: as a fellow, he was in training, and he should have had more oversight by the attending (also known as “consulting”) physicians who were training him. Maybe the fellow was stressed from other issues going on in the clinic and lost control of himself. Maybe the fellow just acted badly. Without any check, we can surprise even ourselves, at times, by the impulse within us to behave badly; it seemingly comes out of nowhere, and without tamping it down, we can unthinkingly act on it. We must check our primitive urges. This check does not have to be external, though the attending physicians who supervised the fellow could have provided an external check for him. However, the fellow could have provided this check for himself; indeed, most often impulse control needs to come from within ourselves.

The cousin of the primitive urge to behave savagely is the primitive urge to study human evil, that is, to try to understand people’s acting on their primitive urges for savage behavior. I spent a good deal of my life as a philosopher studying the problem of evil, and I have no answer. But I have come to believe that we all have within us an urge to act savagely; we all have the ability to commit injurious acts. However, the urge to study human evil serves the purpose of keeping ourselves from acting on these savage impulses. And here we see one reason we should tell the stories of the injurious things other people do to us: in telling these stories, we ponder why people commit injurious deeds in order to check ourselves. These stories of injuries become, for us and for those to whom we tell them, a lesson in how not to act. This is the importance of not forgetting even the most unfathomable and horrible events. We must remember these horrible events, for in remembering we provide a check. Telling these stories saves ourselves from our baser natures and makes us better people. There is a paradox here: when we tell the stories of the injuries of our lives, we are being good to ourselves; for by telling stories of immoral behavior, we subdue the savagery in ourselves.

We tell stories from our point of view. The other characters in our stories, though real, do not have a say in how we tell our stories. Without their side of the story, our versions can end up demonizing others. Our stories can devolve into war stories. This is not the purpose of telling the stories of the difficulties we face in our work as nurses. Rather, if we are to choose beauty over injury, justice over injustice, we should take care to tell our stories in ways that remind ourselves that we all face difficulties. The fellow I worked with, to be sure, faced difficulties. Telling the story of our interaction, however, reminds us—me, him, and you—that there is a just (indeed, a trustworthy) way to act. Telling stories of injustice offers us the chance to imagine that which is just. In this way, I believe that justice triumphs over savagery. Some savagery is too great for any undoing of it, particularly wanton taking of life. However, I believe that we must remember even the most injurious of stories and use them to guide our behavior.

It is not only others who can act unjustly toward us; we can also act unjustly toward ourselves. A friend of mine, a critical care nurse, told me a story of a young adult patient of hers who had been admitted for an as yet unspecified cardiac arrhythmia. The nurse told me that she was certain the cardiac care team would identify the problem and fix it; she was certain her patient would recover. The nurse imagined her patient leaving the intensive care unit, going home, and living the rest of her life in health. However, the patient went into cardiac arrest, and although the team tried to resuscitate her, it could not. My friend told and retold this story to me, asking the rhetorical question of what she had done wrong. She replayed the scene over and over. “What did I miss? What clinical sign did I not see?” Then my friend passed judgment on herself: “I should have seen it coming. If only I had done this or that.” My friend walked around with her judgment of how she did not save her patient. My friend judged herself unjustly, yet she had provided good nursing care, the care any reasonable nurse would provide. The problem with judging ourselves unjustly is that, when we do, we injure ourselves. When we injure ourselves, we cannot find the beauty in the care we have provided.

Search for one moment when your nursing care promoted or restored a person’s health or afforded safe passage from this life. Take time to recall it in as much detail as possible. Let it fill your mind. Find the beauty in this moment. Now find other moments like it. These moments come together to form a beautiful picture of your work as a nurse. Finding the beauty in your work as a nurse saves you from treating yourself unjustly, for beauty, as Augustine said, saves us on life’s rough seas. Beauty breaks the frame of our unjust judgments against ourselves. A young woman dying is unjust, under any circumstances; and when this happens on our shift, we feel its weight. However, remembering beautiful moments of providing trustworthy nursing care to her lifts the weight. When something goes wrong and you, though not at fault, unjustly judge yourself, you can be good to yourself by remembering the moments that you provided good nursing care.

Other people injure us, and we injure ourselves. But there are times when we could have acted differently. We lash out at well-meaning colleagues in the heat of the moment. We do miss clinical signs. We do make mistakes. We are, after all, human. In these situations, we must own up to our mistakes. The nursing profession has well-developed processes to identify the causes of mistakes and change policies and procedures so that the same mistakes do not occur again. We admit our mistakes so that these processes can take effect, for the sake of our patients’ and our own safety. In this way, admitting our mistakes is a way of being good to ourselves and to others. Admitting our mistakes is part of what it means to be a trustworthy nurse, for a trustworthy nurse is honest and imagines herself or himself learning from mistakes.

There are indeed times in which the profession has to say that a nurse’s practice is so unsafe that she or he cannot continue to practice. Few worse fates can befall a nurse, for, as I have argued, nursing becomes who we are; it becomes our identity. Being stripped of the ability to work as a nurse is to be stripped of a part of one’s self. But when this must be the case, the person can be good to herself or himself by no longer practicing as a nurse, for who wants one’s practice to result in grievous injury to colleagues or to patients, or even worse, to be the cause of a patient’s demise?

When injustices are committed against us or when we commit injustices against ourselves, we are good to ourselves when we tell our stories and find justice and beauty in our work as nurses. We are good to ourselves when we admit mistakes and when we realize the limits of our safety. However, we are also good to ourselves when we ponder the good of our nursing care. Let me explain.

When I told my son the stories of my childhood, stories that had to do with universal experiences of figuring out how we live in the world, which can, at times, be truculent, I always ended the stories with how justice healed my injuries. These were not fairy tales or fantasies. I was sitting on his bed, after all, having survived the injuries the stories were about. Sometimes, when I conjured up the injuries of my childhood, decades later, the pain still felt deep. But with each story, greater than the pain was the awe I felt at the fact that my story always ended in the present with my son and me in his room. That fact was—and still is—proof enough that justice heals. It was always a beautiful moment, a moment of healing. By the time the story ended, my son had nodded off to sleep, and I walked out of his bedroom a grown man who had survived the injuries of childhood. I was awestruck each time. The same is true with the beautiful moments of our nursing care: they heal our injuries. And they strike awe in us—awe at there being good in what we do, awe in the good of our simple acts of nursing care. Being awestruck at how good—how ethical—our daily work as nurses is, is another way we can be good to ourselves.

Awe is difficult to describe. It is respect, but it is also surprise mixed with an awareness of our place in the world. The starry sky above inspired awe in Immanuel Kant, the philosopher whose association of awe with morality I mentioned in Chapter 4. I grew up on the desert. On dark, clear nights, I loved to stand alone on the desert sands and look up at the sky. Some nights, I could see the Milky Way, the spiraled galaxy that contains our solar system. It was a breathtaking sight. I would feel small, not small in the sense of insignificant but small in the sense of standing in the presence of something so vast. I would feel my place in the grand scheme of things. Without anyone telling me, I knew this feeling. It was awe, awe at there being what there is, and awe that I am a part of it.

Not only did the starry sky above inspire awe in Kant, but so did what he called the moral law within. We do not need to go into what Kant meant by this to agree with him that when we experience good, we feel awe. Beauty, awe, and good are bound up together. Think of the justice you bring to the lives of people who have been touched with disease and disorder; that is, think of how your nursing care restores beauty to them. This is good, in the moral sense. Now when you see this good, be filled with awe—awe at there being good in what you do, awe at the cumulative effects of the good of nursing around the world. The good that comes from nurses everywhere forms a galaxy of goodness. Find your place in that galaxy of goodness. Feel awe at being a part of it.

Nursing involves mundane tasks. It also involves wonderful moments, moments of birth and aliveness. But it involves injury, too. Justice and beauty and goodness and awe are powerful friends against the daily grit of nursing. Be good to yourself by finding these powerful friends in your stories as a nurse. The more I reflect upon my nursing stories, the more I am awestruck at the beauty, justice, and good my nursing practice results in. The same can be true for you. Reflect upon your work as a nurse and the good that comes from it. Tell your nursing stories over and over, until you can feel awe at what you do. This is yet another way to be good—that is ethical—toward yourself: tell your nursing stories and feel awe at the good that you do.