…i nga wa o muri. The surge of the sea. Whether you think of time as something you move through, so that your past is necessarily behind you, or whether you conceive of time as an encompassing continuum (so that your past stands before you, while wrapping you round, and your future is never-present but ready, waiting behind—i nga wa o muri), there is always the pulse of the sea. In us and round us, the sea. We have that constancy. ~ Keri Hulme
This quote is from Hulme’s lovely book HomePlaces (Hodder and Stoughton, Auckland, 1989). I found the book yesterday as a ‘rare’ book in a bookstore in the town of Hokitika on the West Coast, South Island, New Zealand. For my community health course this quarter we’re reading Hulme’s The Bone People (one of my favorite books since it was published in 1984 and a good choice for teaching community health in New Zealand). After purchasing the copy of HomePlaces, I tramped up the beach several miles back to the hostel where we’re staying. A rouge wave from the wild Tasman almost took me—and the book—out to sea. Perspective. Being next to (and inadvertently in) the very cold sea, as well as being temporarily unhooked from the chatter of the internet, has reminded me of the importance of mindfulness training and of self-care in our personal and professional lives.
Professional burnout is never a pleasant thing to have (or to be around). I have crashed and burned in clinical settings at least twice in my life, so I know what it feels like and what personal and collateral damage it can do. And I’m beginning to feel a bit crispy in terms of my academic role this quarter. Something about living with my undergraduate students 24/7 for three months in ten different youth hostels all over both islands of New Zealand was just not a good idea. My passion for teaching is in serious need of refueling (along with the minivan I’m driving them around in).
Compassion fatigue, moral distress, and professional burnout—the gooey mess that health care professionals—and especially nurses—are prone to. What’s the antidote—besides getting whacked by a rouge wave from the Tasman and washed out to sea?
Self-care. Not the self-indulgent variety of going off to expensive spas and eating dark chocolate, but real self-care. What Rachel Naomi Remen, MD calls heart care: “ways of keeping your heart alive in health care.” David Bornstein wrote a nice NYT article “Medicine’s Search for Meaning” about Dr. Remen’s work (Sept 18, 2013). It focuses on physician burnout and mentions that half of all medical students burn out by the end of their training. Nurses burn out at even higher rates, especially in their first few years of practice.
I’ve read (and used in some of my courses) Remen’s book Kitchen Table Wisdom. But after reading the NYT article, I decided to see what all the fuss was about. I signed up for Dr. Remen’s telephone conference/training call in mid-November. I’m often cynical about self-care, but I also know that cynicism is a marker for burn out. Plus, mid-November in Seattle is a dark and gloomy time, so a little brush-up on self-care sounded like a good idea.
Remen points out that the heart is devalued within health care. She states, “science (the head) is a tool of healing but is not the source of healing—that is the heart.” The heart is an organ of vision—that helps us discern the meaning of the work we do. She outlines a way of establishing a practice that supports the ability to ‘find meaning on purpose’ in one’s work (as opposed to having to be whacked over the head by it).
In response to several questions from some of the conference caller participants, Dr. Remen admitted that we’re all having to work within a broken health care system, but, “that doesn’t prevent us from taking time for self care; staying alive within the system isn’t about changing anything outside of yourself.” And she used this analogy: “If I can’t have a wonderful long drink of fruit juice, I won’t take another sip of water.” She deflected more questions along the same line by saying, “I don’t have an answer for changing the system.” What I thought—and wanted to say—was that self-care keeps us alive (and healthy) and perhaps gives us more energy to work for systems change. And, of course, that is what Dr. Remen has been doing all these years through her work and writing.
She recommends a series of ‘heart practices.’ The following are the two that I like the most.
- Connect to yourself by the mindfulness practice of attention to one’s breathing. “Paying attention at the very end of an out breath as a moment of absolute rest and peace.” Practicing this can build the capacity to come to rest.
- At the end of the day, ask yourself “What surprised me today?” and “What touched my heart today?”
Sometimes in my more cynical moments this all sounds so woo-woo and kum-ba-yahish, but I am convinced that it works. And I will try to pass it on to my students.