Thick Skin or Solid Foundation?

I’ve had several folks tell me lately that I must have thick skin to work in the field that I do.  The heartbreak, sadness, and loss that is faced every single day in the 30 rooms on our unit… and likely in the 576 beds at our hospital…is phenomenal.  Heartbreak isn’t just oncology.  It’s everywhere. One could argue that, despite poor health choices and bad environment, nobody really earns cancer.  I suppose the threat and mortality rate is higher than most, creating a fear that no one wants to ever face.  I get it.

I don’t discount the emotional twinges we get, the lumps in our throat that we swallow as we watch patient’s and families inhale bad news and exhale grief.  This is as real is it gets, people. Super Tuesday doesn’t matter.  American Idol doesn’t exist.  Everything outside those rooms just disappears in those moments with no escape hatch to be found.

Yesterday I said goodbye to two families.  It was a bittersweet day.  One was leaving because it was her last chemo.  A couple of the nurses had brought in cupcakes and bubbling ciders to throw her a small celebration in her room.  She wasn’t even out of her teens yet and she had powered through months of chemo and faced decisions that seemed unfair of her to have to make.  Today, she looked especially beautiful.  Her hair was long and flowing with the front done up in a fancy braid that lined her face. She was glowing and couldn’t stop smiling or bouncing on the bed with excitement. My heart soared for her.  Get back to being a teenager, I silently wished.

Not two hours later, I was saying goodbye in a different way.  A different kind of discharge from the hospital: home on hospice.  I got my patient dressed and sat him at the edge of the bed.  It was a huge task to do even that.  We faced each other with a kind of grand pride that we accomplished this without incident. His blue eyes were glowing and he had a huge smile on his face.  I could tell he was going to be okay.  He suddenly threw out his arms and said “well, can I have a hug?”  With his wife of forty years and two adult daughters looking on, I said “HELL YES” and wrapped my arms around him, taking care not to pull out the tube in his nose.  I looked over at them and they were crying behind their facial masks.  I felt the lump and swallowed hard.  I directed my attention to my heels, making sure they were grounded to the earth.  I felt solid.

After the medical transport guys got him on the stretcher, I walked up in shook his hand.  I thanked him for allowing me to care for him and his family and told him what a joy it had been getting to know them.  He looked at me with slight skepticism and asked me what was next.  I knew what he was asking.

There is no good answer for that, especially with about 30 seconds to give it.  I removed my mask so he could see my whole face. I opted for the truth in a millisecond. I looked him in the eye with steely confidence and said “your body may be giving out on you, sir, but you….(pointing at his heart)…YOU…are going to be okay.”  He smiled, looked at his wife, and said thank you.  I hugged the rest of the family and they headed down the hall.  That would be the last time I would see him.  I felt the lump as I turned the corner.  No one was around.  Instead of swallowing it this time…I let out a huge exhale and went on with my day.

I sit in gratitude right now as I write this. Thick skin?  I am skeptical. If I had thick skin, nothing would affect me and I would not be able to be thoughtful and compassionate. I would care less.  I wouldn’t be trying to understand what others need when they can’t verbalize it themselves?

There are some things I know.  It gives me the foundation so that I can be a pillar for my patient’s to lean on.  We all do it to a certain extent but some of us are better escape artists than others, not wanting to deal with the truth of anything.  It’s “too painful”.  But when we realize that WE are not made of PAIN, that we are separate from pain, things get a little easier.  We do have control.  We can sit in it as long as we like.  We can use it to our advantage.  We can use it as an excuse. We can hide behind it.  We can run from it. But when we stand right in front of it and deal with the root of it, we realize that it cannot kill us.  It’s all the other stuff around pain, our reactions to it, that kill us.  Sitting in the pain with this family as they were told no more treatments were available was an honor.

Human connection is incredible.  It transcends all things.  Without it, we die.

So when I look at the contrast between the two goodbyes yesterday, I see one incredible similarity: true human connection.  No bullshit.  No facades.  Resumes and status bear no significance. Outside those walls, is a desperate world scrambling to do something when what we really need to do is STOP and reconnect with the earth.

With a solid foundation, we can do anything.

We are connected.

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