ASK JOY
I'm an ICU nurse, and I take care of very sick patients. I see so many diseases, and now, at the slightest twinge, I think I've got those diseases, too! What do I do?
~Normal Vitals, RN
Hi, Normal Vitals!
There's usually a few levels of things going on.
1) Empathy. There are three types of empathy: cognitive, emotional, and affective. Cognitive helps us identify others' needs. Emotional empathy lets us feel what they feel, and affective empathy motivates us to act. It's that emotional empathy that can trip us up. It's necessary--without it, we can't easily progress to affective empathy--but if we feel too much of it, it can bog us down. We don't want to STOP feeling emotional empathy, just manage it.
We must manage our feelings.
2) Knowledge. Knowledge is power. It also let's us see possibilities that we had not considered before. Naturally, our ego is then anxious to apply those possibilities to ourselves. Your brain is trying to help you in imagining those things because if you can imagine it, then you should be able to prepare for it and fix it. At least, that's the pathway the brain follows, whether true or not.
We must manage our thoughts.
3) Stress. The ICU is a tough place, and the pressure is real. Constantly exposing your body to stress causes hormonal changes. It affects the vagus nerve, wears down your joints, and inflames your digestive tract. These things are also real.
We must manage our health.
So, yeah, you're dealing with a lot, and it's coming from all sides. But it also gives us a game plan.
1) Manage your health. Stay hydrated. Nourish your body. Strengthen your muscles. Move to increase your heart rate and burn off some of the cortisol. Visit your physician. Take your meds. But also, learn to calm your body. Silence, rest, meditation, yoga, massage, biofeedback, whatever works for you. This will help you learn your body. You will learn what is normal for you and what is not. Then when a twinge happens, you will know whether it is something to be alarmed over or not.
2) Manage your thoughts. Our "lizard brain"--the one that cries out "danger!"--evolved first. Our frontal cortex--planning and logic--came later. The lizard brain will always be louder. It will always be better able to grab your attention than the slower, calmer thought processes of the frontal cortex. That means it's really easy for those thoughts to take over. It's almost like you are a driver with the most obnoxious and panicked back seat driver ever. But you are still the driver. It's not worth fighting with that voice; it will only increase the panic--and occasionally, it hits on something true! As the calm driver, you can LISTEN to the lizard brain in the back, but then assess the situation, apply logic and reason, and come to a conclusion that incorporates your deeper values. Your first reaction in a situation is a REFLEX...your second is the true you. To feel twinges and panic is completely reasonable...but your higher self can analyze the situation, recognize what is true or false, and choose how to move forward.
As you practice this and take responsibility for your thoughts, perhaps you will see that you commonly think a twinge is worse than it turns out to be. Good! Now you know how to "calibrate" your brain. For another word picture, think of a sniper. A sniper knows her rifle. She knows that at a certain distance, she must offset the pull of gravity on the bullet by clicking up the settings in the scope. You can do this with your brain, too. For example, I am a pessimist. But I know this about myself, so I can compensate for it. When I am presented with a situation, and I foresee a bad outcome, I know to step back and "click" the settings up a couple levels. That usually gives me more accuracy in determining what will truly happen. Part of managing our thoughts is learning our tendencies--not to fight them, but learn how to compensate.
3) Manage your emotions. Many times when we manage our thoughts, our emotions are naturally better managed. Our thoughts produce the vast majority (not all) of our emotions, and by monitoring and changing our thoughts we can keep some feedback loops from occurring. Sometimes we need to remind ourselves of some thoughts: You are not the patient. It is not your emergency. You are curious about their situation and choose to observe and help without joining their distress. Sometimes thinking about the separateness can help prevent overflow of the patient's emotions onto ourselves. Some people call this compartmentalization, but I find that people tend to take that a bit too far, to the point of being jaded or cold. The goal is to be an independent individual who occupies the same situation. We can hold space for the patient and be WITH them without becoming LIKE them.
As emotions build, it's important to recognize when you need a break as well as when you need to address the build up. Talking to someone in healthcare can help, and talking to someone who is not in healthcare can sometimes help just as much. Those outside of healthcare offer unique perspectives that can draw us out of our tunnel vision. Think about who those people are in your life and make a regular practice of seeking them out. When we build a habit of talking, then there is no shame to talk when you are in need of help.
Writing can be helpful, too. I find it's nearly like sorcery. Set a timer for five minutes, then write down EVERY thought that comes into your mind. All of it. Don't edit yourself. The good, the bad, the ugly, the shameful, the gross. Write it out. When finished, you can decide what to do with it. I've had clients delete the page. Rip it out of the notebook and tear it up. I've had some burn it. I've had some keep it forever. It's up to you. But it's highly effective for some people, especially when practiced over time.
Ultimately, you're a great nurse. You have kickass knowledge and deep compassion--two critical things to this field. Even better, you reached out.
Keep up the good work.
~Joy