The gift of the work

I started off my day already over it. Yesterday only one of my five scheduled patients bothered to show up. This day was starting with a patient I had seen a year ago who told me the exact same story she was telling the first time we met. This was followed by another no-show and yet another frequent flyer patient who never wants to do anything to change. Overall, I was ready to leave the building.

My last scheduled appointment was a lady who didn’t really want to see me. Her son had cajoled her into coming and she went along with it because she’s a mother and sometimes we do things we don’t want to do. Granted, this woman’s son is in his 60s but still: you never stop being a mom. And your kids never stop wanting you to be well.

Still. This lady wanted no part of it. And I really couldn’t blame her. She’s depressed because she’s basically just waiting to die. She’s had a lot of loss, more than her fair share, as she says. And for awhile we just sat there staring at each other because she didn’t know what I could do for her. “Nothing’s going to change,” she kept saying. “What’s the point of talking about it?”

I was mentally cursing her son for not hearing his mother clearly say she didn’t want to come when suddenly something did change: she started to talk. We talked about what it means to get older, how much loss there is and how lonely it is. She talked about how even in her depression, she’s content with her life. She talked about the child and husband she’s had to bury and how she’s kept those losses tucked away in a little box that she hides from the outside world because she doesn’t want to disturb them. Then she talked about climbing trees when she was a little girl. She smiled. I did too. She said she’d think about coming back.

The rest of the day shifted in my mind. It’s been a long week and I was feeling useless and out of my depth and frustrated. I could hear myself being impatient with my other patients, wanting to rush them out of the office because I didn’t know what they wanted from me. I know what burnout looks like and I could see myself gliding towards the flames. This lovely lady brought me back, just by opening up a little bit and allowing me to listen.

Now I’m not saying that we should rely on our patients to keep us engaged and upbeat about our work. But I also can’t deny that success with one patient at the right time can make a world of difference. It is, I think, what keeps us in the work: watching people be helped, even just for a moment, and knowing that we are the helpers.

I’m also not denying that I’m nearing a burnout point; it’s time for a vacation, clearly. But I am relieved to know that I haven’t completely checked out. This is another gift of this work: the reminders that come from the grace of others, in letting us bear witness to their pain, even though we don’t have any magic answers. How lucky for me that this lady came along today, to remind me.

Photo by  Leone Venter  on  Unsplash

The wave of grief

My referrals seem to come in waves: one month it will be folks who need help managing their diabetes; the next will be a wave of young patients with anxiety. This is only anecdotal evidence of course, but it was like this in hospice too: you begin to notice some trends. This particular month, it’s grief.

I’m quick to say I lead a blessed life, but it has not been without great losses. My mom died three and a half years ago when I was pregnant with my older daughter. It was a terrible time, of course, but her death was not unexpected. In some ways it was a relief; she suffered for a long time. And since I was pregnant with a very wanted baby, there was a lot of joy intertwined with my devastating loss. When she first died, I still worked in hospice and I found that I was able to use my grief to help patients. Not every day of course, but sometimes the conversation opened the door to self-disclosure and it felt both clinically appropriate and personally beneficial.

More time has made it both easier and harder. Lately, the patients I’m seeing who are struggling with their grief are focused on how much time has passed. “It’s been two years,” one told me, “I should be better.” Should is a useless word, especially when it comes to how we feel. I describe grief to those patients as ocean waves: you can be standing at the shore for a long time and not notice them. Then suddenly one knocks you over without any warning. I know this as a clinician and I know it as a daughter without a mother, but still. Still. My own grief sometimes sits on my chest like a weight, making my breathing a little shallower. There is a pricking feeling behind my eyes that signals tears. In those moments, I am afraid that I won’t be able to hide it. I haven’t lost it yet but recently I have felt very close.

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This is grief, I remind myself. This is a big ocean wave. This is because I had a baby recenty and my 3 year old only knows my mom through pictures and because the holidays just passed and because now that I’m a mother, I understand her so much better but I can’t tell her that and because… Because. This is grief.

The question now is, what will I do with it? I’ve been guarding it like a secret but I know that sunlight is the best disinfectant. So here I am, bringing it into the light: I’m having a hard time. Now I’m going to be mindful and intentional and not let myself be swallowed whole. Self-care is sometimes stepping back and being well. And the occasional afternoon hot chocolate. I learned that one from my mom.

The body knows

I had a tricky interaction with a patient a couple of weeks ago. A patient of mine (who has an extensive trauma history) made some comments about my children not being safe in daycare. She knows I have kids because she asked once and it’s such an innocuous question, I didn’t even think about answering it. In fact, I don’t generally have strong feelings around self-disclosure; sometimes I think it can be helpful to build rapport and trust so I don’t worry about answering mild questions from patients. This is all to say, I had no problem with this particular patient knowing a little personal information about me. That is, until she hit me with this nonsense about my kids being in danger because I’m not at home with them full-time. This is a touchy subject for me, because it’s a deeply personal choice that has several variables and the judgement around it feels absurdly sexist. When she said that I should be careful, that bad things could happen to them because they’re with strangers most of the day, I had to work very hard to be still and not let my face betray my internal, white-hot rage.

In the actual moment, it passed fairly quickly. I squashed it down and told myself that this woman thought she was being helpful; she wasn’t intentionally being cruel. (She even told me that she was being grandmotherly with her concern. Ok, lady). It was later, when I brought it up in supervision, that I realized just how very upset it made me. Telling my co-workers about the experience, my hands started to shake; I felt my breath quicken and my face get hot. And I realized, I was still really worked up about those few minutes!

It got me thinking about how we listen (or don’t) to our bodies when we’re working. I’ve written before about working with frustrating patients and suddenly becoming aware that my shoulders are up by my ears and my fists are clenched. How does it sneak up on me? Because I’m not really paying attention to my own body. There’s a lot we have to do when we’re with clients: listen actively, reflect back, read their body language, etc. But we also have to listen to what our bodies are telling us; often we react physically before we’re able to name what we’re feeling.

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Personally, I especially struggle with being in touch with my physical self when I’m uncomfortable with the energy in the room. Give me someone on a crying jag any day; I can sit with that heaviness and have no problem being in my body: breathing deeply, being still, creating a space for vulnerability. But when a patient touches a nerve (usually unknowingly), my fear or discomfort or anger arrive first in my body, try though I may to ignore those feelings. In those moments, I’m trying so hard to reserve judgement and be still and present that I ignore the warning signals that I’m about to emotionally check out. When I feel my toes curl in my shoes and my hands grip the sides of my chair, it’s usually a sign that I’m not going to be at my best, clinically. In those moments, I have to recenter: I take deep breaths; I practice stillness. Then I take my ass to supervision, because clearly I have some things to work out!

The body knows; we do better when we remember that and listen to what we’re being told: to slow down, to reflect, to breathe. And to utilize supervision!

On to the next

Today is my last day as a hospice social worker. I have done this work for more than five years. In those five years I have gotten married, bought a house, struggled with infertility, lost my mom, had a baby, and suffered a miscarriage.  Throughout experiencing all those joys and losses, I have had a team at work that has supported me like a member of their family. They threw me a baby shower; they came to my mom’s funeral; they arrived with food when I had a newborn and barely knew what time it was. They have listened (and listened and listened) as I have talked (and talked and talked) through my joy and my grief, all the while helping me to see how I could continue to do this work.

This heavy and rewarding work. What is there to say about it that will capture the complexity of the last five years? It’s hard, of course, but also more full of joy than I imagined when I started. I have been so blessed by this experience, by the opportunity to meet people facing the unknown and help to bring them a little peace. I have also been frustrated, tearful, anxious, troubled, and stressed out. I have been lucky that those feelings have been balanced by gratitude; by the kindness I have been privileged to witness; by the team I have worked alongside; and by the families I have been privileged to follow. When the balance between gratitude and stress started to tip too far in the wrong direction, I knew it was time to move forward.

I’ll continue writing and reflecting on my experiences in my new role as a behavioral health consultant. I hope you’ll continue reading. This blog has become part of my self-care routine in a way I did not expect and your comments and kindness keep me moving. Thank you, dear reader, for joining me. On to the next!

In Defense of Good Enough

I know how the title of this one sounds but I stand by it. Good enough is good enough.

I think I speak for the majority of us when I say that we put an enormous amount of pressure on ourselves in this field. We became social workers to help people, to fix their problems, to change the world. We can chant “meet the client where they are” a hundred times a day but deep inside there remains a voice that says, “you can fix this!” There is for me, at least. I’m seven years post-Master’s and there are still times that I forget that my goal is not to fix other people’s problems. My goal is to light the way on someone’s path, not lead it. Still, I have patients ask me all the time, “what should I do? What do you suggest?” Those questions put me on edge because I often don’t know the answer. That doesn’t make me a failure, though. It makes me human.

Part of being human means I have my own stuff to work through. There are days when I find my mind wandering in a patient’s house: did I call the air conditioning guy? When will I go to the grocery store? How am I going to get to my next visit on time? In those moments, I have to pull myself back and refocus on the person in front of me. Sometimes that’s hard to do.

Photo by  thr3 eyes  on  Unsplash

Photo by thr3 eyes on Unsplash

When I was on maternity leave and preparing to come back to work, I spoke with a therapist about how I could continue my work. I felt I had a newfound sense of empathy after having a baby but also a newfound sense that nothing else mattered. I feared that a part of my mind would always be preoccupied with thoughts of my daughter: was she eating, sleeping, crying, did she need me? How could I ever be fully emotionally present at work again? The therapist told me, “You will be better at your job and you will also struggle. And that’s ok. You have to accept not being at your best for a while but being good enough.”

I think about that all the time. There are any number of reasons we aren’t on our A game at all times: big milestones, like having a baby or getting married, but also small ones, like an upcoming vacation or an argument with a friend. It is impossible to be the best every single day. I imagine people in other careers have off days; why is it so bad for us to have them too?

I know the answer even before you shout it at me: we’re dealing with real people and their emotions. Our patients don’t care if we fought with our partner this morning or if our oil change is overdue. Their immediate world is fraught with illness and family dynamics and anticipatory grief. They do not have the space to take in our shit, quite frankly. We have to leave it at the door and do the best we can.

And on the days that we know our minds wandered, that we were not the most compassionate, the most healing, the most, we have to forgive that in ourselves. An expectation to be perfect is a good way to feel like a failure. So why set ourselves up that way? Good enough really is good enough.

How do you do this work?

I wrote the other day about a common question my patients ask me, namely what I do as a hospice social worker. That post brought to mind another frequently asked question: How do you do it?

My co-workers and I laugh about this. Patients, their families, people at cocktail parties, all respond with a mixture of awe and fear when I (and my co-workers) tell them what we do for work. "You must be such a good person," they sometimes say (which is deeply awkward to respond to graciously, by the way). Or, "Oh, I don't know how you do it, it must be so sad."

And it can be sad, certainly. (My husband tells a great story about my first few weeks as a hospice social worker wherein I came home crying, telling him he can't ever die. It's funnier than it sounds). But, in addition to the sadness, it can also be humbling and joyful and surprising. It is an amazing privilege and honor to be with someone during one of the most intimate parts of their life. 

But, still. The work is hard.

It is also easy to forget how to care for ourselves and not let the sadness of it overwhelm us. I've heard our work described as addictive: there is an adrenaline rush when you are constantly walking into crises. It's easy to get caught up in that rhythm and excitement, making it hard to recognize the need for a break. Self care is one of the most important parts of our practice and also one of the easiest to put to the side. There is a need for many of us to be all things to all people; it's unsustainable.

So what do I do to take care of myself? I take myself out for long lunches and read trashy magazines. I call my work friends to say, "Please listen to this crazy thing that happened." I take my days off and enjoy them. This is my self care. It is both deeply personal and deeply necessary.

Tell me about yours.