On my morning drive to work, I shake off the cloud of drowsiness, and I debate whether to get caught up on the news – sadly nowadays, a too easy way to already burden myself before my 6:50AM arrival at the hospital – or enjoy the 40 minutes of silence before whatever will unfold, unfolds. I never know who my patient will be. We have the “usual” cases I know to possibly anticipate – the bronchiolitic infant who just needs to be sedated and intubated for a few days while the virus passes, the post-operative spinal fusion who needs good pain management and early mobilization out of bed to prevent pneumonia and muscle stiffness, the craniotomy patient who had a brain mass removed and needs constant neurological monitoring with a drain emptying excess fluid from their head. These are usually the straightforward cases. But in my gut, there always sits an unease on every morning drive, knowing I need to be ready in case I get the unstable, septic patient who decides to lose consciousness after dropping his blood pressure just 45 minutes into my 12-hour shift, and has me running to give fluid boluses and critical heart medications, help with the insertion of a breathing tube, monitor and treat all the lab values that are out of whack lest his heart go into an abnormal rhythm, all the while updating and consoling the terrified parents. The unease never goes away, now 6.5 years into pediatric critical care nursing.
When I’m in the thick of shifts like this, my heart usually sits in an inexplicable place of strange, subdued emotional dullness. Part of it is the intense mental focus and task-orientation that is required to do all I need to do to keep my patient alive. And surely, part of it is self-protection so that the debilitating emotions don’t consume me while I’m still at work. I often feel a low-grade nausea. I know to anticipate a sleepness night as my adrenaline-bathed brain is on overdrive, reviewing all the day’s events, wondering what I could have done better, wondering what will become of the patient’s family. I know to anticipate the flood of emotions tomorrow. I know my kids and my husband will sense that Mommy is really off for a day or so.
I had a shift like that recently. By the time I was in the parking lot getting ready to come home, I’d been at the hospital from 6:50AM til 8:40PM, more than an hour beyond my usual clockout time. I texted my husband, “My patient coded today. Leaving for home now.” I drove home in silence.
I walked through the door over an hour later than usual, drained. Dinner was on the table. My husband sat quietly at his computer. He looked up. “Hey.” And then he went back to his computer.
I lost it.
“THAT’S IT? I TEXT YOU THAT MY PATIENT CODED AND I GET HOME LATE AND THAT’S ALL YOU GIVE ME?”
He was stunned. He’s used to me coming home from work with little energy to talk, so he was giving me the usual space. He had no idea why I was yelling at him, why I expected more support from him that night. I had no idea he hadn’t seen my text. I also had no idea that this far into my nursing career, he still didn’t know what it actually meant to say my patient coded. I had to explain, we were in emergency mode – the patient required CPR, hand-pushed heart medications to restart his heart, and in this case, shocks on his chest from the defibrillator. After all that, we barely kept him alive.
After my husband and I both apologized and untangled our layers of missed communication, he sat with an open heart as I began to sob, but curiously not (yet) out of grief for my patient. What poured out of me was a lament about the demands of life I felt on my shoulders, and the elusiveness of a work-life balance as a pediatric ICU nurse and a mother of two young children, ages 2 and 4. I feel the effects of my weary, scattered “mommy brain” at all waking hours, but most acutely when I am at work and need the sharpness to come faster than it seems able to in those hugely critical moments. I was skeptical about the existence of Mommy Brain until I had my own kids, and oh my goodness, is it ever so real. I feel guilt about how my home obligations affect my work, and how my work obligations affect my home. I see work as a break from home, and home as a break from work, but neither one is actually any real break at all. The very concept of true balance is not a realistic goal at this stage of my life. Self-care, however, still is, and a big part of that is validating and accepting my limitations, and thus accepting who I am as a wife, mother and nurse.
While I love the ideal of giving my best at home, first and foremost, and then giving my best at work, if I’m honest, there is quite frankly no place where I’m currently really giving my best. The emotional, physical and mental demands on a finite person immersed back and forth in motherhood and PICU nursing are simply too much. What I can give to myself and ask of others is deeper self-compassion and grace. As opposed to self-pity, which is carried by an undercurrent of negativity and can feed the bitterness tied to burnout, self-compassion generously allows for the recognition of the difficult things, but with a grace-filled movement towards restoration and perseverance.
From this place of self-compassion, I will give what I can give. Sometimes it will be as straightforward as “no more, no less.” Sometimes I will have to give more than what I feel I can or want. And sometimes, when no one else’s survival depends on it, I will allow myself to give less than I could. But when I beat myself up for not constantly giving my “best”, I’m only beating myself down. Extending self-compassion to my soul frees me to bring what I can with confidence, peace and perhaps most importantly, joy rather than resentment. It also frees me to ask others for help and grace without excessive apology. In family and in nursing, everyone matters a great deal, but in this pursuit of the often-elusive work-life balance, I must remember that I matter too.