My therapist recently noted how much inner work and wrestling I must be constantly doing as a nurse, without being fully aware of what is rumbling underneath the surface. Today I find myself feeling really tender, and I’ve got a feeling it’s because of the recent accumulation of patient stories that have gone unpacked, evoking sensitivities, calling for acknowledgment in the ways they work on me.

It’s the patient and family we were so deeply won over by during their first ICU stay with us, who returned to our ICU after only a short stint at home. We were incredulous they even made it home from the ICU the first time, though we all knew in our gut the recovery was going to be short-term. It’s the clear progression of disease, coupled with their unwavering kindness toward all of us. It just doesn’t feel like people who are this kind, should suffer this type of disease progression. It’s the tension of being glad to see them because we were simply fond of them, but also so sad to be reunited in this context. The tension of rooting so hard for them, and feeling that deep dark rumbling of dread over what we know is coming for them before it ever feels fair or okay. The tension of being glad for how we can help them, and grieving how helpless we feel. So much tension we bear.

It’s the patient who was fine one day, and is now on the brink of death. We see the motionless patient connected to machines, see the vital signs swinging wildly out of our control, so we sort of get that this patient has crossed a point of no return. And yet our minds keep drifting back to that fine one day, when the patient was just hanging out with friends and just had a headache like all people get headaches, not knowing this headache indicated the blow that would sweep a family and a community off their feet. It’s impossible to reconcile the before and after. So much tension. God, I hate ruptured brain aneurysms more than anything.

It’s the patients and families we feel so distressed by, when they take their anger and frustration out on us. I think of the child who came to our unit in extreme, acute medical crisis. We watched her turnaround before our eyes, like being raised back to life from the dead. We were proud of our work, but it truly wasn’t about our ego; we were just so relieved and amazed to see her get better so quickly. And then suddenly, her parents were standing at the front desk of our ICU, berating all the staff for how long the discharge process was taking that morning. They would not be met or moved by kindness. “I see your smile. You can smile when you get that discharge paperwork in my hands, but until then, wipe that smile off your face.”

It’s the tension of working so hard to empathize broadly and deeply with how much stress and despair they are under, and giving them a relatively long leash on their behavior as a result. In the same moment, we are trying to regulate our own stress and despair of feeling run over, belittled, disrespected, but being held to a short leash in our behavior because we have to be ‘professionals.’ Choosing the high road in this particular tension is important and ideal. Even still, we pay a significant personal cost in emotional, mental, social, moral and spiritual energy. The angry families blow off steam, and we pay the tax for it.

We sort of knew this is what we signed up for. And yet, each case marks us so uniquely. So then, when you’re trying to sort out why you feel so strangely marked by a whole conglomeration of cases, all you know is that you feel a jumbled ache inside, and all you can say to loved ones is, “Work has been hard.”

Work has been hard. But I’m not talking about organizing a tight medication schedule, or turning heavier patients, or operating a lot of complex technology. That stuff feels like the easy part. The hard work is that of wrestling with perpetual deep tensions, of trying to stay steady enough to care for the well-being of others, and figuring out what to do with all that rumbles beneath the surface.