Using Perspective As a Tool Against Nursing Burnout

The death rate for humans on the planet Earth is currently 100 percent. I know this is not a pleasant thing to read while enjoying your first cup of coffee this morning, or perhaps you’re enjoying a calming glass of wine later this evening. It’s unpleasant enough that perhaps you will not finish reading this post, but it’s true nonetheless.

Ravens by jparadisi

Ravens by jparadisi

Running parallel to our fear of dying is our pursuit of eternal youth. Cosmetic surgery and procedures are a billion dollar industry. Many men and women consider regular treatments for balding, teeth whitening, the prevention and removal of wrinkles, and coloring gray hair part of normal maintenance. Some choose to have  the evidence of time wiped from their faces by a surgeon’s scalpel.

The struggle nurses face in striking the right balance between hope and realistic outcomes for our patients is in part due to society’s mythical belief that death is preventable, when in fact, it’s inevitable. As humans, nurses buy into the myth to some extent also.

Discussing this, a nurse friend and I joked about gray hairs and wrinkles. She remarked, “Getting old is terrible.”

“No,” I said, “It’s not. It’s what nurses do for a living. We help people stay alive so they can grow old.”

See? It’s a matter of perspective.

Whenever someone asks, “Is it hard being a cancer nurse working with dying patients?” the above thoughts come to mind. The answer is, “I don’t see oncology nursing from that perspective.”

Yes, oncology nurses work with the dying, but I perceive our practice as helping people live to their fullest capacity.

Nurses cannot guarantee patients a cure or how long they’ll live, but by promoting prevention, treatment, and providing tools for managing chronic disease, we encourage them to pursue their best life possible as things stand. If nurses lose this perspective, how can we hope to share it with our patients?

There is balance in the realization that death is part of life. Death and loss cause grief, a normal response. Grief and loss are painful. We fear death and loss, but they are a natural occurrence of living. Maintaining a realistic perspective is a tool for burn out prevention among nurses.

All people die. Nurses are here to help patients live until that day.

I grieve their loss, and mine, because I glimpse my mortality too in the faces of the dying.

Thank you for reading this entire post.

Sometimes a Cigar Isn’t a Cigar

Dreaded Bathroom Mirror photo: jparadisi 2011

The painter Lucian Freud died last week at the age of 88. The grandson of Sigmund Freud, he was a portraitist, making images of friends, family, the famous and the not so much, splayed naked on ruined couches, chairs or ottomans; sometimes draped with animals, mostly dogs. I first learned of Freud in art school, during a figure painting class in which an instructor commented something to the effect of:

“He breaks a lot of rules of painting, but somehow it works.”

I like Freud’s portraits, and was a little shocked after he died to read that many art critics strongly dislike them. Jerry Saltz writes about Freud for NYMag:

“Which brings me to my personal taste. While I don’t particularly like Freud’s work (just last week I saw the Met’s current Freud show and thought, “Meh”). Yet then as now, I admire him greatly. I look at Freud’s intensely worked, eternally noodling oozey surfaces, the incessantly teeming little paint-brush strokes, the Morandi-like limited palette of flesh tones, and his claustrophobic vision of naked models forever posing in his famously dilapidated London studio, and am often struck by how the life of his art seems to drain away. Mostly what I see is nearly maniacal painterly control. Yet Freud is an important touchstone for the many of us who secretly fear that we are not naturally gifted; we who are not precocious geniuses, we non-Picassos who are always unsure that we even are what we say we are.”

Ouch! Those are some harsh words. Good thing I’m not thin skinned.

The opinion that best challenges my own comes from someone whose art critique I hold with regard. He wrote about Freud:

“I hated his work with a passion. Certainly, like everyone else, I could see the penetrating psychological deconstruction he was going for and nailing…his drab palette and ethos of anti-romanticism encapsulated everything I am against.”

(Note:  Romanticism refers to a philosophical movement within art history, not romance, as in sharing a good Oregon Pinot Noir and gourmet chocolates naked on the deck by moonlight…Hmmm. Hey, David.….?)

My friend’s words touched on something for me, and I’ll tell you what it is. I agree, Freud’s portraits are “penetrating, psychological deconstructions” of his subjects. They are disturbing because they coldly render the sitter into gobs of painted flesh, not pretty flesh, but swollen, loose, pale, sweaty flesh. Freud took months to a year to finish a portrait, literally “deconstructing” the sitter through the physically punishing act of posing for hours, days, weeks, and months.

Sometimes, he painted people we think we know, like pregnant super model, Kate Moss. I only know the painting is of her, because he told us it is. Through Lucian Freud’s eyes, I do not recognize her famous face. At times, his portraits remind me of the shock I feel seeing the reflection of my imperfect body emerge from the shower in the in the steamy bathroom mirror, or watching David’s unguarded face in the repose of sleep; in both instances wondering, “who is that person?” This feeling of astonished wonder, this anti-romanticism, is the price of intimacy.

Freud looked at people through the eyes of a clinician, reducing them to bluish veins under discolored flesh. I think that’s why I like his paintings. I am a nurse, and often, the first vision nurses have of a naked patient is similar to one of his portraits. The sensation brings a bit of shock to both nurse and patient. Part of nursing is gaining the ability to navigate within the intimate personal space of another human being. We use a clinician’s eye to assess problems readable in the naked flesh of our patients. However, it is inherent in nursing to turn off the clinical eye and relate to the person residing inside the ailing flesh, with the understanding that they come before us deconstructed by their disease process.

Our decaying flesh is the price we pay for being mortal.