Turning 40: Notes to My Younger Self. #17 Love is Love is Love is Love is Love

#17. Love is Love is Love is Love is Love

I do not believe in walls.

I do not believe in keeping people out.

I believe in loving your neighbor.

I believe in inviting people to the table.

I believe in love.

Love is Love is Love is Love is Love.

All people were made to be loved.

All people were created in the image of God.

All people are invited to my table.

All people are my neighbor.

All people are beautiful.

All are welcome.

As you age, there will be a lot of discussions about walls. Know this: we do not believe in walls. We believe in love. 

Turning 40: Notes to My Younger Self. #16 People are Beautiful

#16. People are Beautiful

When we were younger, we were rarely exposed to people who were different than us. Growing up in a conservative tradition, which we still very much appreciate, we were primarily surrounded by like minded people.  

Southern, white Americans, who prescribed to the Christian faith and attended churches of Christ, and who were primarily middle class Republicans.

So, with the lack of exposure, there was a lack of comfort and understanding.

When I was in graduate school in the early 2000s, people from school would often invite me to hang out, to go to dinner, to attend parties.

I never went.

I didn’t necessarily understand what it meant to spend time with people who were different. I suppose a part of me was afraid. I did not drink. I did not cuss. I did not know what one did at bars. I knew that I was terribly conservative and that they were not. I knew that I held to traditional ideal and I knew that they did not. So, I stayed at home.

In addition to fear, my legalism and ignorance also gifted me a degree of arrogance, an elite ideology of goodness, and humble superiority. I was not like those people.

I missed a lot of opportunities to meet and fellowship and live life with some really good people because of that fear and ignorance.

Thankfully, I grew.

Working has ascribed me to a life of people very different from my self and my tradition. I have met and worked a long side with people from literally all over the world. I have met and worked a long side people from all walks of life. I have met people more conservative than me, much more liberal than me, Democrats, atheists, agnostics.

What I have learned is that people are beautiful, that I am truly no better than anyone else, that God loves all.

I have friends from all over the world: India, Kenya, Afghanistan, Philippines, Nigeria, China, Cameroon, Korea, Ukraine, Tanzania, Ethiopia, South Africa, Russia, Romania, Israel, Vietnam, Thailand, and so many many more places.

I have dear friends who are gay, lesbian, bisexual, transgender, and heterosexual.

I have dear friends who are Muslim, Orthodox, Catholic, Buddhist, atheist, agnostic, Jewish, spiritual, and Christian.

I have met drug addicts, t-totalers, those who only smoke a little weed, alcoholics, and people who simply socially drink.

I am so thankful that life grew from the safe space I grew up in, to the safe space that is now my world.

I am better for these people. All of these people. They have encouraged me to be a better human, a better clinician, a better person, a better Christian.

They have ALL shown me Jesus.

Turning 40: Notes to My Younger Self. #15 Confession

#15. Confession

Community is so powerful and so beautiful.

Community is so important. Having a support system is so important. We need people to love us and encourage us and to build us up.

Once we have true community, one of our biggest fears can be of losing that community, of being unwanted.

Often times, this fear is so powerful that it leads us to secrecy and to shame. We are so afraid of truth, of other people’s perceptions, of being unwanted that we hide within ourselves.

But that hiding results in loneliness, isolation, pain, shame, and fear. The longer we hide, the longer these negative attributes grow and the more isolated we feel.

We fear so much, that we begin to live so little. 

True community is having true fellowship. True community is being free to be authentic and vulnerable and loved.

We read in the book of James, that we should confess our sins to one another and pray for one another, so that you may be healed.

Being healed is the removal of shame, the removal of loneliness, the removal of secrecy, the removal of self-loathing.

The act of confession is an act of self-disclosure for the purpose of being known, of being seen, of being connected and committed to community. We confess our faith. We confess our feelings. We confess our fears. We confess our hurts. We confess our pains. We confess our hopes. We confess our loves. And yes, we confess our sins.

Confession is about life, about healing, about truth. Confession is about being known. Confession is about being authentically loved.

Many years ago, I slowly began to understand the value of confession. Little by little I began to trust and grow that most vital support system. So much of that support system grew out of confession, vulnerability, and love.  

I wish we had not waited to be so bold, but I am so grateful that we did.

Turning 40: Notes to My Younger Self. #14 Pain Hurts

#14. Pain Hurts

What is pain?

I love asking this question to novice nurses or students. I often get an interesting answer, sometimes a very scientific answer. But the answer is really quite simple, the answer is not scientific at all.

Pain is whatever the patient says it is.

Pain is subjective.

Only the person experiencing the pain can measure it, only the person with the pain can tell you what it is like. I can not describe what another person is feeling. I can guess and ask pointed questions, but only they can describe the feeling, the amount, the severity.

I know this to be true of the body. Life has taught me that it is also true of the heart, the soul.

Pain hurts. Sometimes life hurts. Sometimes experience hurts. Sometimes, people do not even realize how much they hurt. But we can not know how hurt someone is unless we ask.

We can not see physical pain. We can not see emotional pain, either.

We can not see that which causes physical pain. We can not see that which causes emotional pain, either.

No matter the type of pain, the cause of pain, or the severity of pain, it is always whatever the person says it is. Weather we think something should hurt or not, it hurts if the person says it does.

Some clinicians do not believe when a patient is in pain. They dismiss their complaints and do not provide treatment. They leave them to suffer, to writhe, to hurt.

I wonder how often we are dismissive of people who say they are in pain or hurt because we do not possibly understand how someone could hurt from the thing they hurt from. So, we leave them to suffer, to writhe, to hurt.

As you grow older and meet people of all walks, remember that their life experience is whatever they say it is. If you are to truly have compassion for those you meet, it must be for all things; even in things you do not see and do not understand.

Turning 40: Notes to My Younger Self. #13 My Ethics are Not Their Ethics

#13. My Ethics are Not Their Ethics

Over the years, I have had to have some seriously hard discussions with a lot of families. Discussions primarily focused on life and death. Mostly death. Discussions about how it will happen and when it will happen and what it will look like. It is in those discussions that I have had to really listen and meet those people where they are. It is also in those discussions that I have learned most about the perceptions people have, weather those perceptions were actually reality or not.

Often, during those discussions, people will ask me what I would do if it was my family member. And I will tell them. But, just as often, they do not ask. They do not ask and then the family chooses to do the opposite of what I feel they should do.

For a long time, I struggled with why they would make the choice that they did.

I struggled with what I perceived their choice to be.

Then, I realized one day, my ethics are not their ethics.

Just because I see the situation one way and the right choice as one thing, does not mean that they are wrong because they see the situation different and choose do something completely different.

Ethics are moral principles that govern a person's behavior or the way they conduct an activity.

Just because they possess moral principles that are different than mine, does not make mine any more or less valid. It also does not make mine any more or less moral.

My ethics determine my conscience.

Their ethics determine their conscience.

There are some things in life that are grey enough, that there is not necessarily a right or wrong, if it does not negate our conscience.

Because our ethics and morals guide our conscience, it is hard to appreciate that someone could have a different view point than our own or that their view point is not wrong simply because it is different. After all, their view is in opposition with our conscience.

In the past, when people would make decisions that I disagreed with, I would tend to argue with them and try to persuade them to see my perspective. I would try and get them to see my view point so that they would change their decision to align with my ethics.

But with time, and life experience, I realized that they believed what they believed to be right as much as I did. While I thought their decision was unethical, they often thought my suggestion was unethical as well.

Learning that my ethics are not their ethics has allowed me a great deal of peace and acceptance, has taught me a lot about my own conscience, and has taught me to be much more compassionate.

Turning 40: Notes to My Younger Self. #12 Meet People Where They Are

#12. Meet People Where They Are

You have to meet people where they are. You just can not make any progress until you do.

Sometimes it is hard to understand where someone is. Sometimes we are in such a different place that we tend to stop listening. We get so focused on trying to get the person to where we are that we can’t hear when they tell us where they are.

When you don’t meet people where they are, you do not listen to them, and they can not hear you. Walls come up, defenses set in, the conversation becomes a stalemate, or worse, a battle. No progress is made. Both parties walk away frustrated and the original goal of coming to a common understanding is not met.

People truly do not care how much you know until they know how much you care. You have to listen. You have to hear where they are. You have to be present for the person you are talking to. In truth, when you listen, you have all the power, all the control. When you hear what the other person is saying, you hear where they are, you hear what they need, what they want; then, and only then, can you help them.

Communication is so extremely important. It is what relationship and life and love is built on.

When we argue, when we fight, when we don’t listen, when we dismiss, we lose, they lose, no one wins.

In truth, it only takes a moment.

Turning 40: Notes to My Younger Self. #11 Torturing People is Torturous Work

#11. Torturing People is Torturous Work

I think I felt something break or crunch.

If you did not, then you are not doing it right.

Some people need to be full code and have everything done. Sometimes it is because they are young and healthy. Sometimes it is because they are old and healthy. Sometimes they are not healthy but a freak thing happened and we can still turn them around.

But often times they are not healthy and the thing that has caught them is going to cause them to die and we are fighting the inevitable. Most often the family is not ready to let go and so we fight and fight and fight.

So, what does the fight look like.

It looks like a tube in every orifice. A breathing tube down the trachea. A nasogastric tube down the nose to the stomach. A foley catheter in the urethra to the bladder. A rectal tube in the anus to the rectal vault. A central line in the jugular vein or femoral vein. An arterial line in the radial artery. A pleural chest tube in the pleural cavity outside of the lung. An esophageal probe down the esophagus.

It looks like toxic drugs to keep them alive. Norephinephrine to shunt the blood away from their hands and feet and toward their heart and brain. Adrenaline to shunt the left over blood away from their hands and feet toward their heart and brain. Heparin to keep their blood from clotting. Dextrose to give them some energy. Insulin to keep their sugar levels down. Bicarbonate to fight their acidosis. Fentanyl for comfort. Versed for sleep. IV fluids for hydration.

We monitor to them so closely. They do not know if it is day or night. They do not know what day of the week it is. Every 15 minutes we take their blood pressure. Every hour we check their blood sugar, their urine output, their vitals.

We place them on machines. Mechanical Ventilator for breathing. Continuous Renal Replacement Therapy for dialysis. Sequential Compression Device to prevent blood clots. IV Pump to administer medications. Feeding Pump to provide tube feeding. Bare Hugger to warm them. Arctic Sun to cool them. Flow Trac to monitor the heart function.

There is so much more.

So very much more.

So, why do we do this job? Because of the ones that do not get caught, the ones who we can turn around and heal.

And.

And we do it to walk with those families who are in profound denial or misunderstanding. The families who want to push on at all cost. We walk with them to explain the fight. Both the battles we win and the battles we lose.

It is hard when you know that no matter what we do the patient is still going to die. It is hard to apply all the tubes, all the drugs, all the machines, and in the end, the hands to the chest that feel the break and then the crunch beneath them.

It is torturous work to torture the dying. Especially when they are old and have lived a good life and it is time for them to pass on. Ideally, to pass on peacefully.

There are things you will do that will break your heart.

Torturing people is torturous work.

Turning 40: Notes to My Younger Self. #10 Mental Health is Just Health

#10. Mental Health is Just Health

In the ICU we tend to focus on multi-organ system failure. We think about respiratory failure when one is on the ventilator, renal failure when one has to have interventions for fluid removal, cardiac failure when one is hypotensive, endocrine failure when one is hyper or hypoglycemic, skin failure when one has pressure ulcers.

Many years ago, when we were a very young and incredibly naive Nurse Practitioner, we would often round with a psychiatrist in the ICU. She was mature and wise and we always tended to learn something from her. One day as we were talking about multi-organ system failure, she stated that the patient had five systems failing. Confused, as we could only identify four, we asked what the fifth one was. She smiled. Neuro, she said, the patient was not on any sedation and had been unresponsive for some time.

It struck me that day how much I had never really appreciated the neurologic system in the same way as the others. I did when someone had a stroke or an aneurysm or a tumor or dementia. But not when they had "mental" changes: confusion, lethargy, stupor, unconsciousness, depression.

Mental health is just a part of health. It is like the skin and the kidneys and the heart.

We think with our head, though, so we think we can control it. We tend to think we are responsible for our emotions, for our affect. We think we can control our sorrow, our happiness. We get angry and frustrated when we can not.

I never remember a time when I was frustrated by my inability to control my blood sugar levels.

I never remember a time when I was frustrated that I could not control the response of my taste buds.

I never remember a time when I was frustrated that I could not make my kidneys stop making urine.

I can not control my mental health any more than I can control any other system. Our neurologic system is a system just like all the others.

As life trials come and you feel overwhelmed and feel flooded with emotion and you have a hard time making sense of it all, remember that mental health is just a part of health.

Work to take care of you, all of you.

Turning 40: Notes to My Younger Self. #9 Perception is Not Always Reality

#9. Perception is Not Always Reality

We look with our eyes, but we interpret with our minds.

Sometimes we see what is, sometimes we see what we think is.

It is often hard to know what the truth is, hard to know the reality of our perceptions. Especially, when we walk into a situation with preconceived ideas and expectations.

Sometimes we want something to be something so badly, that we believe it is, weather or not it really is.

We aren't alone in this, though.

Everyone looks with their eyes and interprets with their minds.

So, sometimes my perception is not reality, but the person I am talking to, who is in the same situation, also has a different perception than what is real; so then you have two people with two different perceptions and no one is able to see the reality of the one situation. This can happen at work, in relationships, in meetings, in conversations. Two people can walk away from one conversation having heard two totally different things.

It is important that we take time to remember that what we perceive may not be what is.

It is important that we remember than what our neighbor perceives may not be what is.

Mostly, it is important that we look with open eyes, listen with open hearts, interpret with open minds.

Turning 40: Notes to My Younger Self. #8 Understanding How I Think and Feel

#8. Understanding How I Think and Feel

We enjoy learning about our self.

I would think most people enjoy understanding themselves better.

Years ago I learned about the Myers-Briggs Type Indicator. I learned that I was an ISTJ, known as the inspector or the logistician. This means I like to work by myself, I like facts, I am very logical, I like order and systems, I am reliable, I am dutiful, I uphold tradition, I am energized by time spent alone, I am calm, steady, stable, cautious, and conventional.

I found the MBTI fascinating because I felt like it was so accurate, but in truth I did not find it to be very insightful.

I was proud of the characteristics it cited and felt confident that it created a good portrayal of who I was.

I used it a great deal to compare and contrast myself with other people. How did we compliment, how did we differ, how can we improve our communication, etc. It is a useful tool.

Then, years later, I would hear people talk about the Enneagram. I would review the Enneagram and then wonder why anyone would need that when you had the MBTI. On first look I found it confusing and I was not interested.

But, in doing some research, I realized that the MBTI tell you how you think, but the Enneagram tells you how you feel.

As stated previously, we are much more of a thinker than we are a feeler. Staying in the head is so much more controlled and trusted than looking at the heart. Understanding my ISTJ nature, this makes sense.

So the idea of learning how I feel was daunting, yet exciting as well.

Now, every time I have taken the MBTI it has come out the same, but the Enneagram was a different story. I took the Enneagram five different times and came out with five different answers. It took a lot of reading and researching to finally understand what I was.

In the end, I found was that I am an Enneagram type 9 with a 1 wing. I am a peacemaker. I learned that I don’t like conflict and will do most anything to keep the peace, that I can become complacent and procrastinate. Ultimately the goal of a type 9 is for internal and external peace.

I had found the MBTI to be fascinating, but, in a short time, I have found my Enneagram typing to be so insightful that it has been life changing and life explaining. I understand more now about the box I have been in all my life than I ever have before. Life makes more sense than it ever has.

Understanding how I think and how I feel is so profoundly important. It helps me to navigate life a little more surely, understand my interaction with others better, and has the power to draw me closer to God.