Lessons in Motherhood: Dying to Self, Finding Love

In my single and then newlywed years, I’m not sure who I imagined myself to be as a parent. I know I was scared and delayed starting a family because of what I thought to be legitimate excuses reasons, but ultimately it came down to fear of everything – how much I would have to give up, how my life and relationships and body would change, whether or not I would be a failure at it all. I didn’t have a clear vision of what kind of mother I would be. Five and a half years and 2 kids into motherhood, I’m still finding my way, learning them, learning me, learning God.

The thing that’s so hard to explain to people who have yet to experience parenthood without sounding like an ungrateful jerk, particularly when children are in their little years (in my case, ages 3 and 5), is the daily dying to self that is involved. I am an introvert who cherishes quiet and alone time; I now have very little of either. I was efficient and now I’m not (hello 36 steps, 2 meltdowns, and minimum 4 arguments to get into the car). I was neat and organized and now I’m not. I slept well and now I don’t. I felt safe(r) and now I feel vulnerable. I thrived on conversations about deep and heart-level things; now my adult conversations are limited and interrupted, and most of my everyday conversations are make-believe and weirdly perpetually argumentative and usually illogical. Even with the awareness that life would primarily become focused on raising my children after that first moment we beheld the positive pregnancy test, I still remain someone with my own passions, goals, and interests that are very much alive. I think it’s this aspect of the daily dying of self that hits me the hardest; not that I’m completely unable to pursue my dreams but I’m certainly much more constrained. Up until I became a parent, what I typically heard was loud, enthusiastic, pervasive urging to go hard after my dreams. “Don’t let anything get in your way!” I’d never been taught what it looks like to gracefully and humbly constrain my dreams for certain seasons, particularly in a way that retains deep hope and joy.

So much of this is about this death-defying fight to preserve the old me, who I was (and who I idolized, quite frankly) before becoming a parent. See, I didn’t just enjoy being an efficient, organized, deep-thinking, dream-pursuing introvert.  Fundamentally, I also thought I was really patient, decently generous, good at caring about others and meeting them where they are at. I loved that version of me in my mind. Parenthood not only challenged and/or undid the former things, which were hugely precious to me; it revealed significant deficiencies in the latter that rattled my happiness with myself, my character, to the core. Who knew that I could speak so sharply to a child who, with no ill intent, accidentally soiled her bedsheets at an inconvenient time for me? Who knew I could be so ungrateful for our food, our home, our material goods, an education, that I could become embittered about the daily process of trying to get my kids fed, dressed, and off to school each morning? Who knew that I could possess such lack of empathy as I demanded that my 3 year-old negotiate life with me at my maturity level (and p.s., turns out I am sometimes the less mature between us). Apparently, God knew, and now I know, and it’s a bit appalling. Looking into the mirror my children hold up to me is like looking into the mirror without makeup, without outward adornment, without a chance to fix my face and smile for the camera. I much prefer the face with makeup, a prepared smile highlighted just right by a groomed outfit. How do I learn to love and accept the unadorned, and then embrace the revealing and refining of it?

A common response is, “Every parent struggles, and it’s ok! You’re ok and you’re not alone!” While it helps to know that other mothers struggle in similar ways as I do, at the end of the day this is no relief for the guilt I still feel for hurting my sweet children’s feelings, nor is it any source of empowerment for me to change. No, actually, it’s not ok that I yell at my kids just because I’m grouchy and don’t want to be inconvenienced any more for the day. It’s not ok for me to trudge through their little years with a chip on my shoulder, always slightly looking past them and looking ahead to the days when I hopefully get more of my independence back. It’s not ok that I miss so much of who they are because I’m still too stuck on me. Yes, these are all common struggles among parents, but that doesn’t make it ok.

I’m realizing that loving my kids starts not first and foremost with loving God (because I fall short there as well), but knowing from my rattled core what it is to be loved by Him. Not a surface, sweet, “Oh I love you, you’re fine, it’s gonna be ok!” kind of love. But a gritty oh man He sees my crap and calls it for what it is, but He remains deeply passionate about the well-being of my soul and is committed to being with me, in my worst, for my best. He loves the unadorned face staring back at me in the mirror. And then He does what I really need Him to do: He turns my gaze off myself before I can heap any more self-condemnation, before I can offer any more self-pity, before I can work to muster any more unconvinced self-cheer. He turns my gaze to Him, the One who covers my shame with grace and forgiveness, the One who fills my daily mundane moments in motherhood with significance, the One who empowers me to serve and grow because He Himself laid down His rights and glory and life to serve and sacrifice for us. He gives me Himself as my Good and Loving Heavenly Father who wants my best in motherhood, and so He uses motherhood itself to reveal in me my worst. In that place, He is unflinching in His love for me. From that place, I can but love Him, love my unadorned self, and love these children He has so graciously entrusted to me.

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Speaker Spotlight for 6th National Nursing Ethics Conference

I literally could not stop shaking when I received the email invitation to be the closing speaker for the 6th National Nursing Ethics Conference next year at UCLA. It is one of the most powerful and in-depth nursing conferences when we consider some of the core heart issues that nurses wrestle with as we are immersed in a profession that puts us face to face with such intimate suffering in this world.

To close out this conference with a 2019 theme of Vulnerability and Presence is no small task. I hope to do justice to the theme, but more importantly, to the courageous attendees who offer up their own vulnerability and presence in order to regularly care for others.

Leading up to the conference, the planning committee publishes various Speaker Spotlights so that people can hear the speakers’ thoughts about ethics and the importance of vulnerability. Carol Taylor interviewed me in late October, and I am happy to share my Speaker Spotlight here with you. Please consider joining us March 20-22, 2019 at the UCLA Luskin Conference Center.

The theme of this year’s conference is vulnerability and presence.  In what ways does this theme resonate with you?

I have had so many conversations with nurse colleagues, and so many internal dialogues, trying to work through the very raw and legitimate question of “How do I stay in such heartbreaking and heavy work over the long haul without shutting myself down?” As we prepared to be nurses, not many of our educators or preceptors talked about how hard, how challenging, how confusing vulnerability could be. There tends to be a quiet assumption that every nurse simply needs to find her/his own way with vulnerability. The majority of the preparation as a nurse was teaching critical thinking and technical skills – not so much in cultivating the power of presence. Yet I believe every nurse finds him/herself wrestling deeply with the issues of vulnerability and presence, the longer we spend with the sick, suffering and dying.   We have long needed a conference that brings us into rich, open, safe and shared conversations about vulnerability and presence as nurses. We need this for ourselves as much as we need it for our patients and their families.

You’ve been to this conference before.  What would you like to say to nurses who are thinking about  attending for the first time—or deciding about whether or not to return?

This conference is extraordinary to me in the courage and hope with which it tackles some of the deepest internal challenges we face as nurses, as human beings. It gives such intentional space for open acknowledgement and exploration of the issues that we so often do not have time to talk through with colleagues in the midst of such busy work days, but experiences we carry with us all the time. We grieve, hope, and vision together in this conference for the preservation and advancement of the true heart of nursing, and that is a truly sacred experience of community.

You’re a practicing nurse.  What are some of the everyday ethical challenges you encounter and can you describe what helps you stay centered so that you can advocate effectively for patients, families, your colleagues and yourself?

I work in a pediatric intensive care unit, where so many parents understandably hold on to so much hope that modern medicine can keep their critically ill child with them for as long as possible. We see many children placed on life support with debatable quality of life. We see children who are abused and yet family members want “everything done” when they appear to only have a lifetime of suffering or minimal engagement with the world ahead. As I am constantly revisiting what helps me stay centered, a few key factors come to mind: 1.) It serves me better to take more time asking questions of families and colleagues and listening carefully before I allow myself to jump to conclusions about an ethically challenging case. This has often helped me filter out voices of people who do not actually know the real situation, and helped me build greater empathy for those most closely involved in the decision-making.  2.) I am learning the value of the very hard work of communicating my own concerns to patients’ families and to colleagues in ethical dilemmas, rather than staying silent. I try to do this with a constant posture of humility and openness to hear the other perspectives, but it helps me resolve some of my own ethical tension when I give myself permission to speak up in a way that is clear but not antagonistic.  3.) I recognize that I cannot avoid ethical dilemmas or grief if I want to be a nurse, so this is not an expectation I hold of myself or of the profession. I try to pursue love, wisdom, humility and compassion above all as I learn to navigate the gray areas together with all of my amazing colleagues.

All nurses are reporting heavy caseloads and multiple demands on their time, energy and expertise. If we believe that we owe every human we encounter the gift of our compassionate and healing presence, how can we keep ourselves energized and focused?  Do you have secrets to share?

I am growing increasingly convinced that it is through entering into what seems to be the hardest things that we ultimately find ourselves more energized and focused than if we avoided them. Avoiding them simply leaves me feeling muddled and weighed down. If I am honest, I can easily use all my nursing “tasks” as a reason for me to shy away from pulling up a chair next to a grieving or “angry” family member, because the tasks will always be there. Quite frankly, performing the tasks come more naturally than opening myself up to hard conversations, to vulnerability and presence with a stranger. But every time I have chosen to spend even just 5-10 minutes listening closely to a family member, I find myself with such a deeper understanding of why we all are where we are with the patient’s care, and how it seems we ought to proceed. It helps me focus and prioritize my tasks better because I understand better what is important to the patient and family, not just to me.

Please join me for my Closing “Creating Safe Spaces for Vulnerability and Presence” at NNEC 2019.

Questions, please email Janine Mariz Burog at JBurog@mednet.ucla.edu

New AJN Guest Post: Reexamining Resilience

Life has been full with a series of speaking engagements with different audiences, all of which have been immensely enjoyable in unique ways. I spoke with a wonderfully intimate small group of NICCU nurses from the hospital where I work about how we can better support one another in our own grief as nurses. The following week, I had the honor of presenting with two of my most respected mentors in the nursing ethics realm, Katherine Brown-Saltzman and Dr. Carol Pavlish, at the recent ASBH Annual Conference.  Later that same day was a lovely afternoon at the SPN Greater LA Chapter Annual Conference, talking about the idea of integrating grief as a practice of resilience.

All of these presentations had me dwelling quite a bit on this hot topic of resilience, and I had to ask, what exactly are we looking to cultivate and why?

It seemed to be a good opportunity to sit down and put my thoughts on reexamining resilience into written word, in this latest blog post for American Journal of Nursing’s blog, Off the Charts. You can read the post here.

How a Patient’s Family Heals a Nurse in this Era of Medicine

(Author’s note: Permission has been granted by all parties involved, including the patient’s family, to share medical details that may make this patient identifiable.)

One of the things that feels most unfair about pediatric ICU nursing is that with critically ill children, you don’t get the comfort of being able to look back and say “At least they lived a long and happy life.” You ache that a baby, a toddler, a school-aged child, a teenager, was supposed to have their whole life ahead. But instead, much of their short life was marked by illness, prods and pokes, lines and tubes, sedation rather than play, a sterile environment full of strangers at all hours rather than a home full of time with friends and family. The deep desire in both the parents as well as the healthcare providers to do anything possible to give them a shot at a future – hopefully one that is meaningful and healthy – is in and of itself right and good. Yet the decision about how much to push both medicine, and the child as the obligatory recipient, in the fight for a future that is neither guaranteed in quantity nor quality, can often be wrought with profound controversy and ethical distress. Clinicians do not necessarily find peace with their work just because a life was physically saved; sometimes quite the opposite, as so potently described in this NEJM article.

K was a little girl who came to our unit for PJP pneumonia secondary to an unknown autoimmune disease; she quickly won over the staff with her charm and spirit. Ben became her primary nurse, and she would count down the days when Ben would be back to work. K once told her frightened neighbor in their shared room, “Don’t be scared. You’re okay, and you’re not gonna die because Ben’s your nurse.” The insight, generosity, and pure trust of this statement give only a small glimpse into the extraordinary person that K was at her young age. But we weren’t naïve; the reality of her condition made her statement so very ironic and bittersweet. We knew she had a battle ahead, so we weren’t necessarily surprised when she was transferred out of the ICU to the regular ward, only to emergently return to us a few days later in worsening respiratory distress. We held our breaths and made faltering efforts to hold up our spirits as she finally succumbed to the need for a breathing tube, which took away the ability for her parents or any of us to hear her sweet voice or see her feisty spirit, now sedated by necessary medications.

K wasn’t getting better, and everyone knew it, including her parents. She had asked for everything to be done, and so her parents promised they would give her every effort. But they knew the final effort at a very invasive therapy known as hemodialysis was going to be a Hail Mary. And as expected, once the hemodialysis started, K’s blood pressure did not improve; it became, in fact, incredibly labile. The miracle was not to be, and so the family decided within the hour of starting the therapy that it was time to remove the breathing tube and say good-bye to this beautiful, vibrant soul. Their heart.

They mourned deeply and immediately, with the heaving sobs of parents who loved their child enough to give her every chance, but also respected her personhood enough to not relegate her to a limbo, sedated existence on machines when there was no real light of life left in her. They had been so kind, so brave, so generous in spirit with the hospital staff through all of our time with them. No one would have once blamed them for being angry or withdrawn; yet they held a posture of such open partnership with the doctors and nurses throughout the entire process. Perhaps they saw us as advocates, caregivers, medical authorities; they might have even seen us as heroes. But in the way they treated us? They simply treated us as people who saw, knew, loved, and wanted the best for their daughter the same way they did. We had conversations in this spirit, and it felt like a safe place for everyone. We talk a lot about wanting to rightfully create a safe place for the patient and family. But we talk very little about how families can create a safe place for the healthcare workers, too. This family gave us a safe place.

You see, this family gave us the gift of meeting and caring for their child. But they also gave to us the profound hope that it is still possible, in this era of pushing the envelope with medical technology, to do everything medically possible for their child and still be completely reasonable and respectful of the personhood of everyone involved – the patient, the family, and the healthcare providers. I find this to be deeply healing, because so much of what I do as a pediatric ICU nurse hurts me in ways that I never anticipated. I anticipated hurting with great apology over having to participate in administering painful procedures, but I accept this gladly if it gives the child a decent chance at survival and meaningful recovery. I anticipated hurting with grief over bearing witness to death, but I accept this if it means I can be a meaningful presence in a terribly isolating time of loss. I did not anticipate hurting with such cynicism over a profession that I once thought to be only driven by good, for good. I did not anticipate hurting with such doubt and self-loathing on the days when I felt myself to be the one who would not let a weary soul rest in peace, but rather continued to agitate, turn, feed, clean, and medicate someone in perpetual distress over their over-medicalized nightmare when there was no real chance of meaningful recovery.

This family’s brave, selfless and clear-minded approach to their daughter’s last days showed me that it is still possible for me and my colleagues to heal in the ways we want to heal, hurt in the ways we accept we will hurt, and not harm in ways we never, ever intended to harm.

Ben may have been present when this precious soul died, but he and K’s parents – and the entire healthcare team in close partnership – allowed K to truly live, up until her last breath.

I find this to be so deeply healing in this era of medicine.

No Ordinary Sunday

The readjusting back and forth between intensely challenging nursing shifts and everyday normal life is a real thing to navigate. It still catches me by surprise every time, how hard it really is.
I am in the thick of a full 12+ hours of trying to manage chaos and logistics in a unit full of very sick patients as charge nurse. In the blur, I am stopped in my tracks by moments of seeing family members who had literally just a minute ago received devastating news. A mother weeps, clutching her child’s teddy bear to her chest. The teddy bear is caught in this strange in-between of what was, and what now is. And then just 30 minutes later, I see the next set of family members with the same, but profoundly unique, broken expression.
I don’t want to grow overly accustomed to that expression on the family members’ faces and what it means. Yesterday held neither the appropriate time or space to let the stories sink in, to let me pay respect to the stories by allowing a human emotional response to all that they hold.
They always hit the next day. I work every Saturday, so often it’s Sunday at church. I’m catching up with friends I haven’t seen in a week. I want to hear about their life and their own joys and burdens. In the pit of my stomach I am nauseous with sadness over the stories that are hitting me. I am singing songs about hope, redemption, and joy, and it is in the practice of trying to form truthful words with my lips that I find the rubber hits the road with what faith in a good and loving God really means. This happens every Sunday for me, this small crisis of faith, as I am reconciling everything I have seen just the day before at work with everything my soul aches to sing with conviction on an ordinary Sunday at church.
I am chasing my healthy children in the church courtyard, taking in the gift that these ordinary moments are – to be able to just chase my healthy children at church. In my mind, I find myself reverently asking the parent next to me, “Isn’t it incredible…that we are here, watching our children play?” But I realize how odd that would sound. I am trying to catch up with friends after a week apart. And I am trying to decide whether to speak of my nausea and sadness, my mini crisis of faith, my weekly reconciling at church of what hope and joy look like for me, what they look like for the families with that indescribable expression that I left at the hospital yesterday. Do they look the same, or are they altogether different? Should they?
This is the navigating that I do as a nurse, between ‘work’ and ‘real life.’ They seem so entirely opposed and contradictory to each other, and yet so deeply and profoundly connected.
There is, for me, no ordinary Sunday.

New Blog Post for AJN: The Nurse’s Temptation to Fill in the Patient Handoff Narrative

In my latest blog post for American Journal of Nursing, I share a reflection on how easy it is for me as a nurse to presume I know a patient and family’s full story when I don’t know it at all. What happens to the nuances of our care when we are or are not aware of this temptation to fill in the patient handoff narrative? Patient details have been changed in this story to protect privacy.

You can read the blog post here.

Vision and Faithfulness

What a curious journey the past year has been. People have been asking me what’s next, and I’ve been asking the same question. I’ve been blogging for awhile about the internal issues I often wrestle with as a pediatric ICU nurse. The writing started purely for my own clarity and catharsis, but colleagues resonated with it, and I slowly began to realize I was speaking for a collective voice without even intending to do so. I was fortunate enough to be granted opportunities to write for Off the Charts, the blog of the American Journal of Nursing, which has been a tremendous joy. I was certain there had to be books and TED/TEDxTalks speaking to the really gritty, nuanced, complicated issues that nurses wrestle with when constantly caring for the sick, suffering and dying – resources that weren’t overly clinical in nature but didn’t diminish the issues with mere platitudes or coats of sugar. I’m still rather dumbfounded at the dearth of books and TEDTalks along these lines. We need strong voices that speak to these issues because the truth is, not all moments in nursing feel meaningful or worth their effort for numerous reasons; yet so many of us still love the work and believe in its essence, or at least what we still believe the essence to be. Often, the struggle in trying to not lose our grip on the essence is the wrestling we must do with the many extra arms that have grown out of its original core – ethical, logistical, administrative, morally and socially challenging arms that all now come attached. This strange thing about nursing is that its own arms sometimes now attack its own heart. This is what we are constantly learning to navigate.

I want(ed) to write a book, but being in the throes of motherhood with two very young children, I was dismayed to find that writing a book is not just writing a book (as if the writing itself is as effortless as that sounds). It’s convincing a publisher that you’ve got enough of a social media following, enough of an audience by way of scheduled speaking appointments, enough of a legitimate voice that will be worth the publisher’s efforts to put it into print and disseminate it. I was disheartened. I had my little blog and the confident support of coworkers, but not much beyond that.

Then…the TEDxTalk, well, it just happened. Honestly when I look back, it’s the only way I know to describe how it became a part of my story. It came together, came apart, and then it came alive. It was painful, empowering, deflating, exhilarating, and for all these reasons it was ultimately a ten-minute capture of my very heart for and about the experience of nursing. 

As a result of the TEDxTalk, numerous speaking opportunities have been extended to me, past and now future.

I presented at Grand Rounds in our hospital on the topic, “Integrating Work-Related Grief for a More Wholehearted Practice,” looking at wholeheartedness not in the sense of “I’m all good,” but in the sense that we can bring all that we have – our joys and sorrows, our convictions and our uncertainties – as real sources of healing and empathy for our patients. Quite frankly, I expected a turnout of about 15 people and imagined they would all be my PICU colleagues, attending for moral support more than anything. Instead it turned out to be a crowd of 60-70 people, very multidisciplinary: physicians, social workers, physical therapists, child life specialists, chaplains, and of course, nurses. I was taken aback by the hunger for this conversation, the gasps and the tears when I said the things that we all feel but seem to have such little space to say. We’ve all been exerting so much energy protecting others from our own grief, and suddenly there was this space to let down our walls. You could feel the relief, the shared understanding, and no small amount of wonder at the question,  “It’s ok to feel these things? And you all feel it too?”

I spoke at the RN Residency Graduation Ceremony about giving our humanity, rather than our presumed super-humanity, as the best gift possible to our patients. Can we give young nurses permission from the start to be human? Yes, we can; in fact, we must.

Most recently, I spoke at the AACN UCLA 2018 Leadership Symposium together with AACN President Christine Schulman on AACN’s current theme, “Guided by Why.” My presentation titled “Finding Meaning and Resilience in Times of Grief, Ethical Dilemmas and Exhaustion” felt like a bit much to cover in 50 minutes, until I realized my goal was not so much to go in-depth with each of those issues, as it was to present underlying questions about why we actually struggle with each of these issues so much. I love thinking outside the box and not saying all the things that have already been said (because truly, others say those things better than I.) I deeply appreciated people who approached me throughout the rest of the day and shared their stories of grief and struggle with me. I never presume to have all the answers, but I always want to have more of the conversations.

There are now additional speaking appointments for later this year, and quite frankly, I can’t say I know specifically where I am to go with all of this. I love bedside nursing. Plenty of people present at conferences, so I don’t presume to be all that extraordinary. I do know I’ve got vision; it’s just a big fuzzy right now. My sense is that God and faithfulness and time will bring the clarity.

I know that I love the public speaking, introvert and awkward maker of small talk that I am. I love processing different and deeper ways to think about nursing issues, and I love sharing these ideas with broader audiences. I hope it leads people to necessary conversations and better conclusions about how to deal with the issues we are facing.

I know that I cautiously guard hope inside that these speaking opportunities will grow my chances of eventually writing that book. I don’t even know yet exactly what it will be about, but I’ve just got a feeling that all of this work can eventually shape and fill the content of a book. One day, God willing.

I know that this isn’t about me. Not to say that I haven’t wrestled with ego issues, because of course, I have. But this would not be meaningful work if it only lifted me up and no one else. The power of medical technology is at an all-time high, yet moral distress is bringing nurses and other healthcare professionals to all-time lows. Patient and family needs are great, but staffing shortages at times feel greater. Yet I still believe in the heart of nursing; I believe it is not a past ideal that we are resigned to sadly shrug our shoulders at and say, “I used to have that heart.” I believe it is a heart that we as a whole people are charged with fiercely preserving in the face of staffing issues, unjust power dynamics, heartache, moral dilemmas, misunderstanding and lack of appreciation. To all of these things, I say – don’t you dare take our heart away from us. Our patients are worth too much. We and the work we do are worth too much. This is the heart I want to share with the public. This is the heart I want to keep alive.