Staying in the Hard Thing: When Glory becomes Gritty

I seem to live in a perpetually tired state nowadays. If I’m looking for the easiest, most honest response to “How are you?” my default answer will be, “I’m tired.” Tired as a mom of two littles. Tired as a nurse to critically ill children. Friends and coworkers nod in empathy, and praise Jesus for all things coffee. It sometimes feels as though we are a people living collectively on the edge of burnout. It begs the question, how do we endure in the hard thing?

I’m not referring to acute crises. That’s its own animal, and I am guessing most everyone has a similar approach to toughing out emergency situations, which typically throw people into sheer survival mode. Bury the debilitating emotions to process later. Do the immediate, most important tasks at hand. Absolutely let the non-essentials slide. Lean on your village. Fall on your knees in prayer. Do each thing as it comes, one thing at a time.

The hard thing I’m thinking of is the hard thing for the long run that you never imagined would be such a hard thing. In fact, you thought it would be the glorious thing: Start your own business, write and publish a book, get married, raise children, work in a job you feel passionate about, become renowned in your field. We set out with a sense of calling, not completely naïve, but confident and motivated enough to choose the dream. The business. The book. The person(s). The career. The glory of a very real and truly beautiful dream.

So what are we to do when the glory becomes gritty? I dreamt about one day marrying a man who had a tremendous heart for ministering to people. The dream came true, and then I found myself crying out to the Lord in tears, “I can’t keep up with his heart! I can’t do this.” When I was first exposed to pediatric ICU nursing, I knew right away this was where I belonged and wanted to be. It was so deeply personal and meaningful. But the experience has not been without moments of tremendous struggle and doubt. I didn’t know it involved all the things it involves. I didn’t know it would make me feel all the things I feel. And I didn’t know it would make me fight so hard to feel anything at all some days. When I became pregnant, I dreamt about the sweet relationship I wanted to cultivate with my children. I didn’t know what to do with the fact that I felt dull, sad and guilty in the first few hours after giving birth to my first child. I have constantly surprised myself at how angry and selfish I can choose to be as a mother. What do we do with our disappointment or disillusionment when glory becomes gritty? How do we stay in the hard thing?

Glory becomes gritty, and this can be bewildering and disorienting. Part of this, I believe, is because in the beginning, we chase the glory because we are blinded by the glory itself. This is not a cynical statement; it’s just the nature of dreams. Maybe we need some initial blindness to even have enough courage to start the pursuit. Our dreams and ideals launch us out of inertia and felt mediocrity, and they carry us when little else can. They are beautiful and often God-given. But in an Instagram-inspired world, the glory can blind us to the fact that these are also hard things. We’ve all seen the photos: a Pinterest-perfect small business grand opening, a well-designed book display on release day, hugely romantic wedding pictures, adorable shots of kids in their Easter best smiling ear-to-ear while hopped up on way too much chocolate, a beautiful portrait of a nurse quietly holding a patient’s hand with reciprocated expressions of gratitude, an executive in his/her prime delivering an impressive speech at a podium. In contrast, there is very little to inform us of the down sides outside of direct experience. The gritty aspects of living out our dreams can catch us by surprise all the more because of the blindness we had in the early days. Perhaps this is why Jesus warned us,

For which of you, intending to build a tower, does not sit down first and count the cost, whether he has enough to finish it— lest, after he has laid the foundation, and is not able to finish, all who see it begin to mock him, saying, ‘This man began to build and was not able to finish’? Luke 14:28-29

We may start to ask ourselves, “Do I have enough in me to see this through the way I originally hoped?” In my most exhausted, discouraged moments, I would try to remind myself, “I chose this!” I chose motherhood. I chose PICU nursing. But somehow that blanket self-motivation has been insufficient and almost even self-blaming. For how could we have known all of what we were choosing? We chose the romanticized version of the story in the beginning, didn’t we? It’s always the glorious path we want and hope for. But people change, unforeseeable situations arise, and they change people – including us – in unforeseeable ways. I’m beginning to realize, it’s not so much about “I chose this” as it is, “I continue to choose this, all of this, today.” I am not the same woman my husband chose to marry over a decade ago. I am quite certain I am not who he envisioned I’d be at this stage. This is not about my insecurities; it’s about every person’s inability to foresee the future. He is choosing me now, and I him. I am choosing my children now, and I will choose them when they change on me again and again in all the years to come. I am choosing PICU nursing for what it has shown itself to be now, and I will continue to do so for as long as my life is called to that ministry.

The discovery of how un-glorious, monotonous, or outright excruciatingly painful the hard thing can be in the trenches, may temper the glory, but it can actually magnify the meaning if you can push through. The meaning in the everyday moments may not become readily apparent until the crisis moments show up. I watched my patient and her parents endure an agonizing six-hour delay of her surgery to remove a tumor. Six extra tortuous hours of telling a very hungry toddler trapped in the hospital that she cannot eat. This is agony for any parent of a healthy child on a normal day. For parents bearing crisis-level stress, it is an indescribable test of patience and longsuffering. Whimpers and occasional whining became intermittent screaming and kicking in the last hour. The parents shut their eyes tight and clenched their jaws with grit. And then, I beheld the glory. In between screaming sessions, the little girl would say, “I love you, Mommy. And you love me too.” The mommy’s reply was always the same, “I love you more than anything.” The little girl lying next to her daddy in bed would occasionally call out, “Mommy?” The exhausted mommy’s reply was always the same, “I am always here for you.” There was no question they had a long-established foundation of love and commitment. I could imagine these exchanges practiced in their home in their everyday mundane; the parents never would have imagined they were practicing for this crisis moment in the hospital. The beauty of their shared love with their child was nothing short of glorious, in the grittiest situation they could find themselves in. Staying in the hard things now helps us stay in hard things for the future. We develop muscles of perseverance, flexibility, hope, perspective, faith, and deep love.

On this side of heaven, some things should be hard. If everyone has written a book or started a small business, then the meaning of each has by default decreased exponentially. I don’t want to feel as though it’s easy to take care of critically ill children and their parents, or else my heart has forgotten how to be moved by important issues. Some hard things should be hard, as we are people who still open our hearts to dream, hope, and care in an imperfect, fallen world. It is our gritty longing for Heaven, groaning quite frankly against the Hell we may see.

For Jesus, God in the flesh, glory became gritty as He walked amongst us and walked His final steps on a dusty road to a cross – for the love of others and the glory of God. We look to Him.

Therefore, since we are surrounded by so great a cloud of witnesses, let us also lay aside every weight, and sin which clings so closely, and let us run with endurance the race that is set before us, looking to Jesus, the founder and perfecter of our faith, who for the joy that was set before him endured the cross, despising the shame, and is seated at the right hand of the throne of God. Hebrews 12:1-2

Confrontations

 

This was my first attempt at fiction in narrative medicine. I submitted it to a journal for consideration but it wasn’t accepted. Disappointing, of course, but there’s so much good material out there for me to learn from, and it was a good exercise.

Based on a true story, many details have of course been changed. When the nurse enters the picture at the end, that’s where I wrote myself into the story, thinking this is the nurse I would like to have the courage to be one day, every day, or even today.

For those who know me personally and might be shocked at my use of profanity in the story, I went back and forth with this but at the end of the day, this is the real world, and this is the expression of really, really strong emotions when things go so far from what everyone had hoped. Even still, in it all, there still remains opportunity for light and for good to enter the picture.

I’m open to feedback in how to tell a story better. Thank you for reading.

*******

Everywhere he walked throughout the hospital, he swore people who weren’t even in his department were looking at him with silent accusation. I heard about what happened. You idiot. What kind of doctor are you? He was sure even the hospital cafeteria staff somehow knew what happened with him and that disastrous chest tube placement last week. He saw it in the glint of distrust in their eyes when he placed his orders. He saw it in the way they laughed with their backs to him while flipping burgers on the grill. How does everyone in this hospital know about that day!? Who the hell is talking about me down here in front of the cafeteria staff, for God’s sake? HIPAA, my ass.

Getting through residency and almost one year of his surgery fellowship was enough time to build a reputation and ego requiring some nurturing and protection. But the humility and wisdom borne from experience, those were still so nascent. This far into his practice, he was fine with the routine chest tube placements, but still found those complicated cases tricky to troubleshoot. I screwed up. No, I didn’t! I don’t know, it happened so fast and I thought I got it in ok. But the kid was screaming and her scoliosis made placement tricky and then the stupid nurse had to go push that code button when I just needed everyone to calm down and let me focus! He was convinced that if the girl had only heeded his pleas to just relax a minute! then she wouldn’t have flinched and his hands wouldn’t have been shaking and the chest tube wouldn’t have gone into the wrong place and this nightmare would not be everyone’s reality. Sterile gloves would not have touched non-sterile fields. The hemorrhage wouldn’t have happened. She developed an infection, which quickly developed into Acute Respiratory Distress Syndrome, and she was once again gasping for air, for life.

This was not how it was supposed to end.

It was supposed to be a routine chest tube placement, one final post-operative step in managing the removal of the cystic hygroma that had been compressing the young girl’s airway in increasing measure over recent years. The chest tube was to help resolve her minor pneumothorax, and overall it was looking so good. Once she got over this final hurdle, she would be on her way towards discharge, towards her new life. God, if she just hadn’t been so damn anxious!

The mother demanded to speak with him a few days after the incident. Her daughter was now on high ventilator settings and heavily sedated. Xeroform and a clean gauze dressing covered the failed chest tube insertion site. If not for the fact that the nurse had just reinforced the outer dressing before he arrived, the serosanguinous drainage persistently saturating the underlying gauze would have accused him as well. My blood is on your hands.

He knew people were calling him an asshole. Fuck them, they don’t know me. They don’t know what I’ve been through to get here. And the thing is, he had promised his wife, pregnant with their first child, that once he got through his fellowship, they could have time together again, work on paying off his medical school loans, and move out of their apartment into a condo, perhaps. He couldn’t risk it all. He had to choose his words judiciously. God it was terrifying.

The girl’s mother rose from her watch at the bedside when she saw him approaching the room. She shrugged her blanket off of her shoulders, tucked her disheveled hair behind her ears, and stepped outside the doors.

“Tell me what happened.” The mother’s tone was controlled, not overly pressing, but also not entirely safe.

“It happens sometimes with chest tube placements. When we realized it was in the wrong place, we managed the issue, got a new chest tube in, and treated her accordingly.” The fellow’s tone was controlled, not overly defensive, but also not entirely apologetic.

“I’m just not getting any sense from you that you feel sorry about any of this.” She didn’t tear up. She didn’t raise her voice. But her eyebrows furrowed, just for a second, just enough to betray her efforts at suppressing the terribly conflicted mess of forgiveness and fury rising from her gut. She swallowed hard and held the vomit at bay. She wanted him to feel so many things, but right now, she just needed him to feel as though he could talk to her.

“Of course…I’m not happy with how things have turned out. But we managed the issues appropriately.” He did not, he would not avert his gaze from hers. This was all he would offer.

She took a sharp breath as one final great protest threatened to unleash against all of her hell. He steeled himself. She could not say if it was sheer fatigue, self-restraint, or resignation that stopped her, but she found her lips frozen in an overwhelmed silence.

She had so many questions.

How can I get you to tell me what happened in any straightforward way?

 Just how sure were you of what you were doing?

 Why wasn’t it an option for you to ask for help before things got so bad? What were you trying to prove?

 Were we just an unfortunate stepping stone in your training? A necessary casualty to boost your resume? Will there be more screw-ups for you to MANAGE APPROPRIATELY?

 Why is it SO FUCKING HARD for you to say to me, “I’m sorry”?!

She found herself unable to do anything but stare at this man with the inscrutable poker face. Who could say if he secretly possessed the king of hearts or all the jokers in the deck. He had been such a welcome sight when he first entered her daughter’s room that fateful day, another key player in moving her daughter forward towards her new life. He was warm, personable, professional. By the time he had left, his role had plunged from the heights of heroism to the depths of the unredeemable. She closed her eyes, exhaled slowly through pursed lips, turned her back to him, and returned to her daughter’s side. He turned to the exit, passed the nursing station, and went to his next case in the OR. He couldn’t explain the dull hollowness eclipsing his relief.

He was back in the cafeteria the next day, holding his ground against all his silent accusers serving him food.

He took his tray to a table and had just sat down when an unfamiliar nurse approached him. Then he remembered the distinctive blond streak in her otherwise dark brunette hair that had caught his eye at the nursing station on his way out from yesterday’s dreadful confrontation.

“Hi,” she ventured gently.

She had only been a nurse for a few years. She was still learning to navigate communication with the physicians. Their place, her place, their voice, her voice.

“I don’t know you, but my name is Christina. I was Jeanette’s nurse yesterday. I know her course of events, and, well, I overheard your conversation with her mom yesterday.”

Shit, leave me alone. The last thing I need is a lecture from a self-righteous nurse who wasn’t even there the day everything happened. I bet those cafeteria guys are watching and just eating this up.

“Honestly, I don’t know what happened that day. I can’t imagine this has been easy for you. I just want to tell you –”

His face was impossible to read. For a moment, she hesitated and her face flushed as she felt her naiveté. But this wasn’t about what she had learned in a nursing school classroom. It was about what drove her into nursing, what was formed in her through all those long days and nights in the hospital with her very ill little brother, watching staff come and go, discerning roles, discerning hearts. This doctor didn’t need to know her story. She knew, and it was enough. And so, though she felt small, she found her place, found her voice, and she pressed on.

“ –I’ve gotten to know Jeanette’s mom. She’s more reasonable than you think. She’s losing her daughter and she knows it. She doesn’t want a big lawsuit. She just wants to grieve without this …question hanging over her.”

He spoke in a slow, deliberate monotone. “I already told the mom what happened that day.”

“No, not that question. She saw what happened. She can’t change it and she’s accepted that. She just wants to know if it matters to you. Right now, and for your future practice. She just wants to know if it really matters to you.”

He was quiet. Christina fidgeted with her fingers, but held his gaze.

“That’s all. I hope…you’re doing ok. Thanks for hearing me out.” She walked away.

He ate a few bites of his lunch, but for the most part, he pushed the food around on his plate, wondering what things would look like if he moved one piece one way, then another.

He stood up, straightened out his clothes, and headed up to Jeanette’s room.