Pre-Order Available: The Healer’s Burden

I am beyond thrilled to share that this book I had the privilege to contribute an essay to, The Healer’s Burden: Stories and Poems of Professional Grief, is now available for pre-order. My essay is titled “Silent Intercession,” and I am so looking forward to slowly making my way through the rest of the pieces.

Here is a description of the book from the editors:

What is Professional Grief?

Ignore. Suppress. Hide. Work in high-loss healthcare environments commonly demands turning away from one’s interior experiences in order to rapidly turn toward the next patient. In a culture that discourages vulnerability, how can a care provider effectively deal with the challenging emotions that naturally arise when faced with death, especially now in this critical time of pandemic? Thankfully, The Healer’s Burden: Stories and Poems of Professional Grief makes a space to tend this occult grief, and not a moment too soon. In a broad array of artistic and accessible perspectives, healthcare workers from multiple disciplines bravely pull back the curtain on their experiences of loss. Despite delving into death, The Healer’s Burden eschews the twin traps of despair on the one hand and platitude on the other. Using principles of narrative medicine, the editors catalyze a much-needed conversation about professional grief by including thoughtful questions and writing prompts. This book is a must for educators and clinicians alike who wish to constructively engage with rather than avoid their experiences of patient death.

With a foreword by Rana Awdish, MD, author of LA Times best-selling memoir In Shock:
“Reckoning with grief is no small task. But ignoring it is no longer necessary. ”

I can’t encourage you enough to buy this book, and share it with the healthcare professionals around you. It’s such an important time for us to bring this conversation to light in this extraordinary year that is 2020.

A Letter from a Parent to Teachers in the time of COVID-19

The school year started with all the assumptions we make about how life is going to go.

She’ll go to school, she’ll make more friends, the teachers will work their magic, I will have some breathing room for myself, repeat for nine months. At the end of the year, my child will have learned whatever she’s supposed to learn for her grade level and I’ll say thank you to the teachers with a gift card, and see you in the Fall!

Come March 2020 and the notice of shutdown of school campuses due to COVID-19.

I realized in an instant that I didn’t know how to work a teacher’s magic. In fact, I was humbled to learn it’s not just magic. It’s a freaking ton of hard work, tenacity, commitment to the kids, commitment to (and patience with!) the families, incredible flexibility with each child’s unique temperament, iron stomach for politics, creativity, and an understanding of their own worth as powerful shapers of future generations even when the majority of people take a teacher’s job so much for granted.

With all the other parents, I mainly fumbled and sighed and cried my way through the first few weeks of “homeschooling.” But our amazing principal and teachers showed up to our kids and our families with a revamped plan that must’ve kept them up all hours of the night to create (and re-create). Led in that spirit, my first grader didn’t seem to bat an eyelash at all the changes. She never melted down, never complained, only remarked now and then that she missed seeing and hugging her friends and teachers. But her teachers stayed positive, engaged, affectionate, appropriately strict, and very much at the helm.

As painfully long as some of the days were with managing kids at home all day every day with distance learning, I got to see through the Zoom classes how a teacher brings a group of children together in a spirit of hope and community with an unshakable focus on continuing growth and education. I got to know my daughter’s classmates and their parents. I got to know my own child better – how she thinks, how she works through struggles, what sparks her to speak up, what inhibits her, what excites her, what makes her sad. I got to know those things about myself better as a parent as well.

By the last week of school, I finally felt surprisingly settled into the new rhythm, as exhausting as all the demands were. And then it was time to wrap up the school year. There was a winding down of online coursework, but there could be none of the on-campus celebratory end-of-year activities. There was a drive-by the school to wave to teachers and staff, where I went to shout “Thank you!!”out the window and found myself trying not to wail with sobs instead. There was a brief pickup of classroom materials and a side hug with her teacher after asking permission, adjusting her mask and dousing her in hand sanitizer. Emotions were at times muted, at times surprisingly acute, mostly confusing.

Then came the final class Zoom meetings. In a talent show on the second-to-last day, another little girl in class said she had a song to sing about saying good-bye but how everyone remains in each other’s hearts. It was off-key and acapella, but at the end of her song, a little boy then burst into sobs. I looked over at my daughter and she was quietly fighting back her tears. It was her first sign of sad emotion since the quarantine started. I wrapped my arms around her, she turned off her video, and waited to compose herself before getting back into the Zoom meeting. She said they were just happy tears.

Today. The final day of school. The online class talent show finished up, and it was time for all the children and their teacher to say good-bye. They all clasped their hands together and pumped their fists back and forth from their chest to the computer screen, “sending love” as their teacher called it. My daughter stayed on until the last minute, as one by one each little square for each classmate’s face disappeared from the virtual classroom. She was already blinking back tears but as the meeting ended, she buried herself in my arms, and we were both crying together.

This year, our kids lost so much. But in this mysterious, imperfect, painful, beautiful, terrible, magical way, we have also gained so much. And teachers and school staff, I now know that you are the most hard-working and the most magical people I know. We did it, and we did it together, but you led the way with your grit and your heart. Our family is sending you all our love.

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.