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

Not Yours, but You

There is an aspect of nursing that I thought would come so much more naturally than it does. The listening ear. The emotional support and connection. I didn’t think it would be so hard. My patient came to us in great discomfort, inconsolable. The parents were tearful, scared, exhausted. I introduced myself to them as gently as I could, and then I lost my words. So I jumped into my tasks of getting the patient admitted into the unit, settled, charted. The whole time, I felt the quiet weight of the parents’ emotions filling the room beyond what it could contain. I wanted to say something, ask something, but I had no words. Performing the tasks was so much easier than making the efforts to connect.

This morning, I was reading the Apostle Paul’s letter to the Corinthian church, and this short phrase jumped out at me.

…for I do not seek yours, but you.

Oh.

My.

This is me:

I seek Yours, God, less often than I seek You.

I seek others’ (fill in the blank), less often than I actually seek others.

And in return, I give my (fill in the blank) more easily and more often than I give me.

Rankin Wilbourne recently preached a powerful sermon, “Lord of the Whips,” in which he pointed out that in our times of suffering, when we seek to find comfort in the reasons why God does certain things, we will be then tempted to place our hope in those reasons rather than in God Himself. This is true of me. The more I seek and find comfort in what is His – the earth and all its fullness, His blessings, His gifts, His explanations, even His comfort (just for the sake of comfort), the less I will seek and treasure Him. That’s why I still doubt and question Him when He withholds what is His from me. It’s so hard for me to separate Him from what He gives. What He gives is always a reflection of Who He is. But they are not equal. His gifts are not always required to prove Who He is. When I don’t get this, I am prone to turn my back on Him, when I just want His things and cannot have them.

When we settle for the mere exchange of things, this is dead religion. God, I’ll give You my time, my service, my good behavior, my things. And I think that You ought to give me Your things, dare I say, Your expected behavior, in exchange. We become frustrated when this exchange doesn’t “work”, when God doesn’t seem to keep up His end of the bargain. As if this is all He ever wanted from us. As if He just wanted things from us, without us.

No. He doesn’t just want things from us. He wants to be with us, and us with Him.

This holds true in my relationships with people. The more I seek what other people can give me – validation, recognition, praise, respect, material things – the less I even seek to know, much less love, them for who they actually are. And concerning my own openness, or lack thereof to others, my experiences in nursing, in friendships, in marriage, all reveal to me how hard it can be for me to give of my actual self. To be quite honest, I’m not even sure what that actually fully looks like. I’m much better at just giving my things.

Curiously, the context of Paul writing that short but profound phrase to the Corinthians comes after he is broken of his legalistic, Pharisaical spirit; redeemed and esteemed in Christ; and then deeply broken again by the loving all-sufficiency of Christ. The ongoing work of God’s breaking in our lives is so that we can say,

Not yours, but you.

Not mine, but me.

close enough to change

He could not speak. His disease process barely allowed him to move any longer. But he was fully present, and he would smack his lips to get my attention. He could use his eyes and a slight nod or shake of the head to communicate his needs and desires. He was fully present, a little boy who had to face the span of life, the briefest childhood, and thoughts of death within too small a number of years. When his mom would leave the room, he would smack his lips. I looked up from my charting. His eyes would dart to the empty chair next to his bed. “You want me to come sit with you for awhile?” His head nodded yes. “You want to watch a movie?” A nod. “Toy Story 3?” Another nod. I walked over, took the seat next to him, and took his hand. “Alright buddy, let’s see what Woody is up to.” The movie started, and a big scene came on. The train was about to go over the cliff, and Woody was trying desperately to stop it in time. My little friend’s lips would smack. I looked over at him, and he was wide-eyed, looking at me, then looking up at the screen, as if to say, “Check out this scene!!” The train went over the cliff with a crash. A brief moment of silence. I looked at my friend, and his eyes were wide with anticipation. He smacked his lips again, looked up at the TV screen and slightly jerked his head up so that I’d look too and not miss the next scene. And suddenly Buzz Lightyear appears, train triumphantly lifted over his head. Buzz has saved the day! I look at my friend and we both have victory in our eyes. “Whoaaaa!! That was SO cool!!” My friend has a little smile, eyes still wide, and we share an exchange of glances celebrating a brief but precious moment when all is ok with the world again.

This is the first time in my young nursing career that I’ve asked to be a primary nurse for a patient, meaning that every time I go into work, I will be able to be this little guy’s nurse for as long as he is with us. The goal is to provide greater consistency of care for the patient, and hopefully as a result, greater quality of care.

I think, however, that it has to do with more than just having someone who is more familiar with his communication style and his preferences. Because I feel myself changing in deeper ways, in the ways I think about my patient. When patient assignments change after a shift or two, it is inherently easier to be less emotionally attached, less involved with the patients. Now that I am a primary nurse for this sweet boy, I find myself not only taking a stronger sense of ownership for him, but I find myself caring more deeply for him and for his family. I find myself thinking more about his journey, feeling more of his struggles and celebrating more of his joys. I go on that train ride with him to the edge of the cliff, and hope with him that maybe Buzz Lightyear will show up and bring some relief again to the fears.

When I asked our charge nurse if she could help arrange for me to be a primary for this patient, I told her, “I think he has so much potential to break my heart.” Nursing is a profession full of tensions and constant battles for balance. Not wanting to get too close or too emotionally involved to a point where it becomes unhealthy, yet wanting so deeply to be authentic, open, human in the best sense of the word, and a reflection of the heart of Christ in what I do as a nurse. Christ did not stay aloof. He got close enough to us to be broken so that love and healing could flow in ways that a careful distance would not otherwise allow.

God, grant me courage to get close enough to change, to be willing to be broken, to become more like You… so that my sweet little patient might know that You are Emmanuel, You are God with us. 

He called this place home

It was without doubt a defining moment in our relationship. We were dating seriously by that point, but I was still unpacking all the fears that were surfacing about letting someone get so close to me. I didn’t expect to feel so vulnerable, or so terrified by my vulnerability. He really had no idea what he could do to my heart if he wanted to change his mind about everything.

So there we were at his house after spending the day together. He was on one sofa watching television, and I was on the other sofa, fast asleep.  And then I woke with a start after hearing a moderate-volume rumbling that seemed to originate from very, very close by. Dazed, I looked over at him and his lips were pressed together in a suppressed half-smile of amusement.

And then it dawned on me.

So I asked in some disbelief, “Did I…just… fart?”

He nodded, and broke into a grin.

And then we hi-fived.

And that was when I knew that I had a safe place in this relationship that my heart could call home.

*cue wedding music*

Ok, so love isn’t really that easy. But the story does illustrate how we open ourselves up to be discovered, for better or for worse, when we enter into close(r) relationships with one another. What adds to the complexity is the fact that it is not only another person discovering who we are, but we are discovering ourselves as well. I was already acutely aware of some of the less lovely parts in me that I preferred to keep hidden for as long as possible. But I didn’t realize there were so many more that would emerge once I began sharing life more intimately with another person. Where did these come from? And so there was my selfishness. My impatience. My dysfunction. My way of doing things (and my very strong preference for it). Laid out for us to see.  There wasn’t enough time for me to sweep out the cobwebs, tidy the clutter, put the dirty laundry away, or pull out the air freshener. And yet he still somehow called this place home, and said it could be my home too.

I am constantly humbled by this love. I am comforted by how it points me again and again to the home that my heart ultimately has in the unfailing, unchanging, eternal love of God.

When we first adopted our sweet dog JJ from our dear friends, the poor little guy was clearly traumatized. He hung his head low on that first unfamiliar car ride to our house despite our quiet attempts at reassuring him, his eyes forlorn, confused, and resigned. At first he refused to walk with us, ambivalent about our trustworthiness and unaccustomed to our role in his life. Some weeks passed, and we worked on the relationship. We got to know his quirks, and he got to know ours. His anxiety visibly lessened, and his affection slowly grew. He began to follow us from room to room, wanting more and more to simply be where we were. One afternoon we were out for a couple of hours, only to find that he had discovered a hole in the fence that was big enough for him to squeeze through. We had no idea how long it had been since he got out of the back yard. But there he was, sitting patiently at the front door, waiting for us to return.

He wasn’t going anywhere. We had taken him in, and he in turn had let us in.

He was home.