The Little Box

Just the other day, I had a conversation with a patient and they asked me "How do you do it?" Granted, we had been talking about a multitude of things ( I am an acquaintance with this person at this point ) - between baby loss, trauma, chronic pain and illness, etc. Nevertheless, I said we just went from one room where we pronounced time of death after doing CPR for 20 minutes or 40, who knows...to the next room to deliver a turkey sandwich and a baby pop with a smile *under a mask now of course* and apologize for taking so long. Some patients are perceptive and realize what is or has been going on around them and return a statement of something like "it's okay, I just hope that person is okay" or "I know you guys are busy." - to which I either don't divulge because of privacy laws or I remind them that yes we are busy, but not too busy to help them. I always make sure to accentuate that statement. I am here for 12.5 hours - regardless - so what does it matter that I'm running blankets and pain meds or doing CPR. I have to be here. And then there are some patients who are oblivious to the outside world and don't care, nor think the world beyond their exam room exists or matters. Or maybe it's my first visit in to this patient's room and they're met with me apologizing for taking so long to make an appearance. Or maybe they'd been waiting too long for discharge and I again, apologize for taking so long to gather their discharge information. I try not to use the "its really busy" or "we're working short staffed" as an excuse or even mention it, as its a constant, and the patient doesn't care, ultimately, its irrelevant. 

We, as healthcare workers, spend a lot of our days apologizing for things we have zero control over. Things we aren't even responsible for. Things that do not require an apology. Eventually, this kind of mental abuse (and yes - that is what it is) takes its toll...at some point. You wouldn't (or you shouldn't) apologize to your friend or family for these things, would you? Probably not. 

- "I'm sorry for delaying the triage of your ingrown toenail, the child nextdoor to you just got intubated." 
- "I'm sorry it took so long for your discharge papers, I was coding the patient in the trauma bay."
- "I'm sorry I didn't get this blanket in here quicker, I was starting an IV on someone who is in DKA and may die if they don't get insulin and fluids."
- "I'm sorry that I did not get this tylenol and motrin to your child in a timely manner, the elderly lady down the hall fell trying to get to the restroom and we had to clean feces, urine, and blood off of her, write an incident report, get her back in the bed, and take her to CT scan."

I have literally apologized for A L L of these things (of course I didn't divulge sensitive info, simply just said "I'm sorry for the delay..." or something of the nature) and more, so many times, more times than I can count. See how silly this sounds?? next thing you know, we'll be expected to apologize for apologizing.  

We have been literally conditioned to apologize, to express guilt or repentance for things that we did not do. Mentally, that is like gaslighting someone. But, as healthcare workers, we do it. What do we do with the things we see on a daily basis? Where do we put all of this empty guilt? Empty apologies. The wrath that we indefinitely inherit. The sights we see that are negative. Things that will / would break you...at least for the day. 

I told this person...we take whatever it is, for the moment, package it up into a tiny little box. We close the lid, tape it shut, package it neatly with a little ribbon and place it on a shelf. Sometimes the shelf gets overfilled. Sometimes, some of these boxes sit for years and never move. Some boxes get barely put on the shelf, stay on the edge, and its so easy for you to just accidentally knock them off at any given time. Some boxes are heavier and get really stuck up there, those take a harder knock to finally fall off, but...boy, when they do. Or sometimes just a little jolt knocks several lighter boxes off. When they ultimately hit the ground, they burst open. It doesn't even have to be anything related to what's in the boxes, doesn't have to be any serious earthquake-like jolt. Sometimes its just...something. Anything. And boom, there they go. Sometimes the content of these boxes spills out in the form of tears, anger, it really varies...but regardless, they come out. Its hard to contain a box that's once packaged up and burst open. It is reminiscent of trying to put the toothpaste back in the tube. Once it's out, it's out. 

This put things into perspective for me. Its not often that I create my own epiphany. But, standing there in that moment, with my mask, gloves, and glasses on - I thought to myself..."wow, some of my boxes have been up there a minute..." and "that really makes it make sense for me today!" I am sure that a therapist could've helped me reach this point much quicker, much less painfully...but nobody ever accused me of being rational. 

xoxo