Lessons from the Bedside: Constipation, Oversharing, and Mental Health

No, not oversharing about constipation. As a nurse, is there ever oversharing about bowel movement woes? There's nothing like the feeling after a really good, healthy poop.

Several months ago, I was talking on the phone to a friend from nursing school and was explaining how it's been a long journey learning to process things with others instead of holing them up inside me like a squirrel hoarding nuts for the winter. 

"Sometimes," I told my friend, "I forget to process things and go back to shoving them deep inside and trying to forget about them. It's so unnatural for me to talk about everything and process it. Every time I go to counseling, I have to relearn to open up. The longer I go without consciously processing things, the harder it is to start again."

My friend graciously agreed, and then the perfect analogy popped into my head.

"It's like I get emotionally and mentally constipated," I decided. "And sometimes it gets so bad it's impacted, and I need an enema to get things going again..."

Too cute. I couldn't resist. (Stock photo from Adobe)

Thank God for nursing friends who, rather than being grossed out, laugh richly and loudly at these kinds of things. In fact, I'm pretty sure she even said she was a big fan of the analogy. Nursing friends. They are wonderful.

Like bowel movements, everything in life flows a little easier when we regularly practice owning and processing emotions, events, and struggles in life. The longer we push the need aside, the tougher it is to begin. When I was a child, I spoke so few words I could remember everything I said to everyone and when I said it. Naturally, I figured everyone else was the same way and wondered why some people would tell me the same stories over and over again. I genuinely believed they were intentionally telling me the story for the fifth time because they thought I needed to hear it five times. I didn't realize until much later it was possible to talk so much you actually forgot what you said and to whom you said it! Though I have since conformed and routinely have more conversations than I can recall, it's still not my natural bent to process life out loud. It's taken a long, long time to develop this habit that's so easy for other.

Of note, conversely, some face the challenge of oversharing and lacking boundaries (the opposite of constipation would be "the runs"). This, as you can imagine, can get really messy, really fast. The nurses who are reading this know what I'm talking about. Sometimes we walk into rooms and have to wonder: "How in the world did they get stool in that spot??"

Sometimes, life gets a little crazy and our ability to process life gets put on hold. Traumas or deaths or major life events alter our habits, and in those times all we can do is lean on each other. We turn to each other the best we can, give supportive care, and clean up the messes as they come. From my own experience, I know we often feel ashamed and judged for our involuntary reactions when life overwhelms us. There was a season after returning from working in a Cambodian hospital I broke down every few hours and breaks between classes were spent in the nursing building's chapel crying. I was embarrassed, but I didn't have to be. Sometimes we lose control. It's temporary, and it's okay.

Unlike bowel movements, learning to share appropriately—enough, regularly, and with boundaries—is a trial and error process. It's one I'm constantly challenged by and one I think we will all continually be adjusting and tweaking throughout our lifetimes.

So I'll keep trying and tweaking. A little daily stool softener like Colace may resemble a phone call to my best friend or a journal entry spilling my thoughts. A little laxative like lactulose or milk of magnesia may take the form of a therapy session. A little antidiarrheal like Imodium may look like the restraint not to tell that person my deepest fears or post a blog about a wound that hasn't yet healed.

The analogies could keep going and going, but the main point is this: we all get a little constipated or have diarrhea mentally and emotionally, and this is okay. Health is the goal, because we all know it's true:

There's nothing like the feeling after a really good, healthy poop.

Lessons from the Bedside: What Foley Catheters Taught Me about Emotional Nakedness

It’s undeniable we celebrate weird things at the hospital. Things like bowel movements, being able to walk without assistance, and really big, long, straight veins. The day when patients’ Foley catheters come out also calls for celebration (except when patients are incontinent; then our little nursing hearts sink a little...)!

It was on such a day when a patient should have been celebrating his Foley catheter coming out that I learned an unexpected lesson about my emotional health.

“Please, can you take this catheter thing out?” my patient had begged all day.

Several hours into the shift, I heard from the doctor: the Foley catheter could be discontinued. I gathered supplies for wound care and for removing the catheter before knocking on the door.

“Good news!” I remarked cheerfully. “The catheter can come out!

Stock photo from Adobe

Surprisingly, the patient sighed deeply, as though disappointed. Although confused by his sudden change of heart, I proceeded to provide wound care, and the conversation turned to other things for a few minutes.

“Okay,” I finally said, “if you’re ready, let’s go ahead and take out the catheter now.”

“Do I have to take my pants off?” he mumbled as he started to roll his pajama pant legs up (up, instead of pulling his pants down).

“Um, yes.” Questions patients ask will never cease to amaze me. (Also, how anyone can wear pants over a catheter by choice will never cease to amaze me.)

“Okay. I just feel so humiliated…” More mumbling. Another deep sigh.

Finally, I understood his hesitancy. He was embarrassed and would rather wear uncomfortable, inconvenient pants than have his privates bared.

As nurses, often we forget it’s abnormal to see people’s bodies — all parts of their bodies. We wipe butts on a daily basis, put in catheters and take out catheters, and deal with every kind of bodily fluid you can imagine. Human anatomy is no big deal; it’s our job to assess it and make sure it’s functioning properly.

However, it is a big deal to most other people. Once I clued in to why this patient was balking at the chance for his number one request of the day to be granted, I was able to address his fears accordingly. Thirty seconds later, the catheter was out. Mission accomplished.

After washing my hands and stepping out into the hall, I began thinking about how this patient had considered discontinuing his Foley “humiliating.” His use of this specific word was actually shocking because to nurses there is nothing humiliating about having a catheter removed. In fact, to me the words “humiliating” and “catheter” have no reason to be in the same sentence.

Yet something about this patient’s words struck a chord with me. I knew that same hesitancy, the same feeling of being humiliated, the mumbling and the deep sighs — but not because of physical nakedness. Because of emotional nakedness.

Despite years of dealing with depression and some serious time spent in therapy, I still find it difficult to open up emotionally, even to my therapist. I still hate admitting my weaknesses and the natural anatomy of my feelings to anyone , myself included. What seemed ludicrous a moment ago when I was with a patient I now recognized in myself: I would rather wear uncomfortable, inconvenient masks than show others the fear and sadness I once believed were ugly and shameful. I would rather roll my pant legs up and acknowledge just a little ugliness than pull my pants completely down.

Yet in the same way healthcare workers in the hospital don’t think twice about seeing patients’ naked bodies, I finally realized mental healthcare workers probably don’t blink an eye at the raw, bare truth about people’s mental and emotional states. When something isn’t working right, someone has to look at it. Nakedness is simply part of our jobs.

With this perspective, I’m learning to be more intentional about overcoming my habit of stalling before getting to the heart of my struggles when I show up for a counseling appointment or pick up the phone to call a friend; I’m learning to try to pull down my emotional pants and check my shame at the door.

Is stripping emotionally vulnerable? Sure. Should we be careful whom we share our emotional and mental nakedness with? Of course. (Wouldn’t want to moon anyone by oversharing inappropriately!) Should we be ashamed and humiliated by emotional nakedness? I’m starting to understand the answer is no.

As a nurse, my job may include physical nakedness. As a human, it will always include emotional nakedness. Because of this encounter at the bedside, I’ve decided: it’s time to stop fighting it and strip right down to emotional nakedness.

Permissions for Life

Over the past couple years "permission" has become very meaningful word to me. It all started when I first came back from spending the summer in Cambodia a couple years ago. I was struggling with reentry to the States and was reading a wonderful blog post by Rocky Reentry that talked about the need to give yourself permission to grieve when you leave a culture.

Permission. In it I find grace and forgiveness. Through it I find freedom. In this season of life, rather than make a list of tasks or goals to complete this year, here are a few things I'm focusing on giving myself permission for.

1. Permission to say things you're not supposed to say

By that I don't mean I'm going to say things like, "That dress looks terrible with those shoes on you" (I'm not the one to consult for fashion advice anyway). I mean saying things like, "Truth be told, sometimes I get scared, and right in this moment I don't want to go to Cambodia." That doesn't mean I won't step on the plane tomorrow anyway (emotions are fickle, anyway, and in 5 minutes I could be pumped about going). It just means fear gets to me sometimes, and it's a very real battle to walk by faith and not by sight.

After growing up inchurch, it can seem un-Christian to be open about our struggles. It's incredibly difficult for me to be vulnerable about fear and faith when it comes to Cambodia—and any change. Yet perhaps admitting our weaknesses and clinging to His grace is the most Christlike thing we can do in these moments.

2. Permission to feel and own emotions

I'm not sure where the idea that emotions—particularly sadness and grief—are weaknesses came from originally. I believed that idea for a very, very long time, but the opposite is true. It takes far more courage to face fear and grief than to run from it.

I've learned the hard way that when we try to numb an uncomfortable emotion, we end up numbing all emotion. For years, I refused to let myself feel emotions because I didn't want to feel grief. A monumental moment for me last year was purchasing a box of tissues. (I know, kind of lame.) But it meant acknowledging tears and grief and in a way, welcoming them. Sometimes we all just need a reminder that it's okay not to be okay. Though it's difficult to sit with my emotions and feel my feelings (I'm not really an ushy gushy type of person), owning, feeling, and sharing emotions is an incredibly healthy practice.

3. Permission to love and take care of myself

This one can also seem downright un-Christian sometimes. What happened to "put others before yourself" and "God first, others second, and yourself last"?

I'm not sure I believe in that mantra anymore. If I'm not taking care of myself, how can I care for others? This is very obvious in the physical realm: if I have a diabetic patient who doesn't take care of his body's nutritional needs, he'll end up with life-threatening blood sugars, wounds that won't heal, hospital stays, etc that will prevent him from physically being able to help those around him. The same—maybe even to a greater extent—can be said for mental, emotional, and spiritual self care. The Lord commanded us to love others as we love ourselves. I think as we learn to love ourselves better, we will learn to love others better too.

4. Permission to ask for what I need

In a way, asking for what I need is part of learning to take care of myself. It's a way of setting boundaries. This is still new to me, so when I put it into practice it feels awkward and like I'm bumbling my way through.

This process is two-step: it requires me to know what I need (self awareness), and then it challenges me to follow through with the action of asking for it. One reason I'm drawn to this practice is that it helps prevent me from blaming others and playing the victim. It's easy to blame people for "not being more sensitive to my needs" or "walking all over me." But in the long run maybe it's better to muster up the courage to clarify boundaries and ask for what I need instead of assuming others will automatically know.

5. Permission to fail often and miserably

This is perhaps the hardest for me to write and accept. The perfectionistic side of me screams that this is heresy. Yet I have found failing often means more growth than success does, and my quality of life soars when I can accept my imperfections.

It's absolutely impossible to move forward in life without failing, without falling flat on my face. So I may as well make a break for it and stumble my way toward living a more full and joyful life.

Perhaps what makes failure so dreadful is not the falling itself or the pain or the slow process of getting back up or even the guarantee that it will all happen again soon. Perhaps the worst thing about it is the shame of knowing others will see me fall. They will see I am a fraud; I am not perfect. I am weak and scraped up and sometimes so broken I seek professional help to get back up. Yet I am encouraged by the wisdom Elizabeth Gilbert received long ago and now shares in her book Big Magic (p. 174):

"'We all spend our twenties and thirties trying so hard to be perfect, because we're so worried about what people will think of us. Then we get into our forties and fifties, and we finally start to be free, because we decide that we don't give a damn what anyone thinks of us. But you won't be completely free until you realize this liberating truth—nobody was thinking about you, anyhow.'" —Elizabeth Gilbert

I don't want to wait until I'm sixty to live from that truth.

6. Permission to forgive myself

With #5 comes, in all likelihood, the fact that I will make a fool of myself. And with making a fool of myself comes the challenge of forgiving myself.

A few months ago I was struggling with the concept of mercy, and a friend told me how one of the Hebrew words [checed] in the Bible that's translated "mercy" is also translated "steadfast love." I'm not a Hebrew scholar or anything, but this helped me grasp mercy. It made sense to me. In some cases, mercy and steadfast love are synonymous. This new perspective makes it easier to accept the Lord's mercy and understand how I can show mercy toward myself. To forgive myself, I must love myself. 

I'm still thinking through several other things I would like to give myself permission for, and I have a feeling it'll be a lifelong process to put these into practice. But keeping these in mind helps me keep my inner critic in check, and the liberating thing is there is no time limit—they are lifelong permissions, and they are permissions for a more abundant life.
 

How do you pursue living a more abundant life?

Are there things you would like to give yourself permission for or have learned to give yourself permission for in the past?