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.

The Truth About Depression: 5 Observations from Someone Who’s Been There

I have a confession.

I’ve struggled with depression for years. I’ve struggled with anxiety, too. For a long time, I tried not to let the world see my struggle. I let shame seal my mouth shut. But today, I want to begin sharing this part of my story—a part that I’ve desperately wanted to erase from my past but remains there nonetheless. I want to write about mental health because it matters, and I don’t think people talk about it enough.

So here is some truth about depression. I’m not a clinical expert or mental health nurse or any kind of therapist. I simply have observations from experience, from a raw wrestling with this intangible mood-killer and productivity-killer and sometimes people-killer. It’s my hope to begin writing more about my personal journey toward mental health, but for now, here are some foundational observations.

Observation #1: Lots of people are fighting the dragon of depression.

In high school, my English teacher used to say that “everyone has their dragons,” meaning everyone has things in life they are fighting against. The dragon of depression is a lot more common than we believe.

When I was a freshman in college, we had a chapel speaker give a lecture on depression. Opening with a statistic, he stated, “One in seven people suffer from depression.” One of the guys in my group started counting how many people were sitting in our row and said, “Hey, that means at least one of us would be depressed!”

I tried to shrink in my seat. That one person would be me.

I don’t know if that statistic is true or not, but I do know that a lot of people experience depression. It isn’t always physically debilitating, and we can’t see it with our eyes, but it still exists, and it’s a lot more rampant than we would like to believe.

Photo credit: Kateland Pricer

Observation #2: Lots of people treat depression like a literal dragon—like a terrifying, mysterious myth.

Unless you’re a conspiracy theorist, you probably don’t spend much time talking about myths. You probably spend a lot more time on what you believe is true and relevant and affecting everyday life.

That makes complete sense—when it comes to actual myths. The problem is, depression isn’t a myth. In that way, it isn’t like a dragon at all.

However, just like a dragon, depression can seem terrifying and mysterious. As humans, we tend to shy away from the unknown, and our solution for the mysterious is to pretend like those things simply don’t exist. I don’t think anyone quite gets depression unless they’ve been there—and even those of us who've experienced it don’t completely understand it. We don't understand why it affects some people more than others, how it creeps up or vanishes or lingers, or why certain treatments or medications do or don’t work. 

Even though we can't explain it, we must acknowledge depression. We have massive educational efforts for diabetes and heart disease—we even have billboards talking about stroke symptoms—but for some reason we refuse to address depression on a wide scale publicly. Yet ignoring depression can be dangerous—perhaps just as dangerous and lethal as ignoring a dragon’s existence.

Observation #3: Stigma is a Silent Killer.

In nursing school we once had a slide dramatically titled, “Hypertension: the Silent Killer.” I chuckled at how dramatic the slide was, but I never forgot it. Later, I decided that in the mental health world, stigma deserves that title. “Stigma: the Silent Killer” is not an overstatement.

Over the past few years, many courageous people have been speaking up about mental illness and opening the floor for a nationwide conversation around it. I have been so encouraged by this! However, these speakers are still a rarity. We have a long way to go.

Stigma is why the people experiencing depression are the ones you would least suspect. Because of stigma, we hide it and try to compensate and sometimes overcompensate. We pretend we're okay, but inside we hate the mask we put on. Stigma leads to isolation and contributes to shame, which leads to self-hatred, which leads to increased depression, which leads to more shame. Ultimately, stigma leads to a startlingly high suicide rate in America and globally. 

If depression is a dragon, stigma is its right-hand dragon buddy. With stigma around, people believe experiencing depression is weak and shameful. The greater the stigma and shame, the less likely people are to seek help. (Trust me, I waited four long years due to stigma and pride before going to therapy and finding help.)

Observation #4: It can always be better.

One of the flaws of depressive thinking is the belief that “it can never be better.” It all seems pretty hopeless.

Sometimes, it takes a friend to hope for you—to believe that things can get better. I was blessed to know a great group of girls in college who also struggled with depression and were brave enough to talk about it in everyday conversations. We hoped for each other when we couldn’t hope for ourselves.

Several of those girls are some of my best friends today. What happened for us was an anomaly, but it doesn’t have to be. It can be better. For individuals, for myself, my friends, and for society. Sometimes "better" is a simple step of courage away, found in working on a project we enjoy or joining a Bible study. Sometimes it's scheduling a coffee date with a friend and holding onto the knowledge that in exactly two days we'll have a friend to sit across from—encouragement and hope in tangible form.  Sometimes "better" is found in a text saying someone's praying for us.

Whatever form it takes, I believe it can always be better. I believe we can create a culture where it isn’t shameful to talk about depression, a culture where we hope for each other, a culture where we know we were made to need each other.

Observation #5: A change in culture starts with individual conversations.

Practically, how do we effect change? I believe it starts with awareness and conversations.

When we talk about depression, stigma is dismantled, and the truth comes out: depression affects nearly everyone at some point in their lives, and it doesn’t mean we’re weak. In fact, those who experience depression are some of the strongest, most courageous people I know.

When we can talk about depression and hopelessness and pain, we gain opportunities to sit with others through the darkness, which perhaps is the greatest help of all. When we can talk about depression, we open the door wide for those who are struggling to find the courage, hope, and community that really is out there for them. For me. For us.

I believe it can be better. I believe it starts with you and me, carrying on this conversation about the uncomfortable topics of depression and mental illness, through blog posts and social media and real-life conversations in coffee shops and work cubicles and homes. It starts with stark transparency and healthy vulnerability and bold humility.

The truth about depression is…it can get better. And it starts with us.

Thank you to my friend Kateland Pricer for graciously letting me use her photo! Katie created a set of photos that captures feelings I could never explain with words. Her email is K.pricer@yahoo.com. She is incredibly talented in the creative realm and just an all-around awesome person!