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: Life After [a Patient's] Death

Recently I took care of a patient who died.

The patient went quickly and without pain, but for some reason the death shook me more than usual. The next day, I found out a different patient had decided to go hospice. At home in my bed, I cried as I thought about how I'd gotten to know these dear people, and how their lives had or were coming to an end. Not in a painful or sudden or traumatic way, but coming to an end nonetheless.

Admittedly, lately I've been working extra shifts at the hospital and have been slightly overwhelmed by nursing in general, and maybe that's why these deaths seemed to affect me more than usual. Saddened by the loss of life, I sat in my bed begging my body to fall asleep while tears slid down my face. Sickness, sickness, death, sickness. Though I love my patients dearly, I was worn out.

Stock photo from Adobe

All I wanted was to help people succeed. It's what gives me the most fulfillment and satisfaction in life. In high school, I played competitive soccer. I only scored once the entire time I played, and the one time was sort of a fluke! I didn't care, though. My favorite position was center mid-field, where I could receive the ball from our defense, take it up field, and set up a scoring opportunity for our forwards. I may have scored only one goal myself, but I couldn't keep track of my assists. When I could create space on the field and send the perfect pass—just the right position, speed, and timing—for a goal, I was just as thrilled as if I had scored myself. Their success was my success. Nothing brought me more joy.

These setups for success were the kind of work I wanted to do every day, and working in a hospital, staring sickness and death in the eye every day, felt like just the opposite.

These thoughts swirled in my brain the next day as I drove around town after dropping by the hospital to say goodbye to our now-hospice patient. I cried in the car, and I told God I was sad, and I questioned what role I had as a nurse in helping others succeed.

In the car at a stoplight, tears slipping down my face, I wondered. I wondered if I had a limited view of success. I wondered if to the patient and to God, success didn't mean staying on this earth. I wondered if it meant them crossing over into eternity and feeling His embrace. I wondered if being one of the last faces someone sees, one of the last hands they hold, one of the last voices to say a prayer for them on this earth—I wondered if this was helping them succeed in moving to the next place they were meant to be, the place we were really all made to be: the presence of the Most High God.

This realization crushed me. I wept like a baby at that stoplight, and I can't help but cry a little now as I remember that sweet moment. We can only see part of the soccer field, and perhaps sitting with someone at the end of life is akin to assisting them with the most epic goal of their existence, the moment they see God face to face.

To be frank, though this perspective helps me process the experiences of this week, it doesn't make death any easier. It doesn't mean I won't cry the next time I have a patient who dies or who make the difficult decision to go hospice. It's easy for others to remind me it's special and important work to care for people in their last months, days, and moments, just like it's easy for others to tell me my work as a bedside nurse is honorable and impactful. Speaking or hearing these words is not the same as living out the moments at the bedside. People like to say nursing is a calling, but even if it is a calling for some, it's still a job. There is still the wear and tear of cleanups, medications, assessments, the moment-by-moment deepening of relationship between nurse and patient in every interaction, and the moment-by-moment decisions and realizations a patient is declining. The sweetness of helping someone succeed does not remove the deep sorrow of death.

Yet, I am thankful there is sweetness and not only sorrow.

Today, I'll keep hoping. Hoping for what's to come, for the day we'll all be on the other side of death, when there will be no more sorrow, only the sweetness of the presence of Jesus. Yet until then, I'll keep praying, and I'll keep crying. And I'll keep doing my best to be a part of the setup for success.

Reentry: Still on the Road

It's no secret I've had a rough time in reentry the past few months. I washed my clothes by hand and hung them up to dry for weeks, and I binge-watched Netflix and drank Dr Peppers by the case to make up for the time my favorite soda and I were apart.

Now, several months (and seasons of Bones) later, here I am.

Life in Waco is falling into a pleasant rhythm, and for the most part things have calmed down both externally and internally. However, every once in a while waves of grief and feelings of missing Cambodia hit me rather suddenly, like a flash flood with no forecast of rain. I'm still learning to navigate these surprise storms. Recently during one of these waves of grief, I heard a song my friend Marc wrote called "Heading Home." The song begins, "There’s a groaning, an aching in my bones/There’s a longing in my heart to find a home." As I listened, it seemed to gather up within me leftover remnants and threads of reentry--the values I've learned, the pain, the hope, and the lessons I'm still learning now--and place them in a bundle right in the center of my heart.

The lyrics didn't tie up the loose ends or weave the threads into a stunning tapestry. No, they simply brought all the frayed fibers to one place so I could see them. All of them, in their varied colors, sizes, shapes and textures, all at once. The hurts and hopes and tears and shouts, all at once.

All of them, all at once, were beautiful. I no longer felt the need to tug at this thread or change the color of that one. With all their quirkiness and shortcomings and distinct characteristics, they were beautiful.

Stock photo from Adobe

While I quieted my soul and listened to this song, I realized a few things. First, even though I'm settling down into life in Waco, I'm still heading somewhere. For a woman with an unshakable travel bug coursing through her veins and wanderlust written on her heart, knowing I'm still traveling is a comforting notion. (However, I am excited for no more reentry processes when the journey ends!!)

Second, the place I'm heading is to be with Jesus in person. To have more of Jesus, to spend more time in His presence, to know Him more. This lines up with one of my greatest prayers and desires lately, which has been to want Jesus more than I want a country, and for my loyalty to be to Him and not to a culture. Home is a Person, not just a place.

Third, I realized the journey home can be beautiful in itself. A road trip by myself through the Texas countryside is one of my favorite things. More than getting to the destination, I enjoy simply driving, soaking in the landscape and praying or listening or singing until my throat hurts. I may be homesick, and reentry may be hard, and I may not truly arrive home for a while, but the journey home can still be beautiful and is uniquely qualified for enjoyment.

As I sat examining this bundle of threads and these lessons learned, I stopped struggling for a moment. Instead of trying to reconcile two very unique cultures and countries, I simply began to thank God for each lifestyle and cultural difference as it came to mind.

Thank You for the communal way of living in Cambodia, and thank you for the individuality of American people.

Thank you for rice and fish and the Mekong. Thank you for microwaves and refrigerators and ovens and pre-packaged food.

Thank you for my students in Cambodia, for the church, for the rhythm of life there; thank you for the job I have in the States, for my coworkers, for healthcare here.

I could keep going for hours, but the point is gratitude humbles me and reminds me how beautiful this world is, even with its pain and frayed edges and tangled up threads. In some way, all those worn out threads create something beautiful in their messiness. I cannot and will never be able to make sense of the disparities between countries and the heartache that hits every time I leave a country. Yet when my focus is on the Maker of cultures rather than on the cultures themselves, I find rest. I don't have to stress about reconciling the differences and similarities and roughness and tangles—because no matter what, I'm still on the road, and I'm still heading home.

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.