What is Pain?

May 8, 2013

***Originally published on June 3, 2009 on my previous blog***

hand x rayFour days ago I had surgery on my hand.

After diagnosing me six weeks ago, my doctor began telling me about the surgery to correct my problem by telling me it was the most painful surgery they do. That information had an odd effect on me over the following six weeks.

For a while it was a badge of honor. I’m sort of wired to seek credit for pain and suffering. It’s an old pattern, and one that’s taken some healing. I noted in the past six weeks that it wasn’t very active anymore, but it was still there.

After that, the high level of pain my doctor warned of was always part of the information I mentioned when telling people about my impending surgery, but I was always sure to down-play it, saying that I didn’t really believe it. But I was clearly still looking for credit of some kind.

Later I left it out completely, usually saying that it was a very common surgery, although the ailment itself was actually very uncommon. (Boy, is my need for specialness big!)

Then about two weeks before my surgery, I got an email from Joe Vitale recommending a book by David R. Hawkins, who I’ve loved since I read, Power vs. Force, several years ago. Hawkins’ new book is called Healing and Recovery, and I ordered it immediately.

Hawkins says some very enlightening things about the relationship between the mind and the body, but he’ll be the first to tell you that the whole mind-body thing is only a fraction of the story. This is paraphrased from Healing and Recovery:

The Body is not sentient, meaning that on its own, it can have no direct experience of itself. That means there’s really no pain in the body itself. There may be physical sensation, but the body itself cannot report pain or pleasure.

The Emotions are not sentient either, meaning that on their own, without a mind to tell us stories about them, our emotions are meaningless; they’re just emotional sensations.

The Mind, however, does lots of reporting about the body and the emotions. Now if your mind was the sum total of who you are, that would mean the mind was the determiner of all of you experience.

But the Mind is not sentient either, meaning that on its own, it cannot experience itself.

It is Consciousness that determines what is held in your mind. (That’s why when you’re under anesthesia; you are effectively without body, emotions, or mind.)

And finally, beyond Consciousness (consciousness being a state in which you still experience yourself as a singular, separate being) there is Awareness, a state in which you experience “yourself” as fully merged with the great collective, with no boundaries, internally or externally.

This is the place from which you can see that you are not body, emotions, mind or even consciousness. This is where you know that you’re the same stuff that God is.

So how about that for timing? Two weeks before undergoing “the most painful hand surgery know to man,” I bump into information that helps me to understand and deeply internalize that pain is essentially optional. If I can see my way clear to tell the truth about who I really am and how that relates to the body in a way that completely lacks any sense of cause-and-effect, I’ll be golden.

Hawkins offered a method of telling the truth that went something like: “I am an infinite being. I am not subject to physical pain. And that is a fact.” I told it to myself a few times in the days leading up to my surgery. The truth of it was so obvious that is sank in pretty easily.

But you never know if the truth will stick around when people start cutting into your flesh.

You know what, thought? It did. After four days–two without any pain medication at all–I have not suffered one moment of pain. There have been physical sensations and awareness of the incision point, but nothing I have even been tempted to lie to myself about–nothing I’ve been tempted to call pain. (It bears noting also that I typed this post using the normal two-hand method without any trouble at all.)

I had some trepidation about sharing this experience with people. Remember I have that need for specialness issue, and I didn’t want this to be about some accomplishment of mine. The truth is, if you’re crossing paths with this information, really it’s an accomplishment of yours. David R. Hawkins told me that he was able to use this simple truth-telling to endure the reattachment of his thumb (severed in a carpentry accident) without anesthesia. Now I have told you another story about how pain is optional.

It’s becoming clear that this web site is reaching into every corner of this big world of ours, so I’m thinking this might somehow drop into the inbox of someone who might really love the opportunity to understand and deeply internalize that pain is essentially optional. If it’s you I’m talking about, I wish you one thing: the ability to tell yourself the truth about how pain is a story that has nothing to do with who you really are.

I am an infinite being. I am infinitely appreciative of all physical sensation.

Namaste,
Rebecca

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Untitled Poem

May 6, 2013

classic-sugar-cookies-lAs I shook the crumbs
Out of my keyboard
They bounced onto the black surface below
And formed letters
Of their own volition.
A little poem
About my eating habits.

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Nurses Know

May 3, 2013

NurseI was in labor for about 19 hours when the nurse took out a diaper.

I was having my first and only child, and I wasn’t one of those women who read everything she could get her hands on about the birthing experience. I knew my own body, and I focused on managing my own experience of my daughter’s birth. An approaching storm that would drop 16 inches of snow throughout the night apparently made all of the babies who were close to ready to be born drop all at the same time. Seventeen of them were born in that unit on that night.

Through it all, I felt cared for. My husband was a great birthing partner, even though, as he said, “It’s more than a little ironic that I’m coaching you in a sport I’ve never played.” He was present and attuned (and funny) and he loved me.

I felt well cared for by my nurse, too. She was stretched quite thin with the heavy volume, but if no one had told me so the next day, I’d never have known it. She was present and attuned too, and while I won’t presume that she loved me, it certainly never crossed my mind that she didn’t. She asked questions, listened carefully to my answers, asked more questions, made sure my husband was well versed in his role, told me everything she knew about what was going on with me, and assured me she’d be back. I like that she didn’t say, “I’ll be back as soon as I can.” She just said, “I’ll be back,” leaving me assured that when she would be back was not something I needed to be concerned about. My job was to breathe through my contractions. She knew what was going on with me better than I did.

One of the times she came into the room, she greeted us and checked to see how dilated I was, and then she brought out a tiny diaper and set it in the small Lucite bassinet that I hadn’t even noticed until that moment. While any number of centimeters that I may have been dilated had some meaning for me, the meaning was fairly abstract. But the sheer practicality of that diaper meant that my baby was coming out. The relief I felt in that moment made me aware of the completely irrational anxiety I’d been entertaining that perhaps this baby wasn’t coming out. It didn’t matter in that moment whether I was a little irrational, however. My nurse knew the score, because nurses know.

I believe that the extent to which the “knowingness” of a nurse can be of comfort to a patient cannot be overestimated. Here are the words of nurse theorist, Kristen Swanson:

“When we stand by a parent whose child has been diagnosed with an end-stage disease, we stay and start talking about the child’s play needs or teaching needs. We do this because we see a tomorrow, even if it feels like the end of the world for the family whose child is about to die. We might not explicitly say to the family, ‘Here is what your tomorrow looks like,’ but we talk about maintaining the child and his or her human growth and development needs. The family gets the message that there is a tomorrow and that tomorrow will still have meaning.”

As Swanson suggests, nurses provide an almost unfathomable level of comfort and encouragement simply by visibly moving forward on behalf of the patient. She calls this action “maintaining belief,” and I think that’s a very good name for it. In my own experience, the nurse believed my baby was coming out, and her well-informed forward movement was evidence enough for me.

In one of Marie Manthey’s nursing salons, a veteran nurse told a story that has stuck with me because it speaks so beautifully to this same point. She was working in an ostomy ward, and she shared how traumatized so many patients are when they are learning to manage their own colostomy appliances. It’s common that people in their first hours or days after surgery aren’t able to even look at the site let alone to move toward learning how to manage for themselves. She told the story of a young nurse who had been working with a patient who was having a particularly difficult time moving past the trauma stage into competent self-care. One evening, this man’s nurse had a special event for which she’d had her nails done and her hair beautifully coifed. She was wearing a formal dress and smelled lightly of the most divine perfume. On her way to the event, she stopped in to see this new patient. Without making any fuss about it, she engaged him in conversation about how he was doing, and then she changed his colostomy bag.

This beautiful person had stopped by and touched him, after which he could no longer see himself as untouchable.

It’s quite possible that the interaction was nothing out of the ordinary for her. It’s impossible to know for sure whether she had intentionally given him this remarkable experience or if it was just something that happened somewhat by accident as she simply maintained belief that this patient (like all patients in his situation) would eventually be able to manage just fine. Because she knew, he knew.

I sometimes bring up the idea that “nurses know” in Marie’s nursing salons, and I tend to get a lot of blank stares in response. I figured out pretty quickly that it was because I was rather enthusiastically telling a school of fish about water. The reason I was compelled to write something on this topic is that I believe that it really is an extraordinary thing that nurses do. When you move forward on behalf of a patient, the patient experiences forward movement, and that is a subtle enough thing that nurses tend not to notice it, let alone to value it.

If you are a nurse, the belief you maintain in your patients and the actions you take that demonstrate your belief that they will live into the next moment and possibly return to a normal life are inherently healing. Perhaps it makes no real difference whether you demonstrate your belief in your patients consciously or unconsciously. It was just something I felt compelled to thank you for.

Reference:
Swanson, K. (2007). Caring made visible. In M. Koloroutis (Ed.). Relationship-Based Care: Visions, strategies, tools and exemplars for transforming practice, (p. 327). Minneapolis, MN: Creative Health Care Management.

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The Nursing Imperative is the Human Imperative

September 25, 2012

I’ve been having conversations with esteemed nurse leader Marie Manthey lately about what she calls “the nursing imperative.” She mentioned the term in one of her Minneapolis nursing salons as something that had been haunting her lately, and now I find that I can’t let it go either. She’s trying to get at the idea of what exactly it is that must always be present in order for nursing to really be nursing. What is the actual core of nursing? What strengthens that core? And what must be present in order for that core to even exist?

In a follow-up conversation, she talked about the importance of vulnerability for nurses (as well as all other caregivers and, of course, anyone who presumes to be in relationship with another human being). Then she said something that hooked me and wouldn’t let me go. She was talking about the reality that all patients and families are inherently vulnerable and then she said, “in order to put the reality out of mind…” She continued speaking, and I even continued to write down what she was saying, but I was completely snared on the idea of “putting the reality out of mind.” It struck me that nearly all of us—whether we’re nurses, patients, or neither—put unpleasant realities out of mind almost automatically. I thought about a recent biopsy I’d had and how I’d framed the whole thing as an annoyance instead of being with the reality that, let’s face it, doctors order biopsies for only one reason. If a biopsy doesn’t make me face the reality of my own mortality, it’s because I’m putting the reality out of mind.

After our conversation, I looked back at the notes I’d scrawled while Marie was talking, and I discovered that she’d gone on to reflect on the fact that nurses are privileged to interact with those who are at their most vulnerable. This privilege is another piece of the nursing imperative puzzle. Perhaps we’re all called to be present in our relationships, but there are times at which our presence is more valuable than others. I may or may not choose to be fully present to my friend’s description of a bachelor party, but my decision to be present (or not to be present) to his description of his son’s illness is another matter entirely. In this case, I’m being offered the privilege of another person’s vulnerability. Whether the illness is ultimately serious or not, I’m privileged to be invited into the reality of it. I have a choice then to leave that reality by thinking or saying something like, “Oh, he’s such a robust kid; he’ll be swinging from the monkey bars again in no time,” or to remain present, ask more questions, do my best to understand what this experience is like for my friend and his son. I have the choice (at least in theory) to stay present to the reality rather than putting the reality out of mind.

What often makes this choice so difficult is that so many of us have our mental/emotional dials set to put difficult realities out of mind automatically. It’s simply a habit. However, as is true of most habits (or perhaps all of them), we repeat an action because it worked at some point to alleviate discomfort or solve a problem. It worked once, so we did it again, probably with very little consciousness. If something is tragic, look away. If a problem is presented, offer a solution. If someone is bleeding, bandage the wound and tell the person he or she is going to be fine. If someone tells you about her biopsy, remind her that 95% of masses like hers are benign. Each of these situations is offering us the privilege of witnessing and joining in someone’s vulnerability. What we do in the face of this vulnerability determines a great deal about who we are as people, and of course, it determines almost everything about who we are as nurses.

It’s clear that half of the nursing imperative is that we have a mastery of the technical aspects of nursing. But the other half of the nursing imperative—clearly no less than half—is staying present to the vulnerability of others. It’s fighting the automatic impulse to put the reality of the other’s pain, fear, disorientation, uncertainty, or inner conflict out of mind, and instead staying fully present to it.

But how on earth is this accomplished? These habits of ours are extremely pervasive and deeply ingrained. Now add to that the day-to-day realities of health care—the chaotic care environments, the time constraints, the increase in patient acuity, the physical demands, and even the realistic concern for our own safety and well-being. This is not exactly the ideal environment in which to train ourselves to be present to the vulnerability of others. Or is it?

I know a lot of nurses, and perhaps my view is skewed because I seem to know only extraordinary nurses, but I suspect that nurses are actually more able to attune and be present than the average citizen. Some may still be in the habit of “putting the reality out of mind” and forgetting the privilege of being invited into the vulnerability of others, but I believe nurses are more than equipped to remember that privilege and to dive into the realities of what the patients and families in their care are going through. Nurses can and must learn to tread those waters without drowning in the sorrows of others. Turning away, shutting down, and cheerfully deflecting are not viable options. They don’t help the patient, and in the long run, they don’t help the nurse either. As Marie also taught me, “Caregivers get energy from human connection. Without this energy, compassion is not sustainable.” When compassion falls by the wayside, so does good nursing, and when nurses feel they’re not living up to their own values as compassionate caregivers, they risk burning out. When the impulse of my compassionate heart tells me to take the time to look more deeply into one who is suffering or to listen for a while longer or to touch when touch is not clinically necessary and I put it out of mind and carry on instead, doesn’t a part of me die? This is the daily dilemma of the busy nurse, and it is also the dilemma of all human beings.

So let’s return to our original questions: What exactly is it that must always be present in order for nursing to really be nursing? What is the actual core of nursing? What strengthens that core? And what must be present in order for that core to even exist? What is the nursing imperative? For this, I turned to Marie Manthey once again:

“The nursing imperative is a two sided coin. On one side there is the imperative to be clinically competent in both technical skills and clinical judgment. The other side is the willingness to step into being with the human being for whom the nurse is caring. In health care, people experience vulnerability at every level of their being: mental, emotional, physical, and spiritual. The privilege of nursing is having the knowledge and skill, the position and relationship, to interact with a vulnerable human being in a way that alleviates pain and increases mental, emotional, physical, and spiritual comfort. This is the privilege of nursing—the being with a vulnerable human being. And if this privilege is ignored or overlooked, nursing isn’t happening. Just doing tasks is not nursing; it is just doing tasks. No matter what is happening in a care environment, authentic human connection with the vulnerable human beings in our care can and must happen. That is the nursing imperative.”

By this definition, it would seem that the nursing imperative lives in each nurse either as unmet potential or as action. Sometimes a nurse’s willingness to embrace both personal vulnerability and the vulnerability of others is visible to everyone, and sometimes it’s crushed deep beneath layers of fatigue, disillusionment, personal problems, or the quicksand of the victimization/entitlement thinking that so many nurses get caught up in. Still, the potential to actualize the nursing imperative does live in every nurse, and a commitment to accepting the often silent invitation of patients and their families to witness and join them in their vulnerability is a privilege that good nurses cherish and nurture. When any nurse ignores the impulse to truly care, the cost is high for both the patient and the nurse. The benefits of following the basic human impulse to care, however, are inestimable.

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The Mother’s Prayer for Its Daughter (by “guest blogger” Tina Fey)

December 11, 2011

First, Lord: No tattoos. May neither Chinese symbol for truth nor Winnie-the-Pooh holding the FSU logo stain her tender haunches.

May she be Beautiful but not Damaged, for it’s the Damage that draws the creepy soccer coach’s eye, not the Beauty.

When the Crystal Meth is offered, May she remember the parents who cut her grapes in half and stick with Beer.

Guide her, protect her
When crossing the street, stepping onto boats, swimming in the ocean, swimming in pools, walking near pools, standing on the subway platform, crossing 86th Street, stepping off escalators, driving on country roads while arguing, leaning on large windows, walking in parking lots, riding Ferris wheels, roller-coasters, log flumes, or anything called “Hell Drop,” “Tower of Torture,” or “The Death Spiral Rock N’ Zero G Roll featuring Aerosmith,” and standing on any kind of balcony ever, anywhere, at any age.

Lead her away from Acting but not all the way to Finance. Something where she can make her own hours but still feel intellectually fulfilled and get outside sometimes and not have to wear high heels.

What would that be, Lord? Architecture? Midwifery? Golf course design? I’m asking You, because if I knew, I’d be doing it, Youdammit.

May she play the Drums to the fiery rhythm of her Own Heart with the sinewy strength of her Own Arms, so she need Not Lie With Drummers.

Grant her a Rough Patch from twelve to seventeen.
Let her draw horses and be interested in Barbies for much too long, for Childhood is short—a Tiger Flower blooming Magenta for one day—And adulthood is long and Dry-Humping in Cars will wait.

O Lord, break the Internet forever,
That she may be spared the misspelled invective of her peers and the online marketing campaign for Rape Hostel V: Girls Just Wanna Get Stabbed.

And when she one day turns on me and calls me a Bitch in front of Hollister, Give me the strength, Lord, to yank her directly into a cab in front of her friends, for I will not have that Shit. I will not have it.

And should she choose to be a Mother one day, be my eyes, Lord, that I may see her lying on a blanket on the floor at 4:50 AM, all-at-once exhausted, bored, and in love with the little creature whose poop is leaking up its back. “My mother did this for me once,” she will realize as she cleans feces off her baby’s neck. “My mother did this for me.” And the delayed gratitude will wash over her as it does each generation and she will make a Mental Note to call me. And she will forget.

But I’ll know, because I peeped it with Your God eyes.

Amen.

From Bossypants, Tina Fey, 2011–I highly recommend purchasing this book. In book form. The kind where the pages are made of paper.

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