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I learned about “vicarious resilience” several years ago. The idea is that not only do we healing professionals need to be aware that we pick up trauma from our patients, but we also have an opportunity to find strength in the way our patients cope with their difficulties. The concept was coined in a 2007 article by Hernandez, Engstrom and Gangsei. I was drawn to the idea, because although it is my job to care for a patient and maintain calm, it’s good for everyone when I allow patients to offer something. By looking to them, I elevate their gifts, promote mutual respect and increase my capacity as a nurse.
Since March of 2020, when the pandemic changed everything for us, I have come back to the idea of vicarious resilience. All of us are feeling new levels of stress both at work and at home, whether it be extra work tasks, fewer resources, changes in routines, financial difficulties, illness or death in our families and communities. We need to get creative to find a path forward. Patients in a rehabilitation setting have often been through a lot of trauma and pain. Although it can be a lot of effort to support what our patients are going through, we rehab nurses are lucky to get to know some amazing people as they go through an epic, if not always glamorous, journey. I’d like to share a few examples of ways my patients’ resilience has informed my capacity to get through this time of shared difficulty.
1: Breath is More than Oxygen
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In nursing school “airway first” is second only to “wash your hands” as a correct answer on a test. Unfortunately, sometimes that means we check to make sure vital signs are ok and then move on to the next task (after hitting the hand sanitizer, of course). I once had a ventilator patient who struggled for weeks with her breathing, even though her numbers were great. After she finally weaned off the vent, she explained to me the reason the ventilator was so hard for her. She had spent years using mindfulness and breathing to manage her stress, and with a machine breathing for her, she had to completely reinvent her coping skills. This machine that was saving her life was stealing her morale, but with the right support and her own tenacity, she reclaimed it with flying colors. What I noticed was that her improvement started not when she was 100 percent better and doing high impact pretzel yoga again, but as soon as she started having just a little more control of her breathing. When I think of her, I am reminded that I, too, can use my breath, in small and amateur ways, to help ground me. There are articles, apps, classes and books that can offer many perfectly effective ways to use breathing as a mindfulness tool. My ability to focus on my breath is one of the few things that has not been affected by COVID precautions. I can do so standing in a long line at Aldi while I fix my gaze on the red “social distance 6 feet” circle on the sidewalk. This low bar for practice is surprisingly useful.
2: There’s Another Way to Do Anything
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One of my favorite experiences as a rehab nurse is working with people who have been living with a functional impairment for decades and who have come back to address a secondary problem. Twenty plus years of living in a quadriplegic body can lead a person to find some incredibly creative solutions to life, and I have felt so lucky to learn from some of the most innovative people on the planet. From technology hacks that would make MacGyver jealous to parenting with one finger, I love getting veterans to teach me the details of their routines. I love bringing that knowledge into my care and teaching for other patients. Also, lately, looking back at some of these rock stars has helped me re-envision my day-to-day. All of us are struggling with the fact that we can’t do things the way we used to. However, there is another way that fits into our current limitations; we just have to trust that we can figure it out.
3: A Medical Hold Is Just That
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Sometimes a patient has a fever, dizziness, scary lab results or some other symptoms that require us to cancel therapy for the day. Recently, a patient who was making very good progress had symptoms that put him on medical hold for a day. There were enough red flags that I was expecting a detour to an acute hospital, and three other steps backward. The next day, all the worst-case scenarios were ruled out and progress continued, that was that. It is so easy for me to anticipate the worst, especially right now. I’m not trying to candy coat anything; there’s a lot of uncertainty, and we have a lot of work to do. However, if I wake up tomorrow, and I can’t do the work because I’m sick, it doesn’t mean that’s the end. Maybe I just need some time to recover. As much as we can’t downplay the potential negative effects of a situation, whether a blood pressure, an altercation, a surge in cases or a really bad mood, we also can’t get bogged down in the worst possible case scenario. It has been helpful to remind myself to do what needs to be done now, and just wait to see what the next steps will be.
4: Wiggle Your Toes!!!
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One day I heard a blood curdling scream from one of my patient’s room. I walked in very quickly as the scream turned into laughter. I realized my patient’s scream was one of joy, not distress. “I wiggled my right big toe!!” she exclaimed. She was as excited as I’ve ever seen anyone be about anything. She had not moved anything below her waist since her injury many weeks before, so this tiny self-initiated movement was an incredible source of hope for her. Since that moment, I have sought to emulate this patient’s excitement over the small things. If it is unsafe to go to weddings, parties, vacations, fancy restaurant meals, graduations and so on, how do we find enough joy in life to keep showing up? I have started planning a few small things every week that will help me miss the big stuff less, and I make a list in my monthly calendar of “small things,” so I can remember the simple things that I enjoyed. It is amazing how much mileage I got out of a delicious piece of expensive cheese that I bought in lieu of a fancy birthday dinner this year. I felt like Laura Ingalls Wilder getting an orange in her Christmas stocking.
5: Unglamorous Goals Are Important
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When the quarantine started, there was a lot of talk about the self-improvement we could accomplish with our extra time. Similarly, when people begin rehabilitation, there is often a lot of talk about big successes, like walking again. Every week I celebrate modest goals with patients, such as peeing without a catheter, or eating with special silverware and a bib instead of being fed. This is the stuff that keeps rehab nurses waking up in the morning (or in the afternoon — I see you night shift). My patient who left the hospital in a power wheelchair and not on his own two feet, but who still feels high self-esteem about having a regular bowel movement every night at 8:30 p.m., is the guy I want on my team. I think about the list I wrote of the fantastically productive routine I would follow during the pandemic, and I’m sure it brings up the same feelings that many of you experience when thinking about the house repairs, the homemade quilts and the mastery of gourmet meals that might not have happened. Whatever we did or did not accomplish, we are accomplishing the feat of making it through prolonged collective trauma, and, much like a successful BM, that is more than enough.
I’m sure any of you reading this can think of people you have worked with who have given you a gem that isn’t on this list. I hope these reflections will help you experience moments of vicarious resilience, or just encourage you to look for lessons other people have to offer.
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Mat K Peltier BSN, CRRN started working in healthcare over twenty years ago as a home health aid and has been a registered nurse since 2012. Mat is currently a staff nurse in the Spinal Cord Innovation center on the 21st floor and is on the Nursing Research Committee at Shirley Ryan 小恩雅. Mat received a BA in literature in 1994 and has been an amateur writer and comics artist ever since, with an interest in medical humanities and other hybrid forms of art and science.
