Something to Talk About: Practicing Self-Talk That Builds Resiliency

The minute the door clicked behind me I realized my mistake. My keys were on the table, and the table was on the other side of the locked door. It was bad enough that I was already running late for a meeting where I was a guest speaker. I’d intended to leave 15 minutes earlier but the morning got the better of me. I always think I can get more done than the time allows.      

“Darn it,” I muttered.

Standing on the side porch, it took a minute to pull myself together and remember there was a spare key in the garage. Fortunately, traffic cooperated and I managed to arrive only 5 minutes late. But as I drove, instead of rehearsing my talk, inside my head I was repeating the same thing over and over, “Stupid, stupid, stupid.” Sprinkled in with, “You need to be more organized; watch your time better. Not be such an idiot.”

Of course, everyone waiting for me didn’t know what my interior narrative was. I quickly apologized for being late, and it was just as quickly shrugged off.

“I’ve done the same thing before. Don’t be so hard on yourself,” said Sally, who had organized the meeting. I felt guilty for arriving late, yet those in attendance were still filing in and chatting. My lateness was hardly noticed by anyone but me.

I find being hard on myself is easier than to be forgiving. I like to think I’m at a place of personal maturity that would allow me not to beat myself up, yet I am also only ever one step away from my natural tendency toward self-doubt.

I think I may be in good company. I see nurses second guess themselves all the time. Maybe it is because many nurses have a tendency toward control. The very thing that makes us good nurses, the ability to organize our day in spite of circumstances we may lose control of, has us soldiering on in the belief that we can mark off all of the boxes on our task list. To miss something, especially if you have to pass it along to the next shift, is to be avoided.

Case

Recently I spoke with a bedside nurse, Amber, who was giving herself a hard time because her patient had a bad outcome. On a logical level, she understood that what happened was unrelated to how she had cared for her patient. The patient was admitted to the hospital with pneumonia and altered mental status. She had advanced disease and her chemo treatment was on hold. Because of the COVID-19 pandemic, the family was not allowed to be at the bedside and all conversations with them were conducted on the phone. They were holding out the hope not just that she could recover from pneumonia, but that she would get strong enough for more chemo. They asked that she be a partial code of “Do Not Intubate.”

When Amber went into the room to pass meds, the patient was hovering on the precipice of respiratory failure. Amber called a code and started CPR but the patient did not survive. Her death was not unexpected, yet Amber blamed herself. “Maybe if I’d gone in earlier I could have done something.” Perhaps it was guilt masquerading as grief. Amber had advocated for the patient being made DNR. We discussed all of the particulars of the case, and it was evident that nothing she did or didn’t do would have changed the outcome, not even if she’d gone into the room earlier. I tried to reassure Amber of that. She nodded in agreement but the look on her face said the opposite. Maybe her internal narrative was already set.