A nurse stopped me in the hallway at work, just a few weeks before I left for Africa, and said, “I need a meditation from you. I need to know how to stop hating my patients.”
I actually thought about it for a long time, because I understood what they were asking. I’ve been there. I still get there, sometimes, although not as often as I used to even five years ago. And I love the work I do, honestly and truly. It makes me sad to see nurses crashing and burning out around me, snide and angry, resentful, lazy and passive-aggressive with their patients, all because they simply have nothing left – emotionally – to give.
Hate drains us of the love we used to have for our work.
So I thought about this meditation at home while I packed, on the plane across the ocean, in a minibus along Rwandan highways, and as I climbed up-up-up-up Kilimanjaro. And now I’m sitting in front of a roaring fire in a brick fireplace, the mantle a marvelous hodgepodge of African wood carvings, drinking coffee that was grown, harvested, and roasted right here on this remote Tanzanian farm. And writing to you.
Stay with me. You were called to this work for a reason. It’s not lost to you yet.
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This is a meditation in four parts.
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Meditation the First: We cannot change our patients, so we must change ourselves.
This is at once the most simple and the most difficult of the four parts.
You must accept that our patients are exactly who they are.
You have no control over this.
You cannot change this.
Whether they are quiet, loud, angry, crying, drunk, high, obscene, lovely, or rude, that is who they are.
Stay here in this meditation for a while until it feels less uncomfortable. This idea forces you to give up a huge amount of perceived control. And that is – for most of us – very frightening.
We can’t change them. The only thing in the world we have the power to change is ourselves.
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Meditation the Second: We hate our patients because they have failed to meet our expectations.
If we want to stop hating our patients, we need to understand why we hate them in the first place. So we need to sink into what ‘hate’ is in this context. And for most of us, it is antagonism towards someone who we feel has wronged us.
If the patient is quiet and complaining of 10/10 pain, you become angry because they are not expressing _enough_ pain. If the patient is screaming in pain and thrashing on the bed, you become angry because they won’t ‘calm down.’
If the patient won’t stop listing complaints, you become angry because ‘it’s not your job’ to fix everything. If the patient only lists one small complaint, you become angry because they are ‘abusing the system.’
If the patient complains of belly pain and then eats a bag of Cheetos in the waiting room, you become livid because they are ‘lying’ and ‘wasting your time.’
You want your patients to be kinder, more polite, less shouty, less abusive, more articulate, more consistent. And when they fail to meet these expectations, you become angry; when they persist in not meeting these arbitrary expectations, you then hate them for it.
And here is the most dangerous expectation of them all, the one that burns us out the fastest: You want them to be more grateful.
You want them to thank you more, acknowledge you for what you have done for them.
To stop hating your patients, you must let go of these expectations immediately.
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Meditation the Third: Understand that the expectations you have for your patients are actually a manifestation your own needs.
If you are angry that the patient is too loud, you are placing your own need for calm and quiet upon them unfairly.
If you are angry that the patient is not showing enough pain, you are placing your own need for integrity upon them unfairly.
If you are angry that the patient lied about their drug use, you are placing your own need for honesty upon them unfairly (and likely placing your own judgement of their lifestyle upon them, as well).
If you are angry that the patient is making repeated demands on your time, you are placing your own need for understanding and justice upon them unfairly.
If you are angry that the patient didn’t say ‘thank you,’ you have placed your own need for recognition and appreciation upon them unfairly.
We cannot expect our patients to fulfill our own needs.
We cannot change our patients.
We can only change ourselves.
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And so, finally:
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Meditation the Fourth: We must change our own expectations.
When we fundamentally change the expectations we have for our patients, when we no longer hold them unfairly accountable for our own needs, they suddenly stop failing us.
And when they stop failing us, we are no longer angry with them.
And when we are no longer angry, we no longer hate them.
This is – I think – also a very difficult meditation. Many of us depend emotionally on the positive feedback we get from this job. We get a desperately needed dopamine blast when we are appreciated, thanked, treated with respect and kindness. And we feel slighted and wronged when it does not happen.
But this dependency – in the end – breeds the cascade of needs and expectations that will, ultimately, lead us to burn out and walk away.
So what kind of expectations can we reasonably have for our work?
I think it is reasonable and necessary to expect that we will be physically safe at work. We need never compromise on our safety.
I think it is reasonable to expect that we will be given a degree of personal respect. Patients will lash out in frustration at the system, but that is a burden we do not need to carry. We cannot change the system in a single shift. However, when they lash out at us personally in their frustration and anger, it is reasonable to expect that behavior to stop when called out.
But beyond that, our expectations need to be centered on ourselves, and we must each search for what those personal expectations may be.
–I expect to provide care that is safe, always, first and foremost.
–I expect to provide care with compassion, even when compassion is not shown to me.
–I expect to provide care with acceptance of their frustrations, even when I do not share them.
–I expect to find fulfillment in the act of service, even if my service is not acknowledged.
When our expectations change in this way, there is not infrequently a sense of loss – a loss of what we used to expect, a loss of the expectation that all our patients would like us and appreciate us for what we do.
But as we lose this, we also lose that drive which leads us to hate our patients. We may no longer try to like them, in some instances, but we no longer hate them, either.
We no longer suffer under that lash of hate – because it was always self-inflicted.
It was always something we did to ourselves, through our expectations.
And now we’ve let them go.
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These meditations will certainly not ring true for everyone, and will definitely be rejected by many.
But maybe, for some of us, they are a place to start.