Nursing U's Podcast
Nursing U is a podcast co-hosted by Julie and Caleb. We embark on an educational journey to redefine nursing within the modern healthcare landscape.
Our mission is to foster an open and collaborative environment where learning knows no bounds, and every topic—no matter how taboo—is explored with depth and sincerity. We delve into the essence of nursing, examining the intimate and often complex relationships between nurses and their patients amidst suffering and death.
Through our discussions, we aim to highlight the psychological impacts of nursing and caregiving, not only on the caregivers themselves but also on the healthcare system at large.
Our goal is to spark conversations that pave the way for healing and innovation in healthcare, ensuring the well-being of future generations.
'Nursing U' serves as a platform for examining the state of modern civilization through the lens of nursing, tackling issues that range from violence, drugs, and sex to family, compassion and love. We will utilize philosophy, religion and science to provide context and deeper understanding to the topics we tackle.
By seamlessly weaving humor with seriousness, we create a unique tapestry of learning, drawing wisdom from the experiences of elders and the unique challenges faced in nursing today.
Join us at 'Nursing U,' where we cultivate a community eager to explore the transformative power of nursing, education, and conversation in shaping a more whole and healthier world."
Disclaimer:
The hosts of 'Nursing U', Julie Reif and Caleb Schraeder are registered nurses; however, the content provided in this podcast is for informational and educational purposes only. Nothing shared on this podcast should be considered medical advice nor should it be used to diagnose or treat any medical condition. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding a medical condition or health concerns. The views expressed on this podcast are personal opinions and do not represent the views of our employers or our professional licensing bodies.
Nursing U's Podcast
Ep #025 Pt 1 - Philosophy Meets Medicine: Transforming Patient Care with Holistic Insights featuring Alex Gamble
What if blending philosophy and medicine could transform the way we care for patients? Join us as we welcome Alex Gamble, a clinical assistant professor of medicine at Stanford, who brings his unique perspective from the crossroads of philosophy and healthcare. From his philosophical roots to his dual focus on internal medicine and psychiatry, Alex shares insights that challenge traditional practices and foster a more holistic approach to caregiving. Learn how philosophical inquiry can enrich the medical field and enhance patient care.
As we traverse the landscape of evidence-based practice, we take you back to its Enlightenment origins and consider its profound impact today. The shift from spiritual to scientific explanations has reshaped public trust in healthcare, particularly amidst the upheaval of the COVID-19 pandemic. Through historical and contemporary lenses, we examine how trust and communication become pivotal in embracing new scientific insights. Could there be a harmonious blend of spiritual and material understanding on the horizon that offers us hope and connection in our multifaceted world?
The challenges faced by new nurses are pressing, with high turnover rates and the erosion of vital oral traditions leaving them adrift. We confront the emotional turmoil and moral injury that arise from a system prioritizing technique over human connection. Through personal stories and reflections, we explore the essential role of self-preservation and community support for healthcare professionals. Together, let's continue a vital conversation that seeks to redefine nursing, support its practitioners, and shape a more compassionate future for both caregivers and patients.
Hi, I'm Julie.
Speaker 2:And I'm Caleb. Welcome to Nursing U, the podcast where we redefine nursing in today's healthcare landscape. Join Julie and I as we step outside the box on an unconventional healing journey.
Speaker 1:Together, we're diving deep into the heart of nursing, exploring the intricate relationships between caregivers and patients with sincerity and depth.
Speaker 2:Our mission is to create an open and collaborative experience where learning is expansive and fun.
Speaker 1:From the psychological impacts of nursing to the larger implications on the healthcare system. We're sparking conversations that lead to healing and innovation.
Speaker 2:We have serious experience and we won't pull our punches. But we'll also weave in some humor along the way, because we all know laughter is often the best medicine.
Speaker 1:It is, and we won't shy away from any topic, taboo or not, from violence and drugs to family and love, we're tackling it all.
Speaker 2:Our nursing knowledge is our base, but we will be bringing insights from philosophy, religion, science and art to deepen our understanding of the human experience.
Speaker 1:So, whether you're a nurse, a healthcare professional or just someone curious about the world of caregiving, this podcast is for you.
Speaker 2:One last thing, a quick disclaimer before we dive in. While we're both registered nurses, nothing we discuss here should be taken as medical advice. Always consult with your doctor or a qualified healthcare provider for any medical concerns you may have. The views expressed here are our own and don't necessarily reflect those of our employers or licensing bodies.
Speaker 1:So let's get started on this journey together. Welcome to Nursing U, where every conversation leads to a healthier world.
Speaker 3:Good morning or afternoon Afternoon, yeah.
Speaker 1:Either way.
Speaker 2:Well, we have a special guest today, alex Gamble. We met probably a little over two years ago. We met probably a little over two years ago and it's a little bit funny because the context of our meeting a mutual friend connected us and knew my experience in healthcare, knew Alex from his whole life, basically and Alex was thinking about starting a podcast and we were discussing what that would look like for him. And here we are he's coming on our podcast, which is just wonderful.
Speaker 3:It's everything ties together.
Speaker 2:eventually it just takes a while to figure out how.
Speaker 3:Yeah, and it's great, I'm excited to be here.
Speaker 2:Yeah, it's awesome. Thank you so much. So one of the things that I'm super excited about is that, because you have a deep background in philosophy and I have been studying philosophy for a while yeah, loosely an independent study all on my own to just kind of make sense of the experiences that I've had and so I talk a lot about philosophical ideas and I think healthcare kind of forces you into a state of philosophical analysis of life and the experiences that you have. So to me it makes sense that I or anyone would look to philosophy for answers. But I'm looking forward to being able to tie some of the pieces of the puzzle that I've been presenting loosely to my to our audience and having somebody that has a real knowledge of it pull it together for me I'm super excited about that Well, I'll certainly do my best.
Speaker 2:Yeah, no, you're you're going to do great. Why don't you tell it? Introduce yourself, tell us kind of about how you became what you are today.
Speaker 3:Sure, yeah. So my name is Alex Gamble. I am currently a clinical assistant professor of medicine at Stanford, working with their palliative care team, both on the inpatient and outpatient sides care team both on the inpatient and outpatient sides and the journey to get there was a fairly long and winding road. It started, as you mentioned, with an undergraduate degree in philosophy, although at the time I had already had my sights set on medicine. And it was some mentors all the way back in high school who pointed out to me if you're doing a pre-med course of study, then your degree can be in whatever you like. And I was really fortunate to have the opportunity in high school to take ancient greek under dr michael cusick, and part of that course was translating, like plato you know from the greek, and and that really is is what put that on my radar and really got my imagination going, because when you're translating it, there's all this incredible wordplay, there's all these like double meanings and things. So there's both these ideas that were just lighting my brain up and then also this, like this greater sense of depth and humanity, and Dr Cusick was great at giving us the historical context and that, I think, was kind of the beginning for me of seeing like there's these powerful ideas that can be deployed, you know, from thousands of years ago in modern life, and there's also this like really context, important part of it, like understanding kind of, where you are, um, and so I was like, okay, if I'm going to go into medicine, there's going to be probably these big questions, this kind of tool set that philosophy offers for like unpacking and working through things feels like it'll be really useful and like really valuable. And so that was kind of my foray into philosophy and got that degree and also was doing my pre-med study and then went to medical school, didn't know what discipline I wanted to pursue.
Speaker 3:Found out that you could do combined training in both internal medicine so general adult medicine and psychiatry, which my observation in the hospital as a medical student was. You know, the identified psychiatric patient doesn't stay on the psychiatric unit. They have heart attacks and they have kidney disease and they have the same kinds of medical issues that everybody else has. Of course we know that actually they have them at higher rates and it's much more complex. What I observed was their care on the general medical floor didn't seem as good as everybody else's right. The best they could hope for was a consult psych team to see them, and then it could still be a lot of communication breakdown and disjointed care and I was like we could do better for these folks. But I had no idea how and was very fortunate to run across a mentor in Dr Anjum Bhattacharya who was med psych trained and was very encouraging. And so I pursued this combined training in internal medicine and psychiatry which gave me this more holistic view to patient care and I think, really fit well with the kinds of perspectives that I had developed up to that point.
Speaker 3:The question you get in med psych is what are you going to do with this? Because most systems aren't set up to really like unify these different perspectives. Right, medicine is often very siloized, things are very separated that we're having separate conversations. And so then I found palliative care and got to rotate with the palliative care team at the university of Iowa where I was a resident on a couple of occasions and the first time saw boy. This really makes a great use of both sides of my training. Right, there's like the physical symptoms the pain, the nausea, the shortness of breath that the internal medicine training really gives me a lot of insight into. There's the emotional aspects of it, the anxiety, the depression, the interpersonal dynamics that that psychiatric and psychotherapeutic training really spoke to. The second time I rotated with the team I got a better view of the kind of systems change opportunity because most of what we're getting called to see were like people in terrible crisis and most of that crisis reflected, you know, broken things in the system and I was like, wow, so this, this gives me an opportunity to really see how the system could be improved to to benefit the people that the system is meant to serve, and so I could impact many more people if I could effectively advocate for systems improvement and systems change. And that was really exciting. And so that's kind of the quick version of my path to where I am now.
Speaker 3:I have had a few different job opportunities. I got to work on building a program from scratch in rural Missouri and then was working at a busy community program doing inpatient palliative care. That was kind of my pandemic job, which is a very intense version of palliative care, and then now have really had this really incredible opportunity to be at Stanford and focus on both the patient care that I really love doing. That really involved palliative care with people with serious illnesses and commit to teaching you know they have a wonderful educational enterprise here and then also kind of work at this interface between palliative care and and psychiatry and psychotherapy, trying to help introduce more of those tools and skillsets from the world of therapy.
Speaker 3:That I often see is related to your first question, that the philosophical piece. Right, it's like what are those underlying tools? What are the frames? How do we think about what we're doing in a way that can be impactful in the context of each individual person, right, and so both being able to move into the crisis that our patients are often facing, while also being able to see again how does our system work, how is it working for us as human beings, as individuals within that system itself, right, who are witness to and participating in these struggles and the suffering of these people that are in front of us? And so you know, every little layer, like most people, every little string, that thread from my earlier life gets woven together into this thing that I'm now trying to stitch together in a way that that makes sense and hopefully can be impactful for the people that I'm serving and my colleagues that I'm serving alongside. Yeah, so that's, that's my path from philosophy student to, you know, clinical assistant professor and kind of how I weave those things kind of back and forth in between.
Speaker 3:But it's interesting because you know, as I'm sure we'll talk about, the the system side of things doesn't always seem to reflect that philosophical perspective and I think it's often left, you know, to the individuals in the system the doctors, the nurses, the social workers, the spiritual care providers to to make sense of the thing Right and to take a step back, to notice, you know, where there's friction and where there's pain and where there's suffering and struggle, you know, not just in our, in our patients and their loved ones, but in us and in our system as well.
Speaker 3:And I find that it's really that, that philosophical perspective, that tool set where you can kind of take a step back and unpack things, that often gets deployed. You know, though we don't call it that or necessarily say it that way, that's very much the thing. So it makes sense to me, caleb, for the questions that you all are unpacking and the things you're trying to make sense of, the experiences that you have that I know that you've shared with me and have talked about on the pod, and Julie as well to reach into that ancient toolkit, the tools that people have been trying to put together, and it's cool because they're still there for us.
Speaker 2:Well, it's interesting because I hear you saying practical things that connect to something that I said in the last pod and I've actually said it multiple times on the pod.
Speaker 2:Since we first met I've spent probably I mean really a lot of that time reading and learning about the Enlightenment period and what kind of drives that study. For me is the questioning of evidence-based practice, meaning all of our systems are derived from evidence-based practice. But so much of the distrust that was kind of cultivated with COVID and that already was underlying in the psychosocial milieu of America that people just stopped trusting the healthcare professions. So much of that is rooted in misuse of evidence base Meaning that my observation is that I mean, I think the underlying observation of everyone is when we're told that milk is high in cholesterol and you shouldn't drink it and then five years later they come out and the evidence says that we should be drinking it, that that cholesterol is good for us. So that to me is a picture of of that siloing of systems that were like, which takes me back to how did we get to evidence-based practice and what is it? How did?
Speaker 1:we get to evidence-based practice.
Speaker 2:And what is it so which takes me all the way back to the Enlightenment period. The Enlightenment period was, you know, in a lot of ways. You know it even goes back to the printing press. The printing press, without the printing press, information is not consolidated and mass distributed. And the that that as as we kind of processed through the um, the information dump that humanity received from that invention, which you know, like nichi talks about, uh, you're, you know, nichi's entire journey is kind of predicated on the, his overwhelm of of, like I can't consume all this knowledge. He, you know, quits his job because, you know, as a, as a teacher in the, in the college, because he, like it's pointless, I'm never going to learn it all Like so he's looking at the world in in practical terms and coming up with his ideal. And you know, I think about that sometimes, Like how would Nietzsche respond to today? Oh, my gosh, Like he killed himself five times already. You know, it's wild.
Speaker 2:But so that takes us up to the Enlightenment where, up to that point, we had been answering the existential questions through spiritual means, we had spiritual texts, and that's where we dug from that.
Speaker 2:Well, the 30 Years War, if you're familiar with that one of the worst wars in history was a religious war in Europe, and that was what really kicked off the Age of Reason, which led to reductionist thinking, which was essentially materialism, reducing the material world and searching.
Speaker 2:You know, the idea of the age of reason is that we have, we possess, all of the knowledge and skill and wisdom to use our reductive and deductive reasoning to come to truth. Set aside the religious texts and the spiritual answers to the existential questions and we're going to pick up the exploration of the material world to answer those questions. And today, where I see us is we have reached to the full. We've fully realized that material exploration and the example that I use is MRIs that we're able to use an MRI and observe someone doing a meditation practice, that demonstrates the efficacy of that practice and we can map it biochemically to prove that it's true. So we're at this very interesting point where we have this, the silver lining, and all the kind of darkness that we exist in right now, uh, or perceive that we exist in. The silver lining is that that those two paths have an opportunity to, to, to come together in a beautiful way.
Speaker 3:Um yeah, there's always. There's always opportunity, right. I mean I think there's. We can frame the these, the kind of struggle of the time, in in lots of different ways, right. I mean, like I spent a lot of time reading and thinking about Plato and you know, you think about like the contemporary struggle at that time between this notion of like philosophers and softness, right. So people that are like in the pursuit of this notion of truth versus people that are just like very persuasive with language, right, and like that. That's sort of like Nietzsche talked about, like the softest time, our time, right, that like there's always this kind of like struggle that's there. And I think if we look at, as you were saying that the struggle through COVID, it's very much kind of that piece of it, right Is like people on, on average, you know, people don't have a deep understanding of the scientific method, right, that like well, we come to you know the evidence shows X. So then we promulgate that information, then we progress the science and now the evidence seems to tell a different story. We share that information and the average person who maybe doesn't have an investment or a deep understanding about, like, what that process looks like and how that works and testing hypotheses et cetera, would just look at that and say like well, nobody knows what the hell they're talking about you told me it
Speaker 3:was one thing. Now you told me it's literally the opposite thing. You know why? Would I listen to you, right? And then?
Speaker 3:And then we devolve into this thing of like. It's about relationships and trust, but ultimately, underneath all of that is like well, is this about just convincing you? What I want you to think Is this about manipulation? Or is this about the pursuit of truth, which is, you know, in fits and starts, and it's uneven and it's you know, it's a process and it's all this kind of stuff? And and beneath all of that is the communication challenge of like, of trust in those pieces, and like sharing information and convincing someone of it relies on not just how compelling the data is right.
Speaker 3:Like what I'll often say in the hospital is like people don't doctors don't change their practice, medical providers don't change their practice in general because you bring them a compelling paper. They change their practice, they change their behavior, they change their way of thinking because they trust you. They feel safe to recognize the fact that they're not perfect no one's perfect. Their practice could be better and they see you as potentially having something to add to that right. So there's like these two things at play. There's like, yeah, we need to think through this and try to come to a right answer. We need to do studies, we need to gather information. But then, through this and try to come to a right answer, we need to do studies, we need to gather information, but then whether or not it's actually going to be compelling to someone else also hinges on not just the way that we communicate it, but also the feeling that other people have about us. Right, that, like, ultimately, there's this impassable divide between all people in that the choices that I make you cannot compel me to right. The most you can do for me is try to make it easier for me to make a good choice. But what does that mean? What does it mean to make it easy and who decides what? What the choice is, that's good, right, like those are philosophical questions.
Speaker 3:But there's this other element of just like sophistry, and that's to me, that's one of the big challenges of, like the COVID era and the era that we're in now is that loss of trust is, you know, people who are able to present arguments. It's this, this sophistry, right? They take the language of the evidence base, right? So there's this shambles of the system where we said, like we need to practice evidence base, right, we need to, like, have the decisions that we're making for what we feed our children should be based in something other than vibes, right, it shouldn't just be like, well, that seems right, so let's do it. And and then there was this splintering of trust in that system. But there's still the linguistic things that are there.
Speaker 3:Right, that someone can say, oh, a study X or Y shows, and you have all these people moving into the space building trust, right, so you have, like, the, the influencers for health, and they're using the language of the evidence-based system, but they're doing it in a way that is like cherry picking and really setting a standard for the supplements that they want to sell. Right, that was like that to me, was the really interesting data coming out of code? Was that, like, so much of the misinformation that people were getting was coming from a very small number of people who were like AB testing messages or like, okay, this shit is sounds scary, let's present it this way, this way, which one goes viral. And then, great, let's lean into that. And then, on the backend, why are these people doing it? Cause they're selling supplements. Because they're saying, if you take enough of the zinc, you know if you take this stuff that I'm selling you. So they're out there saying a scary message using language that sounds like what people were used to hearing from people they were trusting, right Within the context of the medical system, and then seeing someone who's speaking to them in a way that they find compelling, so they build trust and then that's where it goes.
Speaker 3:But as a society, we want to have a clear idea about what actually makes people healthy and that hijacking of that language and the breakdown of that system. And then you bring in all these other factors right where it's like we've paywalled healthcare. So I've got someone online who is taking advantage of the current media environment where you can build a parasocial relationship. So it feels like oh, I know, I know dave, dave. Dave is real, like I've seen dave's kids on his reels and he's a. He's a guy just like me and he's got. He talks about his family struggles and I can trust and believe in dave, and dave is saying that you can't trust the doctor and they see dave every single day and they feel like they have a relationship with dave. Meanwhile, the medical providers who spent their life like, like learning the difference between you know baloney and good stuff right Like informationally, not saying baloney is not good, but the like the.
Speaker 3:You don't have a relationship with them, you can't see if you want to see your doctor, if you just want to ask, like, hey, I'm seeing a lot of stuff and I'm freaked out and I don't know if I should take this vaccine or not, or if I should be drinking you know fish tank cleaner or not, and what do I do? Well, it's going to be five months before you can get to that office and then when you get there, the visit is going to be 15 minutes and you know they need to check your blood pressure and talk to you about this other stuff. And it's so hard to talk to someone who is reliable, who you can trust, that you just don't have that relationship. And into that vacuum are folks who don't have this notion of health at heart.
Speaker 3:Right, and and that to me that's like the scary space is like people are doing the best that they can, the way that we've set our system up because there's all these other factors, that that shape and color that has made it hard for people just to just to get by right, like just to get the information that they need from someone that they can trust, that's actually motivated toward their health, not someone else's profit motive, and, of course, that's not to say that the healthcare system itself isn't heavily influenced by a profit motive.
Speaker 3:Right, there's also those challenges, but I want to be cautious, not to get too deep into the weeds or too far away from those questions, cause I know there's meaningful questions that we want to dig into today that really impact the people you guys are talking to. Right, the folks that are inside of that system, caught between these different channels. Right, the the financial imperatives of the system, the distrust of the people that we're trying to serve, and that certainly contributes a lot, I think, to the conflict and the distress and the moral injury that you guys have talked a lot about.
Speaker 1:Yeah, yeah, I mean it. There's so many things that go into it and you know those little nurses coming out of nursing school, going to the bedside and I mean they don't even have a glimpse of the gravity of the system that they're entering and the things that they're going to have to deal with, and all while trying to figure out you know who they are and how they relate into that system. It's very it's. It's so much deeper than you know what, what anybody realizes that's.
Speaker 2:That's why like to me analyzing the enlightenment and all of all of the philosophical progression of thought and how that that is impacting all of us and the experience that we're having, because the evidence base is the product of enlightenment and ultimately produce that. It's not. You know, there are many progressions from that, but we exist in this, this kind of this system that has embodied that siloing of data. I've used this example before Take an apple, you cut it in half and you analyze it's got a red peel, it's got the meat, it's got the vascular system that carries the nutrients and the fluids, it's got the seeds, it's got the core, it's got all these things. Okay, that's an apple? Not really. You have to to keep going. You have to keep looking at the atomic and molecular structures that are existing in each one of those individual components, and so the, the thing that was a unified whole, is sliced into these silos of data. That, oh, that's an apple. That that's an apple, not not this thing, that's an apple, and we've created all of our society around this. This, I mean. I think that's the. I think that's like one of the examples that I'm using in as I'm writing. I'm writing about all these ideas and these thoughts.
Speaker 2:And one of the ideas is, if you look back immediately preceding the enlightenment, at art history, it was the medieval art was, was all religious context, and then, right, right there there's this shift to realism where the artists begin painting what, what life really is, and and and. So there's and and. Then you follow art history forward and and look at, you know, einstonian time, einstein's time, and how art uh shifted. You know the, the, you know the artists operating in mimetic functioning. They're embodying and representing the philosophy or the culture, what they're seeing in the culture. So in Einstein's time, the transition became abstract art, which is relativity, art which is relativity. So we're seeing how, like when you analyze art history through a philosophical lens, a philosophical or cosmological worldview lens, you can see the progression and and where we're at today is everything is segmented and siloed.
Speaker 2:And and these nurses that are coming out of nursing school, they have no idea what they're entering into. They're connecting to the goodness and the soul within them that wants to care for other people, because they've been institutionalized their whole childhood and they want to do something good for the world. They want to do something good for somebody else. They want to do something good for somebody else and then they go throw themselves into this system. That doesn't care. It's so, just doesn't care about it, it's because it's facts over here. It's facts over here and we have to do this and we have to do that and you just don't matter. And then you end up with a crap ton of trauma and moral injury and you start a podcast, dr Justin.
Speaker 3:Marchegiani. And here we are. Yeah, dr Tim Jackson, yeah, I think it's. You know, like y'all are touching on you know these different things that are, I think, are so crucial, right, and like really resonant. You know part of it is, you know to to become part of the system and the roles that we're talking about, right, so so the focus of your conversation is about, you know, nursing, right, so there's a skillset to.
Speaker 3:To be a nurse is to have a particular skillset, right, and you go through training and it's about acquiring a skillset. Of course, that skillset is deployed with human beings, who are these wonderful, complex entities, right, with all this stuff going on. So we're learning a skillset to take care of them from this medical standpoint, to take care of their physical body, but of course, you can't separate that from their emotional self. And so you go through, like you go through your nursing training program and it's like, yeah, you need to be able to start an IV and draw blood. You need to have awareness about these medications and how they're going to impact your patient, and you also have to learn how to communicate with this patient about what's going on. And this might be somebody who who has schizophrenia, or might be somebody who is in the middle of a crisis, and you know you're coming to that with the skills and experience of your life. And you know you're coming to that with the skills and experience of your life.
Speaker 3:Many people follow a path like I did just going right through from, you know, being a kid and having relatively limited life experience, into a setting where suddenly you're thrust into a very intimate space with folks. And what is the skillset focused on? Right? Often much less on those human characteristics. There's often not a lot of the historical context. You know, Kayla, that you're talking about, like how you're entering, you're going to become part of the system. Where did the system come from and who's in charge of it and how does it run? Like that's not part of it. So you acquire the skillset. They say, great, you're ready to be a nurse, you got your license and you're in practice and then and I think this is like really the point of your conversation Then your education begins and, to the degree that you are uneducated about the larger context of the system, you are vulnerable to enormous injury because you're there with your warm and open heart, exposed to all this suffering and distress and death and dying and all the dynamics of the system, and it's just like getting tossed about in a storm.
Speaker 3:Right Like where, how am I going to find my footing Right? The conversation I feel like you guys are hosting is how do we help these people who step out this door and are blown away in a gale. How do we help them get their feet back under them and what are they going to stand on? And some of that is hey, let's talk about the historical context of the system that you're in. Let's talk about why this is the way that it is and let's talk about what's firm inside of you that the world around you will always be this swirling storm. Let's talk about how do you find something solid inside of yourself to get a footing underneath you, and that's such, I think, a valuable message because, to your point, the system on average doesn't have that in it.
Speaker 3:I think the other thing and I'm not sure how much you guys have talked about this, but the other thing is that the historical, the time that we're in historically is, there's also been this real erosion of the kind of oral tradition in nursing right, because you've had so much churn and turnover and and this was something that I saw, like even as I I started my practice right, like when I got out of training and went to this rural hospital and saw what what I was seeing was you had these, what would I would call the, the historically normal version of the system, where you had these veteran nurses who'd been on these units for decades right and understood the system so deeply. Right, and like that local system culture, like. This is our version of the larger medical system, and here are the people and here are the politics and here's why we do it the way that we do it, and also here's that deep human knowledge about how we stay firm in this work, how you can see this kind of incredible, profound suffering and still not be destroyed by it. Right, like that depth of knowledge. In those veteran nurses, you see the system start to churn them out and then the system is completely staffed by people that are, you know, six months or a year or two years out of training, who have this deep need to learn the system, to learn themselves, to like, grow these other skills and the profound depth of knowledge that should be there for them in those veteran nurses is gone. That should be there for them in those veteran nurses is gone and that that sense of connectedness to a system, having a sense that I am part of something that is focused on delivering something good to these people, that my, my tender heart brought me here to serve them.
Speaker 3:Right, like I, I can't find my link and so we wind up searching, right, and I think you guys are great examples of that, of like, okay, well, if it's not here, if I come out this door and there isn't something for me to hang on to, that's going to keep me from blown away, right, what happened?
Speaker 3:You get blown out of the system. And if I'm going to make my way back, it has to be because I have some sense that there's a reason to go back right into that storm, which I think is reflected in your tender hearts. Right, and the recognition that there's still people in there suffering, right, and that's, I think, to me so much the depth of the call for people that enter healthcare is just the recognition of our common humanity and suffering and saying, like, I want to do something about that. And the trouble is we find these paths to get dropped in and then we become, right, the first responder is the second victim, right? I hear these people crying and I want to go be there with them. And I get there and I, it turns out, I'm getting crushed by the same thing that crushed them, and I didn't see it coming, and I didn't see it coming.
Speaker 1:Yeah, oh yeah, that is so. It just feels so real and palpable because when I graduated nursing school in 2000, and it doesn't seem like very many years ago, but I mean it kind of was it was we call them our mothers. There were mother nurses there who had been there for also their whole career and you don't find many of those anymore in the hospital. They have been weeded out and so there is no what feels like there is no grounding mechanism to get the new nurses into the system, because it is a system in a safe and proper way they are. They're like leaves just blowing by, being very, very influenced by by anything external, because they have no grounding. And I think that is what Caleb and I had was a lot of that grounding. Because you look at your mom like, is this okay, you know, like this is very, very scary but she's okay, Just like a child looks like at a mom, like if mom is okay, I'm going to be okay. So it becomes a familiar, scarer, scary thing. But you have that grounding to kind of to continue through.
Speaker 1:And these nurses that are coming in and leaving after six months or two months or they get out of orientation and they are petrified of losing their license, lose they don't even know, like they had no idea what it was going to be like, or it's, you know, completely opposite of what they saw on social media. That being a nurse was, and I think that was then, and that is not how it is anymore, and so it feels scary. I'm always scared. I say that all the time. I'm scared for nurses coming out of nursing school because it's not what I had and I don't know where they are going to get that grounding from and how to you know what? What can we say to them? It's just so, it's so crazy, but when you said that that's, I could feel it in my bones.
Speaker 3:That is why yeah, I think that's what you guys are doing here, right, that's what you're speaking to is trying to offer.
Speaker 3:You're trying to be the mother, the mother nurse, right Through this pod of offering and grounding space.
Speaker 3:You know and and, and you know, reflecting both your own experiences right Of, like how you were harmed and traumatized by the system in the way that many of them may be, that there can be some resonance there, like that's the creation of, of a community. I think that's the challenge, right, I think, if we can recognize, hey, things have happened in our system across the country that have ground out a lot of these elders, right, the people that again held that, the oral tradition of nursing right, and the depth of history, like they were the historical touch points for that local setting, right, like, why do we use this form for this thing? Well, you know that there was that doctor that came through here and he said we need to do it. There was jaco came 10 years ago and they, like, they carry the history of the reason we do this stuff and they carry the human knowledge of like how to, how to move through those things, because, yeah, they're, they're the, you know, in therapy.
Speaker 3:Talk about the holding environment, right. So you say, like we can go to this scary place and I have someone there who can stabilize my fear, right? So we talked about there's the biological piece and there's the psychological piece, the emotional piece, and that's not just with patients, that's with us too, like we're all human beings in this thing and so our, our training often doesn't include that, and so to me that, I think, is the deep and interesting question. Where we are now? Okay, so that is sad and it's tragic and it's frightening to think about. We had this system that was very human, where we entrusted, you know, these, the people that have been here to hold the history, to share it, to hold the humanity, to share it, to help, kind of, you know, hold us through that process.
Speaker 3:If that's gone, if the system ground them out, that's frightening Cause it's like, okay, well then, our, our, the thing that was stabilizing this is gone. Now it's unstable and and we know that it's going to cause injury, and if it's just going to be endless injury, holy cow, like, how are we going to move forward? And I think the conversation you all are hosting is the creative, the artist effort, right, caleb? The artist moving into the space to say, okay, we need to imagine a new system. If the old system is gone and this thing is not working, what can we imagine differently? What could that look like? And I think that's the challenge of where we are now for people that are within the systems to recognize that need to say, hey, the training that you're going to get as a nursing student isn't going to.
Speaker 3:It was always incomplete and it remains incomplete and we relied on people that were going to be on the other side of your training to help finish you, to help finish your education and like help you learn how to be a human being doing this work, how to learn how the system works and why, and thereby give you opportunities to help continue that evolution and keep it moving. How do we replace that? What is that going to look like? And I think there's an interesting opportunity there, because it allows us to then think about that in a more systematic way. So actually, I think there's an opportunity first to get back to this enlightenment notion.
Speaker 3:Right, the evidence-based like what? What should we actually be doing here, instead of just going like well, you know, we had susan, who is unbelievable and she's been here 30 years. Susan wasn't perfect, like there were gaps in susan's knowledge. Susan, you know, had favoritism. Susan had implicit bias, right, like she had favorites out of those. You know she was great at bringing these nurses up, but she was better with some of them than others because you know what I remember about Susan she always ate garlic at lunch and she had bad breath.
Speaker 2:That's what I remember.
Speaker 3:So there's an opportunity for us to advance. I think, right If we can identify the problem. And that's the thing I think that you all are doing is like, you see, there's this problem that we have a system that's that's bringing these, these caring human beings, on the way to where they could affect some, some good work and then it's lacking supports and it's causing a lot of damage, and there's absolutely this crisis.
Speaker 3:That's on. That was there before, but we had some different supports and the system has changed in a way where some of those supports we relied on on are gone. And now the question becomes so what are we going to do about that? Right, and and y'all are here hosting this conversation to to number one, draw attention to that fact, to say, like the system is broken and it's causing harm to the people that are running in here to try to do some good, and that's not okay. Right, and I and I really appreciate the way that the conversation that you all are hosting with your pod is just cutting through the, the craziness I think some people feel where they're like, oh, you're in the system and everybody's acting like it's fine. You're like it's not fine, I'm injured. This is awful. So just to hear someone else say, like you're injured, it's broken, it's it's not working well, right, like, gives a dose of reality. We're like okay, my experience is real. Right, like, that's. That's the first part of creating some safety and, and I think, also waking up to the fact of like oh, this isn't how this should be Right. And then you're taking this other step with them and saying like and there's ways out of that, there are places you can connect with, there are ways that you can ground. Here's why this is this way, which I think also wakes people up to the possibility that it could be different, it could be better. Right? God, god almighty, the creator of the universe, did not give us these medical systems. Right, some people came together and said, yeah, let's do it this way, and that's why we're doing it that way and and we can, we need to advance, that we need to think about like is are we trying to do here and is it working? Right? Like, apply a little bit of philosophical inquiry, right, and I think we can see like it's not working. It's not working right, it's hurting people, it's causing injury, it's got some real big gaps in it. But if we can see those gaps, there's an opportunity for us to address them. Right, if we can stay in the space, and that's, I think that's a hard thing, right, it's like that's the biggest question Can I stay in this space?
Speaker 3:Number one can I remain intact? Can I be standing? Can I move through the door of my training and stand in this gale wind and the rocks of moral injury are blasting me in the face. Can I find a way to keep myself safe so I can stay standing here? And then can I find a way to try to make this a little bit better? Can I build a little bit of a shelter here?
Speaker 3:Right, and for some of us that means we need to exit the system. Right, I need to. I need to stop getting hit in the eyes with rocks before I can even open my eyes up and look to see which way I want to go. And then I need to go find some plywood, right. I'm like, okay, well, the wind is strong there, so if I'm going to head back into that space, I'm going to need some plywood, right? What's that going to look like? Let me read about enlightenment philosophy. Let me read some Nietzsche. Let me get some tools together where I can begin to unpack my experience. Because what is in this metaphor I'm stretching so hard? What is that strong wind? Right, it's the emotional reaction inside of me to the thing that I'm seeing. I can't recognize that, I can't articulate that as I begin, but that's what's happening. Right Is like I'm seeing people suffer, I'm seeing the system failed them.
Speaker 3:I'm seeing that I'm part of that and that wounds me and I'm and I'm freaked out by that and I'm overwhelmed by that and I'm coming in every day, as I've heard you guys talk about, and then I keep showing up every day and I'm doing that same thing and I don't even have the time or space because I've got seven patients on this floor. They're all crazy sick. I've got to check all these boxes, I've got to make all these orders happen. I got these doctors yelling at me, you know. I got my supervisor yelling at me and like there's not even enough room for me to step back and go like what the hell am I? What's? What is the worst part of this for me? Right, and the creation of that making room for that. Is there a safe space where I'm out of that gale? But I can reflect on it, I can make enough contact with it to start to wrap my head around it.
Speaker 2:And then what?
Speaker 3:can I do? Right, yeah, and that's that's what I see you all doing is like you're trying to head back in there with some plywood and you're like, babes, this wind is brutal, let's get in here, come here, we see you, we see you.
Speaker 3:You're bleeding. It's not good. It's not good. Come here, come here. Come here. There are other people that see you and what you're going through is real and it will kill you. If we don't do something, if we don't wake up to the fact that you're under this injury, you're not going to be able to to stay here and do the good that you want to do, you're not gonna be able to live your life Right, and that that awakening function is crucial because people will sleepwalk into their death Right, because and and and, not out of ignorance or stupidity, but out of care because, they see, they see I have to stay here.
Speaker 3:People are suffering here. If I'm not here, who's going to be here? Yeah Right, and that's that can be deadly. So we want to honor that, that care, that love that has carried people to that place where they have entered a caring profession, and we need to give them what they need to succeed there right To be able to be intact human beings who can let that suffering pass through them without destroying them, right, who can differentiate between the suffering I'm observing and my own suffering and also recognize that, even if I have good separation, even if I can differentiate between what my patients are going through and what I'm going through, I'm still going through it and I still need to have some process. Is that my sense of spirituality? Is that my religious practice? Is that my interpersonal connection? It can be a lot of different things, but it needs to be something.
Speaker 3:But if I lack awareness that that's happening to me and I'm not thinking about and creating that space, and if I don't have an example to help show me that, right, so I, I I see and hear you all being here as recognizing that void space that the mother nurses who could be relied upon, have been driven out of the system, and still the need is there. And then people are suffering and they're not awake to their suffering. They don't have a space where they can be safe to go. I'm suffering, you know you guys are, are there speaking to that and they're going. I know I'm suffering and I know that it's real and I have no idea where to go.
Speaker 3:I'm so overwhelmed I don't even know where to begin. Are you guys are? Are they're offering them something? Right, like babes, plywood, plywood, something solid, block the wind, block the wind, block the rocks, slow down the damage. And then like let's, let's put something together here, right, like what can we build that into?
Speaker 3:And I think that's such an unnecessary piece and I so deeply appreciate, you know, both your willingness to take the time of your precious lives to hold this space and the work that both of you have done and continue to do to say, like, all right, what are tools we can put out there for people? Right, and and for some folks that may just be putting their headphones on and hearing your voices and just hearing the reality of someone going like that is, what you're going through is real and it's not right and it's not okay. And there's something else for you here, right, and if that can begin to create a sense of safety and give someone a direction where they can go, where they can stay intact and stay in that work, we'll all be the better for it.
Speaker 1:That it clicked for me now. It feels, you know, a lot of what we see is just a reflection of what's on the inside, and you could look at it like we kind of created those mothers to ground us on an external realm. But really, if you can find grounding within yourself like if these new nurses can find grounding and comfort within them instead of looking externally, because really right now there is nothing external they can ground to, so you really do have to find it within and ground down, then you would be able to separate and not be so reliant on the external environment to support you, because you're able to support yourself. And so I think we do talk a lot about supporting yourself, caring for yourself, understanding yourself rather than than just letting yourself blow around. So it is finding the tools, getting the wood, getting the plywood, creating your shelter that we speak about.
Speaker 3:Yeah, and I, you know, the thing that I would add to that, julie, is I cause I think that's that's so right on is and there's a commonness in our humanity where we can find those people around us, right. I think it's. I think it's a mistake. I share your skepticism that the system is going to save us Right.
Speaker 3:But, what is the system? It's a lot of people, right. So if we can say, hey, there's, there are people that are in there that are in this struggle, there are other people in there that are in that struggle, and can we find that Right? So, as we begin to build absolutely, we got to put your own oxygen mask on first, right. And as I get mine on, as I start to build a shelter, how can I begin to identify the people around me that are building their shelters too, and can we put them together Right?
Speaker 1:Yeah.
Speaker 3:Yeah, because because if we, if we can become collaborative, right, we can build that, we can join together, we can build that system. If we can find the people that are around us, who share this concern, right, that are there out of the warmth of their heart to give something, can we do that? And I, and I would go so far as to say, at some level, everybody in there is trying to do that. There's just a lot of things that get in the way and so can we. Can we find even in that that, the person in the system who feels totally in opposition to us, there's something, there's some commonality there that we can connect with? And to me, that that's the interesting question.
Speaker 3:Right, my the, the scared part of myself, my ego, wants to fear and protect myself from harm from this person that I see is being opposed to me. What I want to do is, you know, honor that right. Don't just go to them and let them cut me down but say like, yeah, okay, yeah, we want to be careful, but there's something there we can connect with. We can all work together in a purpose. But I have to be coming from a safe place first. I have to create some sense of stability. If I don't have any, if I don't have a shelter I can rely on inside of myself, it becomes very difficult to do the rest of the work or to do that in a way that I can keep showing up for. So yeah, like how can we kind of build that out?
Speaker 2:We hope you've enjoyed this week's episode.
Speaker 1:Remember, the conversation doesn't end here.
Speaker 2:Keep the dialogue going by connecting with us on social media posted in the links below or by visiting our website together let's continue to redefine nursing and shape a brighter future for those we care for.
Speaker 1:until next time, take care, stay curious and keep nurturing those connections.
Speaker 2:And don't forget to be kind to yourself.