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How I Built a Suit of Armor as a Nurse (and Stayed Human)

Robb, Jonathan Peter BSN

AJN The American Journal of Nursing: September 2016 - Volume 116 - Issue 9 - p 72
doi: 10.1097/01.NAJ.0000494705.09111.f4
Reflections

The formation of a resilient professional persona has its pros and cons.

The formation of a resilient professional persona has its pros and cons.

Jonathan Peter Robb works as a district nurse for the National Health Service in London. Contact author: jonathan.robb@gmx.com. Reflections is coordinated by Madeleine Mysko, MA, RN: mmysko@comcast.net. Illustration by McClain Moore.

Figure.

Figure.

Armor, once in place, is hard to take off. Its weight becomes not comfortable exactly, but familiar, and its absence leaves us feeling naked and vulnerable.

During my graduate year as a nurse, one of the unit managers sat with me at the end of a long shift, one of my last on that unit, and told me I had the potential to be a good nurse—that I had an instinct for people and the intelligence for the job. She only had one criticism. I was like her: I cared too much.

I nodded, giving the impression her meaning had sunk in, but in truth I didn't really get it. Isn't that sort of our main job as nurses—to care? I felt good about this criticism; I saw it as a compliment.

But now, six years into my career, I laugh when I think of how she would have seen me, a young enthusiastic man wading down a path lined with thorns, oblivious and without armor.

Because here's the thing—caring hurts. You don't need to be a nurse to know this. Everyone knows, eventually. But my job helped clarify this truth.

To begin with, it was caring about the ramifications of my actions. The weight of being responsible for a person's health wasn't one I had prepared for. Sitting in lectures doesn't train you for the moment when you're standing at the end of a bed looking at a patient who is struggling to breathe, semiconscious (but who just last week was sitting up and talking), and thinking: Did I miss something? Is this my fault?

It doesn't prepare you for when you walk into a room and family members pin you with their eyes and ask questions like “Why isn't he better?” and “What are you even doing?” These questions pierced my already tenuous self-assurance.

It was also caring for people who didn't have the capacity to get better. The only family members I'd lost were in their 90s, healthy until the day they died. I hadn't experienced chronic diseases or terminal diagnoses. I'd never seen how a disease could rob a person of every aspect of life. I hated learning this.

But it was also caring when the patient didn't. I think this one cut the most. I would work until my body ached, and then the next patients wouldn't care that I was trying and worrying for them—they wanted to know how we'd fix them, but had no interest in taking care of themselves. They repaid caring with aggression and rudeness. Their indifference seemed to refute my belief that if you did your best, it would count for something.

So I did what you do when you're tired of hurting and being exposed—I built my armor.

The process was gradual, subtle. It was clenching my jaw and telling myself I was doing all that I could do, and realizing that everything else was out of my hands, and learning not to care so much.

It was switching off the part of my brain when looking at a dying patient that kept saying, This isn't fair or This is horrible, and just getting on with my job.

It was a thickening of skin when a patient complained, despite our best efforts, again and again—and letting their ingratitude roll off me, a bead of toxic water on my armor.

And with practice, I got good at it. I learned to laugh at the selfishness and madness of some of the people I cared for. I learned to empathize while keeping some part of myself just for me. I picked up the knack of not bringing it home, of handing over to the next nurse and letting it all fall out of my head.

I'm not worried by this. Someone could think of this as a deadening of myself—but I still care. I've treated some people who never learned to build armor, who feel everything. Many end up unable to function, depressed, crippled with anxiety. Every hardship they encounter cuts them to the marrow.

I think the trick in carrying the armor's weight and staying human is in learning when to take it off. For me, it's sloughing off every chafing piece of armor at the end of the day, exposing that self I kept protected to my loved ones.

Because I've also treated people who never learned to take their armor off. Their suit of metal fits so well that they forget it's still on. These are often lonely people who rail against everything and everyone. They've been in their armor too long and they've forgotten how to be vulnerable—and how vulnerability can make you feel connected and, paradoxically, safe.

I'm neither proud nor resentful of my armor. It allows me to continue to do my job, to navigate the path of thorns without being torn up. It lets me care without caring too much. I think my old unit manager would be satisfied with the balance I've struck.

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