When I listen to nurses tell their stories, I am often reminded of the practice of lingchi, or the ‘Death by a Thousand Cuts.’ This practice was a gruesome form of torture thought to originate in China, and involves exactly what it sounds like, multiple cuts made into the flesh of a person until death ultimately occurs. While it is unlikely that Chinese cultures did in fact carry out the practice as we in the West imagine it, the notion serves regardless as an apt metaphor for what our nurses go through. Working in a contemporary hospital can feel like a slow and prolonged death by a thousand cuts; although, unlike the use of lingchi, which was meant to be very public and humiliating, few ever see the lacerations that are torn into the bodies of caretakers. It is the cumulation of these tiny assaults that can lead to the various and devastating outcomes that we see in healthcare today, such as high attrition rates (meaning providers leave their profession entirely) or other extreme reactions like turning to self-harm by choosing addiction or suicide.
Sonja Bernhard, a registered practical nurse at St. Joseph’s Healthcare in Hamilton, Ontario, recently spoke out against violence in our healthcare system (i.e. code whites) and shared her feelings about the rampant levels of burnout on CBC Radio’s The Current. Sonja portrays how patients often try to express “x, y, and z” to her about their care, “or their perceived lack of care”, to which she says, “we are listening, but we are not really hearing them”. Simple requests from patients, those that really cannot be managed in today’s healthcare climate, are falling on what seem to be deaf ears, but this is not exactly the case. Providers hear these pleas and cries, and despite not being able to address all patient concerns, they do grieve the sad fact that they must sometimes choose to ignore patient complaints, and they internalize the guilt over what they understand to be a failure of the self (instead of a failure of the system). If Sonja were to be truly honest with her patients, she might say to them what she told CBC listeners, which is: “just give me the facts, I just need to know what I need to know to keep you alive, because that’s the only thing I have left to give”.
I see this same sentiment buried in the eyes of critical care nurses who run around the medical ward with drugs in their hands trying to address multiple alarming pumps, doing their best to assist their coworkers in turning patients, all the while grasping their nursing note closely to painstakingly record every detail. At the same time, a patient may gesture for a glass of water, an action that is easily ignored by avoiding their gaze, or a family might be calling, calling, calling on the ICU phone to speak to their loved one, when no one is available or willing to pick up. In reference to England’s healthcare system, a 2011 headline read “Want to know the NHS’s real problem? Ask a nurse for a bowl of cornflakes”; this is a simple sentiment that accurately summarizes what is happening in Nova Scotia, which is both a symptom of economics and the effects of a global pandemic. When you are a mere bystander, say a family member at the patient’s bedside, it is easy to say “why can’t the nurse just get my mother a bowl of cornflakes?”. In reality, the nursing role has become so technologically complex, and so demanding in terms of its protocols, that simpler modes of bedside care are now almost impossible to perform.
These “needs” should be addressed, but they simply do not make the cut in the triaging world. Like Sonja says, the above examples of simple patient requirements (e.g. wanting a glass of water) are at the bottom of the list when it comes to keeping them alive. There is only so much providers can do, so they must choose to make sacrifices. Such sacrifices result in two harms: (1) the patients suffer from not being truly cared for in all senses of the term; and (2) providers are left with the guilt and the fallout of having betrayed both the tenets of their profession, and likely, their own standards of personal excellence. The thousand cuts that overtake providers are dealt out in the form of unending requests from patients or families, being overburdened with tasks, being snagged on policies, in having uncertainty towards what is right or wrong, in having to convince others of their own values or their patient’s values, and the sheer exhaustion from working so hard, and advocating so diligently, with what feels like very little benefit. Sonya refers to her nursing practice today as constantly being in “survival mode”, something she never thought her career would be about.
What I want to draw our attention to here, is that nurses are trying their best, in every second they are giving everything they have, and they are still coming up short. Sonja says, “we are aware of this, and it’s breaking our hearts”. Providers ought to leave their professions over the abuse and burdensome nature of their careers, however, I believe the real reason they leave is that they are heartbroken. They are not able to be who they truly want to be as healthcare providers. Nurses are not apathetic by nature, and despite how it may appear (e.g., the looks on their faces, or their absence from your room) when they ignore your call bell or refuse to answer the phone, they take that guilt home with them every single night. Staff do however, rest assured that they have delivered you to your scan in time, managed your pain, made sure your surgery was prioritized, or mobilized you, and most importantly, kept you alive. These items are what take priority, and it is all caretakers can manage right now. They are then tasked with coming back to work the very next day only to face more shortages, ethical dilemmas, and irrational mechanisms that are special to a public system of delivering care. It is no wonder that hospitals globally have reached a breaking point.
Header image via shumanlegal.com.