
As my term with Dalhousie’s OpenThink initiative comes to a close, I wanted to take this opportunity to go full Brene Brown and allow myself to be a bit vulnerable with you all. I want to talk briefly about my own personal reasons for investing my time and energy into the research that I do every day and to share with you some of what keeps me going despite the challenges that threaten exhaustion. Ultimately, I want to introduce you to a new way of viewing hope. When I wrote my first blog, I joked with the nurses I work with afterwards saying that it was my “love letter” to them. I wanted providers to know that the reason I do this work is because l want to give a voice to their struggles, even if I do not completely understand them. I still try to do the best I can to interpret their roadblocks and headaches and to transform this knowledge into understanding. Despite being a shadow, an onlooker, a support staff, I have been given extremely privileged access to many areas of hospital care over the years and many windows into the private lives of patients and providers alike. I have held hands, caught vomit, cried with patients, argued with physicians, watched horrific traumas, felt the weight of body parts, irrigated lungs, peered into the brain, held a beating heart, stood silently after many deaths, and had endless conversations with distressed caretakers.
The main thread I have carried with me throughout all these experiences has been to continually look to providers to ask them about their feelings in the face of such grueling circumstances, those nail-biting and sickening moments that only hospital units seem to be able to offer. Understanding provider wellness is not purely a research interest to me — it is a life’s work. Like a curious detective, I have worked hard to immerse myself in various healthcare environments to see the uniqueness of different units, and to know the various people behind the curtain of care. To discover what medicine really feels like I knew there would be no shortcut, I knew at a very young age that I had to see things first-hand, I had to exist in nursing units, surgical suites, and stand beside intensive care beds. I would have to live the life of healthcare vicariously through others, to see it, feel it, and hopefully come to know it myself. There is no substitute for the visual and guttural feeling that arises as you witness a family member tenderly play Leaving on a Jet Plane on an acoustic guitar to their dying loved one as they lay sedated and intubated on the ICU. But also, there is no substitute for knowing the casual nature with which death truly becomes commonplace in healthcare, even unnoticeable if you have seen it enough times.
Despite all of this careful ethnographic work, does being able to personally feel the (partial) ramifications of medical life give me any real clues about how to make it better? That is a question I often concern myself with, especially since the pandemic has hit. I also wonder if (in its current state) medical life is even a “life worth living” given how hard it can be. I have noticed a shift as of late, in that there is a lot more silence. Providers are quieter about the issues facing them since COVID-19 began. Even when I ask nurses directly about staffing shortages, the challenge of training new hires, and whether they can see the light at the end of the tunnel, I am surprised to receive blank stares, or see diverted eyes. What I have yet to consider is that trauma can be too difficult to talk about, especially if we feel there is little hope. So, what is happening right now? Are we unable to talk about the hopelessness that is in the air, or are we simply hoping that things will go back to the way they used to be?
These questions funnel us nicely into a discussion on “hope”, hope for caretakers, patients, and the future of medical care. What does it mean to have hope at such a critical time? Jane Goodall, a lifelong conservationist and nature lover, addresses this question in “The Book of Hope: A Survival Guide for Trying Times” as she looks at climate change and the effects of the pandemic. Jane says that “there is hope for our future – for the health of our planet, our societies, and our children” but “only if we all get together and join forces”. Dr. Christy Simpson, of Dalhousie’s Bioethics department, has recently been engaged in teaching what is called “critical hope” with NSH staff, an idea that I would like to discuss as a possible way forward. An important distinction can be made between what is considered naïve hope and critical hope. Naive hope is the idea that things will work out, somehow, because they must. Naive hope pays mere lip service to the fact that our institutions will surely be able to self-correct, and our lives will return to normalcy soon without any acknowledgement of how. This concept of naive hope can be somewhat conflated with what is also called “toxic positivity”, whereby we blindly look for silver linings and leave little room for uncomfortable conversations or disagreement. Toxic positivity can nicely be summarized by the simple statement: “everything is going to be fine”.
In contrast, critical hope recognizes the fact that discontentment and difficulty are part and parcel of facing rapid global changes, and that a process of reflective equilibrium will be required to move forward. Critical hope acknowledges the messiness, while not giving up on the idea that we can make it through to the other side of any crisis with a little reflection, patience, and collective engagement. Paulo Freire, a Brazilian philosopher who wrote deeply on the topic of engaging critically with pedagogy, has said that “without a minimum of hope, we cannot so much as start the struggle…but without the struggle, hope, as an ontological need, dissipates, loses its bearings, and turns into hopelessness…and hopelessness can become tragic despair…hence the need for a kind of education in hope”. We need to be able to contend with our challenges in a more realistic way without losing hope entirely, a way that does not dismiss the truth of how hard the challenges facing us can feel, but similarly, does not leave us so despondent that it washes away our ability to imagine alternatives. Freire feels that we must determine “to what degree each individual, organization, and government is responsible for taking action when humans suffer” and to prioritize what can be done at each level.
Jane Goodall argues that we need to take notice of what is happening around us, and then act. It is through action that we make progress, but that action should also be well informed. When everyone does their part, no matter how small it is, we can win out, and in turn, we can overcome our sense of apathy or despair by coming together to support positive change through what might be considered productive struggle. Goodall reminds us of how quickly we developed a vaccine for COVID-19 by harnessing the intellectual power of individuals and the cooperation of organizations to respond to our collective need. We must open the channels freely for discussion and exchange, and even if our values are not perfectly aligned, we will make headway by finding common ground where it is possible. So, I urge you not to lose hope at this time, and to see whether the facets of critical hope can be of assistance to us now. Jessica Riddell, an English professor and author of the article “Combatting toxic positivity with critical hope” uses a beautiful analogy from philosopher Parker Palmer, who says that broken hearted people are not broken apart, they are broken open. This process of breaking us open gives us two options: we can succumb to our anger and flee, or we can find deeper empathy in our hearts and choose to fight.
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