Living above the Line

Is it just me or did nursing school make anyone else feel like they had to be a saint upon graduation? Maybe it's because I went to a catholic university ... I don't know. Regardless, the more and more I do this job the less and less I feel like a saint. I recently got report from someone telling me about my 35 year old patient who is an alcoholic and is dying from end stage liver disease. Now, I agree that this is a sad case. I'm sure there was something in his life that he couldn't handle and he turned to the bottle to make himself feel better; I get it; but in reality the first thought that came to my mind when she told me this was "well this is what happens when you drink too much." I know to most, especially for those not in the medical field, I probably sound like a cold hearted you know what, and that's okay; I was recently called that by someone so it's not a big shocker; I think compassion fatigue is what I'm suffering from (that sounds a bit nicer than cold hearted you know what); or maybe I am just being a realist.

I once worked with this wonderful nurse at St. Anthony North hospital in Colorado named Marsha Parker. She was an ex-army nurse, head of the quality department and one of my many mentors at that hospital. She introduced me to a term "living above the line." Living above the line means you take responsibility for your own life and you stop blaming things outside yourself for your situation. I usually refer to people who are living "below the line" as victims. Below the line thinking is when you are consumed with the problems, drama, and excuses for why something can never get done. There is always a problem, even with the simplest tasks such as picking up groceries or getting your mail. You are continuously consumed with the “why” something happened rather than “what” can be done to move forward. There’s a comfort with staying where you are, and you’ve conditioned yourself to offer excuses instead of overcome them. It’s a mindset. Below the Line living leaves your frustrated, angry, unsatisfied, defeated, fearful, defensive, stressed, resentful, and anxious much of the time. People who live below the line are constantly blaming others for their behaviors as well as their suffering. Sound familiar?

I think this type of behavior is very common in the world of medicine. Many of our patients are in the hospital as a direct result of their own bad behaviors. What bothers me the most about these patients is that most of them seem shocked that they are sick; like no one ever told them that drinking, smoking and eating poorly is bad for you. Healthcare has now become a customer service industry where the "customer is always right." You can't say anything to a patient that might make them upset in fear that they might choose another hospital to go to; I once got in trouble for telling a woman her breathing problems were related to her obesity. How can we help people get better if we can't hold them accountable for their behaviors. I know there is a time and a place to bring up accountability and often times the hospital can be a challenging place to do so without getting in trouble. So I choose to bring it up here and now.  Here are a few examples of preventable behaviors that often lead to a whole lot of suffering:

• Smoking cigarettes will eventually lead to some form of lung disease. When you get older you will most likely experience some shortness of breath with activity or at rest, will require frequent visits to the hospital where we will most likely either put a breathing tube in your lungs or place you on a breathing mask for days on end. You will most likely be very anxious and feel like you are suffocating because your lungs are no longer functioning and there is nothing we can do about it. The only thing you can do is quit smoking before this happens. 
• Drinking alcohol in excess for many many years will eventually lead to liver failure. Your eyes and skin will turn yellow, your belly will fill up with fluid, your kidneys will shut down, you will become very confused, lethargic and eventually unconscious. There is nothing we can do for you at this time. You are not a liver transplant candidate. Seek help early before its too late.
• Eating in excess to the point of morbid obesity. You will most likely develop diabetes, heart disease, sleep apnea and possibly cancer. You will have many skin issues and have a hard time healing when you get sick. Food is an addiction, get help.
• Non-compliance: If you are diabetic and you don't watch what you eat and take your medications appropriately, you can expect that dialysis, blindness, neuropathy, loss of limb, foot ulcers and a heart attack will be in your future. 
• Being lazy: Exercising is key in preventing a whole host of chronic diseases. Get off the couch and go for a walk.

These are just a few of the many bad behaviors I see that can lead to suffering. Fixing these behaviors and living above the line requires hard work but that's just a part of life. You cannot take the easy road all the time. Using alcohol or drugs to avoid suffering will only lead to more. It's time to stop making excuses and start taking responsibility for your actions. If something in your life isn't going the way you want it to then change it.  If you know your fate is being a one legged man spending three days a week on a dialysis machine and that doesn't sound appealing to you, then do something about it before its too late.