Recovery came softly

A vision of grace amid an eating disorder.

From Mockingbird

Mockingbird is an organization devoted to “connecting the Christian faith with the realities of everyday life."

Under a tree, backlit by a sun set, two people sit in chairs outside and talk.

Harli Marten on Unsplash.

This article, by Lindsay Holifield, first appeared in Mockingbird. Published by kind permission.

I turned sixteen years old in a lavender-walled bedroom on the eating disorder unit at Texas Children’s Hospital. Surrounded by eagle-eyed nurses watching my every move and whirring machines keeping me alive, I quietly transitioned to Sweet Sixteen. The unit’s charge nurse was a gruff woman named Lupe, and despite her job, she did not particularly like children. But it was my birthday, and in an uncharacteristic act of kindness, Lupe offered me a slice of cake. She must have briefly forgotten her surroundings, because I was not a normal teenager. I was a patient on a pediatric eating disorder unit, and I broke down sobbing at the mere thought of such a high-calorie food entering my body.

This was my first birthday in a clinical treatment facility for anorexia, but it would not be the last. After receiving the initial diagnosis of anorexia nervosa as a teenager, the doctor’s pronouncement sounding like a death-knell at the time, I would admit to twenty treatment facilities on separate occasions across a period of fourteen years.

The treatment staff began to greet me knowingly when I would re-admit after only a few months out, as though I was an old friend returning from vacation. “Welcome back, Lindsay,” they would say, as they took my luggage and inserted yet another nasogastric feeding tube. Over time, I began to be labeled “chronic,” and I internalized a belief that I was one of the sufferers who was fated to live the rest of my life under the oppressive weight of this struggle.

I would have to try harder. I would have to pull myself up by my bootstraps and willpower my way into recovery. After each attempt under this approach, I would fall flat on my face.

It seemed that no matter how much motivation I mustered up, this internal drive to self-destruct would not leave me alone. I desperately wanted to wake up each day without having to submit afresh to the hellish existence of self-starvation and running till my lungs felt on the verge of collapse. But I felt chained to this destructive cycle deep into my bones, despite my best intentions.

I was often berated by various treatment providers for not having enough motivation. I didn’t necessarily want to die, but I could not find the strength within me to fight off the voice in my brain that demanded self-destruction. Doctors and mental health clinicians made it clear that if I really wanted to get better, I would have to try harder. I would have to pull myself up by my bootstraps and willpower my way into recovery. After each attempt under this approach, I would fall flat on my face. The despair of my situation began to swallow me whole: there was no way out, because I could not yell at myself enough to make myself well.

Because of the lavish softness I was shown, I began to approach myself with greater softness.

I was twenty-six years old, and I was sitting in a green folding chair in the summer on a farm in Nashville, Tennessee. The woman in the folding chair across from me is decidedly in support of my recovery, but she isn’t yelling at me or giving me a stern lecture. Instead, she is explaining with great care and tenderness how much sense my struggles make in light of my previous life experiences. “Perhaps,” she says gently, “your brain was trying to survive great pain. Perhaps you were simply trying to make the ache go away the best way you knew how.” Her compassionate words break something open within me, and I start weep like a small child. No one has ever approached me with compassion like this; they are all afraid being too soft will simply enable me to further harm my body. But they are wrong. It is precisely this compassion and sense of being witnessed that softens my armored heart.

Recovery did not come overnight, but I can unhesitatingly say that the compassion of a woman on that farm in Nashville is what radically changed the trajectory of my life. Because of the lavish softness I was shown, I began to approach myself with greater softness. The voice of condemnation quieted, and I slowly turned from self-destruction to life.

Do you not hear the gospel ringing out here? My story of recovery is simply a zoomed in image of the grander story, the beautiful truth that makes up the fabric of our existence. Admitting powerlessness to destructive forces of sin and death is important, but the condemnation of the law will not save us. It is the extravagant, one-way grace of God that resurrects the dead.

I have heard similar fears in faith communities that I continually hear in my recovery communities: if we are too extravagant with compassion, we are enabling sin and destructive behaviors. But I am a living testament that compassion is what softens hearts of stone, armored up by self-protection and attempting to earn love through behavioral perfection. I would have died many times over save for the compassion that chased me down and embraced me, and being held in such tender kindness was the only thing that could have changed my fate. I believe this for mental health, yes, but more importantly, I believe this for the rescue of all of humanity. The grace of God is the sole agent of resurrection and change.

To the surprise of those who cling tightly to rigid, white-knuckling versions of recovery, my behavioral change occurred only after I was met with a grace without strings attached. This should not be surprising to Christians, however. Here again, the gospel glaring back at us, that repentance is a response to the kindness of God. This is the God who loved us while we were dead in our sins, while we were powerless to the forces of the world, the flesh, and the devil. Against our behavior-driven moral sensibilities, God offers us grace that is a free gift, compassion in its fullest expression, and it is the only thing that will bring renewal and healing to the inhabitants of this desperately aching world: minds, hearts, and bodies included.

Article

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.