Fourth

I recently listened to Douglas Abrahams’ and Jane Goodall’s recent work The Book of Hope. For those who have gotten into audio books a highly recommend this one, primarily because Jane Goodall does her own narration and listening to her voice in itself is calming, inspiring and just awesome. The whole book revolves around hope (probably evident by the title). Jane Goodall says we often use the word hope incorrectly.

It is not ‘passive wishful thinking’ - allowing us to just sit by and expect things to get better. Jane emphasizes over and over again that real hope requires ‘action and engagement’.

This type of hope seems to be increasingly necessary in the world. When I first started writing this blog post I was focused on ‘hope’ in the context of the covid-19 pandemic; the toll it has taken on the physical and mental health of individuals and communities. Thinking of how we move forward and grow. This afternoon, my mind turns toward ‘hope’ in a broader sense; hope for the environment, for democracy and for the well being of society on a global scale.

I think Jane’s definition of hope is really important, the idea that it requires action and engagement. She gives 4 reasons for hope in her book:

• The Amazing Human Intellect

• The Resilience of Nature

• The Power of Young People

• The Indomitable Human Spirit

The feeling of hopelessness had become pervasive before I left the hospital; both in the spirits of the healthcare workers, in the patient’s and in their families. It seemed there was little we could do to change what was happening around us. I think agency is key in hope; as it is in democracy - and when the feeling of agency is lost it makes it very easy for us to give up. This is where resentment, anger and division start to take hold.

Covid-19, which is now surging in Western Europe, might be on the rise yet again in the U.S. This means more stress on an already extremely stressed hospital system. A new report ‘Clinicians of the Future’ came out saying one in three clinicians are considering leaving their jobs by 2024 and over half saying they want to leave the healthcare field permanently.

From my own experience and from talking to others I noted an overarching feeling that a sense of agency is being taken away from both providers and patients. More rules, less resources and less time. And as hospital’s administrations departments have grown there is a growing sense of division between the clinicians and administrators. Many nurses have noted that the hospitals they work in seem to either not care, or choose to overlook, the emotional and physical toll that the pandemic has taken on front line workers.

Those making the big decisions at many large hospitals seem to be more and more removed from the direct patient care. For clinical staff, this direct patient care is what we prioritize every day at work; even when the pandemic is not on the front pages.

While at the start of the pandemic there was a general feeling that clinicians (doctors and nurses) were willing to sacrifice our personal lives for the greater good. We isolated ourselves from friends and family, worked overtime shifts and used what resources we had to make due. It was stressful, but there was some sense of unity, of being called to duty during a time of real need. Humans are indeed made physiologically to adapt to temporary and short-term stressors, and that’s what frontline staff did in March of 2020.

Chronic stress is different. The body adapts to short term stressors in a healthy way by protecting us when there is a threat, a challenge or an opportunity. Chronic or long-term stress on the other hand has detrimental effects on the body; our immune system weakens, disease is exacerbated, inflammation starts to break down our defenses. Mental and physical performance declines. This chronic stress seems to be the new ‘normal’ for society and individuals, but it is not sustainable.

We see the implications with increasing deaths due to mental illnesses in the country, more hatred and anger. An increasing amount of division between groups and an increasing feeling of isolation among individuals.

On top of that there’s this lack of hope for an end, and a feeling that there’s nothing we can do except stand by and “hope for the best”. This is the feeling I had for some covid-19 patients in the ICU and often the feeling I get when I read the news in the morning - but this isn’t the type of hope Jane Goodall talks about.

Without drawing this out too much I wanted to share one story that I found particularly distressing and illustrates this division that is causing healthcare workers to leave their fields. About a month ago I talked to a friend who is a nurse in Connecticut and works on a unit that had been converted to a ‘hybrid unit’ with covid and non-coved patients. Now he said covid patients are being admitted right along side other high risk patients (this unit takes a lot of medical oncology patients and sickle cell patients). He had written letters to the administration saying “it goes against everything medicine stands for, the idea of do no harm”. He hadn’t received any response. Additionally he was told by his manager to not tell other patients or their families that covid-19 positive patients were on the unit at all. All of the nurses on the unit received an email from the nurse manager stating:

“We just wanted to take an opportunity to thank you for all that you have done and continue to do to care for our patients. We will stay strong together so that we can continue to be our best selves… Your feedback, physical and mental well-being is important to us….

The following updates and recommendations have been made:

• There are no officially assigned COVID rooms. Patients with similar issues, including COVID, can be cohorted anywhere..

• We should not disclose that we care for COVID patients to visitors or patients even when asked. We can let those that ask know that we care for a variety of patients in medicine areas.”

I should note not all hospitals are doing this, I talked to one doctor who noted that in his Boston hospital covid-19 positive patients are in an entirely different section, blocked off from the rest of the patients. But the point is, many who are providing direct patient care are not being heard, they are being told what to do even if it is against their own judgment. Hope requires agency, action and engagement - how can we sustain hope if we are not being allowed to take action or to engage? The words ‘thank you’ and ‘we will stay strong together’ loose their meaning when actions do not align.

On that note, I heard Brene Brown once define integrity as ‘choosing courage over comfort, whats right over what’s fast, fun or easy; and practicing values not professing values’.

In some ways I think we have lost sight of this idea of integrity. The fear of challenging the ‘norm’ inhibits us from looking at the bigger picture. The self-centered way we often conduct ourselves prevents us from listening to and having compassion for those around us.

This brings me back to Jane and The Book of Hope.

“There seems to be a disconnect between our clever brain and compassionate heart”

~ Jane Goodall

In some ways communities and businesses can be compared to the human body - and right now they’re suffering from the effects of chronic stress due to a variety of reasons. To some extent, this is unavoidable. There will always be stressors in our own individual lives and as a global community. But more and more I’ve realized that the really important thing is how this stress is handled.

As individuals, businesses and countries we have not dealt with stress in a healthy way - we are looking at symptoms rather than causes of our stress. Our narrow and individualistic focus seems to actually be exacerbating the stress, making us sicker and less resilient in the face of new challenges.

“Intelligence is the correction of errors” - Robert Breedlelove (on The Lex Freedman Podcast)

Humans are unique in that we can delve into problems when faced with challenges and come up with solutions. Jane calls this ‘the indomitable human spirit’ and 'the Amazing Human Intellect' which make us capable of residency and true hope. That’s how we have evolved as a species.

Jane is a good example of hope and resiliency, and there are many others we can all think of.

Jane says at one point “I suppose examples of the indomitable human spirit rallying us to ‘fight the unbeatable foe’ and ‘right the unrightable wrong’ have been with us throughout history”.

But to grow and take proper action requires all voices are heard, all parts of the metaphorical ‘human body’ need to work together and support each other. It also requires that we all feel empowered, that individual actions and voices matter. This, after all, is why we fight for democracy and human rights.

I think it can all start on a very small scale; we learn to handle our own personal stressors in healthy ways. We look at one another as all being part of a whole and abandon that individualistic mindset.

That being said, we can learn how to best take care of our own mental and physical health first, knowing we can only help others if we are healthy and fulfilled ourselves. Hope after all is contagious, and so is resiliency and empowerment - we see this with Ukraine as civilians stand up and fight with the hope of gaining freedom. I think, at the end of the day, as we learn to handle stress and obstacles on an individual scale we will be able to handle these much larger challenges in a more productive and compassionate way.

Growth is never comfortable or easy. But the alternative of not growing and staying the same is clearly not comfortable or easy either. So I feel like we all might as well attempt the uncomfortable and hard processes of growth, the ones that require action and engagement and the ones that give us hope.

Just a few quotes of Jane’s from The Book of Hope to end this one, because I think she's great...

"Hope is what enables us to keep going in the face of adversity. It is what we desire to happen, but we must be prepared to work hard to make it so.”

“forgiveness is how we unchain ourselves from the past.”

“if [people] worked together physically, and united spiritually, [we] could achieve anything.”