Having Teeth

I think I was unfailingly gentle with patients, let them rant, and tolerated their abuses. Eventually, their rant lost steam and we started to get to the core of their often legitimate frustrations. They might be directed at an unrealized hope for a dreamed of healing. Or, they might feel they weren’t understood. A pinhole in a balloon release pressurized air madly at first out of a pricked balloon. Then, the balloon eventually loses pressure and falls to the floor. That is often the way it is with our anger. For me and for patients. You just had to allow the progression of release without judgment.

I’m sorry, they would say after their pain and frustration lost steam. My job was to listen for the core of where I or we had gone wrong and give space for the release. There wasn’t any reason to be defensive. Wait for it.

Sometimes, however, there was no release. There was no slowing down. It was only one long, continuous rant. These patients required a different touch. When their statement of rage went on without lessening or changing tone, I knew something else was necessary. I needed teeth.

*Stop right there. You are allowed to feel angry and frustrated. We need to hear you and try to understand you. You aren’t allowed to create fear for other patients and my co-workers. You are not allowed to raise your voice at us or make threatening comments or gestures. You aren’t allowed to use profanity at us. If you do that, the police will be called and they will treat you very differently. Now, Stop.

It took a long time to be comfortable with having teeth. It’s not easy to feel comfortable with my own fear of the discomfort of being around anger. As a child, I regularly saw rage and it frightened me.

I had come to believe that I was supposed to be endlessly forgiving, tolerant, and to shrink in fear.

This isn’t (and shouldn’t be) the case. We need boundaries. Those boundaries should have meaning. We should be able to say No and should regularly practice saying No. It is a sign of our strength, clarity, and purpose. I love the title of the excellent book by psychologist Kristin Neff: Fierce Self-Compassion: How to Harness Kindness to Speak Up, Claim Your Power, and Thrive. Wow! That doesn’t sound like the absence of boundaries, does it?

If saying No feels uncomfortable or unfamiliar, it’s probably good to practice. Here’s two ways to practice:

• Growing up, No meant punishment, like being sent to my room or told I was selfish for wanting. So even now, when I tell myself No about money or something else I want, some part of me still hears my father’s voice. When I want to get a sodium-heavy, non-nutritious taco, and say No, I can hear that voice. What if, instead of hearing punishment, I said: You’re hungry. You deserve something that actually satisfies you. This isn’t it. Let’s wait for something better. We might end up happier if No was simply a decision, not a reflection on our character or moral choices.
• It can be helpful to practice saying No with people we trust, people who don’t have a dog in the hunt (those for whom the stakes aren’t high). Try it with your neighbor when they ask you to water their plants for the third weekend in a row. Or with the friend who always suggests expensive restaurants. Tell them straight: “I’m retired. I’m really watching my finances these days, So, how about there choose someplace that’s comfortable but less expensive?*

A boss helped me (and others) stick up for themselves as professionals. At the end of a meeting, she asked a question. Do staff feel they can speak up for themselves? She wanted to understand the experience of some staff who’d been dressed down by a doctor. Then, she exhorted us to summon a Wiser Voice. It was the sentence, You are the Professional in your Scope of Practice. Not the doctor. Not the family. Not the patient. You went through the training to do what you do. Don’t let them demean you and your boundaries. That’s what you tell them. I know what I’m doing and you do not get to talk with me like this. Then, you tell me. I heard her summoning my stronger self in those words.

It may feel contradictory to want to be mindful and still have boundaries. The reality is this: Saying No is how you remember you’re real and matter.

N.B. Here and elsewhere, I refer to my Dad in ways that will seem judgemental. I don’t mean to imply that he wasn’t a good Dad. Given what he had to deal with as a child and teenager, he should have god-like status. He wsan’t equipped to be a father. So, while we weren’t close, it wasn’t because he didn’t try nor because it didn’t matter. He was a good man and I was truly fortunate to have him as my Dad. I’ve left my own fatherly damage.