Overcoming Fear

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It is said that the cattle rancher can tell us about the herd and the plains, that a fisherman can tell us about the winds and tides, the shepherd can say to us about his flock and the wolf, and the warrior can tell us about his victories, losses, and his scars (Adler, 1952, p. 24). Still, the nurse can tell us about their meetings with the human condition of severe weakness, frailty, loss of strength, the deteriorating mind rampant with depression and delerium, the fearful, the scared, those who hurt with intractable pain, and the all too familiar site of a corpse lifeless, motionless and bereft of heat at the end of life (Emanuel, 2018). What do a rancher, fisherman, shepherd, warrior, and nurse have in common? Resilience.

Roman Warriors

The Romans were known for engaging in conflicts and skirmishes with enemy territories on purpose to stay militarily fit. According to Montaigne, whose father set an example to him a flair for education (Adler, 1952, pp. 330-331), that the wellspring of idleness will corrupt the warrior, in essence, unless the warrior, having something to bathe his blade in other than the sweat from his training needs blood, training alone will deteriorate his morals. As such, the Romans bred in the youth of their soldiers a contempt for danger and death, and some of the gladiators were not satisfied enough near their dying moment to die bravely at the hands of an opponent, but rather to perform and exhale and spill their blood and do it cheerfully.

Whereas the Romans possessed nerve, mettle, and spine during their imperial reign, those traits were as ordinary as the discipline, principles, and virtues ingrained in today's Marine Corps, as evidenced by the author's own experience as a veteran, which includes honor, courage, and commitment. As elements of resilience, the same virtues that support the warrior within translate to helping those who care for others, albeit doctors, nurses, coaches, or teachers, termed the helping professions.

Overcoming Fear

We have insight from over four hundred years ago about that menacing mental distraction called fear. Fear has affectual outcomes on human behavior, either positive or negative, or better understood, fear can be either inhibitory or excitatory. Fear, in other words, according to Montaigne, can promote cowardice or boldness. Mental health definitions are provided by the Diagnostic and Statistical Manual of Mental Disorders, which states that the emotional response of the body to a potential or an actual threat to one's person is fear (Craske et al., 2022). Montaigne, who was plagued by a horrible, debilitating case of what was called quinsy, better known as tonsillitis, had such an incapaciting case of it in his later years that it kept him from speaking. He describes and tells us that the internal mental function of fear can help a person turn the wetland marsh plants of "reeds and bullrushes into pikes and lances" (Adler, 1952, p. 25). Again, fear can often help grow "wings to the heels...sometimes it nails them to the ground" (Adler, 1952, p. 26). Anyone can relate to the debilitating effects of fear, which our ancient ancestors knew about way before we began to study the impact of anxiety in mental health circles today. As recorded in his Essays, Montaigne refers to the writing of Cicero, "fear drove out all intelligence from my mind" (Adler, 1952, p. 26). When fear hijacks the mind, poor decisions often ensue.

As the author of the Palate and Pabulum blog, the experience of fear has been circumstantial and situational. For example, parental fear, childhood and adolescent fear of bullying, fear of being shot at while retreating off the beach of Mogadishu, Somalia, fear of failing state licensure exams, fear of taking care of the critically ill patient in the intensive care unit, and fear of God. One might argue that some fear is healthy or needed, and some kinds of fears can be life-debilitating, preventing one from living a whole life, like those who suffer from phobias. However, there is hope. Whenever we encounter fear, our brains are hardwired to make memories to protect us from potential threats, all designed to keep us alive. However, researchers tell us that getting back on the proverbial horse is the key to overcoming our fears (Southwick et al., 2023).

The following tips from the great work of a former psychiatrist and researcher on resilience are listed, but understood from the perspective of the author of Palate and Pabulum when dealing with and overcoming our fears. From the leading expert on human resilience and his esteemed colleagues, Steven Southwick, Dennis Charney, and Jonathan DePierro, give this advice (Southwick et al., 2023).

First, reappraise fear and think of what opportunities are available to learn from. Next, always remember the core values and the mission one has. Third, take a chance to learn more about what is feared, and explore knowledge deficits if a potential threat is unknown. Fourth, practice techniques for managing symptoms of fear, like anxiety. Fifth, use the social support of friends and teammates. Lastly, there is something to be said of a spiritual connection and having a mentor helping one deal with their fears.  

An Opportunity to Learn

As a veteran Marine and registered nurse, opportunities have always been presented to think about what can be learned from situations in which to overcome, for instance, how to care for someone critically ill in the ICU as a new grad nurse, thinking to oneself, unless this situation is given to learn how will the experience ever be gained. There is a saying in ICU residency training from veteran nurses to new grads after they receive the report, "Now go into the room and see the patient." Often, new grad nurses in the ICU are paralyzed about taking care of some of the sickest patients, but to overcome the fear, the nurse must open the patient's door and go in.

Mission Oriented

Having been a veteran, this is self-explanatory, but the mission of the day, as well as the hospital, is to keep a patient alive. Remembering to help the patient get their procedures, medicines, and timely therapies helps one to overcome the fear of the sick patient. Timeliness of care is also an element of a mission-oriented perspective to overcome the fear of caring for sick patients. For example in the care of cardiac patients, such as when a person has a heart attack, time is of great necessity, an element of intervening to help a patient, minutes can be the difference between life and death, the cardiac catheterization department has the goal and mission to help the patient intervene within ninety minutes to help save a life, and beating the clock is the goal.

Learn about what is feared

Critical care experience, hands down, is the ultimate teacher and takes many shifts, days on the unit, weeks, months, and years to become second nature, for instance, being able to instantly look at a twelve-lead EKG and see if there is a cardiac event occurring. Likewise, experience can help the nurse quickly address signs and symptoms when patients present to the units and know right away when and how to address a situation, for instance, when a patient reports that they have a history of heart disease with low blood pressure they are now feeling "dizzy". However, learning through study, tutorials, books, and research articles, nurses gain knowledge about the patients that they will encounter. Studying about cardiac patients in the off hours between shifts and cases in the hospital helped the author overcome the fear of unknown patients' pathology and disease states.

Practice Skills to Manage Fear

For as long as can be remembered, skills that have served the blogger well in overcoming and managing fear have been the internal dialogue and self-talk before going into the hospital, and not knowing what kind of challenges would be faced for the day. As a repetitive reminder, a saying that is repeated daily every morning for the past twenty or so years has been, as soon as the door of the Tacoma pickup truck is closed, to repeat aloud to oneself, "Back in eight," and "Just make it to the next meal." The saying primes the mind to remind that all will be okay. This saying is remembered during the early days of Marine training.

Friends and Co-Workers

Survival in the unit is impossible without a teamwork mindset; it is hard to get through a twelve-hour shift alone. As such, being the only one to struggle managing the care of challenging patients, such as those with tenous blood pressure or failing to wean on a ventilator, all stress-producing situations will not help a nurse overcome the fear of caring for patients. However, with co-workers and colleagues, it becomes within the bounds of possibility.

Mentoring and Spirituality

It has been the experience of this blog author that many great tutors and mentors have helped attain the skills that are now second nature. Of note and a many hindrance to others, which at times some teachers and mentors have been, as Montaigne suggests when quoting Cicero, that "the authority of those who teach, is very often an impediment to those who desire to learn" (Adler, 1952, p. 64). However, not many can argue the value of a great mentor who takes an apprentice under their wing to show them the ways of taking care of patients.

Finally, as a child and even now as an adult, having a connection with a higher power is paramount to overcoming fear, especially when caring for critically ill patients. The higher power for the author of this blog is the Christian God. A spirituality that helps with caring for others helps with managing fear. As an example, it is the belief that, as an instrument of God, the skills and abilities of a registered nurse help care for others and reduce fear-related anxiety.

References:

Adler, Mortimer J. (1952). The Essays of Michel Eyquem de Montaigne. In The Great Books of the Western World. (Vol. 25). Encyclopedia Britannica.

Craske, M. G., Manicavasagar, V., Schultz, S. K., Zbozinek, T. D., Wolitzky-Taylor, K., Ollendick, T. H., Muris, P., Mesri, B., LeBeau, R., Brown, L. A., Bogels, S., & Baum, K. B. (2022). Anxiety Disorders. In American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (5th ed., Ser. Text Revision, pp. 215–262). essay, American Psychiatric Association.

Emanuel, Ezekiel J. (2018). Palliative and End of Life Care. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 1), Harrison's Principles of Internal Medicine (pp. 47-63). McGraw-Hill Education. 

Southwick, S. M., Charney, D. S., & DePierro, J. M. (2023). Resilience: The science of mastering life's most significant challenges. Cambridge University Press.