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.

Train for resilience

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To capture a reader's mind, it is best to tell a story. On June 3, 2017, Supreme Court Chief Justice John Roberts delivered an electrifying commencement speech at his son's ninth-grade graduation from Cardigan Mountain School, which is insightful, striking, and believed to be necessary and applicable not only to aspiring adolescents but also to adults. The following is a paraphrase of his words, intended to encourage the young audience; you can watch the recording on YouTube.

In essence, Chief Justice Roberts said that he hoped that they would be mistreated from time to time so that they would come to understand the value of justice. He mentioned that he hoped they would experience betrayal, as that would teach them the importance of loyalty. Apologetically, he hoped they would occasionally feel alone and isolated, so they would not take friends for granted. The justice spoke of wishing them bad luck from time to time so that they would appreciate and be aware of the role of chance and probability in their lives, and that success and failure in life are essentially a common thread in humanity. He advised them to embrace losing and experience the glory of an opponent, so that they would learn the value of humility in sportsmanship. He emphasized the importance of listening to others, noting that it is best understood when ignored. Finally, he told them that to learn compassion, he hoped they would feel discomfort. The justice wrapped it up by saying that these are all inevitable human experiences, and that learning from them will greatly depend on the type of character one has or needs to develop.

Resilience

The commencement address by the chief justice highlights the importance of resilience in our lives and is a refreshing message that is modern and relevant. The ancient stoic philosopher Epictetus tells of the accomplishements of Hercules and explains to us in his discourses on providence that the only reason why Hurcules was able to live up to the name is precisely becuase he was given opportunity and situations to demonstrate his hurculean strength and vitality against such opponents and threats like a lion or bear or deadly basilisk and men who sought his life (Adler, 1952, p. 111). The myths and tales of the ancient Stoics, along with the sharp words of encouragement from a Supreme Court judge to his sons' graduating class, offer valuable insights worth recalling.

Challenge the common denominator

Scholars tell us that if children are exposed to opportunities early in childhood where they must forgo rewards and expectations, or, as Averill et al. (2018) describe, moments where gratification of a want is held off, they promote resilience, self-control, and regulation of their behaviors. Although no one would expect kids to have to grapple with a hungry lion or an angry bear, as the mythical hero Hercules did, the speech the justice gave to the young graduates was an essential element in preparing them for life's challenges and stressors.

Stick around or bail?

The author's father was a pipe fitter and welder for a major oil-producing company, British Petroleum, in Texas. Stories about safety and danger at the "plant" were part of his vocabulary. One time, it is recalled that the author's dad had a new crew coming onboard in his section, and he would tell the new crew, since he was the supervisor, that if anyone saw him running towards the gate, they would be too late. He was referring to his innate abilities and years of experience, and his ability to sense danger, which had occurred a few times during his career. He knew the inherent risks involved in the volatile process of refining crude oil and making plastics and fuel. If the reader is astute, one may remember the Gulf of Mexico disaster a few years ago, which was subsequently made into a movie starring Mark Wahlberg, called Deepwater Horizon. These were some of the types of environments that the authors' father worked in.

Additionally, scholars inform us of the biological hormonal response to stressors in our world. One can imagine that a thousand years ago, the primary stress response was survival. As humans, we woke up and searched for food, water, and shelter, and did our best not to be eaten by a hungry pride of lions. Today's stressors are particularly significant for youth, including the passing of exams, fitting in with their peer groups, and managing bullying. By contrast, adults face the life stressors of those who are gainfully employed, balancing their professional responsibilities with their personal lives (Averill et al., 2018). Either way, whether we are running away from something that is trying to eat us or trying to pay bills and perform well at work, the body reacts with the same hormones.

Briefly, the fight-or-flight system of the sympathetic nervous system is responsible for helping the body prepare for survival situations. It has many hormones involved to help us flee the scene for safety, primarily the hormone that causes the heart to race and helps the heart muscle contract more forcefully is epinephrine and its close twin, norepinephrine (Averill et al., 2018). These are normal responses to a perceived impending peril, and there are other biological processes to help bring the fight or flight response back to normal levels once the body has responded to the situation or if the threat to one's survival has dissolved. However, when these situations are elevated in the body from chronic response to perceived threats, such as chronic stress, the incessant stimulation of the sympathetic nervous system can cause unwanted symptoms of anxiety, fear, and in some situations, post-traumatic stress (Averill et al., 2018).

References:

Adler, Mortimer J. (1952). The Discourses of Epictetus. In The Great Books of the Western World. (Vol. 12). Encyclopedia Britannica.

Averill, L. A., Averill, C. L., Kelmendi, B., Abdallah, C. G., & Southwick, S. M. (2018). Stress response modulation underlying the psychobiology of resilience. Current Psychiatry Reports, 20(4). https://doi.org/10.1007/s11920-018-0887-x

Is anyone immune from the winds of circumstance?

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When I feel the pains of trials, I turn to God and the comfort of the scriptures. However, in my youth, I did not have a believing faith, as the writer of Hosea put it, I was a "half-baked cake and mixed in with worldy influence (Holy Bible, Hosea 7.8).

As a youth, growing up in the Gulf Coast near what is called by some as Hurricane Alley, we fled once from a category three hurricane that had landfall in and around Galveston, when we returned I remember seeing debris, trash and the remnants of Texas gulf coast flooding from the rain and the powerful storm surge. The image of sailboats, recreational watercraft, and the enormous gulf shrimping boats on land in the middle of the freeway leading from Texas City to Galveston was unbelievably drastic, as if a heavenly hand had picked the ship from the harbor and transported it to the highway. The Gulf of Mexico and its powerful ocean currents during hurricane landfall can move large pieces of waterborne vehicles, a sobering reminder of the forces of nature that we cannot control. Additionally, the damage caused by buildings and homes with roofs flying apart due to accompanying tornadoes, often spun off from hurricanes, underscores the unpredictability of these natural phenomena.

I recall seeing where a building once stood, specifically the concrete foundation. As a kid, I used to work in a bait house that is no longer where it used to be; the salty waters of Galveston Bay have claimed the building and are now part of Poseidon's kingdom. The only remains of the often-visited bait shop are the column stilts in the sandbar, which previously held a robust fish and bait shop and a tackle store.

Storms of Life

Sometimes, I refer to commentary to add depth and understanding to scripture from scholars more versed and studied than myself, a practice that I have only recently learned to appreciate the humble value of exposition. A deeper look at Hosea from the commentary by Lloyd J. Ogilvie reveals an emphasis on the theme of the ancient Israelites during a time when they relied heavily on the financial resources in the land, namely Egypt and Assyria (Holy Bible, Hosea 7.11). Instead of relying on God to supply and provide, and during times of distress or trial, they cried and wailed in their beds instead of seeking out God through prayer and meditation (Ogilvie 110-111).

I pause to take a moment to interrupt a train of thought, because I feel it is important to mention, and I believe that is how God works sometimes in our lives. When we search him out, he gives us clues, hints, and signs. Upon reading more of Lloyd J. Ogilvie's commentary on the book of Hosea, I was struck by his reference to John Steinbeck's The Winter of Our Discontent. The theological mind is of particular interest to me as I learn, and I am also interested in the reason for the reference to Steinbeck's work for the commentary on Hosea. To gain a deeper understanding, I read an excerpt from the book, which allowed me to learn more about the attitude of the fictional character, Ethan Hawley.

Erosion Kills a Man

Ethan Hawley faces difficulties; the challenge is that he was reared in a well-to-do family, and is now in dire straits and working as a grocery store clerk. As he speaks in the story, the work of sweeping, stocking shelves, and providing customer service is beneath him. Ethan, struggling to pay his mortgage and worried about caring for his wife and children, feels disempowered working for someone wealthier than him, when he believes he should have owned a prominent business. It appears that Ethan is losing heart.

As the story broadens, Ethan and a local banker engage in conversation that provokes Ethan's irritation. The banker, aware of Ethan's family heritage and acquainted with his father's business acumen in the past, is surprised by how Ethan's cynicism and display of no desire to strive, is apathetic, void of enthusiasm for work, and has not accepted a temporary financial setback. The banker tries to pick up Ethan's spirits, saying something similar: "It is not all lost. Just start over and change your attitude." As it is, Ethan responds to the bankers remarks that it must be easy for him to suggest to another to overcome a hard time in life since he himslef has not had to grapple the same obstacle and that a man does not fall or succumb to failure from a direct hit; instead, what brings a man down is slow deterioration (Steinbeck 13).

Although sometimes we are hit with trials that can immediately cripple us, such as a family death, a job loss, an unexpected illness, financial hardships, or, as mentioned before, natural disasters, we are often slowly worn down by life itself.

I can identify with Steinbeck's fictional character, Ethan. The elements that can erode the spirit of man are common to all and are familiar and recognizable: the rains of vanity, the gusts of materialism, the tides of our backgrounds and life events, as the commentator of the second epistle to Corinthians expounds, discussing Paul's description of his life challenges in spreading the gospel (Tasker 76-77; Holy Bible, 2 Corinthians 4.17). The highly intense thermo effects of lust, compounded by the relentless abrasive rubbing from the sands of anger, along with the debris and scraps of overindulgence, envy, and laziness that slowly, consistently, little by little eat away at and into the fabric of a man, can cripple his external being.

The similarities and contrasts between the Israelites in Hosea and their apparent reliance on other nations for support, rather than God, and John Steinbeck's Ethan, prompt reflection on our own life and situation in the absence of genuine dependence on God.

As a Christian, I reflect on Jesus' parable about sowing seed (Holy Bible, Matthew 13.22), which represents the type of ground that has thorns growing in it. God desires to plant his spirit in a person. One type of soil where God plants in the heart of men is a kind of ground that has allowed thorns and briers to grow up with the good seed of his spirit, but as the two grow together, the robust thorns and thistles suffocate or choke out the good seed.

The analogy here is that the spirit of God and his teachings are planted in the heart and mind of a man, but the thorns and briers of greed, the strangling vine of envy, the roots of lusting after the world, and the budding flowers of life's worries drown out the God-spirit-planted seedling. Like a vapor that fades away, a Christian's commitment and faithfulness to Jesus' teachings are tested when adversity strikes, and this has been my experience.

Earth Trembling

Unlike Texas hurricanes, living in California, the ground often quakes and trembles. One is familiar with the fluctuations and movement of the ground, especially in Southern California, which includes Los Angeles and its surrounding cities, towns, and districts. The Northridge earthquake in 1994 was felt as far south, as San Diego county, at the time where I was stationed at Camp Pendleton, I was awakened at the time, by a fellow Marine shaking my bunkbed to wake me up for something, to my surprise and everyone else, however, we all were startled by the early morning movement of the squad bay by the trembling of the ground, that was over just as quickly as it began, although felt for more than a hundred miles away in Oceanside the epicenter and surrounding builidngs, structures and landscape in the San Fernando Valley suffered catastrophic damage that left people with out necessities for weeks, and took years to rebuild and recover. Similar to the devastating effects of hurricanes in Texas.

Fires of Life

We are prone to anual fires as well, recently this past year we had terrible fires that devastated areas of surrounding towns of Los Angeles, although tragic and devasting is the loss of personal property and the dispersion of people from their homes, what I see when reading the paper or watching the news, and is common in most of the images after the destruction of what was left are the same images burned into my memory as kid living in Texas and arriving back from evacuation to see what was left are the ghostly, permanent, almost immortal resilient slabs of impenetrable concrete foundations and it is here that I will conclude my thoughts on a lasting foundation.

Foundations

Recently, in our country, we have seen and experienced, at least online and in the news, and by extension, personal accounts through associations and relationships with individuals impacted, the devastating aftermath of natural disasters like hurricanes, fires, floods, and earthquakes. The events are tragic, and for those who live in those areas, picking up the pieces is trying and will leave long-lasting scars emotionally and physically.

My thoughts are with those who have been affected, from fires and floods to earthquakes and tornadoes, and words cannot comfort those who have lost loved ones; they will fall powerless in the face of grieving eyes and mourning ears. Although I try to shine the light of God's guidance, I hope it seeps through.

Jesus ' teachings serve as a foundation for us to remember and live by. He often used motifs, such as the image of building a house that stands firm even when storms come (Holy Bible, Matthew 7.24-27). The apostle Paul also described how our earthly bodies are prone to decay, but if we do not give up or lose heart, we can look forward to eternal life (Holy Bible, 2 Corinthians 4.16-18). However, we may feel outwardly worn down, like Steinbeck's despondent Ethan. We can relate to the Israelites and believe that our material possessions are of the utmost importance, but with faith, we know the spirit that God places in our hearts will last forever, as he takes care of us.

Works Cited

Holy Bible. New International Version, Cornerstone Bible Publishers, 1999.

Ogilvie, Lloyd John. The Communicator's Commentary. Hosea, Joel, Amos, Obadiah, Jonah. Vol. 20, Word Inc., 1990.

Steinbeck, John. The Winter of Our Discontent. The Viking Press Inc., 1961.

Tasker, R. V. G. The Second Epistle of Paul to the Corinthians: An Introduction and Commentary. Wm B. Eerdmans Publishing Company, 1977.