Book Review: The Comfort Garden - Tales From the Trauma Unit ...

I'm late posting this week after spending two days on the livingroom floor, resting and exercising a wayward lumbar disc back into place. While the view from the floor was not exactly exciting, the opportunity to read Laurie Barkin's award-winning new book, The Comfort Garden, was.

Laurie was a psychiatric nurse consultant on the surgical trauma service at San Francisco General Hospital for five years before leaving to heal her own vicarious trauma. Her book is a memoir of her work with traumatized patients; her relationships with her coworkers and family; her interactions with a healthcare system losing its way due, in part, to managed care and compassion fatigue; her own journey through the pain of secondary traumatic stress; and the healing and sustenance she finds in SFGH's Comfort Garden.

This is a book worth reading by anyone who works with traumatized people and their families. Between Laurie's compelling stories lie many insightful observations and pearls of wisdom:

There's a word for people like Rochelle: counter-dependent; people so phobic of being weak and dependent on others that they deny their own normal needs. Lots of nurses are counter-dependent, caring for others but unable to care for themselves or to allow others to take care of them. I should know. I'm one of them.

Too many of us nurses are bad about self-care. We're overweight; we smoke; we overwork; we slip into addiction. We're so used to being the helpers that we can't see when we ourselves need help.

I had begun to wonder if I was in danger of losing my grip; if the random trauma and human cruelty I've witnessed every day at work for the past four years has been affecting me because of some defect in my character. Now I know that it may have something to do with the dose of trauma I'm exposed to every week in the absence of enough support to ameliorate it.

Our director ... created a buoyant work environment and hired energetic and idealistic staff... he taught us to exaggerate and celebrate miniscule moments of success with our patients. I have applied that lesson to my work with all patients ever since...

I walk in The Comfort Garden when I need to clear my mind (of the trauma stories).

According to the most recent journal articles, people who dissociate in response to trauma are the most likely ones to develop PTSD. However, a good social support system can protect a person from developing PTSD. 

Resonance between people - the warm and responsive embrace between two souls - protects and heals us from the world's ills and makes possible its greatest bounties. 

From the point of view of style, I found The Comfort Garden an easy read but from a content standpoint, I was introduced to people and situations so authentic and well-drawn that I had to pause from time to time to pace my emotional response. That is not to say that Laurie uses gratuitous descriptions in her story-telling. Quite the opposite, in fact. There are few "gory details". Rather, it is her accurate depiction of unrelenting trauma exposure that took me back to my work in hospital settings and triggered familiar emotions.

The feelings I felt most strongly, though, as I finished this book, were those of gratitude for fine nurses like Laurie Barkin and hopefulness for a future that acknowledges the impact of secondary traumatic stress and strives to provide support and build resilience for all trauma workers.

This touching and inspiring story received the American Journal of Nursing Book of the Year Award for 2011 and it is deserving of the honour.

If you are interested in ordering a copy of The Comfort Garden, you can go to the online store at Moss Communications Publishing.

Baby Steps Toward a Healthy Heart ...

February is Heart Month and as a former coronary care nurse, a former cardiac spouse, and a woman-of-a-certain-age, I take a particular interest in heart health.

I've always rather prided myself on not having any of the risk factors for heart disease but over the past few years, since stopping running and power-walking due to running injuries in both feet, I've noticed my weight beginning to creep up and my waist circumference increasing. This week, while doing the Canadian Heart & Stroke Foundation Risk Assessment, I had quite a rude awakening - one that has motivated me to clean up my dietary habits and to find an alternate way of getting The Montreal Heart Institute's recommended minimum of 30 minutes  exercise a day.

I have decided to reduce my sugar intake (my Achilles heel - I'm the original cookie monster!) and to ride my stationary bike at intervals throughout the day when its too cold and wet to want to take my usual walk around the lake. These two changes seem small enough to be manageable, (we so often sabotage ourselves by taking on too much at once), and yet large enough to make a difference. I will report back to you on my progress in making these changes over the next month. (And, if anyone wants to join me in making some "babystep changes" toward a healthier heart, you're more than welcome to post your intention here.)

While perusing the Heart & Stroke Foundation website, I found a number of great resources including 10 healthy eating guidelines and some delicious heart-healthy recipes. On their February calendar there are different dinner recipes for each day of the the month, including a particularly good one for Hearty Tuscan Soup.

There are also many fantastic, flavourful recipes in two of my favourite heart-healthy cookbooks  -

1.  Lighthearted at Home: The Very Best of Anne Lindsay by Anne Lindsay

2.  The Best of HeartSmart Cooking by Bonnie Stern.

Whatever your current state of heart health, I hope you will join me in taking the Heart and Stroke Foundation's Risk Assessment and then in deciding, with your own health professional, how you want to optimize your cardiac health. (Another gentle reminder that those of us who care for others do better when we care for ourselves first!)

Keeping the Love Alive ...

While some people seem to regard Valentine's Day as a commercial venture best avoided, I tend to think of it as a yearly opportunity to be intentional about expressing your love and appreciation in your most significant relationships.

It is easy, when caring for others all day long, to arrive at the evening hours exhausted, depleted and less than interested in conversation, let alone the amorous expressions of your significant other. The observance of Valentine's Day (or week), can offer a focused opportunity to begin to renew your connection with your loved one.

Research over the years has taught us that the work of physicians, nurses, psychotherapists, police, lawyers, clergy, and other professional helpers can have a profound impact on primary relationships. And a survey of 300 + family caregivers, published today at caring.com, revealed that although some believed that caregiving had enhanced and strengthened their relationships, 80% of respondents felt that caregiving had strained their relationship, 89% said that caregiving had kept them away from their spouse, 48% said that caregiving was causing them to drift apart, 46% felt that it was having a negative impact on their romantic relationship and 34% thought it had taken a toll on their sexual relationship. Harsh numbers, indeed.

So, how can we begin to re-pair our heart connection with our partners? It can be surprisingly simple, though not necessarily easy.

1.  Take care of yourself so you have the energy to nurture your relationship. Think back over the past year and acknowledge the times when you have really cared for yourself. (Don't be critical if there aren't too many. Just see today as a starting point for improving your self care.)

2.  Talk and listen to each other. Make space and time to reconnect with each other every day - even if it's only for a few moments. Protect that space and time. Reach out to each other, vent, and talk about your feelings, problems, expectations, frustrations and appreciations.

3. If possible, create a regular pattern of getting away together so you can connect at a deeper level - being geographically away from the sources of your stress can do wonders for your perspective. If you can't get away, create a vacation at home (or at a friend's home while they're away). Unplug from the electronics, don't answer the phone, eat delivery meals or cook together, watch a DVD, nest. (Remember to tell your family and friends that you're taking a break so they don't go into a in a state of panic when they can't reach you.)

4.  Get help with the responsibilities that drain energy from your relationship. Together, identify the top three or four drains on your relationship energy and brainstorm out-of-the-box ways of getting help. I spoke with a young woman recently who said her hectic life as the young mom, dancer and choreographer, and family caregiver had eased considerably when she and her husband decided to get a bookkeeper to handle their business books, to ask a local nursing student to babysit one evening a week for date night, and to share the housekeeping and baby care more evenly.

5.  Pamper each other. Do one small thing to pamper each other every day whether a neck rub, drawing a bath, buying coffee or a glass of wine to share in the garden, putting a love note in a bag lunch, breakfast in bed, making or going out for a special meal, offering to do one of your partner's chores, getting a massage together, going for a walk without the kids. If your partner is ill, he or she can recruit a friend to bring a selection of cards or gifts to your home to choose something for you on special days. Or try online shopping.

6. Remember that there's more to sexuality than intercourse. Even if you're seriously depleted or your partner is ill, you can still express your love physically. Spoon, hold, cuddle, stroke, touch each other tenderly without the expectation of intercourse, allowing loving closeness to be the goal.

7.  Take time to reflect upon your lives together. Remember the hurdles you've overcome and the pleasures you've shared. Visualize all the threads of memory that tie the two of you together. Early in my husband's illness we recognized that, in all the stress and grief, we might lose track of some of these stories, so we bought a beautiful "memory book" and wrote down, in detail, all the happy memories we could think of in our years together. It's now a wonderful gift to look back on on Valentine's Day.

8. If the loss of your loved one's cognitive abilities or the loss of the love in your relationship or the lack of a romantic relationship altogether makes you hate the very thought of Valentine's Day, tell someone you trust about your feelings or write about them in your journal or burn them out in some physical activity. Expressing them will usually bring some relief. Consider giving yourself a gift of flowers or chocolate or a spa certificate. Start a tradition of sharing time, cards, or small gifts with a friend or family. (My sister is taking me out to Barbara-Jo's Books to Cooks, tonight, for dinner and a lesson on cooking for one!)

Valentine's Day will mean something different to each of us but I wish each one the opportunities to make it a happy day.                  

A New CF Resource for Helping Professionals ...

I have just finished reading my friend and colleague, Francoise Mathieu's, new, revised, and expanded edition of The Compassion Fatigue Workbook and it's a keeper.

Written in Francoise' trademark bright and informal style, the book synthesizes basic compassion fatigue theory from experts such as Charles Figley, Beth Stamm, Eric Gentry, Anna Baranowsky, Babette Rothschild, Laura Lipsky, Laurie Anne Pearlman and Karen Saakvitne, and others.

In addition, she offers sage, practical strategies for reducing CF risk and increasing CF resilience including the use of low-impact disclosure in informal debriefings, tracking stressors, improving work-life balance, self-care, relaxation and stress reduction, and committing to change.

This workbook will be particularly useful to helpers at the beginning of their professional lives, as they establish healthy patterns for sustaining themselves in their work. It will also appeal to those of us who are of sufficient years to have missed newly-discovered CF information in our original training programs.

So, congratulations to Francoise!  And, if you're interested in purchasing a copy of her workbook, you can go to her website store and find one there. Enjoy!