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Yearly Archives: 2015

The team I leave behind

I am leaving Ottawa in two weeks.

I don’t have that many feelings about it. It’s a city. I grew up here. It has houses and schools and public transit and public swimming pools, all the things I needed as a kid. No better than most cities, no worse. I’m not sentimental. But the city isn’t what’s hard to leave behind.

I am leaving behind some of my closest friends–but we’ll still be friends, I hope, even across the distance. Hell, I’ve been doing long-distance friendship with people all over the world for years.

The hardest thing to leave is the one that I can’t replace, or take with me in any form. Cities are cities, interchangeable for my purposes. Friends are still friends, even when it’s over Skype and gchat. But the place where I first learned what it was like to be really, truly, part of a team… I can’t take that with me, because I can’t take the team with me.

Nursing is hard, and relentless, and grinds you down. It’s an endless Man-Against-Nature war. Starting out as a new RN, it often felt like I was fighting that war alone. But in the last six months or so, something changed.

There’s always something magical that happens, on those days when someone’s patient is crashing and it doesn’t matter whose patient, because it’s everyone’s problem, and everyone steps in, helps, does what they can. And there’s something else that happens, equally magical, when a group of nurses work together and fall into a pattern where they know each other, and joke amongst themselves, and first and foremost trust each other almost completely.

A morning, in the ICU. I haven’t charted yet, but people are shinier. Hey, do you need help with anything? A reposition. Okay. We turn your intubated patient onto his other side. Do you need help with anything? An epi drip, please, make sure it’s quadruple strength, no, really. The IV pump ringing in someone’s room; the propofol bottle is empty. I fetch a new one, make a mental note to sign for it later. Do you need help with anything? I’ll fetch you a clean sheet, sure. New admission’s here. Isolation; I’ll gown up. In the room; does the patient need a catheter? I’ll put one in, I’m here anyway. Bring my patient down the hall’s vital signs up on the monitor. Hey, my patient’s BP is low, I think his norepinephrine drip is empty, can you go change the bag while I’m stuck in here? Thanks. Do you need help with anything? A bag of phenylephrine, okay. Patient is ringing the call bell. I answer. They want a drink of water. I check the chart, because the patient’s nurse is on break; they’ve got diet as tolerated ordered. I bring them water. The patient in the corner room needs to be suctioned; I do it without a second thought.

My team. We know each other like a walk down a familiar hallway. Cynthia: small, dark-haired, bright-eyed. Used to work in the ER. Smart as anything, warm with a ready ‘thank you’ always on her lips, occasionally philosophical, but practical on a moment’s notice. Joanna: wears her hair in a bun, with elegant Polish beauty. Conscientious, careful, sometimes anxious and too eager to please, but generally 100% on top of her shit. Alyssa: tiny, blonde, bubbly. Ran a marathon last year. Calls her patients adorable, like I do; we bond over bathing unconscious, intubated patients together. Chantal: big blonde bun of hair, wears the amazing mascara that she sells to all of us. Big personality, sarcastic sense of humour, cracks me up every time. She’s great with confused patients; they’re like little babies, she says, they get squirmy when they’re uncomfortable, just turn them and they settle. Mia: tall, with a nose piercing that she carefully tucks in and hides at work. She worked in pediatrics for ten years, and she’s great, but underconfident, so used to being 100% in control that she finds the new ICU environment overwhelming.

On a civilized day, we laugh together. We help turn each other’s patients, and share jokes at the nursing station. We retell the antics of various patients, and fellow staff. Humour is a necessity, a survival skill.

On a busy day, we support each other. Hey, do you need help? We prepare bags of meds for each other. Bring forgotten supplies to isolation rooms. Program each other’s bloodwork. Hey, I can’t get an IV, can you try?

On a really busy day, it’s like we’re one mind, a superorganism with a dozen hands and feet and half a dozen voices. Afterwards, sometimes it’s hard to remember who did what; we only register the fact that it was done. Patient arrives. You’re admitting this patient? Stay out, take your report, we’ll put her in the bed. Place the patient on the monitor. BP’s low? Page the doctor? I’m on it. Hey, can you prepare me a phenyl drip? I’m on it. Need IVs. On it. Bloodwork. On it. Transcribe the admission orders. Prepare antibiotics. I’m on it. I’ll need meds for intubation. The doctor’s giving verbal orders. I’ll give meds, but someone needs to chart. All right, I will. Can you just grab me the stuff for a NG tube? Thanks. You can call for the chest X-ray now.

On one of the days that are so awful they make you cry afterwards– I’m standing in the hallway. Cyn, I need help. Cynthia’s busy–but you never ask for help unless you need it, she says. What do you need? Set up a dialysis circuit. Stat. Okay, help me connect it? Done. Thirty minutes later, and my patient’s lost her pulse. I haven’t eaten all day, I’m ready to rip my hair out, but the others are there. Charting. Placing meds into my hands. Taking turns on CPR. I need a central line tray. Okay, done. I’ll prime you a line for an epi drip. What do you need? I don’t know. I don’t even know. My room is a mess and I can’t think. Okay. Sit down. Do your charting. I’ll tidy up for you. Afterwards, when the new shift has arrived and we’re all half-collapsed in corners, trying to pick up the pieces in the right order and chart half-remembered things that happened thirteen hours earlier, vital signs scribbled on scraps of napkin and taped to the inside of a window… Hey, are you okay? Need to talk about it? Thanks. Later, maybe.

Sometimes we’re frustrated–another thing goes wrong, and we roll our eyes. Seriously? This is really happening? We’re tired, we haven’t eaten and we need to pee, but we deal with it, and afterwards it takes forever for us to finish charting and go home, because we keep stopping to rant, one-upping each other for most ridiculous story.

 Sometimes we’re scattered, and we drop some of the pieces, but they get picked up. Anyone remember what time we intubated her? Uh, I’m gonna guess 16:30. Did someone prepare the vancomycin? No. On it now. Why hasn’t Xray come yet? I’ll call them again, I guess. Hey, whose bloodwork is this on the counter? Oops, mine. I’ll send it. Your bag of insulin is empty. Oops, uh, do you have time to make me a new one while I’m stuck in this isolation room? I had vital signs written on a bit of paper, I put it down somewhere, has anyone seen it? Oh, here it is.

Sometimes the exhaustion, the caffeine, the resignation to being behind on everything, and the adrenaline rush balance each other perfectly, for a kind of crystal-clear alertness and bottomless willpower that I swear I will never experience anywhere else, ever. This patient is trying to die, guys, but we won’t let her. We’re all in the room, or just outside it. We look around at each other, and none of us are quite smiling, but we’re all feeling alive, the most alive that we’ll ever be.

I have a deep-running desire to be useful. And, in Anna Salamon‘s words, to be used like a human. My job at the hospital is the first place where that ever felt close to fulfilled–where I felt like I was working to my capacity, using my brain for everything it could do, often things I hadn’t really believed I could ever do. It took my drive to serve and help others, and hit that button over and over and over again. Starting out, I worked way too much overtime, because a part of me never wanted to leave the hospital.

Nursing probably isn’t the place where I can be the most useful, in terms of positive effects on the world. Maybe it’s the place where I can feel the most useful, where all my sidekick buttons are pressed all the time, where I can fit seamlessly like a brick in a solid and unbreakable wall. Or maybe it isn’t. I will find other ways to be even more useful, and hopefully even more fulfilled. I will move on.

But I hope I will take some of what I learned with me: the way a team feels, and the ingredients you need to make it happen. Roughly compatible personalities, hard-won trust in one another, and a worthwhile problem to solve. This is what it feels like, to serve others joyfully. Rationalists, complaining that your kind can’t cooperate– This is what is possible. I can’t take this team with me, but I can take what I learned, and maybe build up something like it around me, someday, somewhere.

I am Samwise

Mindspace is wide and deep. “People are different” is a truism, but even knowing this, it’s still easy to underestimate.

I spent much of my initial engagement with the rationality community feeling weird and different. I appreciated the principle and project of rationality as things that were deeply important to me; I was pretty pro-self improvement, and kept tsuyoku naritai as my motto for several years. But the rationality community, the people who shared this interest of mine, often seemed baffled by my values and desires. I wasn’t ambitious, and had a hard time wanting to be. I had a hard time wanting to be anything other than a nurse.

It wasn’t until this August that I convinced myself that this wasn’t a failure in my rationality, but rather a difference in my basic drives. It’s around then, in the aftermath of the 2014 CFAR alumni reunion, that I wrote the following post.

I don’t believe in life-changing insights (that happen to me), but I think I’ve had one–it’s been two weeks and I’m still thinking about it, thus it seems fairly safe to say I did.

At a CFAR Monday test session, Anna was talking about the idea of having an “aura of destiny”–it’s hard to fully convey what she meant and I’m not sure I get it fully, but something like seeing yourself as you’ll be in 25 years once you’ve saved the world and accomplished a ton of awesome things. She added that your aura of destiny had to be in line with your sense of personal aesthetic, to feel “you.”

I mentioned to Kenzi that I felt stuck on this because I was pretty sure that the combination of ambition and being the locus of control that “aura of destiny” conveyed to me was against my sense of personal aesthetic.

Kenzi said, approximately [I don’t remember her exact words]: “What if your aura of destiny didn’t have to be those things? What if you could be like…Samwise, from Lord of the Rings? You’re competent, but most importantly, you’re *loyal* to Frodo. You’re the reason that the hero succeeds.”

I guess this isn’t true for most people–Kenzi said she didn’t want to keep thinking of other characters who were like this because she would get so insulted if someone kept comparing her to people’s sidekicks–but it feels like now I know what I am.

So. I’m Samwise. If you earn my loyalty, by convincing me that what you’re working on is valuable and that you’re the person who should be doing it, I’ll stick by you whatever it takes, and I’ll *make sure* you succeed. I don’t have a Frodo right now. But I’m looking for one.

It then turned out that quite a lot of other people recognized this, so I shifted from “this is a weird thing about me” to “this is one basic personality type, out of many.” Notably, Brienne wrote the following comment:

Sidekick” doesn’t *quite* fit my aesthetic, but it’s extremely close, and I feel it in certain moods. Most of the time, I think of myself more as what TV tropes would call a “dragon”. Like the Witch-king of Angmar, if we’re sticking of LOTR. Or Bellatrix Black. Or Darth Vader. (It’s not my fault people aren’t willing to give the good guys dragons in literature.)

For me, finding someone who shared my values, who was smart and rational enough for me to trust him, and who was in a much better position to actually accomplish what I most cared about than I imagined myself ever being, was the best thing that could have happened to me.

She also gave me what’s maybe one of the best and most moving compliments I’ve ever received.

In Australia, something about the way you interacted with people suggested to me that you help people in a completely free way, joyfully, because it fulfills you to serve those you care about, and not because you want something from them… I was able to relax around you, and ask for your support when I needed it while I worked on my classes. It was really lovely… The other surprising thing was that you seemed to act that way with everyone. You weren’t “on” all the time, but when you were, everybody around you got the benefit. I’d never recognized in anyone I’d met a more diffuse service impulse, like the whole human race might be your master. So I suddenly felt like I understood nurses and other people in similar service roles for the first time.

Sarah Constantin, who according to a mutual friend is one of the most loyal people who exists, chimed in with some nuance to the Frodo/Samwise dynamic: “Sam isn’t blindly loyal to Frodo. He makes sure the mission succeeds even when Frodo is fucking it up. He stands up to Frodo. And that’s important too.”

Kate Donovan, who also seems to share this basic psychological makeup, added “I have a strong preference for making the lives of the lead heroes better, and very little interest in ever being one.”

Meanwhile, there were doubts from others who didn’t feel this way. The “we need heroes, the world needs heroes” narrative is especially strong in the rationalist community. And typical mind fallacy abounds. It seems easy to assume that if someone wants to be a support character, it’s because they’re insecure–that really, if they believed in themselves, they would aim for protagonist.

I don’t think this is true. As Kenzi pointed out: “The other thing I felt like was important about Samwise is that his self-efficacy around his particular mission wasn’t a detriment to his aura of destiny – he did have insecurities around his ability to do this thing – to stand by Frodo – but even if he’d somehow not had them, he still would have been Samwise – like that kind of self-efficacy would have made his essence *more* distilled, not less.”

Brienne added: “Becoming the hero would be a personal tragedy, even though it would be a triumph for the world if it happened because I surpassed him, or discovered he was fundamentally wrong.”

Why write this post?

Usually, “this is a true and interesting thing about humans” is enough of a reason for me to write something. But I’ve got a lot of other reasons, this time.

I suspect that the rationality community, with its “hero” focus, drives away many people who are like me in this sense. I’ve thought about walking away from it, for basically that reason. I could stay in Ottawa and be a nurse for forty years; it would fulfil all my most basic emotional needs, and no one would try to change me. Because oh boy, have people tried to do that. It’s really hard to be someone who just wants to please others, and to be told, basically, that you’re not good enough–and that you owe it to the world to turn yourself ambitious, strategic, Slytherin.

Firstly, this is mean regardless. Secondly, it’s not true.

Samwise was important. So was Frodo, of course. But Frodo needed Samwise. Heroes need sidekicks. They can function without them, but function a lot better with them. Maybe it’s true that there aren’t enough heroes trying to save the world. But there sure as hell aren’t enough sidekicks trying to help them. And there especially aren’t enough talented, competent, awesome sidekicks.

If you’re reading this post, and it resonates with you… Especially if you’re someone who has felt unappreciated and alienated for being different… I have something to tell you. You count. You. Fucking. Count. You’re needed, even if the heroes don’t realize it yet. (Seriously, heroes, you should be more strategic about looking for awesome sidekicks. AFAIK only Nick Bostrom is doing it.) CFAR has tasked me with finding ten of you.

I’d like, someday, to live in a culture that doesn’t shame this way of being. As Brienne points out, “Society likes *selfless* people, who help everybody equally, sure. It’s socially acceptable to be a nurse, for example. Complete loyalty and devotion to “the hero”, though, makes people think of brainwashing, and I’m not sure what else exactly but bad things.” (And not all subsets of society even accept nursing as a Valid Life Choice.) I’d like to live in a world where an aspiring Samwise can find role models; where he sees awesome, successful people and can say, “yes, I want to grow up to be that.”

Maybe I can’t have that world right away. But at least I know what I’m reaching for. I have a name for it. And I have a Frodo–Ruby and I are going to be working together from here on out. I have a reason not to walk away.