Peace of Mind: Imagination or Reality?
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Kathleen Huynh, BSN, RN, SCRN
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MSN in Nursing Healthcare and Simulation Program
The Carol & Odis Peavy School of Nursing, University of St. Thomas, Houston, TX, USA
“There are more things…likely to frighten us than there are to crush us. We suffer more often in imagination than in reality,” wrote Seneca the Stoic to his friend Lucilius Junior around the year 65 A.D. (Seneca & Campbell, 1969). Seneca’s wise words ring true throughout the ages: anticipatory reactions often cause more suffering than suffering itself. Seneca posited that fear of suffering exaggerates potential misfortunes, leads to panic, and impedes development. I have come to understand this personally through my experiences in nursing.
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I like to describe our experiences as being a constructed reality. By this I mean our reality is constructed from both our insights and our empirical observations. Thus, the subjective and objective combine into what is our experience of reality. Often, the subjective experience of our insights serves us well and provides a richer meaning to our human interactions. A bundle of flowers given to us by a loved one could be a sweet reminder of love, or a bitter betrayal if given to another. However, when this impairs our functions or induces unnecessary suffering, we are carrying a perception that is limiting and harmful rather than helpful.
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The Stoics (Seneca, Marcus Aurelius, Epictetus, Cato, Zeno, and others) realized this principle. They believed in focusing on what was in one’s control and interior demeanor by disciplining thoughts and reactions. The principle of acceptance was emphasized even when events were challenging, unpleasant, or unexpected. They even went so far as to recommend rehearsing worst-case scenarios and the practice of acceptance. In practicing stoicism one “holds on to oneself” so that even unexpected, stressful situations do not disrupt one’s peace of mind.
I vividly remember the moment early in my nursing career when I realized my emotions were creating a reality that wasn’t empowering me to help my patients. My patient in the emergency room holding area was in atrial fibrillation with a rapid ventricular response (a.fib RVR). Her heart rate was 160, with a blood pressure of 210/120. I was surprised, emotionally strained, and internally freaking out. The interior “soundtrack” of my reality was a dramatic and tense symphony the crescendo of which was impending doom. Not only was I worried for my patient, but I was also worried for myself. Had I done something wrong? Was I doing something wrong? Was I about to do something wrong? I did not have much experience managing patients with a.fib RVR at that time. All I knew was I needed to call the physician, and I didn’t remember which cardiologist had been consulted for her, nor was I familiar with the host of cardiologists staffing the hospital.
At that moment, I recognized my interior state was impairing my ability to focus on how I could improve the situation. To help my patient, I needed to take certain steps as efficiently as possible. That meant acknowledging the knot inside my stomach and the tension in my throat, then directing all my energy into addressing the medical emergency.
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The Stoics believed enduring difficulties with a “can-do attitude” of learning and resilience was the best approach for living a peaceful, growth-minded, and virtuous life. Taking a stoic approach meant not avoiding a difficult situation, complaining about it, being overwhelmed by it, or resenting it. In my scenario, the stoic approach meant setting aside my anticipation of terrible things to come, assessing the variables out of my control, and concentrating on the variables within my control: calling the cardiologist, communicating with and monitoring the patient, and administering medications. With these done, her situation resolved to a stable rhythm of atrial fibrillation with a controlled ventricular rate.
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No doubt, nursing is a profession that tests one's limits of endurance. Over time, greater nursing experience and clinical knowledge have empowered me with an understanding of what is in my control. For example, I cannot control how the physician, or the patient responds, nor whether the electronic charting system works properly. However, I can control how I communicate with the physician and patient. I can learn to keep a pleasant look on my face when things are not easy. I can hit the reboot button for a hard reset on the computer that just will not load and then ask for a workstation on wheels. I can call the pharmacist to ask very nicely for that medication to be expedited for my patient in a.fib RVR.
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A life lesson I learned was to get to know the different moving parts that go into taking care of a patient and develop relationships with them. Thus, in the future, if faced with a similar situation, the phone call to the pharmacist would be effective, and asking the manager for a computer on wheels would be expedited. And I can learn to stay in contact with my internal dialogue, so I suffer less in my imagination, and perhaps in reality too.
Reference
Seneca, L. A., & Campbell, R. (1969). Letters from a Stoic: Epistulae morales ad Lucilium. Penguin Books.