Care, work, ethics, justice, kindness, and the long haul.
SUMMARY
I write summaries for people who have to carefully marshal their time and attention.
The healthcare workers’ strike in my town, and the company’s violent response
The hospital as a site of violence as well as care
The need to make ethical decisions, over and over
Going back out to the line
The doctor and the nurse were friends, visiting the winter market together on a Saturday morning. I know this because they stopped at the Climate Anxiety Counseling booth to talk with me. They worked at a psychiatric hospital, and although their jobs were different in kind, status, and pay, the story they told me was the same. Too many hours on, too little time off in between, too few people to do the work, threats by visitors and assaults by patients. The “wellness” recommendations from the administration were so inadequate as to be insulting. The two friends were lonely, tired, angry, feeling used. They had a better grip on those feelings than their patients, but not by much.
I was glad they were talking to me and to each other. Talking about something can be the beginning of doing something, and the something you do depends a lot on power. The staff at the hospital—not doctors, but the nurses, dieticians, social workers, everyone else—have the power that lies in a union, so they are on strike. As I write this, they’re entering the strike’s fourth week. The Providence Police Department was slapping $500 noise complaints on people who drove past honking in support. The hospital administration cut off striking workers’ health insurance on May 31 (illegal) and posted their jobs as open on June 3 (illegal). Someone drove a car into one of the organizers on June 4 (illegal, obviously. She wasn’t gravely injured). Some of the workers at this hospital have already been sleeping in their cars because of how little the hospital pays them for their work, which is extremely hard in itself, and even harder to do well.
I’m in a group chat for strike support. A couple of the striking staffers pass on updates and requests. Other people in town coordinate dropoffs (cooked food and groceries, water and toilet paper, popsicles for hot days and ponchos for rain) and announce their plans to join the line for part of the day. When I was up there the other day, one worker carried this sign: IT WOULD BE LIKE TAKING HEALTH INSURANCE FROM A BABY… OH WAIT! CARE NEW ENGLAND DID! The sign has a photo of their baby on it. He’s adorable. One person walking beside me talked about how she works on the dementia and memory care ward, how she’s worried about the elders she takes care of and how they’re doing. She offered one of them a haircut and beard trim before the strike started. He accepted.
In the strike support group chat, someone shares a video interview with K, a hospital worker, that aired on Instagram, and one of the nurse delegates writes to us about her own experience in involuntary psychiatric care when she was 15. She’s explaining why she, like the co-worker who spoke in the video, treats patients with respect and dignity, rather than coercion and violence. “I know that any hands on is trauma to a patient and potential injury to staff,” she writes, “so my goal is always—deescalate, validate, provide support, no hands on. The staff who feel the same are being forced out. K is one of the good ones. I have many times watched him walk up to a very large, powerful patient who was threatening violence and say, ‘Hey, I wanna change this dynamic. What can we do to make you feel safe?” K has worked at the hospital for over 30 years and doesn’t make much over $20 an hour.
The staff’s emphasis is on the ways that patients have hurt them—other signs show photos of bruises and bite wounds—but of course there are staff who hurt patients too, as the nurse delegate’s comments imply. I grew up with a kid who was sexually assaulted at school, was so thrown by it that inpatient treatment seemed like a good idea, and was then sexually assaulted by someone who worked in the treatment facility. Many people who’ve been in involuntary hospital care can tell stories like this, if not about themselves then about someone who was there when they were: clear-cut abuse of patients by supposed caregivers, and also someone who was restrained, or medicated against their will, not because they were about to hurt someone but because they were “uncooperative.” The standard phrase is “a danger to yourself or others,” but who is assessing the danger, and how are they making that call?
Sometimes it’s murky, what happened. My sister-in-law is mentally ill. She has had several bad times in hospitals that she didn’t want to go to. Whether the bad times were because she was compelled to stay in a place where she didn’t want to be, because people working there hurt her or neglected her or treated her with contempt, or because things that would have helped her in the long term frightened or enraged her in the short term, is not possible for me to determine—we don’t know each other very well, we don’t talk, and she also says a lot of things to other people that are definitely not true. This makes it hard for her to live with people, or to do things that might make her life, ultimately, more livable. At this moment, we don’t know where she will live. She’s not safe in the hospital, she’s not safe anywhere else.
Another person I know who struggles with his perceptions of reality is in that condition because about a year ago, he was broke and had pneumonia, so he went to the clinic and told them to give him any and every medication that would enable him to work. He turned out to be one of the people who are susceptible to steroid psychosis. Months later, he still has times when his perceptions depart sharply from those of the people around him. If you read this and thought, “The real problem here was his bosses and landlords,” we agree! That’s why the hospital staff is on strike, and why more and more and more collective action and solidarity are needed. And it’s also true that once the situation the bosses and landlords created hit this crisis point inside this particular person, everyone else in and near the situation had to decide what to do.
A nurse named Sarah, who works in Oregon and recently was part of a successful strike on similar grounds—fair compensation and safe staffing—wrote recently about violence within care in a way that I was grateful for:
Violence—verbal, physical, active, passive, institutional, direct, inadvertent, malicious— pervades the hospital. You provoke people into violence, and then use that violence to justify why you must do actions that further provoke them. And also people are not helpless victims of circumstance, mindlessly reacting to whatever is the most noxious stimuli. But also we aren’t not that. You have to interrupt the cycle somewhere. I think grace is one of the most powerful things we can give each other. I also think people own guns. Institutions have enormous overt and covert power that can feel impossible to resist, and they are made up of people with necks you can wring, and those people are the agents of that unstoppable power, and those people don’t have unlimited agency and make choices every day about how and when to exercise it.
Because you can substitute almost any institution for hospital (although the hospital shows an especially stark version) the choices are what I want to highlight here. Some of the staff at Butler may well see themselves as only victims, and the patients as enemies or objects of contempt as much as the administration is—though that is not at all what I’ve heard in the support chat or from people who’ve spoken to me on the line. Some of them may be striking only in their own interest or in the interest of their fellow workers—though, again, what people are saying to me is very different. Worse conditions do breed violence, and better conditions do breed care—by which I mean, they make certain choices of how to act seem more or less inviting, feel more or less possible.
People in pain of all kinds do often lash out, and they lash out with what they have a grip on: words, volume, a piece of furniture. The pain doesn’t need to be “correct” or “accurate” to make this more likely. Distress, exhaustion, overwork and shame can push someone further away from being a kind person, closer to being a bully. Ethics and rules can be a counter to raw power, the power that says the person to hit is the closest person who can’t hit back, as well as a counter to entrenched power, the power that says maintaining itself is worth any cost to anyone else. Rules and ethics are there to even things out between K and the unnamed patient to whom he was suggesting an alternative; they are also there to even out things between Care New England and the striking workers. They aren’t always effective in leveling the playing field of power. They’re often unequal to the task of meeting violence and pain. But we still need to use them, to choose them, to choose with them, every time.
“We’ll never solve this,” Sarah wrote. “You literally have to think about it forever, each and every time, and honor each success and failure by learning something new for the next inevitable moral dilemma that’ll be along any minute now and is probably already here.” This is why you don’t get to give up. You get to sit down, or step out—in fact, you have to, or you’ll collapse. But eventually you will have to get back in again and answer these moral and structural questions:
Given the conditions I’m in, what will I do?
How can I enact fairness within unfairness, kindness within unkindness?
How can I be fair and kind to someone and to myself as well?
When do I favor them over myself, myself over them?
What if I choose wrong?
These are basic human questions; wanting an end to them is understandable, because they’re grueling and it’s often a case of the least bad answer rather than a good one. But they will never end. Efforts to end them once and for all will kill a lot of people and still not work. You yourself will likely become weak and ill, if you live long enough, and you’ll need care. You may be, in the course of needing that care, unkind. People tasked with providing that care may also be unkind to you. I hope that they will not. I hope that it will be easier to care for you, or for me, because the people caring for us will be well-paid, well-supported, well-rested, unafraid. With that in mind, I am going back out to the line this week, probably with a bag or two of tangerines.
“Management gave us a set of proposals with lower wages, higher health care costs, less on retirement and no movement on our workplace violence committee,” another nurse delegate said on May 29. “We are more than ready to return to work and resume caring for our patients, but we should never have to choose between our safety, our livelihoods and the profession we love.”
I wrote a book, LESSONS FROM THE CLIMATE ANXIETY COUNSELING BOOTH: HOW TO LIVE WITH CARE AND PURPOSE IN AN ENDANGERED WORLD (Hachette Go, 2024). This newsletter holds the ways that what's in it has branched out: new reflections, events and workshops, unresolved questions, further reading, ways to connect and act. I'm glad to be here on earth with you.