The Worst Thing You can Say to an Anxious and Confused Person

by Jackie Levin | Dec 13, 2016 | 5 Comments

“Between stimulus and response there is a space. In that space is our power to choose our response.”

Viktor E. Frankl, Man’s Search for Meaning

Several years ago, around 4 PM on a Saturday afternoon, I arrived with my mother at a seriously overcrowded New York City Emergency Department, 24 hours after her cardiac catheterization.

We came by ambulance after she rapidly decompensated from her elegant and together-savvy-self into a confused and contracted incoherent woman. Searching for a cause, it seems most likely that she didn’t eat or drink enough since the procedure, became nauseous, then anxious and started hyperventilating. Still, there was no way I could fix this myself at home.

While we wait for a physician, my mother repeats the same two questions, “Jackie, what are we doing here? What’s this for?” as she pulls at the IV tubing.

“Mom, you became dehydrated and now you are getting fluids through the IV.”

Hours go by. I watch the IV drip at a snail’s pace and resist a compelling urge to reach across my mother’s chest, sneak a turn of the stop-cock and open it up.

Instead, I leave her and go to the desk and ask when the doctor will get here. I am as repetitive to them, as my mother is to me.

The intern comes and goes, a resident comes and goes, and still the IV drips on. My mother tells them, “No,” she doesn’t have a cardiac condition.

“Mom, you just had a cardiac catheterization yesterday.”

“I know, that’s why I don’t have a heart condition.”

My eyes roll (I’m embarrassed to acknowledge).

Another hour and we still wait for the doctor and his or her evaluation and an answer to my prayer to give my mother more fluids through the IV. I move to the foot of the stretcher, part the curtain, and with an edgy curiosity, scan the other waiting patients and family members through their open curtained rooms.

Across the way and along our bank of stretchers, under the bright ER lights, families are pacing, reading, talking on cell phones, and some are even dozing. I’m sure they are waiting hours like we are.

My thoughts darken from possibly doing one crazy act (taking on the decision to manage my mother’s IV) to thinking maybe we could band together and start a riot.

My mother, calls my name, asks her two questions again.

“Just Relax, Mom!”

Ugh. With these two words, “just relax” I feel myself deflated. I’m a failure as a mindfulness practitioner, stress-reduction teacher, and a daughter.

Why “Just Relax” Doesn’t Work

I’m not sure what your experience is, but “just relax,” said as a command, rarely works. It’s really quite annoying and can even become fighting words.

“I don’t want to relax!”

“Why should I relax!”

“You’re telling me to relax?! You relax!”

My mom scowls and turns away from me.

When one is anxious and confused, relaxation is counter-intuitive to the brain in it’s attempt to survive a threatening situation.

Recognizing my slip-up, I grant myself a little moment of humor. If I had said, “Run!” to my mother, that probably would have made more sense. But “relax”, not so much.

The good thing about having a Mindfulness practice, though, is that even if it’s not the first thing you grab onto, you always get another chance.

“Between stimulus and response there is a space. In that space is our power to choose our response.”

Viktor E. Frankl, Man’s Search for Meaning

And that’s what I did.

After those dreaded words came flying out of my mouth, I knew not to speak until I sorted out what was going on inside me. After a couple of mindful breaths, I mentally took in my situation.

The whole city is on diversion and the doctors and nurses are scrambling to see everyone. My mom is intermittently confused and anxious, she’s getting some fluid and for now, she is safe.

Me, I’m worried, but I’m also mad, or maybe I’m really disappointed in myself, that I didn’t protect her better, that I didn’t see this coming. I feel I let her down.

What to do when stressed and worried and want to help someone who is anxious and confused?

Step One: Take care of yourself. This is one place where you do want to place the “proverbial oxygen mask” on yourself before attempting to support someone else. It’s easy to say “relax,” but far more effective to show how to relax. So here is where you breathe. An intentional focused breath is a powerful stop gap between thoughts, emotions and the reactions that follow.

Step Two: Check in with yourself in a compassionate way.Name that you are worried, tired, exhausted, not in the mood to help, frustrated. All those things that arise when worried and scared. That softens the road ahead. For me, this was my mom, after all, and I was living somewhere between fear there could be something dangerously wrong to incredibly impatient, (pretty) sure it was a simple problem to fix. As a nurse, I wanted to be perfect and help her. Recognizing I’m human, let go of some of the tension.

Step Three: Give the person some control. Before you attempt to show someone how to relax, spend a few minutes observing them to find their strengths. In my mom’s case, her mind isn’t retaining information, so no amount of explanations is going to help. Instead, I hold her hand, let her know that I am with her. Then, instead of me telling her how to feel, e.g. “just relax,” I ask her to tell me how she is feeling. She has some level of control and I can respond to an actual need.

It’s nearing dawn, my mom has been evaluated, a nurse opened the IV wide, and she is more coherent.

She asks one more time about the IV. “Why do I need this?”

I say calmly, “You were dehydrated and you needed fluids.

She says, “Well, the only fluids I need now, is a scotch and ginger ale.”

She’s back.

*******

Over the many years since that night, I’ve had loads of opportunities to practice that pause, sometimes after I’ve reacted, but mostly now, I recognize the stress trigger before it has it’s talons on me. And I’m much calmer and patient amidst the everyday stressors and pressures at work.

I know the nurses and physicians that night were doing their best under difficult circumstances, but the truth about health care is, it’s always difficult, always busy, dynamic, complex, variable.

It’s one of the reasons I practice mindfulness meditation regularly and focus my work on teaching other health professionals mindfulness practices, so they too, find moments of stress are handled with greater ease and calm.

Do you need less stress and frustration, so you can work with more ease?

Research shows that health professionals who learn mindfulness meditation:

improve their effectiveness at making decisions,
enhance their communication with patients and with colleagues,
get more rest and sleep and more work done in less time,
enjoy their work more and,
manage the stressors of a dynamic, complex and at times, inefficient system, with greater ease and mastery.

And are happier.

Mindfulness practices literally transform life and work from the inside out by the function of neuroplasticity and increased awareness of triggers; fixed patterns of our brain become more fluid, flexible and resilient.

I want you all to have an opportunity to learn mindfulness and that’s why I created my course, Room to Breathe: Rewiring for Ease.

Room to Breathe: Rewiring for Ease Mindfulness Course for Health Professionals is open for enrollment through March 31, 2017.

Much appreciation and love for all you do everyday,

Jackie