Social Work

10 Things I Learned From My First Year as a Social Worker

June 1st officially marked the end of my first year as a social worker. If you don’t know much about medical social work, check out this post. It’s been a rough year in many ways, but it’s also been one that resulted in significant growth for me, both professionally and personally. I was reflecting on the past year and decided I want to share a few things I learned in my first year as a social worker.

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1. Expect the unexpected. From personally delivering (aka riding) a motorized scooter to a patient’s room to being screamed at by patients about the hospital food to arranging an inpatient marriage ceremony  — you just never know what will happen or what you’ll be called to do.

2. Unconditional positive regard is the name of the game. I see a lot of people on some of the worst days of their lives. Either they or their loved one are sick enough to require hospital care. Due to stress, fear, exhaustion, personality, or some combination of these, people are understandably upset and perhaps not their most congenial selves when I meet them. And that’s OK. They don’t have to like me.  Frankly I don’t have to like the patients that I work with, nor approve of their actions. I just need to meet them where they’re at, without judgment. I try to be respectful and compassionate, and I always try to keep in mind that I know almost nothing about the person’s struggles and problems that led them to the moment I started working with them. Unconditional positive regard is something that I will constantly be working on, but I feel like I gained a greater understanding of its importance over the past year.

3. Burnout and compassion fatigue are real.  They aren’t just concepts in a textbook. I knew I was starting to get burnt out a month ago when I found myself feeling tired and overwhelmed and getting annoyed when patients or their families needed my help with complex social situations. I just wanted to do my assessments and get them out the door. That may sound harsh, but it’s the truth. If you’re finding it more difficult to care, you’re probably getting burned out.

4. Self-care, self-care, self-care. To be honest, the emphasis on self-care during graduate school always felt fluffy or overplayed, but I understand the importance of it now. The best way for me to combat burnout or compassion fatigue (see #3) is to take care of myself. The basics — healthy eating, adequate sleep, and exercise — make a HUGE difference for me. I also found that pursuing interests outside of my work, such as writing this blog or volunteering with Make-A-Wish, is especially helpful when work is frustrating. Finally, making sure that I leave on time has been a game-changer for me. It gives me a greater sense of control and helps me feel like work isn’t taking my time and energy away from me.

5. Advocacy is the most important part of my job. Whether it’s identifying systems-level issues that need to be addressed (like increasing access to palliative care options) or making sure that a patient’s voice is heard, advocacy is essential. In medicine especially, I feel like I need to hand out bumper stickers that say, “People have the right to make bad decisions.” I may not agree with someone’s choices, like when patients with an alcohol use disorder choose to go home instead of to a treatment program, but as long as they have the capacity to make their own decisions I will vehemently defend their right to do so.  There’s been more than one occasion when I had to talk to the medical team about self-determination because they were holding up a discharge to push patients to choose the option they felt was best. The medical team’s intentions were good, but it was still paternalistic. Sometimes this kind of advocacy doesn’t exactly make me popular on the multidisciplinary team, but I feel that it’s necessary to respect the patients’ decisions, regardless of my own opinions.

6. Social work skills are just as useful for coworkers as they are for patients. My role in the multidisciplinary team is as important as my direct role with patients. As a medical social worker, my work with patients does not exist in a vacuum. It’s not one-on-one work with a patient. I’m working with the patient, doctors, nurses, physical therapists, occupational therapists, speech therapists, nutritionists, etc. I often end up using the basic skills I learned (i.e., active listening, reflection, boundary setting, empathy, etc.) as a facilitator and to help smooth disagreements between disciplines.

7. Gallows humor is necessary. Like many people who work in healthcare, my coworkers and I make jokes about death and disease. The humor isn’t cruel, and as one physician in an article on Medscape put it, the difference between gallows humor and derogatory humor is like “the difference between whistling as you go through the graveyard and kicking over the gravestones.” Our jokes aren’t at the patient’s expense; they’re a coping mechanism to help deal with the constant stream of macabre circumstances.

8.  The work will never be finished. Everyday I make a list of all the things I should work on, and inevitably I never complete my list. Every time I cross a few things off, a couple more are added on. It has taught me to prioritize and to accept that I will never be done. One of the best adjustments I continue to work on is letting go of the expectations I have for the day. I only get frustrated if I have an idea of how things are “supposed to go.” It’s best if I approach my days with curiosity, wondering what crazy things will happen that day.

9. Life is short. A small but significant number of patients I work with either die in the hospital or leave the hospital on hospice. And sometimes it’s completely unexpected. I recently had a younger person come in for what they thought were gallstones, but it turned out to be stage IV pancreatic cancer. His prognosis is about 6 months. Seeing how quickly life can change is a constant reminder for me to stay in the present and enjoy it and to make the most of the time I have with the people I love.

10. People’s strength and resiliency is amazing. For all of the death, loss, anger, and family disputes happening around me, I am always impressed and inspired by the strength demonstrated by patients and their families. I’ve seen a son step up to care for his estranged father who he hadn’t seen in 15 years. I’ve seen a man move heaven and earth to get his partner home so he could pass away with his beloved cat at his side. And I’ve seen a patient fight his way back from a devastating stroke, regaining the ability to swallow, walk, and speak, in order to live independently again. For all of the negative things that can happen, it’s imperative to remember these moments; people truly are resilient.

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The Root of All That Is Wrong

This weekend my friend Caroline and I headed to downtown Raleigh for HKonJ’s Moral March. HKonJ stands for Historic Thousands on Jones St People’s Assembly Coalition. The purpose of the Moral March on Raleigh is “to hold a mass people’s assembly to reaffirm its commitment to the 14 Point People’s Agenda and to hold lawmakers accountable to the people of North Carolina.” The agenda addresses public education, health care reform, living wages, environmental justice, voting rights, and more.

Though I marched for many reasons, I was most motivated by supporting Medicaid expansion in North Carolina. I find it truly repugnant that the leaders of this state will not expand federally-funded health care coverage to 500,000 of North Carolina’s low-income citizens. It sends the damning message that some lives matter less, and a political statement is more important than those lives.  Reflecting on the fallacious notion that some people are more valuable than others made me think of this quote:

“The idea that some lives matter less is the root of all that is wrong with the world. ” -Paul Farmer

This is why social justice is the keystone of social work. I believe my most important role is to make it known and understood that all lives, especially the lives of those who are disenfranchised, matter.

P.S. If you don’t know much about Paul Farmer, I highly recommend Mountains Beyond Mountains by Tracy Kidder.

The Impeded Stream

One of the oldest sayings in social work is, “I’m a social worker, not a miracle worker!”

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While it’s mostly a joke, I am frequently called into situations when no one knows what to do. In some ways, it’s intimidating to be viewed as the resident problem solver, but I also love the opportunity to be creative and explore options. Those “What now?” situations can be frustrating, especially if I’m in a time crunch or none of the options are good, but they keep me on my toes and teach me so much, no matter the outcome. My friend Caroline introduced me to the following poem, and it resonated with me. Perplexity, though trying, is what brings out my best work and the most important lessons I learn.

It may be that when we no longer know what to do
we have come to our real work,

and that when we no longer know which way to go
we have come to our real journey.

The mind that is not baffled is not employed.

The impeded stream is the one that sings.

– “The Real Work” by Wendell Berry

Compassion Hurts

One of the trickiest things about social work (or really any helping profession) is genuinely caring about people without taking on all of their burdens. Obviously most people are attracted to helping professions because they want to do just that: help. However, it’s easy to see why people burn out in social work and related fields. As caring people, there is a tendency to empathize and take on that person’s pain, but you also need to be able to step back and see the problems without being overwhelmed by them. I was recently introduced to the quote below, and it resonated with me. It speaks to the paradoxical nature of being a social worker; you must care deeply but retain a certain level of detachment.

“Compassion hurts. When you feel connected to everything, you also feel responsible for everything. And you cannot turn away. Your destiny is bound with the destinies of others. You must either learn to carry the Universe or be crushed by it. You must grow strong enough to love the world, yet empty enough to sit down at the same table with its worst horrors.”  – Andrew Boyd, Daily Afflictions: The Agony of Being Connected to Everything in the Universe

 

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