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Vital Exhaustion

When I heard Roshi Joan Halifax use the term Vital exhaustion I had a visceral experience of recognition. A profound part of me resonated with those two descriptor words which are also a metaphor. Experimenting with the term, trying it on so to speak for the last few months, I am sharing it with you to help you nuance your understanding of where you may be at in terms of Self care, burnout, compassion fatigue and compassion satisfaction. Next week’s blog will address the last 3 experiences and working with assessments of these experiences to begin addressing the symptoms and underlying causes. The term is not new and it has an interesting history, let’s take a peek.

Vital Exhaustion

Metaphors help us articulate and understand our experiences as sentient beings. Merriam-Webster defines vital as, “concerned with or necessary to the maintenance of life”. The term Vital exhaustion touches all of our interpenetrating fields: physical, emotional, mental and spiritual- and maybe especially the last. When I heard the term Vital exhaustion it was as if the spiritual part of me felt heard too.

In the early 1990’s the concept of Vital exhaustion was explored by cardiologists Appel and his associates. They reported three defining characteristics: (1) feelings of excessive fatigue and lack of energy, (2) increasing irritability, and (3) feelings of demoralization that precedes myocardial infarction and sudden cardiac death. “Therefore, it was suggested that Vital exhaustion is a mental state at which people arrive when their resources for adapting to stress break down.” (my italics)

In 2010 it was reported that European psychiatrists have been using the term Vital Exhaustion as a possible way of defining a  nervous breakdown “which is defined by its temporary nature, and often closely tied to psychological burnout, severe overwork, sleep deprivation, and similar stressors, which may combine to temporarily overwhelm an individual with otherwise sound mental functions.”

Research in Heart Math, in “the past two decades has shown that the heart is an information processing center that can learn, remember, and act independently of the cranial brain and actually connect and send signals to key brain areas such as the amygdala, thalamus, and hypothalamus, which regulate our perceptions and emotions.” Though we don’t know where Spirit lives, it is based in a unitive experience and sages refer to the wisdom of the heart. Vital exhaustion seems to relate to the organ of the heart, and to other fields of human experience. Maintaining Vital energy needs to be ongoing and planned. By putting  Self care into my calendar daily it has become a habit. Otherwise, it is easy to act on automatic pilot focusing on lengthy “to do lists” moving to exhaustion and becoming drained of Vital energy.

When you contemplate the term Vital exhaustion, what is your experience? What part of you responds- your mind, body, emotions and/or spirit? Over time you may notice that it takes on different meanings depending upon different stressors in your life and your ability to tune in and care for your Self.

Next week we will contrast Vital exhaustion with burnout, compassion fatigue and compassion satisfaction and look at measuring them. In the meantime, notice your experience of your Vital energy. Can you give it words? What strategies and tools do you employ to manage the stress in your life? What do you do to maintain your Vital energy? Do you take time in nature? Maybe you meditate, pray, journal, spend time with pets… Share with us what do you do to nourish your beautiful, kind, generous, courageous Self?

Some find our   Self Care for Vitality a free Virtual Connecting Weekly Call-in for Nurses a form of nourishing Self care.  There is a short guided relaxation, followed by a short time for silence in community and optional sharing.

Wednesdays 6:30-7:00 pm EST   Phone 712-432-3066 Pin 177444  You are welcome to join us.


Vital Exhaustion, pp 2032-2033, ©2013, Douglas Carroll
, http://link.springer.com/book/10.1007/978-1-4419-1005-9

Benedict Carey, http://www.nytimes.com/2010/06/01/health/01mind.html

Awareness Begins in the Heart, Not the Brain, http://www.mindfulmuscle.com/heart-has-consciousness-knows-before-brain/


Healthcare: A Right or A Privilege

Yes or No: Do you agree with Dr. Martin Luther King, Jr. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

In 1948 the Universal Declaration of Human Rights was created. Article 25 states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”  Wikipedia https://en.wikipedia.org/wiki/Right_to_health

The 115 Congress and President-elect Trump speak of removing the Affordable Care Act (ACA) and privatizing Medicare and Medicaid. As a citizen and a nurse, you are called to consider: is health care a right or is health care a privilege? As a nurse in North Carolina, I see the inequities and feel the pain of the injustice as the state legislature refused to accept the Medicaid expansion funding that came with the ACA. (There are now 1/2 million without health care because of this.) The ripple effect touches every aspect of life in this state. The economy has fewer jobs, an increase of more than 24% of children under 18 living below the poverty level in the last 5 years. There are fewer health care providers and consequently, there is less care provided with the already worn caregivers shouldering more responsibilities. Perhaps most especially nurses…

The National, Economic, Social Rights Initiative writes:

  • The human right to health guarantees a system of health protection for all.
  • Everyone has the right to the health care they need, and to living conditions that enable us to be healthy, such as adequate food, housing, and a healthy environment.
  • Health care must be provided as a public good for all, financed publicly and equitably.

Take a minute and breathe. Contemplate privatizing health care. What are your thoughts and feelings about this? Is there a difference between health care and insurance care? What are the physical, emotional, mental and spiritual costs and benefits of each for our families, friends, our neighbors and the public in general? How does it impact your work?

Dr. Don McCanne

writes a daily health policy update, taking an excerpt or quote from a health care news story or analysis on the Internet and comments on its significance to the single-payer health care reform movement. On January 10, 2017 he commented on an interview of President Barack Obama by Ezra Klein and Sarah Kliff of Vox Video.

He writes:

Virtually everyone wants affordable access to health care, for themselves at least. Most want a better system than what we have under the Affordable Care Act. But the nation is divided as to whether ACA needs to be repealed prior to improving the functioning of our health care financing system.

So the point is that there is broad agreement that we want the system improved, but the Republicans, who are in control, are hamstrung by their anti-government ideology which prevents them from offering the government solutions that we would need that would actually be effective in improving the system.

Repealing ACA would further impair the functioning of our system, so the Republicans would have to introduce effective policies that would more than compensate for the deficiencies that would be created by repeal. Almost any piecemeal solution would require greater regulation and more government spending, anathema to the Republicans. Suggestions to date coming from their camp would leave us worse off than what we currently have. It is no wonder that they refuse to tell us what their replacement proposal would be.

If they really do want to improve the system, and they say they do, then they have two choices. Either provide beneficial tweaks to the current system, which will cost more and require greater regulation, yet fall far short of reform goals, or replace the current system with a single payer national health program – an improved Medicare for all. The latter would greatly improve the financing of health care, ensuring true universality, improved access, greater choice in care, and affordability for each and every individual. And we could do that without increasing spending above our current level.

The Republicans have an opportunity to provide us with a replacement program that would be vastly superior to building on our current dysfunctional system. Both President Obama and President-elect Trump have acknowledged the clear superiority of a single payer system. Most progressives, a majority of moderates and a plurality of conservatives agree. Now all the Republicans need to do is show us.

Engaging in these conversations is not easy. I work with nurses who say, “I‘m not political.”  However,  health care is not a spectator sport. It is about people’s lives- the quality, the safety, and the sanctity of life. If you believe that healthcare is a right, then figuring out how to make it affordable and accessible is a priority and you need to be at least informed and when you are moved by your conscience become active.

Medicare is not perfect, but it has made health care accessible to many of our loved ones. Why not expand it so our full society benefits? The slogan, “Medicare from womb to tomb” gives me hope.

Video: https://www.whitehouse.gov/videos/2017/January/20170106_President_Obama_Interview_with_Ezra_Klein_HD.mp4

Transcript:  https://www.whitehouse.gov/the-press-office/2017/01/06/remarks-president-vox-live-interview

With love,


Healing, Authenticity and the Paradox of Boundaries

Boundaries are elusive, energetic, practical, conceptual and permeable. Understanding your boundaries is essential to compassionate, healthy relationships with your Self, your family, your friends, and your employers. Living an authentic life means knowing your limits — your boundaries around what is okay/not okay — and making it clear to yourself and others.

Boundaries maintain your integrity. But setting boundaries isn’t just about saying “no” or carving out time for self care (although it is about those things). What about your actual, physical space? The fact is, each living being is an electromagnetic energy field (invisible to all but a few highly sensitive folks). That energy extends beyond our bodies, commingling with the energy fields of others. In other words — we are all connected.

Your boundaries will change depending on who you’re with, how you’re  feeling, what you eat, how much time you have, and what’s going on in your electromagnetic space.  Your fields — internal and external, personal and professional — swirl together with those of your peers like one of those colored moving sand art toys.

So essentially, boundaries aren’t just “yes or no,” or “set it and forget it.” They’re permeable, ever-changing, and largely conceptual. Legal and professional boundaries provide protection for health, well being and healing.

Nurse Practice Acts of each state basically agree:
“Patients can expect a nurse to act in their best interests and to respect their dignity. This means that a nurse abstains from attaining personal gain at the patient’s expense and refrains from jeopardizing the therapeutic-patient relationship. In order to maintain that trust and practice in a manner consistent with professional standards, nurses need to be knowledgeable regarding professional boundaries and work to establish and maintain those boundaries.” The nurse’s interior influences what happens in the care recipient, and vice versa —  so nurturing healthy boundaries is both  ethical and professional. Preventing burnout, is elemental to the process of protecting the sacred bond that exists between nurses and those they care for. It is also important for healthy employee/employer relationships.

How you practice Self care, and how you care for your mind and heart, has a direct influence on your consciousness.
It’s the first and most important piece in creating authentic connection — to your Self and to others. The trick is to simultaneously recognize and honor your boundaries and your interconnectedness. Celebrate your uniqueness as an individual and your connection with others. Imagine a big sound echoing off a mountain. Although we may no longer hear the sound, it rises up and continues to reverberate in time and space. Just because you can’t see something (like the electricity that turns on the light, or the electromagnetic fields connecting you to every other living thing) doesn’t mean it’s not there. Such is the illusive nature of boundaries, and the value of understanding our connectedness as humans, as caregivers and care recipients.

A recent participant in the VIP program spoke of signing off on letters with “Take care… Give care.” Good Self care makes it possible to both give and receive, recognizing the paradox and fluidity of boundaries, and the ethical imperative of preventing burnout by setting healthy personal and professional boundaries.

What are your experiences of your boundaries being crossed, maintained, and permeable? How do you experience your electromagnetic field?  What do you think about the idea that preventing burnout is an ethical issue?

Let me know.

Take care of yourself…

With love,


A note from Padma August 2016

Conceptual peace and cultural diversity symbol of multiracial hands making a circle together on blue sky and green grass background.


As some of you know, when I chose the sacred and glorious profession of nursing I was clueless about how deeply it would grow me as I showed up being a nurse in various settings. Since graduating UNC Chapel Hill in 1974, with a Bachelors in Nursing the nursing process: assessment, diagnosis, plan of care, interventions, and evaluation are in the marrow of my bones.  It colors the way I experience and operate in the world as parent, daughter, friend, colleague, teacher, caregiver and fellow on the spiritual path of love. Nursing has touched every aspect of my life. Being a nurse reminds me “that we are all in this together.”

If one person is suffering, we all are. And, that deeper than interdependent, we inter-are. understanding Inter-being

Wow have there been changes in nursing, health care and in me in the last 42 years.

Being a nurse gave me the opportunity to work with my colleagues at Lenox Hill in order to unionize in the 1980’s.

Nursing has given me the research to back up my experience of distance healing.

Martha Rogers was my professor at NYU on the Science of Unitary Human Beings in 1976 Nursing Theory – Unitary Human Beings . Her grand theory and the training in Therapeutic Touch that I received at Pumpkin Hollow Farm with Delores Krieger and Dora Kunz began the expansion of  my understanding with regard to human health and the interplay of fields and systems; the complementary approaches in health care. Research now shows that what was once labeled “alternative” is now one of many models, in addition to the medical models used in addressing health care issues.

Nursing has offered me many ways of supporting my family

Doing my best to balance family and work life, I healed from burnout several times and stayed in the profession.  This profession has always been here for me as a source of income and just as importantly a deepening of my spiritual and emotional intelligence. For example, after working med/surg at NY Hospital and Lenox Hill, I realized that developing a private psychotherapy practice in Manhattan gave me the opportunity to help people experience and heal on emotional, mental and physical levels that we could not address in the hospital. Knowing that birth is a natural event, finding out what is important to parents and helping them to achieve it was another way of being a nurse. While home educating my 2 daughters, I happily became a certified Bradley childbirth educator in my area. bradleybirth.com

At the other end of the life spectrum, dying is again a natural event and working as a hospice case manager for 14+ years, my work reflected “the science of caring is the art of nursing.” Current Nursing Theory

Assisting dying people, caregivers and colleagues in approaching the process from an integral perspective, I recognized that the transformation of one impacts everyone, including the nurse. I also co-created with the Director of Volunteers,  an 11th hour certificate training program for the volunteers based on my training at the Metta Institute. Metta Institute

Nursing is now giving me the opportunity to continue to serve in a new way.

Above Image for NL#1(This picture is one I took- the idea of sharing what I have to offer, and of sowing seeds…)I have learned so much from patients, colleagues, friends and family going through the ups and downs of being human on this planet. I also continue to learn from you as I navigate the unfamiliar territory of social media and entrepreneurship. I’ve continued to work with nurses, patients and organizations and or the last 2 years I have been creating a business,
Integral Nursing Solutions, PLLC-

As health care continues to evolve, so have nursing roles. Self-care and resilience are buzz words in the lexicon of nursing programs, departments, research and education. A lot is being said about self-care and INS is designed to support the implementation of self-care practices by providing both in person and online programs and workshops with CNE credits to nurses and the organizations that employ nurses. Humans grow and heal in the loving, supportive company of others. Integral Nursing Solutions provides the personal and loving support that is needed to develop internal strengths to manifest the courage to be vulnerable enough to grow in new ways that heal us. Helping nurses to develop personal keystone habits that support them as they provide the dedicated and beautiful service they offer in the world of nursing, healthcare and beyond.

This newsletter will be posted periodically with articles that I write and that you or others write. So, if you are a nurse and/or a writer, and would like to post here, please feel free to send me your posts. The world is busy and if you get to a point where receiving the email no longer meets your needs, you can always unsubscribe.

In the meantime… Welcome and I look forward to our conversations and collaborations.

The next newsletter will include: Why the name Integral Nursing Solutions and the logo of a honeycomb?

Sending you blessings for clarity, joy and delight till we visit again.

With love, PadmaINS-logo-cells-only-summer

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