When I worked as a veterinary anesthesia technician in a university setting, every other weekend I was on call (that place of dread where boundaries are essentially non-existent) for 48 of those hours. One occasion fell on the day after Thanksgiving, and actually began the night before with the emergency department requesting my presence for a procedure at 9 AM the following morning. I barely got any sleep that night worrying about the case the next day.
After the “planned” emergency case, I received another, an MRI/spinal surgery on a Dachshund – adding five more hours to an already long day that was supposed to be a “holiday.” When the day was finally done, I proceeded to the final task of every shift I ever worked: walk the barn. Anesthesia technicians are on call for both small and large animal cases, and it is a superstitious tradition to walk through the large animal side before leaving to see if any patients might need anesthesia. By this point It was 4 PM and my day already felt unusually long – likely since for me it “started” the night prior as I began to think about the case.
There was an Appaloosa gelding being worked up for colic, and noticing the extent of the diagnostics being performed, I set up the colic surgery suite, anticipating the next few hours to be taken up by the large animal medicine staff trying several rounds of sedation on the horse before the decision to go to surgery would be made. By 9:30 that evening, the team decided to proceed with surgery. Anesthetizing a horse for colic surgery at any hour is as demanding a job as there is in veterinary medicine but when it is done in the middle of the night (which of course it was when the horse did not improve), one thinks of fishing boats on the Bering Sea at night in wintertime. Disaster feels closer than usual, and you depend on each other to live through it.
The faculty surgeon and I anesthetized the horse and the OR tech, surgery student, and residents from emergency and surgery all joined in the elaborate dance of preparing the horse for abdominal surgery. The sense of “crew” is always increased within teams that trust each other in weird situations like midnight colic surgery. There is also the absence of hierarchical pettiness that seems so prevalent during daylight hours. The surgeon asked if he could help me with my many tasks of getting a horse to the maintenance phase of anesthesia before he scrubbed in. I gratefully accepted his offer and gave instructions, and we were ready for incision in half the time.
We finished up at 3:45 AM, and the horse rolled smoothly into a preparatory position to get to its feet in the recovery stall. The resident and I managed the head and tail ropes to steady the horse when it decided to try to stand. As the horse rested to gather its wits to rise, my phone rang. A dog with a foreign body. The surgeon saw my face and said, “Go take care of it, buddy, we’ll clean up.”
As I drew up the drugs at 4:15 AM for what had to be the last case of this interminable shift, unable to measure the exhaustion, the large animal faculty surgeon appeared and asked if I would like anything from Waffle House. I asked for a very large coffee, and secretly noted this instance of a professor “crossing over” to offer help to another department. Seeing the sun as I walked out was defeat and victory. I remember nothing about driving home or making it to bed.
In the years following that twenty-three-hour shift, my reflections have centered around the sustained exposure to the proximity of disaster due to being on call for 48 hours and having that time filled with potentially life-or-death situations. But as I tell it now, I chose to highlight the times when I let someone help me in a situation ruled by self-preservation. Why?
As we will learn in this exploration of boundaries, letting something or someone in, saying “yes” while in a state of desperate self-preservation, is just as important, if not more so, than keeping something or someone out, or learning to say “no,” despite feeling the fear of losing respect.
Boundaries exist everywhere. Think back to anatomy and physiology and the functions of cell membrane proteins. My old instructor liked to describe their job as “recognizing self.” They were concerned with basic chemical survival questions like: Yes or No? In or Out? We sense and respond to the echoes of those microscopic processes in our attitudes, emotional reactions, and decisions every waking moment, whether we know (or like) it or not.
To accomplish the constantly prescribed task of “setting healthy boundaries” for increased professional quality of life, we need to understand that the boundaries inside and outside us, our own “permeability” in all phases of work and life, are pre-existing and unconscious, and mostly beyond our complete control. What do we shrink from, run towards, allow to touch us, block, resist, or hide from the possibility of? What are we afraid of losing? Boundaries are often categorized in three ways:
- Porous: a person’s behavior is typified by oversharing, overinvolvement, and keeping others (and themselves) “on call,” as it were. They let everything in or out. They are afraid of saying “no.” They are often labeled “dependent,” but are merely operating from the fear of rejection, a form of fear of loss. Sadly, a side effect of porous boundaries is the acceptance of mistreatment.
- Rigid: those with rigid boundaries operate from the need to avoid, to protect oneself, and detach from close social connections. They let nothing in or out. They are afraid of saying “yes.” They are often labeled “independent,” and tragically so because they never ask for help. Being inwardly focused and protective of their boundaries, they fear the loss of respect, and seek to avoid even the possibility of rejection.
- Healthy: A person practicing healthy boundaries values and trusts their own perceptions and opinions. They neither over- nor under share. They communicate needs and wants openly despite fear of rejection. “No” is not taken personally. They manage to achieve the ability to adjust their permeability according to their values, which they do not compromise for anyone.
You may notice how much the two extremes of permeability, rigid and porous, have in common. At their heart, they are the two extremes of fear on either side of love. To practically address the often-prescribed practice of setting “healthy” boundaries, we now have the conceptual background to approach this dynamic system of in or out, yes or no. We behold an ongoing dance, internally and externally, between being vulnerable enough to say “yes” and let in, and being self-respecting enough to say “no,” to shut out.
That means we are all in the middle of an experiment with ourselves and with each other. Everyone has their own “permeability profile,” as it were, shaped by experience and completely different from any other individual we may encounter. What would it be like if we tried something like improving our ability to set boundaries according to our basic needs, our core values, and the wellbeing of our fellows? For example, why not try accepting help every time it is offered for a week or so and see if we do not feel more connected and supported in our work? Or why not power down all our communications technology during time off and see how quiet our minds can become? These are two simple ways to practice Yes and No that are designed to strengthen both our sense of autonomy and the feeling that we are not alone.
The reality is that we all contain and respond to porous, rigid, and healthy boundaries according to our own sensitivities, needs, and confidence in our energy level and adequacy to meet challenges. It might be hoped that every person’s unique repertoire of vulnerabilities and strengths would be accepted and embraced, made clearer by the lines we draw between Yes and No, In and Out. Drawing and enforcing those lines is the act of love we show to ourselves and the world.
Some of The Dance Steps (in no particular order)
- Accept help when it is offered
- Offer help before it is requested
- Ask for the help you know you will need
- Do not mind-read, assuming that “a reasonable person” would automatically know that a need for help exists
- Rejection of an idea is not rejection of a person
- Try powering your phone completely off for a half-hour and see how that feels
- It is OK to have secrets
- Not everyone needs to know everything