I Should Have Said No

Can you see this patient today?
His appointment is tomorrow,
he came all the way from Nebraska.
Can you work extra tomorrow,
we are short, just four hours extra?
Would you be able to work Christmas this year?
I know, I’m sorry, you’ve worked most of them
but Sally’s mother is dying.
Can you work extra weekends?
When she quit, that put us in such a bind.
We need you in now, a mass casualty alarm.
I need you to be on this new committee.
You’ll have to work harder today,
Ben’s child is sick, no one can come in.
You’ll have to go home today, the census is low.
No, you don’t get paid you’ll have to use vacation time.
Can you come in, there is a disaster alert?
Can you move any of your patients?
I know it’s 7 pm, but the ICU is full;
we have a code blue coming in.
We have a new consult; I know it’s time for you to leave
but this patient is sick and needs to be seen.
There is a new computer update
we have to chart even more data.
No, I’m sorry you can’t have your child’s birthday off
we really don’t have the extra help.
You will need to prove you are competent,
here are twenty tests to take each year.
No, we can’t hire more relief, they cost too much to train.
No, you can’t get a raise, yes I know
the cost of living here has skyrocketed.
Our study shows we pay what local hospitals pay.
The cost of your health insurance is going up again.
Yes, I know I wish it included natural medicine too.
We want you to take a survey to tell us
how happy you are working for this organization.
The patient you just saw has no insurance.
The patient you just saw cannot have that test,
his insurance company is denying it, can you call them?
The patient you just saw is complaining about you.
The patient you just saw wants to change providers.
The patient you just saw fainted in the waiting room.
The patient you just saw asked for your phone number.
Can you be on call tonight?
Oh, you were on call the last four nights in a row?
You’ve gone without sleep for 48 hours?
How can that be, you only have 15 people on your list?
Can you take this extra shift?
Your last patient just called they are on their way,
their child was sick and they had to find a babysitter.
The patient in room 301 has taken a turn for the worse.
The patient in 222 wants to leave, now!
There was a large crash on the highway can you stay?
You missed one of the medications on discharge,
Medicare isn’t going to pay for their stay.
You forgot to add this to your patient’s record.
You forgot to chart his allergies
You really need to lengthen your history and physicals,
we can bill higher if you chart more.
Can you see this patient during your lunch hour?
She called complaining of incisional drainage.
Can you call this patient back today?
She sounded like she was in a lot of pain.
You’re going on vacation again?
You say you really want to retire?
What would you do in retirement?
You spent so much time and money on your career
You have so much respect in the community
Everyone loves you, you’re the best!
You say you would never have entered healthcare
if you had to do it all over again?
What can I do to help?
It’s too late?
Are you sick?
Are you ok?
Don’t cry.

Lynn Kincanon has been a nurse for thirty-six years. The first fifteen were spent in intensive-care units and emergency rooms across the US. For the past twenty-one years, she has been a nurse practitioner in cardiology and cardiovascular surgery at The University of Colorado Health, in Loveland, CO. “I do a lot of performance poetry, as well as creating poetry shows that include music and storytelling. I have published two chapbooks, one produced with a grant from the National Endowment for the Arts. I am currently writing a book of poetry about my work experiences that includes observations about life and death experiences, both in the human form and in the natural world.”

About the Poem

“This poem is a culmination of everything, written at the end of my career. While I have loved my work as a nurse practitioner, looking back I realize that a great deal of my life was consumed by a work ethic that I’ve come to see was bringing me close to burnout. This poem was inspired by a New York Times article about doctors and nurses being taken advantage of by the healthcare system.”

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49 thoughts on “I Should Have Said No”

  1. Beautifully put. Thank you. A healer post-stroke who is still a healer trying to reinvent myself. If it’s what you are meant to do, you find a way, but yes, you learn to say no.

  2. When I left medicine (Board certified subspecialist, medical director) in May 2019 I called it retirement. In reality you could think of it as escape before it killed me. Your words apply to many of us and are so very eloquent. I still feel guilty for “abandoning” my colleagues (nurses and doctors and the others who entered medicine to help and heal others) but I was unable despite many efforts to make a difference in the workplace abuse from corporate administrators that had no idea what they were making us do. Thank you for this truth speaking.

    1. Deb, your comment is a powerful testimony to the toll it takes. I think the one thing that I regret the most is not making a difference in this arena. Yes I made a difference in the lives of my patients and coworkers, but not in the overall system. I did speak up telling the administration of the over worked and understaffed stress. I did speak up and ask for sessions to defuse and to process trauma and grief, I did speak up saying we needed more help, I did speak up…but ultimately I see, especially today in this unspeakable time of COVID stress, that these things are very very hard to do in a profit driven system. I would love to hear if it is the same in countries such as Canada and Great Britain where Doctors are asked to see patients every 15 minutes and nurses are asked to take care of too many high acuity patients. I think using my voice in this area may help someone, somewhere feel like they are not alone and able to change their lives even a little to make it more whole, more holistic for themselves not just for their patients.

  3. As a personal friend of Lynn’s I have seen the toll her work has taken on her life and health. However, her dedication and efforts to provide the best care has always been her strength!

    Also, as a wife of a husband who was chronically ill for over 25 years I spent many hours in hospitals and offices in the care of excellent dr’s and nurses. My husband was given many more years of life than had been expected and we saw first hand time after time the grueling hours our medical heroes endure.

    Two weeks ago my primary care Dr. shared that he is retiring at age 60. He’s had it and expressed concern for those in this field who are just beginning. The demands continue to build for those caring for the sick.

    I thank Lynn for giving voice for those who have felt the same and are able to know they are not alone. You have given them a gift that will last forever!

    1. Thank you, Melissa. I had no idea your MD was retiring. I understand his concern for those who come behind him. There are some amazingly dedicated doctors and nurse practitioners and PA’s out there. What we all want is fairness and balance in our lives. I feel as if I have worked in the best and worst of times. I have had a fabulous career, but you are right that it has been fraught with being overworked and underpaid (especially for the hours I worked). My career started in the AIDS crisis and is ending with COVID, what a wild ride.

  4. Lynn, you’re writing is stunning and is a stunning portrayal of endless
    and varied tasks taken on by those I refer to as “angels on earth”. Your description certainly reflects what I had always imagined was happening on a daily basis in the world of nurses. I wish everyone could read this poem so that they would understand and treat nurses much better than is typical. Nothing to be taken for granted for all the sacrifice these hard working professionals go through on a daily basis. Thank you.

    1. Thank you Sharon. Half of the reason or should I say most of the reason nurses and nurse practitioners work so hard is because they love their co-workers and they love their patients and they love the work they do….It is a profession that really needs a boost of power. They are in need of being able to have a lot more control over their career and their lives. They have the right to work in a safe environment where staffing levels are appropriate for the acuity levels of the patient. So much has to change, I just hope it continues to do so.

  5. Lisa R Henderson

    Well said and entirely truthful.

    And if one should drop dead at work, the help wanted ad will be placed before your obituary runs.

    1. Wow, Lisa…what a powerful comment. My dad always told me that no one is indispensable, and to think you are, to work like you are is a mistake….thank you for your comment

  6. Kathy Kincanon Nosek

    Lynn, that was so eye opening and at the same time, somewhat familiar, as I know you so well my dear sister! We have many teachers in our family, but you are the only one in healthcare. I have always admired what you do, and do so well. I know full well I could never walk in your shoes. I have heard your stories throughout the years, and I always wondered how you did what you did. I know when our own mother was living with Joe and I, she would ask me to do a simple thing, (but in my mind it was a huge medical procedure), I would immediately tell her, “wrong daughter.” Your profession is a calling, and you are an angel sent from heaven to do everything in your power to heal the sick. When mom was dying you were at her bedside 24/7 for weeks without a second thought. Your presence was so appreciated, you not only gave mom comfort you gave me a reprieve, and because of the circumstances that brought her to her final place, I never would have had that. Mom was in the best possible hands with you, which I know could not have been easy on you. All these years caring for others has brought you right to this time of retirement. My wish for you in the years ahead; every single happiness; doing all the things you love to do, you deserve it all. I cannot wait to share the years ahead with you after 2020 has taken that very precious time from us and many others. I love you. Kathy

    1. thank you for your comments Kathy, for the years ahead, for all the times I never came home for the holidays because I was working!! Like I said in my poem, I would do it differently if I had to do it all over again, but we have many more years ahead to enjoy time together…though my one regret is I don’t have those years to make up with Mom and Dad
      .

  7. I am a person outside the medical field who has had the good fortune to avoid hospitals through most of my life. When I read this poem I hear how unreasonable and unnecessary pressure is put on the health care provider. I imagine the focus of the medical industry has drifted to profit centers and efficiencies, forgetting it is flesh and blood human beings actually providing the services, healing patients. The long hours, shifts in schedules to maximize profits for the organization, hazardous work without hazard pay or other consideration. I really wonder if this is a sustainable model. I can imagine a world where nurses are treated as the dedicated professionals they truly are, earning fair salaries, with scheduling and management that keeps an eye to fostering stability and preventing burn out. A kind gentler system just might result in better health results for patients.

    1. Eve, that is my fondest hope that the system will continue to change, or the employees will change the system. Something has to change.

  8. As a lay person (i.e., patient), I knew the situation was bad, and getting much worse with the pandemic, but this extraordinary poem describes a situation far worse than i had imagined. Thank you for your honesty and your craft.

    1. Thanks for reading and commenting on the poem. I think there is a statistic out there that more than half of health care providers would not go into health care if they had it to do all over again. My whole career obviously had some amazing times in it, I was there for the incredible patients and their families and my co-workers. The institution that I work for now (UCH) is actually an institution that has really made a lot of strides in trying to take care of its employees…but nothing can be done when nurses are short-staffed, or the census is high, or acuity is high. This poem was even written before COVID!

  9. I can relate to so much in this poem and I still have nightmares of being the ‘fixer’ along a conveyor belt of broken patients. And that was from working in community health clinics, not in hospitals. The pandemic, or more precisely, our country’s failures in dealing with the pandemic, is causing more and more nurses, physicians, and other healthcare providers to burn out.
    Thank you for sharing this powerful poem.

    1. Josephine, I would go up and down the scale of burn out in any given year. Very little attention is paid to this, the inordinate stress that one is put under, the way the system continues to squeeze us into time slots, the harsh reality of higher acuity of the aging population, the way mental health is delivered, the addictions, the unresolved grief and pain, it was really overwhelming! I think one of the greatest unspoken stresses is how we are all perfectionists…feeling as if we cannot make a mistake, that we are more than human in this regard. I must say it was a banner day when the pharmacists in our organization took a greater role in guiding practice and adhering to guidelines and it is always appreciated (at least by me) when nurses would come to me with questions about a given order. …..sometimes when I review any day in the life of my career I wonder even how I made it through that day. My answer…with reading and writing poetry, with walking among the trees, with dance. I hope you are working in a field that brings you joy.

  10. Thank you for writing this, Lynn. The expression comes through very clearly. I am thankful for your sacrifice as a provider.

  11. Yep, At every stage of my education and medical training I was sold on the idea, that it would GET “easier”, when in fact as your level of responsibility increases the ETHICs and responsibility of MEDICINE becomes consuming and our Medical Directors know well how to exploit our vulnerabilities, get us too do 36 hour shifts, put off our personal needs and time, and we want to HELP each other out, even when we never reach out, and then in the midst of a Pandemic when we have been bending over backwards tapdancing copious amounts of data points in to an unwieldly EMR, and struggling to keep up with the Flood of pathology heightened and exaggerated by COIVD 19, tincture of time and the evolution of managed care, when we demand a tacit modicum of reciprocation, many in our current societal crisis, don’t even have the consideration to wear a mask!

    1. Misha, thank you for this compelling comment. It was always the carrot and the stick. Even now at the end of my career as I put in my plan to retire I am asked to stay on, to be available in the times of COVID, in the uncertainties ahead, and I am proud to say I said NO. One of my thoughts as I leave my profession of 36 years is that I am extremely shocked at the callousness of the American public in the regards to lives of myself, my coworkers, and all of us. Their not giving a damn if our lives our threatened by their selfish, totally inhumane behavior over wearing a mask and social distancing. Never in my life could I have imagined this. Please take care.

  12. Perfectly said I’ve been on the health field for 20 yrs first as a pct then as a nurse and there is no break it’s just go go go to the point that you sleep and dream of work and that you forgot something! Then still wake up loving your job because you help people and they are happy and greatful. I love my job no matter what.

    1. Jennifer thank you for commenting and I know that is why nurses and doctors and all providers in healthcare stay in their fields because they love taking care of people. I loved my job many times and I hated my job many times, it was always a love/hate relationship because I always would beat myself up for not doing more when I already was doing too much. It is hard to explain, but I think the poem does that. I too have had those nightmares I forgot something…..those are powerful reminders for us to remember we are not robots, we are human and it is when we connect with others as we do in our work, that is the magic.

  13. Dr. Louis Verardo

    Ms. Kincanon, your piece was difficult to read. It did not strike me as someone mouthing random gripes about her workplace, but rather someone deeply challenged by the conflict between patient care and self care. You made me think about many instances in my career as a primary care physician (I retired from practice late last year, just before COVID hit) where I stayed late, or saw an extra patient, or did something above and beyond, justifying it as dedication to patients, but inevitably shortchanging some part of my personal life in the process. I have to confess, I never really reconciled the inherent conflict in my actions, although I eventually made my peace with saying no to some requests for additional efforts at clinical work. Being perfectly honest, I never was able to be completely comfortable with those decisions, and in retirement I reflect often on why that was the case. Some of the other comments I read tonight before writing my own have provided me with further insight into this issue, and for that I thank you, the other colleagues who wrote in, and PULSE.

    1. Dr. Verardo. Thank you for your moving comment. As is our bent, we continue to have conflicting emotions because I believe that is integral to who we are. Why is it that we often think we did not do enough, when we did all we could, and many times more. I often worried when I worked in the ER’s about primary care doctors who at the end of a long and grueling day would have to come in the ER to admit their patients to the hospital, to sometimes stay late into the night writing orders, checking statuses, see their other patients, go home exhausted to come in early before their clinics started…and do it all over again. I always felt that was terribly hard on a family and hard on them. There are so many solutions to this if corporate would be more innovative and less money directed (profit). All I know is that I used up every drop of adrenaline I have in all the years being addicted to it working in the ER’s and ICU’s. PS: Did you ever read the article in the NYT regarding the ethics of this? I could try to find the link to it again if you would like me to.

    1. Anna, wow! I work with a woman named Anna, she is amazing too! Oh, I just let out a big sigh for you! Now, let us begin to live our lives authentically and find something that heals us along the way. We entered our careers as wide eyed hopeful women and I am leaving it the same way though with my vision less rose colored. I am grateful for many people whose lives have touched mine and whose lives I have touched. I am just so ready to stop. I am grateful you did. Thank you for writing, take care of yourself.

  14. This is poignant and difficult to read and yet a powerful springboard for conversations that we need to have. Thank you.

    As a communication specialist, saying “No” is one of the most important and tough communication skills that doctors, nurses and other healthcare professionals need in order to stay healthy AND provide safe care and optimal patient experience. It is right up there with “I need help…”, “I can’t work an extra shift safely.”, and “Stop, wait, that is the wrong medication.”,.

    This perpetual asking by leaders is a way to exploit our compassion. Plus, our own egos are in the equation b/c we want to save the day/person and we don’t want to appear to be inadequate.

    While there will always be exceptions and saying “yes” when we don’t want to or shouldn’t, a persistent and pervasive pattern of it helps no one.

    I keep wondering how our collective voices might have impacted the system…if we had said “No” back in March….I/we won’t go in the room w/o PPE. A bunch of burned out healthcare professionals won’t be much good to anyone.

  15. Speaking of “being taken advantage of by the healthcare system” – There is a move afoot to file class action lawsuits against some large healthcare systems for violating OSHA regulations by forcing employees, i.e. doctors and PAs, to work in a toxic, mentally unhealthy environment. Take all that’s noted in the poem above, add in brutally dysfunctional EMRs and unprecedented burnout rates, and there are those who can make a case for OSHA violations.

  16. marc d wager, md

    you nailed it! it perfectly answers the question, “why would anyone want to leave such a rewarding career?” brava! enjoy your well-earned retirement…

    1. Carole. Thank you. I cry every time I read it myself, which may sound odd, but it just evokes the days again, the nights again. Something has to change, it may just have to be what we accept and do not accept as right and wrong in our professional lives.

  17. Gabrielle Langley

    Thank you for having the courage to speak honestly about our burnout in healthcare. It is truly a “death by a thousand cuts.”

    1. Gabrielle. Thank you for your comment. Pulse actually gave it that headline, which I find to be quite apropos. I think in many of my jobs I was living strictly on adrenaline and had no idea that I was on the brink of burnout all the time until I could not go on anymore like I was, and had to make major changes which included going part-time! That saved me and enabled me to work a little longer, but I am done. (january 10th). This poem was written before COVID! It did not even contain the quandary I feel around that with many of the public acting as if they do not consider the lives of others, especially healthcare workers. That just adds a whole nother level.

  18. Wonderful and overwhelming at the same time. by the end of the poem I felt completely exhausted, although only a tiny fraction of what health providers must experience. Thank you for your dedication all those years. And congrats on the NEA grant.

    1. Wow! My career trajectory is similar to yours. The sentences that hit home were speaking of staying home when the census is low. Those times make me furious, even if I’m not the one that got the call. Let your employees have a nice day, one that doesn’t feel like they are in hell!
      This is really part of a set of triplets- 2nd is “go work on another floor, they’re busy.
      And the third is after staying home for the census, they ask if you can come in now because it got busy…

      1. Kay. That particular way that nurses were treated, sent home, not paid on low census days was a blow to our profession and would never have occurred in any other professional field. It diminished our professional status and is the worst decision the system ever initiated. This is one of the ways that nurses need to unite and refuse to work under such unjust treatment. Surely there are better solutions, surely there are middle managers making these decisions, whose sole job is to think this stuff up and enforce it. Eliminate their positions and let the professional nurses do their job in all facets. There is so much work to be done on any given day, one should never be “sent home” and heaven forbid, to be called back!

    2. Laurie. Thank you for your comments. It is overwhelming. It actually exhausts me and makes me cry again each time I read it. Yes, only a tiny fraction of what we experience, yes I could have gone on and on and on and on and on….but I had to end it somewhere, and not totally exhaust me (or the reader). The NEA grant was part of a funding grant given to a local Art Restoration project for a Feed and Grain building in Loveland, Colorado. I got part of the grant because I had an installation in the building with my poetry and art collection and my book was created around that. I was honored, thanks for mentioning it!

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