There is a level of discomfort nurses are pushed to that goes beyond tight staffing, busy 12-hour shifts, and mental tracking of our patient's disease process. It is the inner stretch of our emotional, relational, and spiritual muscles. We are pushed to wrestle with questions and issues beyond what we find comfortable, and then we must learn to live with a certain unresolved level of discomfort. We can't go back to a perhaps safe naivete about life as we knew it before we saw how indiscriminate some forms of suffering and death could be. Our own theological wonderings come to light, and our capacity for vulnerability and intimacy is tested when certain patients find a way past the self-protective walls we put up. Sometimes, all the big questions of life loom over us in the course of one 12-hour shift.

We are stretched in how we think about quality of life. My everyday thoughts about quality of life usually revolve around the quality of my relationships, how much free time I have to enjoy my hobbies, what delicious food or special coffee treat I might enjoy today, how much traffic I encountered, and whether my kids seem to have everything they need. I've had my share of personal trials and tribulation, but overall I live a life of abundance. Still, the degree to which I can struggle with discontentment is embarrassing.

Then, I go to work, and all my thoughts about quality of life shift dramatically.

* If a previously healthy teenager suffered a spinal cord injury that left her quadriplegic, and the family places her in a facility but visits regularly, how do I help this teenager and her family navigate their journey to redefine their sense of quality of life? Can I help?

* If a patient has been abused and is now cared for by foster parents but shows very minimal interaction with the outside world due to the brain injuries he sustained with abuse, is this a quality of life worth maintaining?

* If a patient was born with a combination of mental retardation and cerebral palsy, and doesn't appear to respond much to his environment, is this a quality of life worth sustaining when he has come down with a bad case of pneumonia and is struggling to be weaned off of a breathing tube and hospital ventilator?

For obvious ethical reasons, it's not for me to answer these questions. And it is clearly unfair for me to compare my personal definition of quality of life with theirs. But who draws the line between one life and another? For now, as all parties involved seek to define the meaning of these lives, I am part of the medical team playing an active role in life-sustaining activities for these patients. This is stretching me.

We are stretched in how we respond to the weaknesses and wrongdoings of others. My everyday thoughts about responding to others' weaknesses currently revolve around whether my children are behaving well or whether my husband and I are experiencing any tensions as a result of our commonplace personality differences. I live in relative peace with friends and neighbors.

Then I go to work, and all my responses toward the weaknesses and wrongdoings of others are stretched.

* Can I show compassion, kindness, and respect to a parent who is suspected of as-yet-unconfirmed child abuse?

* Can I show kindness to a parent whose child got a lifesaving liver transplant when the parent comes across as rude and entitled?

* Can I extend understanding and patience to a parent who is anxious to the point that she questions and criticizes my nursing practice?

How much ego and defensiveness do I bring to my nursing practice? How much judgment? How much grace? How far can kindness go before it feeds entitlement and poor behavior? How should this change, if at all, when the person standing before me is overwhelmed by deep grief and stress? I am being stretched.

We are stretched in how we think the world works, and in how we think it should work. My everyday thoughts about how the world works usually tend toward some sense of expected justice. Punishment comes to people who break too many rules. Follow the traffic rules and you won't get into a bad car accident. Hang out with the right crowd and your life won't be negatively affected by people who make bad choices.

Then I go to work, and all my thoughts about how the world works are shaken up and stretched.

* The star basketball player with the sweetest family is diagnosed with stage IV cancer just before graduating from high school and is dead within weeks.

* The baby who hardly had a chance to misbehave is diagnosed with a fatal form of muscular dystrophy that won't allow her to see her first birthday.

It pushes me to rethink what goodness, justice, and hope look like. It pushes me to reexamine my convictions about God. It pushes me to face my own fears, my own feelings of entitlement and vulnerability.

The temptation in writing a post like this is to try to wrap it up with well-packaged answers to help resolve the tensions that surface with this type of reflection. But I suppose the whole point is that there are no well-packaged answers, and this is the experience of the nurse. This is the inner stretching of all we feel about ourselves, others, and the world we walk and work in.