Consent. We talk about consent in the colloquial sense as it relates to bodily autonomy, specifically that of sex. However, there are many, many facets of this concept that are much broader than that. I've talked about it obliquely in enough blog posts that it is time to discuss it directly. I saw this comic/video on the internet ages ago, and I think it still encapsulates an important understanding of consent and sex in a specific analogy, comparing it to offering someone a cup of tea.
You've just clocked out for the day. It was a long day. An exhausting day. There are still a number of tasks that have to be done yet before you can rest, including making something to eat, a few time-sensitive discussions, and a couple of home-related needs that need doing. You decide to lift your spirits by running through the drive thru, only to find that they are out of the necessary pieces for your favorite pick-me-up. You drop your keys trying to unlock the front door. Clearly, the universe must hate you today. Someone important in your life (significant other, parent, close friend, etc.) then arrives in front of you and starts to talk about a heavy topic without preamble.
How would you feel in that moment? This person is important, and in this hypothetical you care about what they have to say, but the timing, the timing is just terrible. They did not check for whether you were open to listen at that moment, simply demanded your attention and your energy without confirming whether you were available to provide either. There's the recognition that you want to be available and that you simply don't have the emotional bandwidth existing in the same space.
A two-second question of "Hey, is now a good time?" can make a huge difference, when choice is introduced back. The previous events of the day do not disappear, but an ask where I have the opportunity to agree, to care for and with that individual because I care and not because I was not offered a choice, that allows me to invest more fully. Asking for attention or time or empathy or any other resource (tangible or intangible) instead of demanding feels better, recognizes the humanity of the giver, that they are not simply a service to be utilized. I am more willing to give when I am asked. I like to give when I'm able to, but the joy vanishes when it becomes an expectation. If it's a demand, I may acquiesce but with a degree of anger in the back of my mind, severity depending on the situation and any established pattern. For example, a bigger ask without checking tends to generate greater resentment, yet a person who consistently demands even small pieces, there's a gentle but real grudge there that accumulates.
Yes, this means that the person being asked has every right to say no. This is important. If the question is asked and the answer cannot be no, then it isn't a question--it's a demand, just prettied up. One can be disappointed that the answer is no, but they should still respect it. Otherwise, it's not consent. Coercing and cajoling someone to make the "correct" decision is not consent. And if I have a question that cannot be no for some reason, it's important to pause and ask myself why, not the person who said no. My need is not their responsibility.
At work, I find that this is a tricky element to manage. Alarms all around me and all at once are always demands. I have had patients that only speak in demands, either because I am only a service to them or they are heightened enough to forget. Sometimes, it is death by a thousand cuts, where by the end of the shift I have a great deal of resentment toward that person, situation aside. On the flip side, I have had patients that are so worried about bothering me that they neglect their needs--I make sure to invite these patients to call out, giving them consent in advance to have their needs met, because they have made the acknowledgement that I am a person and have demands on my day that they don't know about. Sometimes, I have to make clear boundaries, such as "I have two people ahead of you, and then I can bring your water," or "I cannot help you with that at the moment, but I will let your tech know and they will get there when they can" or "I am not in charge of when your food tray comes up and cannot make it come any faster."
This happens with peers, too--there are some people who are better about asking if I'm available to talk or can help do X or Y than others. Naturally, there are situations in a hospital that have some real urgency where it is appropriate to demand help; there are also places where urgency is felt but is more flexible. I try to emulate the behavior I would want, setting qualifiers like "Are you available," or "Do you have space for," or "When would be a good time to," or prefacing the conversation with "the answer can be no" before making the request. The latter in particular helps stop the flow of excuses when all I need is a quick yes or no so I can hang up and call someone else if need be. I try to ask if people have space for a question when I need a sounding board, before launching into the specifics while someone is trying to catch up on charting. If it's a longer phone conversation, I try to ask if they have a moment to discuss before jumping into the larger part of things. And again, sometimes the answer is no. At this point, I find another body or wait until that availability is there or sometimes help them complete their task so they are free to help me with mine.
The days I feel most tired from work seem to be the days that consent has been violated the most. A demanding patient wears me down differently than one that is needy or emotional or even confused. I find, too, that the best thing I can do for myself on my days off to truly recover is to make it clear to my household that I am setting my own schedule for the day, dictating my own rhythm. This might include doing tasks for the household and meeting appointments, but I still set the order and pace for the day without waiting on another body. A day off where I'm waiting on one thing to happen so that I can do X or Y (e.g. waiting on a package to arrive so I can sign for it before going about the rest of my errands for the day), that is not very restorative to me. I need a clear space to re-establish my own autonomy again, to fight for consent only with myself.
Looking back, I think I've always been sensitive about this to a degree, but I have not had the vocabulary to pinpoint the exact reason, just an underlying frustration that I was unable to name. And, it crosses into my PTSD experience, where threats to my autonomy are particularly heightened, a hypervigilance to potential threats resulting from trauma-informed thinking and survival patterns that served their purpose for a time but have since turned those patterns into difficult, deep ruts that the wheels cannot easily deviate. Now I can recognize some things that are happening, name them, and pause to honor the feeling. There is still more work to be done, and sometimes that means taking myself away from activating spaces to regroup. At home, I tell folks that I need space for a bit and listen to my body for guidance on whether I need to move (likely exercise in some capacity) or be stationary (distraction through a movie, blog, etc.). At work, I acknowledge aloud to myself that I am activated in the moment and find a small task that I can check off, redirect to a single task rather than multiple, designate a boundary (particularly to patients), find a reason to step off the floor, and/or go to the bathroom to lock to door, if only for a moment. In other words, at work I find small pockets where I can let off enough pressure to keep moving. I am still finding what strategies work best: it is a comfort and a curse that no two days are the same.
I want to invite and be invited to interact, to be a part of the group, to be helpful. I want to be asked and exemplify what it is to ask others. I want to honor choice and consent beyond the colloquial usage, as I want mine honored in return. Even friends who "don't want to be a bother," the ask is the only way to find out. Introducing an earnest question back into our speech will bring a whole new dimension into our mutual communication.
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