Victorious endurance: To pass the breaking point and not break


I’ve been thinking a lot about endurance recently.

COVID-19 is surging in the United States. Health care workers exhausted from the first and second waves are quickly reaching the verge of collapse. I’m seeing more and more heartbreaking articles about the bone-deep fatigue, fear, and frustration health care workers are facing, and I weep. As horrible as it is to be fighting this terrifying, little-understood, invisible virus, health care workers are also fighting an equally distressing war against misinformation, recklessness, apathy, and outright denial.

Dr. Leslie Flores

As if that wasn’t enough, we are also dealing with racial and social unrest not seen in decades. The most significant cultural divisions and political animosity perhaps since the Civil War. A contested election. The fraying of our democratic institutions and our standing in the global community. The weakest economy since the Great Depression. Record unemployment. Many individuals and families facing or already experiencing eviction and food insecurity. Record-setting fires, hurricanes, and other natural disasters that are only projected to intensify due to climate change.

That’s a lot to endure. And we don’t have much choice other than to live through it. Some of us will break under the strain; others will disengage by giving up clinical work or even leaving health care altogether. Some of us will pack it in and retire, walk away from relationships with family members or longtime friends, or even emigrate to another country (New Zealand, anyone?). Some of us will passively hunker down, letting the challenges of this time overwhelm us and just hoping we can hang on long enough to emerge, albeit beaten and scarred, on the other side.

But some of us will experience victorious endurance – the kind that doesn’t just accept suffering but finds a way to triumph over it. I came across the concept of victorious endurance in the Bible, but its origin is earlier, from classical Greece. It comes from the ancient Greek word hupomone, which literally means “abiding under” – as in disciplining oneself to bear up under a trial when one would more naturally rebel, or just give up. The ancient Greeks were big on virtues like self-control, long-suffering, and perseverance in the face of seemingly insurmountable difficulties; Odysseus was a poster child for hupomone. I believe the concept of victorious endurance can be applicable for people across many belief systems, philosophies, and ways of life.

The late William Barclay, former professor of divinity and biblical criticism at the University of Glasgow, Scotland, said of hupomone:

It is untranslatable. It does not describe the frame of mind which can sit down with folded hands and bowed head and let a torrent of troubles sweep over it in passive resignation. It describes the ability to bear things in such a triumphant way that it transfigures them. Chrysostom has a great panegyric on this hupomone. He calls it “the root of all goods, the mother of piety, the fruit that never withers, a fortress that is never taken, a harbour that knows no storms” and “the queen of virtues, the foundation of right actions, peace in war, calm in tempest, security in plots.” It is the courageous and triumphant ability to pass the breaking-point and not to break and always to greet the unseen with a cheer. It is the alchemy which transmutes tribulation into strength and glory.

Barclay further noted that “Cicero defines patientia, its Latin equivalent, as: ‘The voluntary and daily suffering of hard and difficult things, for the sake of honour and usefulness.”

In the midst of the most challenging public health emergency of our lifetimes, I am seeing hospitalists – and nurses, respiratory therapists, and countless other health care workers – doing exactly this, every day. I’m so incredibly proud of you all, and thankful beyond words.

I doubt that victorious endurance comes naturally to any of us; it’s something we work at, pursue and nurture. What’s the secret to cultivating victorious endurance in the midst of unimaginable stress? I’m pretty sure there’s no specific formula. I don’t mean to sound like a Pollyanna or to make light of the tumult and turmoil of these times, but here are a few things that, based on my own experiences, may help cultivate this valuable virtue.

Be part of a support network. In the midst of great stress, and especially during this time of social distancing, it’s especially tempting to just hunker down, close in on ourselves, and shut others out – sometimes even our closest friends and loved ones. Maintaining relationships is just too exhausting. But you need people who can come alongside you and offer words of encouragement when you are at your lowest. And there’s nothing that will bring out the best in you like being there to encourage and support someone else. We all need to both receive and to give emotional support at a time like this.

Take the long view. When we’re in the middle of a serious crisis, it seems like the problems we’re facing will last forever. There’s no light at the end of the tunnel, no port in the storm. But even this pandemic won’t last forever. If we can keep in mind the fact that things will eventually get better and that the current situation isn’t permanent, it can help us maintain our perspective and have more patience with the current dysfunction.

Focus on who you want to be in this moment. This is the hardest time most of us have ever lived through, both professionally and personally. But let me throw you a challenge. When you look back on this time from the perspective of five years from now, or maybe ten, how will you want to remember yourself? Who will you want to have been during this time? Looking back, what will make you proud of how you handled this challenge? Be that person.

Look for things to be thankful for. In the midst of the chaos that is our lives and our work right now, I believe we can still occasionally see moments of grace if we keep our eyes open for them. If we aren’t looking for them, we may miss them entirely. And those small moments of love, touches of compassion, displays of selflessness, and even flashes of victorious endurance in yourself or others are gifts to be treasured and held on to – to give thanks for.

Embrace a cause greater than yourself. May I suggest that one thing that might help our efforts to cultivate the virtue of victorious endurance during difficult times might be to embrace a cause that is bigger than yourself; that is, one that lures you to focus beyond your immediate circumstances? What are you passionate about, outside of your life’s normal routine?

If you don’t have a passion, consider what you might become passionate about, with a little effort. For some of us, like me, this will be our faith in God. For others it may be advocating for an end to racism or for broader social justice issues. Maybe it’s working to overcome our cultural and political divisions or to strengthen the institutions of our democracy. Perhaps it’s getting involved with efforts to mitigate climate change. Maybe it’s reaching out to the homeless or hungry in your own community or mentoring a child who is being left behind by the demands of remote learning.

Or perhaps what you embrace is even closer to home: maybe it’s working to eliminate health disparities in your institution or health system, or figuring out how to use technology and resources differently to improve how care is being delivered during or after this pandemic. Maybe it’s as simple as re-committing yourself to personally care for every patient you see today with the very best you have to offer, and with patience, compassion, and grace.

Find something that sets your heart on fire. Something that makes you want to take this difficult time and “transmute tribulation into strength and glory.” Something that, when you look back on these days, will make you thankful that you didn’t just hunker down and subsist through them. Instead, you accomplished great things; you learned; you contributed; and you grew stronger and better.

That’s victorious endurance.

Ms. Flores is a partner at Nelson Flores Hospital Medicine Consultants in La Quinta, Calif. She serves on SHM’s Practice Analysis and Annual Conference Committees and helps to coordinate SHM’s biannual State of Hospital Medicine survey. This essay was published initially on The Hospital Leader, the official blog of SHM.

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