Since its release in December, I've watched the movie Encanto with my kids three times, undistracted, and like many families right now, the soundtrack is also playing on repeat in the car, house, and mind. I haven't experienced emotive earworms this strong since "Let it go" (Frozen 1, of course). 

The Encanto story and songs are packed with style and content, and as a hospital Chaplain informed by family systems theory and international medicine, I sense certain struggles of my patients, families and staff (myself included) reflected in the story’s richly developed and varied archetypes and their growth.

It’s likely that many of us working in healthcare, under banners that read “Heroes Work Here,” relate to the feelings of Luisa, “the strong one,” as she sings "Surface Pressure:"

I’m the strong one, I’m not nervous
I’m as tough as the crust of the Earth is
I move mountains, I move churches
And I glow ’cause I know what my worth is…
But…

Under the surface
I feel berserk as a tightrope walker in a three-ring circus
Under the surface
Was Hercules ever like, “Yo, I don’t wanna fight Cerberus”?
Under the surface
I’m pretty sure I’m worthless if I can’t be of service

It’s pressure like a drip, drip, drip, that’ll never stop, whoa
Pressure that’ll tip, tip, tip, ’til you just go pop, whoa-oh-oh

I cry every time I hear this song, and sometimes even when I think about it.

Why? Each time I hear Jessica Darrow belt out these lyrics, tears well up in my eyes. It isn’t necessarily that I am currently feeling pressure like a drip, drip, drip that’ll never stop, (though I can certainly imagine, or remember, or foresee the sensation), or that I’m feeling the weight of pressure-driven burnout happening in HCW’s all around me. Sitting with my feelings and hot watery eye balls when I’m “under the surface” with Luisa, (albeit a fictional character), I feel moved by the vivid and visceral realness of her “inner life” compared to how she presents, realizing that many people are going about their days with an inner sense of self that doesn’t quite match the way they appear and interact with others...and that the mismatch can be costly.

People who serve on a Palliative Care teams know this. We work to explore “under the surface” of a person for physiological and psychological perspective on their sense of self, their health and their medical needs. We experience a tiny sample of their inner landscape, often looking for data, and sometimes sensing what it might look like if an artist painted it, or sound like if it were made into music. As an outsider, patients and their families sometimes invite us under the surface with hope that we can bring relief to some of the pain of mismatched inner and outer life.

But wait, if I could shake
The crushing weight of expectations
Would that free some room up for joy?
Or relaxation? Or simple pleasure?
Instead, we measure this growing pressure
Keeps growing, keep going
‘Cause all we know is

Pressure like a drip, drip, drip, that’ll never stop, whoa
Pressure that’ll tip, tip, tip, ’til you just go pop, whoa-oh-oh

I wonder how we are each navigating the path between our inner and outer life. How do you explore or try to sense what’s going on “under the surface” of your own day to day work and relationships? Do you ever express it, through art or other mediums? Do you feel you can access and appreciate your inner life easy enough?

Some further reading:
Vicini, A., Shaughnessy, A. F. and Duggan, A. "On the inner life of physicians: analysis of family medicine residents' written reflections." Journal of religion and Health 56, no. 4 (August 2017): 1191-1200.

About the author: Nikki Kelley Kleinberg is an APC Board Certified Chaplain at a Level I Trauma Center and quaternary care hospital in Philadelphia, PA. One of her areas of professional interest has been that of applying interpersonal and self-study skills used in chaplaincy to the wider context of healthcare provider interactions. She is an ordained Deacon in The United Methodist Church, an active member of The Upaya Zen Center, Zen Mountain Monastery, American Humanist Association, American Teilhard Association, and Religious Naturalist Association; a volunteer Chaplain for the Temple University Emergency Medicine Residency Program; and a recipient of the Ralph Thomas Taylor Award for Inclusive Worship from The Hospital of the University of Pennsylvania. She is a founding member of two intentional housing communities, one in which she lives with her partner and two children.