To drive home the distinction between guilt and shame, I will share an experience from when Alexis was hospitalized (1997).

We’d taken our Daughter who was six months old at the time, to Children’s Hospital in WDC. She had a consultation appt with a gastro-enterologist there. After a short physical assessment the doctor said she needed to be admitted and stabilized.

Part of this effort meant placing a naso-gastric feeding tube so she could be adequately nourished. We had no understanding at that time, of the impending physical complications that awaited her fragile little body. I always considered myself to be a “good soldier” and when given instructions I followed them to a “T”. I wasn’t a nurse at that time, just the mom of a very small, very beautiful, and very vulnerable infant girl.

So yes, Alexis was admitted and we gave permission for the nurse to place the naso-gastric tube. It was so invasive and looked terribly uncomfortable. It is a small tube that goes through the nostril, naso-pharynx and into the stomach. The receptive end of the tube is taped to the face to keep it secure, and liquid nutrients were set to infuse from a feeding pump next to her crib. We were trying to get some weight on her.

A few days into the admission, still getting my bearings and completely sleep deprived, I’d been holding Alexis along side of her crib. She was receiving a tube feeding and was hooked up to the pump. With my back to the door, I heard someone enter the room and say something.

Without thinking about the NG tube, I rotated my body around to see who it was. In doing so, I pulled Alexis’ body away from the pump, which subsequently ripped the tube out of her nose and off of her face.

I can’t truly explain the devastation I felt. As an RN, knowing what I now know, about this feeding tube system, I may not have been as horrified (I still would have felt badly) but at that point in time, in my mind I might has well have pulled out one of her major organs. The tube lay on the ground, formula still pumping out of it, and Alexis cried as I tried to console her, mortified that I’d hurt her.

Here is where the distinction between guilt and shame comes in:

Guilt: “I made a mistake, I let my daughter down, I turned the wrong way…I will be more aware, cautious and present so I never do something like that again.”

Shame: “I am a terrible mother. I can’t believe I hurt my own Daughter. I can’t do this. I am not capable of seeing this through. Why did I even become a mom if I can’t be trusted to protect her? I am so ashamed and scared.”

The experience of guilt (and it was so terrible) was the accountability of the mistake, including how to avoid it next time. It infers hope, since I can do things to better respond in the future.

The experience of shame jumps right to being flawed. If I am not to be trusted, and not capable, and a bad mom, I might as well give up now. Shame infers hopelessness, there is no way to fix me since I am broken.

The nurses couldn’t do enough to console me when this happened. I cried and cried, probably a mixture of tears over what had happened, and over what was HAPPENING period. One after another, they continued to assure me that Alexis was fine, that this happens and often it is the patient who pulls that tube out on their own. We just needed to replace it. Which we did.

I certainly wasn’t thinking about the distinction between guilt and shame when this happened. I didn’t even know there was such a difference. But I recognize that had I been ashamed over that mis-step, rather than just feeling guilty (which is hard enough!) I might have blocked my ability to show up fully for Alexis in the coming weeks and months that led to her death.

And if I hadn’t shown up fully for Alexis, I would have been ashamed.

Let’s not internalize our mistakes. Pick ourselves up, dust ourselves off, acknowledge that we can do better and call it a day. Any other approach is simply not productive.