Tag Archives: professional grief

The weight of their grief

We approach the humorless with humor; I think it’s the only way to cope. Sometimes there’s nothing to be done. Sometimes it’s sudden. Sometimes it’s a sudden insult but death doesn’t come suddenly. Then, their watch begins.

The rules about how many visitors to an ICU room go out the window. As many people as that room can fit, and outside visiting hours too. Sometimes we break other rules too, to allow children and the burning of smudges. The treatment decisions are guided by family, not the doctors anymore. The doctors have washed their hands.

The neurosurgeon has seen the CT scan (ah, technology) and too much time has passed since the bleeding begun. Your brain, in a box. Increase the pressure too much and it becomes toothpaste squeezed through the hole at the bottom of your skull. The phrase we use for this injury is “not compatible with life.” It’s less politically correct amongst ourselves. There’s just joking: “go towards the light;” when we have to shut off life support sometimes we dryly refer to it as being “the grim reaper.” In his room, though, it’s different. Their vigil makes it a sacred space.

Those who enter do so only out of necessity, with more respect than even the┬ácemetery┬ácommands. We are quiet and as discreet as we can be, but somehow it still feels like a violation to go inside and do my job. Moreover, it’s difficult to watch their internal struggle: they have heard our words, they know there is no hope, but they reach for it anyway. They are grieving not only the death that hasn’t happened yet but the lost opportunities for his recovery. They’re grieving their lost hope at the same time as his loss, and all their losses before it as well.

They share these losses with me when I enter, while he actively dies; they’ve lived through this more than once. I try and keep my words to a minimum, aside from condolences and apologies for my intrusion. I am more proper than I usually am, even on a good day. I ask if they want the door closed. I enforce silence in myself. It isn’t my words that they want.

When I leave that room I feel like I walk slower, my breathing and my body heavier. I am moving in slow motion through water, the resistance of the air demanding more of my strength. I am brought back to where I was, when I last experienced such grief. I say a silent prayer for the fact that I had no vigil, in retrospect the finality of these things is a gift. I try to shake off the heaviness of it all, perhaps remarking at it to my manager or a coworker.

It is impossible to be wholly unaffected when they only currency in use is hope, and I have empty pockets. I can’t make this easier. All I can do is try to remember enough that it’s harder to forget, as I will eventually, as I always seem to. I’ll be reminded again of their grief soon enough, except at the same time it won’t be theirs, it will be someone new, and the grief will be fresh, and I will have my task, to be the cup-bearer of the good death.

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he walks alone

Many of the stories I have to tell aren’t really my stories. They’re the stories of others. Sometimes it’s the patient’s story, sometimes it’s the family’s story, and in this case, it’s the surgeon’s story.

She had been told she had to have bowel surgery to resect a tumor. She was quite frightened of this because she’d seen it happen to other members of her family, and they had gotten quite sick and nearly died. She was terrified of what would happen, especially after the surgery, when an arduous recovery would not necessarily mean that she was cancer-free.

She procrastinated. Her procedure, while not exactly elective, depended on her consenting to the surgery, and so she put it off. As is wont to happen with cancers, and especially gastrointestinal ones, she became more wasted as the weeks wore on, her body unable to properly absorb the nutrition that she was able to keep down.

Finally, the day came where she reached the point of no return. She presented in emergency gravely ill, with suspicions that her bowel had perhaps obstructed and perforated. She was operated on by one of the best — I didn’t enter into that equation until after her surgery.

She’d arrived decompensated and in poor condition and required a lot of blood during surgery. As happens somewhat rarely, she had a transfusion reaction. This precipitated respiratory failure and my involvement. Sadly, due to multiple factors, including how truly sick she was going into the surgery, her body failed to rally. Her surgical sites refused to heal and broke down, requiring further laparotomies. Finally, after returning to the operating room for the tenth time, the surgeon threw up his hands. There was simply no more bowel left to resect. Either she would recover, or she would not.

I remember a conversation that I had with him in the hallway after he had discovered she’d have to go to the theater for the last time. He had taken very personal care of this patient, not handing her over to a colleague even over the Christmas break. He poked his head in on her every single day that he was physically able to.

“You know, you think you do a good job…” he said to me, shaking his head. Knowing only the little that I knew, I tried to offer some meager reassurance that he had done what he could with what he had, which was arguably not very much to begin with. He simply shook his head and walked, alone, down the hallway to get the patient on the slate for surgery.

He carried the entire weight of this person’s recovery on his shoulders. I can only imagine how he’d felt when she began the downward spiral towards her eventual death. Especially being as he’s South African, reading Bongi’s post about the graveyard made me think of him. There most certainly is a tombstone somewhere in this man’s mind, with that woman’s name on it.

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the one who doesn’t cry

An unanticipated death; some professional embarrassment in there for good measure. Difficult, due to the fact that the one who died was a child, and a sweet one; that, and the fact that it was likely our fault in some way. (The reader is left to imagine the multitude of ways in which one person in a team of probably hundreds could be possibly at fault. Trust me. We’re all wondering the same thing.)

A debriefing; listening to the vignettes of the family and the child from the circle of chairs in the playroom. Some tall people on some tiny chairs, wilted from night shifts, or the ones fresh from days off, with perfectly applied makeup. They had a long time with this baby, they laid down in his bed and hugged him, patted his tummy to comfort him in that way they had seen his dad do, taking him to the playroom instead of starting his feeds … interviews with mom … years of past history … perhaps wondering why they hadn’t intervened earlier.

If there’s anything I’ve learned through a multitude of shitty situations, a multitude of debriefings, it’s this: no matter what is your fault, it’s over. Learn from it, for it’s the only possible positive outcome of an entirely crappy situation. Beating yourself up about how it could have been better if you had the power to go back in time and fix your fuckups is ultimately a failed exercise in self-loathing, and the self-loathing is an obstacle to learning: what’s happened has happened, so learn for next time, and prevent it from happening again.

A lot of that happened in that debriefing. From the strong and silent among us semi-blaming themselves, knowing what they’d do different, to the ones who have what seem like the easiest jobs in that they are only so tangentially involved, nearly everyone seemed upset nearly to the point of tears.

Except me.

It came to be my turn near the end, and I spoke of equipment malfunctions, problems with sensors, recalibrating X and Y, and of being pissed at myself (not blaming) because I had been so absorbed in the equipment that for that critical minute, I forgot to look at the patient. I wasn’t upset at the death of the kid, I was more pissed at myself that I had immediately jumped to the conclusion that the equipment was messing up on me.

To be fair to myself, the rest of the equipment hadn’t exactly been working as intended, and I’d had problems from the get-go. Things were quiet and stuff that should have been watched wasn’t, but it’s hard to not feel a bit like an uncaring goon when the people who weren’t even there for the arrest seem significantly more shaken up than I am.

It’s remarkable to me because, I think, this is not simply because of respiratory or because of the sheer amount of times I’ve been there when somebody’s died. I don’t think it’s that I’ve become desensitized or somehow heartless regarding the whole incident. Indeed, I was upset about it — I just did all my crying immediately afterwards and not in the debriefing. So it goes.

I think, however, that last paragraph is a bit reflective of how RTs are. We have the face we show to the rest of the team, and then there’s the things we say, the stuff we complain about, the opinions we share, the discussions of what bother us, the planning what to do next, that we all do behind the closed door of the respiratory department. The reason I never cry at organized debriefings, the ones headed by a social worker or someone with training for crying people, is because in order to keep doing what I do, I have to do it every day, by myself, behind a closed door. More often than not, I do it with other RTs. Sometimes, like the particular instance that struck me this time, I end up doing it at 2am with other health professionals, like the nurse who gave me a hug before I cleaned my vent and went home to bed.

I think it’s healthier that way; that I know how to debrief so that I can sleep, that I do it automatically and without needing hand-holding or prompting. I think it’s what means I can do my job without having a nervous breakdown.

Long ago I used to worry that not crying about these things meant I was getting callous and gritty, jaded and bitter, all those things that they usually say about surgeons and cops. I don’t worry about those things anymore: I think I have a better understanding of grief and attachment as a result of having done it more times than I can count. I can survive without losing compassion. Maybe some would call it tough, but I hate that word for this. It’s not some kind of machismo bullshit need to appear all stiff-upper-lippy. It’s just self-preservation. I can sleep without waking up screaming, I can go to work the next morning, and I can still have fun at work. I still love my job. No matter how shitty it gets, I plan to. For a long, long time.

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