I wrote this post a year ago but it was too raw for me to publish at the time.
I want to write about shock, because one day last Summer I sustained two shocks in quick succession and it was interesting afterwards to watch how I reacted, how the body reacts, how the mind responds to assaults that come out of the clear blue on an ordinary day.
As a hospice nurse I am no stranger to death, but all deaths are not equal. The slipping away of a 94-year-old who has been bedbound for months with Alzheimer’s disease is not trivial, but it doesn’t shock me. Sometimes, however, I get a patient I immediately love and become very connected with, someone I am thrilled to get to know, and whom I know from the start it will hurt to lose.
One summer I had two such patients: both with cancer, both wonderful women in very different ways. They came on service within days of each other, even lived near each other, and I had an uncanny feeling their deaths would be near to each other too.
One Thursday I started my work day as usual, by checking the after hours reports to see if any of my patients had issues overnight. Sure enough, the family member of one of these women had called in. I called her, asked how their night had been. It was terrible, she said. Now if this woman said things were terrible, I knew they must incredibly bad. These were not people to complain. I told her I’d be there after my first visit, which was to the other patient, who was at this point actively dying. As soon as I put the phone down, the word terrible echoed in my head. I called her right back and told her I’d be there immediately. I could hear the relief in her voice.
On my way there, I had a sense of dread. I was going to have to recommend more care to them. My patient would hate it: strangers in their home, a hospital bed. Just the day before when I visited her, she had declined the bed, shaking her head and smiling. I’m not there yet.
I walked into their home. My patient was lying on the couch and I saw immediately that she was dead. A wave of shock hit me. It was so sudden, I had not seen any signs the day before that she was this close. My own grief washed over me at the loss of this extraordinary woman, and then I realized that her family member was in and out of the room, that she didn’t know, and I was going to have to tell her.
She came back into the room. I summoned all my strength, took a breath, and told her. I remember that my exact words were “I’m so sorry, L, she’s gone.” It seemed like such a small, naked word for what had just occurred: gone. We stood there in the living room and the tsunami of her shock and grief swirled around us. I watched myself go in and out of disbelief, just as she did, but I also felt her emotions jog me back into my professional role. I watched myself put my feelings over to one side, something that I have been adept at doing my whole life, for better or worse. Shock! I’ll deal with this later. For now, what do I need to do?
I stayed there an hour, until more family members arrived and I felt it was okay to leave, promising in response to their request that I would return later in the day to sit with them and the body.
My team leader had texted me, asking me to call her when I could. I called her from my car, and quickly told her the story of the death and how shocking it had been, how sudden, the anguish I felt that I hadn’t had time to prepare them in the way I like to. She listened compassionately, as she always does, and then she said I’m really sorry to have to do this Sara, but I have some bad news to tell you. A coworker nurse of ours, they had just found out at the office, had taken his life the day before.
A second shock wave hit. Wait! He’s dead too? This was a young man, very beloved at hospice, an excellent, meticulous and very kind nurse. He had a partner and many friends. She told me the manner of his death and I cried for a minute in desperation, thinking about how he must have felt in his last moments. I felt myself casting about for a way to incorporate this information into the day I had already had. It was too much, and at the same time, I knew I could handle it. Again, I remember consciously putting my feelings over there, to the side, where I would deal with them later. I had three more patients to see, including my other lady who was actively dying, and honestly I did not know what else to do at that moment besides to go on with my work. It’s what I know how to do, it’s what I need to do right now. I knew that in my own shock, it would ground me to have to enter the homes of people in great stress and help them to deal with their trouble. This was not altruism, but the knowledge that dealing with someone else’s suffering was preferable at that moment to dealing with my own.
One of the great benefits of working for hospice is that they really know how to respond to death. A gathering was organized for 3pm that afternoon. About a hundred of us sat in a circle around a photo of our coworker and some flowers. Led by our chief spiritual counsellor and another grief counsellor, we were encouraged to share not only stories of him and how we knew him, but specifically what we were doing when we heard the news, how we heard it, and how we felt in our bodies and hearts when we heard.
What was I doing when I heard the news. The phenomenon is familiar to anyone who lived through the assassination of JFK, the day John Lennon was shot, or 9/11. But it is also familiar to many people who have had someone close to them die. The moment they heard the news is imprinted vividly on their brain: what they were doing, where they were, how they felt. It’s an important part of grief work to be able to tell that story. All of us in hospice have listened to those narratives a thousand times.
As the stories poured out, some themes emerged. Why didn’t he reach out to us? Did we miss the signs? Were there red flags and we didn’t see them? It struck me how often the nurses in the room used the word isolation. Hospice nursing in the field can be a very isolating job, particularly for intake and night and weekend nurses. We talked a lot about the need to take care of ourselves, to detach from the job, do things we love, and be with the people we love. That bears repeating: be with the people we love.
I finally worked up the courage to talk, which I sometimes find hard in gatherings like that. I told how I had received the news immediately following a shocking patient death and watched myself put my feelings to one side to deal with later. I told how a patient later in the day had asked me how I was and I heard myself say I’m great! I wondered aloud when I would be allowing myself not to be so great. I know I was far from alone in the room in my way of coping.
That Friday night and Saturday, I went out with friends, listened to music, and cried a lot. I also went on a long bike ride. Just the act of clipping in and rolling out made me feel deeply calm and reminded me of the pure joy in my life, the simplicity of watching my wheels go round and round. Riding distills life down. All I have to do is focus on the road, staying safe, getting up this next bit of hill to the corner. I rode to a place where I knew my patient had gone on her last outing, and it healed some of my sadness to think about her there.
Sunday morning I checked my work phone, because self care only goes so far and I have poor boundaries. My other patient had passed very peacefully early on Saturday, just 44 hours after the first.
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