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by Charlotte Huff They leave your heartstrings dangling. Then one day, the bed sheets are neatly straightened and they’re gone. Ask clinicians about death on the job and they start describing faces. The man with metastasized colon cancer who wanted to know precisely how many more days he would live. The terminal patient jaundiced to Day-Glo orange. The young mother who knows the minutes are sifting away to say goodbye to her children. "I’m not good for a week after that," said Molly Poleto, an Albany, New York, hospice nurse and board member of the Pittsburgh-based Hospice and Palliative Nurses Association. "I will actually experience symptoms of depression. I experience some fatigue and some appetite changes."
Personal connections In an instant, a flash of humanity can close the distance in ways you never imagined possible, according to Susan Brace, PhD, PsyD, RN, a Los Angeles-based medical psychologist. "You can be taking care of the meanest, nastiest patient in the world, and they can say something that will get to you."
Brace, who worked nearly a decade in the intensive care unit, remembers one critically ill woman who became a treatment nightmare. Topping 400 pounds, she was battling a lower gastrointestinal bleed, screaming for chocolates, squirming on the bed, pulling out tubes, and refusing to have her blood drawn. Then one day, in a quieter moment, Brace recalls: "She said, ‘I wish I had become a dancer.’ You could see for a moment—a whole life just flashed." Letting emotions out Pushing down emotions is like trying to drown a beach ball in a swimming pool, says Pam Taylor, MDiv, a Houston-based hospice chaplain. At Texas Children’s Hospital, the staff of the pediatric intensive care unit has become accustomed to sitting down with Taylor when patient death becomes too much. At first, Taylor said, they were reticent. "Now, they are ready the minute we shut the door. They show anger. They show hurt. They cry." Secretaries and clerks will sit alongside clinicians. The support staff, Taylor said, can bear a hidden burden, especially when they serve as translators. "And the doctors will say, ‘Tell this lady her baby is dying.’ " Clinicians can get very close to dying patients and still maintain some professionalism and objectivity, says Jill Brace O’Neill, MS, PNP, RN, a nurse practitioner at Texas Children’s Cancer Center. They also can back each other up, watching for signs of excessive personal involvement, says O’Neill, who has conducted research into therapeutic relationships. There are no hard and fast rules, she stresses. But when a clinician becomes secretive about a relationship with a patient, it’s a fair guess that he or she is starting to cross that clinical line. Safe support Immediately removing yourself from a personally draining case may seem logical, but is not necessarily the best solution long-term, says Brace, who suggests first seeking support from a colleague and then a manager or hospital-based mental health professional. Why? "You are on a tightrope," she said. What if, for example, the patient reminds you of your deceased mother? "Maybe this is the time," suggested Brace, "to say, ‘Hey, I can finally grow from this.’ ’’
But at most institutions, support networks tend to be the exception, Brace said. "What I’ve seen is nurses taking care of other grieving nurses in back rooms." She advises clinicians to lose themselves in "life-affirming" activities, such as baking bread, planting tulips, or learning to play the piccolo. One clinician in an AIDS support group saved a few of the flowers given each deceased patient, building a large wreath for the front of the hospital unit. The burden of coping alone often falls on the shoulders of young clinicians, says Shelton, who works to make herself available. "We want them to know that they can talk to us." Saying goodbye
As health professionals "we are let into this narrow window in their lives that lets us see the core and essence of who they are. I feel honored to be part of any of it." |
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And
clinicians don’t always have someone to lean on, said Margarette Shelton,
MOT, OTR. As a student, a cluster of three deaths left her reeling.
"These are people with powerful things happening to them, and
I am a witness to it and had no one to process it with," said
Shelton, now a senior member of the occupational therapy team at University
of Texas Medical Branch at Galveston. 
In
Poleto’s hospice program, teams regularly gather for bereavement meetings,
reading off the names of patients who have recently died. Poleto personally
takes comfort in her own spirituality, praying for the child’s family,
as well as spending more time with her own. She throws herself into
physical activities, chopping wood or playing tennis. "And I
usually turn that energy around and do something for another family
in the neighborhood."
The
final journey toward death is an intensely personal one, O’Neill said.
She sometimes attends a patient’s funeral when she needs a sense of
closure, especially "with families that I have walked through
every step of the dying process with."