There’s a term for it. For the grief we caregivers suffer when we lose one of our patients. Professional grief, we call it—a phrase that in its dry detachment captures the all-too-rare acknowledgment of the feelings of professional caregivers. We may, or may not, have been trained to support and comfort the immediate family of one who dies, but few if any of us are taught to deal with our own feelings of sadness and helplessness.
Nurses are better at it than doctors. Here’s a story I like to call Marshmallows. It’s included in soon-to-be-published medical memoir, “Healing by Intent”.
“So why’d you ask me?”
“Well, you’re up here a lot,” Edith, the ICU nurse manager, answered.
True enough. Pediatric oncologists spend a good bit of time in the ICU—and things don’t often go well.
“You’re a good bit older, too.”
“It’s that obvious, is it?”
“Oh, you’re still a kid to me. But they don’t know that.”
Edith was referring to the seven nurses who were about to descend on her office. We both giggled—she was in her late thirties and I wouldn’t see sixty again.
“Yeah, I guess I’ve been around the block a few times. And I’ve probably got twenty years on any of our ICU docs.”
“I haven’t invited them, by the way. Just the nurses and you. They’ll think you’re here because of Ella.”
Ella had been a patient of mine with a glioblastoma—an almost universally fatal cancer—and the most recent child to die on the unit.
“So they don’t have to know you’re really here to hold my hand if the going gets tough,” Edith added.
I knew what she was getting at. The senior nurses could be hard to handle. Edith had told me earlier that they’d lost five patients in the last two weeks. She’d called this meeting because of the tensions building between the nurses and ICU doctors. Rose—the nurse caring for Ella when she died—had come close to boiling point with the attending doc—I’ll call him Dave—and his over-heroic efforts. Her opinion, anyway.
A brief knock and the nurses began filing in. There were only two vacant chairs, so the rest sat on the carpet and leant up against the legs of the ones in the chairs. There was some friendly jostling as the room filled to capacity. I knew all seven nurses by sight, several by name. I sensed they all knew me, the way nurses know all the docs who work on their unit. Things settled to an expectant silence, then Edith looked around at everyone in turn.
“It’s been real hard here lately, we all know that. So this is just a place for you to vent, share your feelings, anything you want.”
Rose spoke right up. “Too right it’s been hard. Some of those kids were never going to make it. But the docs just can’t seem to get it sometimes.”
Annie picked it up. “Yeah, with that last code—as soon as Dave finally called a halt, he just went straight back on rounds. Like nothing had happened. Left it to the intern to break the news to the mom. Jeez, he’s an unfeeling brute.”
Her outburst gave everyone permission to blow the lid off.
“I never thought it could get this bad …”
“Five deaths in—what, a week and a half …”
“Some of those guys just don’t know when to stop …”
“Maybe we should have called an ethics consult …”
“My boyfriend’s getting pissed at me, crying every night …”
“Mine took off. I’m about ready to quit …”
The cacophony went on for several minutes. Two nurses were crying freely, feeling the unspoken permission, venting feelings too long held in check. A sense of release began to surface, but Edith let things run, knowing they needed to do this. As things quieted, she stretched out both hands to the two closest nurses, and the rest took the cue, hugging and holding hands. Tears gave way to brief grins. I laid a hand on the shoulder of Mia, whose back was propped against my knees. She freed her own hand, raised it to grasp mine and return my squeeze. My throat thickened. I grabbed at a handy box of tissues and blew my nose, then offered the used tissue to Mia. Grins became guffaws. Edith took time to embrace everyone with her beaming smile.
“Thanks for coming—all of you. And feeling you could say your piece. We’ve all got a lot of crying to do. So to hell with boyfriends who can’t hack it. There really are some good men out there!” More giggles. “Hey, maybe Dave could use a few hugs. Can’t hurt, might help!”
Rose looked at Edith like she was about to nix the very idea, but she stayed quiet. Maybe even picturing the scene?
“Just be sure you don’t blame yourselves,” Edith went on. “Like things could have turned out okay if you’d just done things a bit differently. Second-guessing can keep you awake all night.” She paused to take in everyone in turn. “Just know you did your best. I’m real happy you all decided to work here.”
Which got the sniffles going once more. I realized none of the nurses had launched any more attacks on the doctors after the first few salvos. The anger had surfaced fast and hard, then quickly opened up to expressions of grief. Like everyone knew it was the core thing, this big knot of helplessness and heartache. That shedding it was what this precious time was for—not for blaming absentee docs for their decisions and actions.
Rose freed up a hand to open a couple of packs of marshmallows. They made the rounds along with someone’s flask of Gatorade—no one seemed bothered about drinking from the same container. People grabbed handfuls like they hadn’t eaten for a week. Candy quickly started spilling. After a bunch of face-stuffing and munching, one suddenly flew through the air and caught Rose in the chest. Someone yelled, “Marshmallow fight!” cuing Rose to hurl several back in the general direction the first missile had been launched. Everyone began scrambling for larger handfuls and slinging them in random directions, tears giving way to screams and guffaws. After several minutes of bedlam, the energy started to stall.
Rose finally yelled out, “Okay, you can eat them all up now!”
There were no takers: most of the marshmallows had gathered a coating of rug or been ground under knees or butts. The brief feast over, we set about working with damp cloths from the bathroom, wiping off bits of goo from chairs and carpet.
“Anyone need their butt wiped?” Annie offered.
As I left, I checked my watch. Less than an hour—not too long out of a 168-hour week. Nobody was going to burn out today. And someone’s boyfriend might even get a big kiss tonight.