Observations

When a Special Patient Dies

A routine of self-care helps to cope with loss

Clocking in for my night shift, I was filled with dread. A longtime patient of mine had been moved to the PICU at the end of my last shift because her septic body was beginning to shut down. She had been ravaged by leukemia. She was 15 years old.

Looking at the assignments that night, my dread was realized: Her name was gone. She had died.  I was a new nurse at that point and this was the first time that a patient of mine had died. A week later, I attended her funeral. I hugged her mother as we cried at the front of the church.

I struggled for weeks after her death and had a difficult time finding a way through my grief. It was like a maze — a maze I couldn’t even bear to move through. I wasn’t trying to deal with my feelings because I had no idea how to even begin.

Lessons Learned

My first thought was to escape to the mountains. I normally spend weeks each year hiking through the mountains of California and the deserts of Utah. These are the places that bring me peace. The world makes sense when I’m outside; this is where I process my feelings.

Behind the Griffith Observatory in Los Angeles is a trail leading to the top of Mt. Hollywood, a prominent peak that gives a panoramic view of the L.A. basin. There is an overlook with a couple of picnic tables. For me, this hike has turned into a ritual of sorts — a ritual of sweat and fresh air and introspection.

It was through this practice that I came to realize that each one of the patients I had lost — those deaths — had taught me something.

That first cancer patient taught me about happiness. Trite, I know; trite, but true. She taught me that no matter what pain you were going through, you could always smile.  She was in and out of the hospital for years, but I didn’t once see her angry or unhappy. There were times I saw her in immense discomfort, but she was still able to tell me a joke.

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Meeting her infused my life with joy. I’m reminded of something one of my nursing school professors used to say: “You can either be wet and miserable, or just wet.”

Another patient of mine died suddenly in her sleep at home, a week after she was admitted for a kidney biopsy. I had just taken care of her the week prior. That patient was often in the hospital and I was often her nurse — not because I liked her, although I did, but because she hated nearly every nurse on the floor. She was 20 years old and so smart that most of the pediatric nurses had no idea how to deal with her.

Truth be told, she worked my nerves as well, and in turn she usually only tolerated me.  She had a habit of ignoring people. Nurses would ask her direct questions and she would stare through them, refusing to answer. She would often do the same to me, which was infuriating.

Yet, I was gutted when I heard that she died.  She taught me the most valuable lesson I’ve ever learned yet as a nurse: treat everyone as if they deserve your best care. Some patients may act ungrateful or seem undeserving, reject your help, complain or even threaten you. They may be mean and rude. They may ignore and lie to you. They may be truly awful.

Regardless, each patient is deserving of respect, understanding and care.  I have to remind myself of this sometimes when patients are annoying or when parents are aggressive. It’s difficult at times, but it’s essential to having a nursing practice with integrity.

Grief Comes Home

I spent years trying to understand the deaths of patients, trying to figure out what it all meant, and then that grief hit my personal life. A week before writing this, a very good friend of mine died.

He had always dreamed of moving to Hawaii. About a year ago, he finally made the move. I was treated to amazing pictures of ocean and greenery and I envied his new life. Nine months later, he was admitted to the hospital with unexplained blood clots.

Three months after that, he died of advanced pancreatic cancer.  He was an amazing man, with a gentle snark and wit that would light up a room. He was brutally honest. His words sometimes hurt, but only because he would never tell me what I wanted to hear, always only what I should hear. He was the mirror that I needed.

I sat on top of a picnic table on Mt. Hollywood and looked out over the entirety of Los Angeles, my pen on page and tears in my eyes. I reflected on how knowing him has altered my life for the better, how refreshing I found his brutal honesty and how I could grow into a better version of myself if I could embody just a few of these characteristics.

Finding Your Own Path

Nurses help people through some of the most difficult times in their lives. We become good at taking all the fear and grief into ourselves to be strong for our patients. But we can sometimes forget that we too need to deal with our grief.  It’s important to manage our own emotional wellbeing so that we can be better practitioners.

These are some things that have helped me do that:

  • Deal with mental health issues. Admitting to struggling with depression, anxiety, PTSD and other mental health issues is not a weakness. Neither is seeking help.
  • Get active. Even if it’s just walking around the neighborhood. Leave the phone at home. Learn to unplug and get in touch with the uncomfortable parts of your mind.
  • Nurture yourself. Caregiver burnout is real, so be kind to yourself, whether that means a Netflix binge, pedicures, weekends at the beach or Vegas, staycations, gardening, crosswords, naps or anything else. Find out what works for you and do it — and don’t apologize for it.
  • Rituals are comforting. Like my hikes up the mountain, rituals serve as a reminder to allow yourself time and space to delve into the hard work of healing.

Jon Garrison, RN, MSN, works in pediatric kidney transplant and writes in his spare time about life, health, technology and connection.


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