All Deaths Are a Great Loss

When I was in nursing school, an “elderly” instructor (she must have been at least 60)

Bones (Redivivus) by jparadisi

Bones (Redivivus) oil on canvas by jparadisi

asked our class,

“Is the death of a young person a greater loss than the death of an old person?”

The oldest student was maybe 30. Unanimously, we agreed that the death of a young person is the greater loss. The instructor’s expression let us know she did not agree,

“All deaths are a great loss. No one wants to die. As nurses, you’ll do well to remember this.”

My first nursing job was in pediatrics. I remained in pediatrics for 15 years, and my student perception of the death of a young person being a greater loss than the death of an old person was never challenged. However, now that I am an adult oncology nurse, I have a better understanding of what our nursing instructor was trying to teach us that day.

Few people would argue that the death of an older person is sadder than that of a young person, but that’s not what my nursing instructor had asked. She asked, “Which is the greater loss?” The losses are equal, but for different reasons.

The death of a young person is a great loss because the world loses a potential Picasso, Hemingway, or Madame Curie. The parents of the youth lose the legacy of grandchildren who may have been born to their child. If grandchildren are already born, they lose a parent. The dying youth loses a full lifetime of experiences, love, joy, and sadness — the bittersweet fruit of a ripe old age. A piece of hope dies with them.

When an old person dies, the world loses a Gandhi, Rosa Parks, or Mother Theresa. More commonly suffered are the loss of a spouse, a parent, a close friend, or confidant. We lose someone with whom we share common history and memories. Upon death, an old person takes a piece of life from those left behind. With this understanding, I sit at the bedside of elderly patients, holding their hands as they grieve out loud their cancer diagnosis and impending deaths. I grieve their loss as greatly as I did the loss of my pediatric patients.

Nurses know that every passing life is a loss and there’s peace in knowing there’s no need to judge.

Using Perspective As a Tool Against Nursing Burnout

The death rate for humans on the planet Earth is currently 100 percent. I know this is not a pleasant thing to read while enjoying your first cup of coffee this morning, or perhaps you’re enjoying a calming glass of wine later this evening. It’s unpleasant enough that perhaps you will not finish reading this post, but it’s true nonetheless.

Ravens by jparadisi

Ravens by jparadisi

Running parallel to our fear of dying is our pursuit of eternal youth. Cosmetic surgery and procedures are a billion dollar industry. Many men and women consider regular treatments for balding, teeth whitening, the prevention and removal of wrinkles, and coloring gray hair part of normal maintenance. Some choose to have  the evidence of time wiped from their faces by a surgeon’s scalpel.

The struggle nurses face in striking the right balance between hope and realistic outcomes for our patients is in part due to society’s mythical belief that death is preventable, when in fact, it’s inevitable. As humans, nurses buy into the myth to some extent also.

Discussing this, a nurse friend and I joked about gray hairs and wrinkles. She remarked, “Getting old is terrible.”

“No,” I said, “It’s not. It’s what nurses do for a living. We help people stay alive so they can grow old.”

See? It’s a matter of perspective.

Whenever someone asks, “Is it hard being a cancer nurse working with dying patients?” the above thoughts come to mind. The answer is, “I don’t see oncology nursing from that perspective.”

Yes, oncology nurses work with the dying, but I perceive our practice as helping people live to their fullest capacity.

Nurses cannot guarantee patients a cure or how long they’ll live, but by promoting prevention, treatment, and providing tools for managing chronic disease, we encourage them to pursue their best life possible as things stand. If nurses lose this perspective, how can we hope to share it with our patients?

There is balance in the realization that death is part of life. Death and loss cause grief, a normal response. Grief and loss are painful. We fear death and loss, but they are a natural occurrence of living. Maintaining a realistic perspective is a tool for burn out prevention among nurses.

All people die. Nurses are here to help patients live until that day.

I grieve their loss, and mine, because I glimpse my mortality too in the faces of the dying.

Thank you for reading this entire post.

Grief

“A voice was heard in Ramah, weeping and great mourning, Rachel weeping for her children; and she refused to be comforted, because they were no more.” Matthew 2:18

I Wish I’d Said It

Ravens oil on canvas by jparadisi

You cannot prevent the birds of sorrow from flying over your head, but you can prevent them from building nests in your hair.

-Chinese Proverbs

Privacy and Grief

 

Sometimes a Surgical Mask Feels Like a Gag by jparadisi 2010

One of the difficult things about working in an outpatient infusion clinic is not knowing the outcomes of many of our patients. They come to us for treatment from a multitude of physician’s offices, all over.  Cancer patients come at regular intervals for weeks, sometimes months. Many arrive with life-threatening disease looking for one last remission, or simply enough time to see a child graduate from high school or the birth of a grandchild.  We listen as they tell us about the disappointments and the blessings of a cancer patient. We meet their families and loved ones. When they complete the course of treatment, they stop coming in. Most of the time we never know what happens to them.  HIPPA privacy laws limit our ability to find out. This is very different from my previous work in pediatric intensive care units, where nurses celebrate a child’s long anticipated discharge home or attend at the child’s death, and grieve along with their parents. Either way, I knew what the outcome was and dealt with the accompanying emotions. I knew how to respond to families I ran into at a grocery store.

It happened again a few weeks ago. Drinking a cup of coffee I found her obituary in the morning paper. She was one of those special patients who were easy to love. Her prognosis was grim, but her attitude was good; she was a fighter. From a grainy newsprint photo, she looked out at me. She had hair in the photograph and I realized I’d never seen her with hair, but the eyes were the same, clear and full of laughter and hope. She’d been dead for few weeks by the time the obituary was printed.

HIPPA laws prevent me from looking up her family’s address and sending a card or flowers. The obituary did not include instructions to send donations to a favorite charity or anything like that. So I’ll send one off to one of mine, in honor of a patient who touched my life. Her name will not be mentioned, and her family will not know, but I will feel better.


Pick Me

Absence (installation 2009) by JParadisi

I am five years old, lying on a mat on the floor in a darkened room. Peeking out of the corner of tightly squinted, but not quite closed eyes, I watch Mrs. Sundeman, seated at a child-sized table, place gold stars on our morning’s work. She sits on a child’s chair. With the side of my face pressed against the mat on the floor, her black shoes with stout heels are in my direct line of view. I peer up towards her face, willing her to see I am a good napper. “Pick me, pick me,” I chant silently. “Please pick me.” I force myself to lie still on the uncomfortable mat.  It’s naptime in kindergarten, and I want to be the best napper so Mrs. Sundeman, the teacher will pick me to have the magic pencil. Then I will choose, one by one among the sleeping children, who will get off the mats first by tapping them on the shoulder with the magic pencil. With the magic pencil, I choose who returns to play and who stays on the uncomfortable mats.

I am not chosen. It is not enough to lie still with squinted eyes. Mrs. Sundeman prefers children who dream unconsciously to those who like me cannot lie still without thinking. I do not know how to lie still and not think of something. Even with my eyes tightly closed, I see swirly lines and arabesques in brilliant colors against the black backdrop of my eyelids. My thoughts are full of ideas for pictures I will draw and I struggle not to tell the child lying closest to me, because we are not supposed to talk during naptime.

I am an adult now. I am a Registered Nurse. I hang bags of chemotherapy on IV poles and attach it by tubing to the IV sites of cancer patients looking at me hopefully as if I am administering Jesus in a bottle. They come in hoping for a cure, but many would be satisfied with simple remission, allowing them another birthday, another holiday, another anniversary with their families. I can hear their silent chants, “Pick me, pick me.” I smile at them while setting the pump. I ask if they are comfortable in their lounge chairs. I bring them warm blankets and pillows.

She lies in a lounger. Her cancer refuses to go into remission, and we both know. She no longer chants “pick me, pick me.” I gently hug her body of skin stretched over fragile bones. I never had the magic pencil. I never will. I am not the one who gets to pick, and for that I am grateful.

The Volcano Lover

Cinder Cone with lava field in the background photo: JParadisi

Cinder Cone with lava field in the background photo: JParadisi

     Recently, I walked to the top of a volcanic cinder cone in the Cascade Mountain range, in Oregon.  I have been in love with volcanoes for decades now, since I first heard of the ruins of Pompeii in the fourth grade, and  images of cataclysmic geology flowed  like molten lava within my ten year-old imagination. 

     I read the novel, The Volcano Lover, by Susan Sontag, simply because of its title.  It wasn’t  as much about volcanoes as it was about submerged passion and possession, but I enjoyed reading it.

     It was weird, walking on the top of a volcano, though it’s been more than a millenium since its last eruption. Volcanoes in the Pacific Northwest don’t conjure tropical images of the goddess Pele hurling showers of orange and red molten stone at the lovers who displeased her. Pacific Northwest volcanoes are more subtle. They simmer quietly for eons, occasionally belching benign plumes of white steam, seen for miles.

     I didn’t live in Oregon when Mount St. Helen erupted in May of 1980. But I have seen large spirals of steam billow up to the sky from it,  like no cloud I’d ever seen before.  It was a few years ago. I had just gotten off work, and was going to my car on the top of the hospital’s parking structure, when I saw it. A coworker of mine, who I occasionally ate lunch with (we liked the same bench in the hospital’s garden during good weather) was the only other person there to see it. We sat on the hood of his car, watching the phenomenon, and congratulating ourselves for having the best seats in Portland for this spontaneous performance. A year or two later, I can’t remember, this same coworker, who loved nature, his family, and his patients, was shot in the head by an intruder in his home, who stole the very car my now deceased friend and I had sat on that day, watching the volcano, and wondering what would happen next. 

     You never know what’s brewing underneath.

     I thought about all of this while walking the cinder cone. Life is unpredictable. One day you’re healthy, the next, you or someone you love is in an accident, or diagnosed with a life-threatening illness. Or you get a phone call from a stranger, telling you  “I’m very sorry to inform you ma’am, that your loved one was found dead…”

     With this in mind, I refrain from judging my outpatients who irritably or sheepishly ask me to let them go out for a smoke, between their infusions of chemotherapy. A diagnosis of cancer motivates some patients to quit, but others find it so stressful, they don’t have it in them. Some of them berate themselves with guilt, because of it.  I do my duty, and encourage them to quit, but I know first hand that a healthy lifestyle doesn’t guarantee a cancer free life, and out of compassion, I share this knowledge with them. 

     I think about safety, and how to avoid danger, and this quote, from the sci-fi movie Demolition Man bubbles up from memory:

 “I have seen the future. Do you know what it is? It’s a 47-year-old virgin sitting around in his beige pajamas, drinking a banana-broccoli shake, singing, ‘I’m an Oscar Meyer Weiner’.”

     I’m learning that the rules we make for ourselves only create an illusion of control. We have choices, but we don’t have control. Or rather, we have control until it’s taken away from us, through illness, accident, or a violent crime. We walk, not realizing the volcanic turmoil underneath the smooth surfaces of our lives, until an eruption occurs.

     You never know what’s brewing underneath.

When You Professional, Sometimes You Suffer

     It is late in the afternoon, and it has been an extraordinarily busy shift. My fatigue, along with that of my colleagues, is compounded by our worry for a much-loved coworker out on unexpected medical leave, our worth-her -weight-in-gold unit secretary is out on a planned medical leave, and if all that isn’t enough, an important and well respected physician in our oncology community died suddenly in an accident. We received the news this morning. It is a horrible, no good, very bad day. And it is so busy, we can’t take time out to give one another a hug. You can see the tears we hold back in our eyes.

     He is my last patient of the day. He needs a a blood test today, then he’ll return to the clinic tomorrow for his treatment. He tells me he feels horrible, no good, very bad today. He asks me if he can stay and begin his treatment this afternoon. I look at the clock. To honor his request means I will stay at least an hour over time. He may have seen me wince, or maybe I sighed, because I know I am going to do what he asks. A worried expression crosses his tired face, and he looks around the unit at the other patients. “It’s very busy here today? Lots of sick patients? You are tired?”

     My heart was touched.

     “Yes, we have many patients and they are very sick today, but you are sick too, and it’s my job to take care of you. I will start your treatment this afternoon. You need it.”

    He smiles with what little energy he has. He holds my hand and says, “When you professional, sometimes you suffer.”

    I squeeze his hand and walk away to send his blood to the lab, before he can see me cry.

Birds of a Feather

photo J.Paradisi

photo J.Paradisi

     I do not know which to prefer,

 

The beauty of  inflections

Or the beauty of innuendos,

The blackbird whistling

Or just after.

Wallace Stevens

Thirteen Ways of Looking at a Blackbird

 

 

Ciao, Babbo.