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.

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.