Oncology nurse Theresa Brown is a regular contributor to the New York Times’ blog “Well”. Today she writes about how nurses cope with grief on the job.

Published in: New York Times
Issue/Volume: April 1, 2009
Written by: Theresa Brown, R.N.

4/1/2009 – My unit director tries to help by having a local organization called the Good Grief Center come by every other month to hold hour-long workshops over lunch. Whichever nurses are on the floor that day meet, chat, get to eat a real lunch, and hear some good talk about healthy grieving and the importance of making time for ourselves.

Aye, there’s the rub, because when the Good Grief Center comes, whether any nurses are able to attend depends completely on the vicissitudes of the day. Last time they held a meeting I very much wanted to go but had to “hang chemo” right in the middle of the session. Regardless of the intensity of the discussion, our mobile phones can and will ring, drawing our attention away — a doctor has questions, a patient’s son is calling, radiology says to transport the patient in room 1001. Once, a nurse who was in the Good Grief meeting was told she needed to take better care of herself — only to discover that her patient had fallen while she was away.

These ironies of scheduling make me hear “Good Grief” not just as a model for healthy mourning, but also as an expression of the job’s frustrations, as in “Good grief, Charlie Brown.” In fact, when I first heard about the Good Grief Center I heard it in the Charlie Brown sense because it seemed so apposite to nursing and health care in general.

A patient poops on himself for the fifth time that day: “Good grief!”

A patient pulls out her tracheostomy and a surgeon reinserts it at the bedside while the patient, who is delirious, screams and physically fights him: “Good grief!”

Three people die over the weekend and there’s no time to be sad about it: “Good grief!”

My hospital also pays for us to have free individual sessions at the Good Grief Center if we feel we need them. This off-site arrangement works better for me because it means I’m not trying to process my grief during stolen time on the job.

I’ve gone twice now, once to talk over a particularly gruesome death, and most recently to discuss our very tough December. I thought the counselor and I would talk about death, grief and grieving, and we did some of that, but mostly we talked about how to leave work at work. One idea she had was to call a friend when I leave the hospital at the end of shift, making an immediate break with my work world. Some people, she said, sit in their car for 10 minutes listening to the radio, zoning out, before they take off for home.

While talking to the grief counselor I realized that riding my bike the two miles to and from the hospital transitions me from work to the rest of my life. My ride home is mostly uphill, and the last few blocks can be a killer after a 12-hour shift. But when I finally get home, sweaty and panting, I’ve mulled over the ups and downs of the day — the blanket I forgot to get someone, the home care nurse who drove me crazy, the impossibility of being three places at once — and I’ve also begun to digest the sadder kinds of events that weigh on me over time.

Dealing with work at work needs to happen, too, and as nurses we confront death, and our own grief, in specific ways. We make crass, unrepeatable jokes that people not in the know can find shocking. It’s a defense mechanism, and we recognize the humor for the release it is. Sometimes we cry and get angry, swear loudly, drink too much when we get home, and tease each other mercilessly on the floor.

Off and on we think hard about quitting, about doing nursing work that isn’t so continually sad. Different nurses, for different patients, go to viewings and funerals, and others, like me, have a rule about never going. We make rash promises not to get so attached, and then, after we meet our next round of patients, promptly break them.

The most helpful thing we do on the floor to process our grief is talk to each other. Out of the blue the nurse working next to me might tell me, with disbelief, that a patient has died. “He was just here; it seemed like he was doing so well.” Word spreads in whispers, “So-and-so is going home on hospice,” “Mrs. X is ‘comfort measures only.’ ” We sit around the conference table at the start of shift getting report. As one nurse says, “Oh, he died,” everyone briefly stops to listen, to ask, “Who died?” and to leave a small moment of silence in that patient’s wake.

The Good Grief Center, leaving work at work, talking amongst ourselves — all these things lighten the burden of sadness. But ultimately what helps me the most is remembering why I come to work at all.

Death is hard, but the really hard part about this job is not giving up hope. When I think about hope in the midst of so much despair, another image from “Peanuts” comes to mind. Who does not know of the many times Lucy has enticed Charlie Brown with a football perfectly placed on the ground for him to kick? She positions the football and convinces him that this time she will let him kick it, only to pull the ball away at the last minute as he’s rushing forward. Carried upward by the momentum of his aborted kick, Charlie Brown flies through the air screaming, “AAUGH!” and lands flat on his back, “WUMP!” In one strip, as Lucy holds out the ball to him, Charlie Brown asks, “How long, O Lord?” Lucy, standing over him after he has once again fallen for her trick, answers, “How long? All your life, Charlie Brown…All your life.”

A part of me looks at all our patients, those with new diagnoses and the old timers, and thinks, just as Charlie Brown does when he sees Lucy holding the football, “She must be kidding.” Then I, like all of us nurses in oncology, get into position and run my heart out toward the football.

Because unlike Charlie Brown, I know that sometimes toe will hit leather. The ball will soar away into the distance lost to sight. So many deaths, but at that moment, even if it’s only for a year or two, one patient’s time on earth preserved. Sometimes, one or two good kicks can be enough.