Why We Don’t Know What to do With Grief

(Taken from my nursing blog, http://heartofnursing.blog)

In my recent interview for an upcoming NPR TED Radio Hour podcast (9/17) on “Heartbreak,” the host, Manoush Zomorodi, asked a series of insightful questions from many angles about my experiences with grief over the years as a pediatric ICU nurse. Those questions have sparked many thoughts that I believe are worth exploring and sharing in a series here on grief, with hopes that we can take a closer, courageous look at grief and reframe our perspective on it during a time when we are all feeling it perhaps more than ever.

Unfortunately, recent world events give us countless issues to grieve on many levels. Please note this blog series will primarily focus on grief and loss more on the individual/personal level, though I think some of these ideas will be pertinent to broader societal issues.

And with that, the first thought I want to tackle is: Why we don’t know what to do with grief.

Before we tackle some reframing of grief, I think it’s important to consider why we run for the hills from it before we even give it a chance to just be a normal part of our lives.

Denial of its possibility is ingrained into our culture from day one.

I’ve lost track of the number of times I’ve heard or said myself, “I just thought that happens to other people in other places, not to me, not to us here.” Our blind spots to the assumptions we make about life as people in a wealthy, powerful nation profoundly shape our shaky personal response to real suffering, loss and grief.

We are a culture obsessed with convenience and easy fixes. Any ICU nurse (that’s me) can tell you how much we love our easy fixes to life’s pains and problems (hello, all the medical interventions), but also how powerless and detrimental some presumed fixes can actually be (again hello, all the medical interventions). We just keep assuming we can always find a way out of our grief, if not avoid it altogether.

Grief is too closely associated with negativity.

This is a tricky statement because there is obviously some connection between the two. But sometimes “toxic positivity” is completely out of touch with reality, and grief is more in touch with reality than we care to admit. You can have days of intense grief and intense negativity, but they don’t necessarily go hand-in-hand. You can also have days of intense grief and also have solid hope. Because we have such a hard time recognizing this, and we are a fix-it culture addicted to “positive vibes only,” we are strongly tempted to reply to someone’s healthy, normal grief with “At least you…(can still have another child),” or “You should just be thankful that x, y, and z.” This actually ends up invalidating and somewhat shaming what is actually a normal, healthy response of grief to a real loss. We think it’s necessary (and even possible) to somehow cancel out the grief by diverting attention to some more “positive” thing over there, instead of giving healthy space and permission to cultivate and process normal grief.

In other words, we only know how to battle negativity by trying to shut it down, which in most cases is probably wise to not indulge it too much. Unfortunately, because we almost automatically associate grief with negativity, this means we typically respond to grief by trying to squash it as well, even when its manifestation is actually a very healthy thing.

We struggle to be quiet and patient with hard questions.

With Google Search at our fingertips, we are more accustomed than we realize to having all the seemingly hard answers so readily accessible. Will my children growing up in this Internet age really even learn to think for themselves? It is in many ways a gift to crowdsource knowledge and have others do so much of this hard work for us. But when it comes to grief and loss, which are so intensely personal and complicated, we have to do the work ourselves of wrestling with the hard questions grief often raises, and this feels daunting because we simply don’t practice it much day to day. We deeply resist the discomfort of having our worldview and our assumptions of how life “should” operate be so profoundly challenged, and often prefer relief and escape from that discomfort over working towards the building of a different, deeper life foundation.

We don’t know what to do with things that cannot be explained.

Even as we work through hard questions, there remain some things that cannot be fully explained. There may be a medical explanation, coroner’s cause of death, but there are other types of answers we often search for that we simply won’t find in their entirety. Our need for control and power chafes against this. But when I’m suffering, it’s usually not clear and specific answers that actually soothe my soul. As the wise singer/songwriter Rich Mullins once sang, “And I know that it would not hurt any less…even if it could be explained.” When I’m suffering acutely, I find the most comfort in having space to lament, being accepted and embraced as I am by safe loved ones, and being helped to just take the next step forward when everything else about the future seems too murky or overwhelming.

We struggle to see what a good and hopeful life can look like with grief always present.

This, I think, is key, and will be the topic of a future blog post. (Note: it won’t be a blog post with answers, per se, but an exploration of what we do to ourselves and each other when we only define a good life in a narrow way – and what we can do for ourselves and each other when we learn to broaden that definition of a good and hopeful life.)

Thanks for reading this far. I would love to hear thoughts, comments, disagreements, as long as they stay civil and productive.

what I wish I could heal as your nurse

Would you give me permission to tell you

without overstepping my bounds, personal, professional

that this is not your fault.

You were only trying to take good care of your baby;

you didn’t know,

you didn’t know.

 

I see the protest in your eyes,

Someone has to be to blame, and that someone is me.

If I had known, if I hadn’t done this, if we hadn’t done that

our baby would still be alive.

 

How can I help loosen the grip that this mistake

threatens to hold over your life?

Would you give me permission to tell you

Can I tell you, you are still a good mama

Can I tell you, you are still a good papa

 

Can I tell you, your baby would forgive you too if he had the words;

of this I am sure.

 

Can I tell you, he knew you loved him to the very end.

Your tears baptize him

and your blessings flow

 

and flow

 

and flow.

 

How a Patient’s Family Heals a Nurse in this Era of Medicine

(Author’s note: Permission has been granted by all parties involved, including the patient’s family, to share medical details that may make this patient identifiable.)

One of the things that feels most unfair about pediatric ICU nursing is that with critically ill children, you don’t get the comfort of being able to look back and say “At least they lived a long and happy life.” You ache that a baby, a toddler, a school-aged child, a teenager, was supposed to have their whole life ahead. But instead, much of their short life was marked by illness, prods and pokes, lines and tubes, sedation rather than play, a sterile environment full of strangers at all hours rather than a home full of time with friends and family. The deep desire in both the parents as well as the healthcare providers to do anything possible to give them a shot at a future – hopefully one that is meaningful and healthy – is in and of itself right and good. Yet the decision about how much to push both medicine, and the child as the obligatory recipient, in the fight for a future that is neither guaranteed in quantity nor quality, can often be wrought with profound controversy and ethical distress. Clinicians do not necessarily find peace with their work just because a life was physically saved; sometimes quite the opposite, as so potently described in this NEJM article.

K was a little girl who came to our unit for PJP pneumonia secondary to an unknown autoimmune disease; she quickly won over the staff with her charm and spirit. Ben became her primary nurse, and she would count down the days when Ben would be back to work. K once told her frightened neighbor in their shared room, “Don’t be scared. You’re okay, and you’re not gonna die because Ben’s your nurse.” The insight, generosity, and pure trust of this statement give only a small glimpse into the extraordinary person that K was at her young age. But we weren’t naïve; the reality of her condition made her statement so very ironic and bittersweet. We knew she had a battle ahead, so we weren’t necessarily surprised when she was transferred out of the ICU to the regular ward, only to emergently return to us a few days later in worsening respiratory distress. We held our breaths and made faltering efforts to hold up our spirits as she finally succumbed to the need for a breathing tube, which took away the ability for her parents or any of us to hear her sweet voice or see her feisty spirit, now sedated by necessary medications.

K wasn’t getting better, and everyone knew it, including her parents. She had asked for everything to be done, and so her parents promised they would give her every effort. But they knew the final effort at a very invasive therapy known as hemodialysis was going to be a Hail Mary. And as expected, once the hemodialysis started, K’s blood pressure did not improve; it became, in fact, incredibly labile. The miracle was not to be, and so the family decided within the hour of starting the therapy that it was time to remove the breathing tube and say good-bye to this beautiful, vibrant soul. Their heart.

They mourned deeply and immediately, with the heaving sobs of parents who loved their child enough to give her every chance, but also respected her personhood enough to not relegate her to a limbo, sedated existence on machines when there was no real light of life left in her. They had been so kind, so brave, so generous in spirit with the hospital staff through all of our time with them. No one would have once blamed them for being angry or withdrawn; yet they held a posture of such open partnership with the doctors and nurses throughout the entire process. Perhaps they saw us as advocates, caregivers, medical authorities; they might have even seen us as heroes. But in the way they treated us? They simply treated us as people who saw, knew, loved, and wanted the best for their daughter the same way they did. We had conversations in this spirit, and it felt like a safe place for everyone. We talk a lot about wanting to rightfully create a safe place for the patient and family. But we talk very little about how families can create a safe place for the healthcare workers, too. This family gave us a safe place.

You see, this family gave us the gift of meeting and caring for their child. But they also gave to us the profound hope that it is still possible, in this era of pushing the envelope with medical technology, to do everything medically possible for their child and still be completely reasonable and respectful of the personhood of everyone involved – the patient, the family, and the healthcare providers. I find this to be deeply healing, because so much of what I do as a pediatric ICU nurse hurts me in ways that I never anticipated. I anticipated hurting with great apology over having to participate in administering painful procedures, but I accept this gladly if it gives the child a decent chance at survival and meaningful recovery. I anticipated hurting with grief over bearing witness to death, but I accept this if it means I can be a meaningful presence in a terribly isolating time of loss. I did not anticipate hurting with such cynicism over a profession that I once thought to be only driven by good, for good. I did not anticipate hurting with such doubt and self-loathing on the days when I felt myself to be the one who would not let a weary soul rest in peace, but rather continued to agitate, turn, feed, clean, and medicate someone in perpetual distress over their over-medicalized nightmare when there was no real chance of meaningful recovery.

This family’s brave, selfless and clear-minded approach to their daughter’s last days showed me that it is still possible for me and my colleagues to heal in the ways we want to heal, hurt in the ways we accept we will hurt, and not harm in ways we never, ever intended to harm.

Ben may have been present when this precious soul died, but he and K’s parents – and the entire healthcare team in close partnership – allowed K to truly live, up until her last breath.

I find this to be so deeply healing in this era of medicine.

No Ordinary Sunday

The readjusting back and forth between intensely challenging nursing shifts and everyday normal life is a real thing to navigate. It still catches me by surprise every time, how hard it really is.
I am in the thick of a full 12+ hours of trying to manage chaos and logistics in a unit full of very sick patients as charge nurse. In the blur, I am stopped in my tracks by moments of seeing family members who had literally just a minute ago received devastating news. A mother weeps, clutching her child’s teddy bear to her chest. The teddy bear is caught in this strange in-between of what was, and what now is. And then just 30 minutes later, I see the next set of family members with the same, but profoundly unique, broken expression.
I don’t want to grow overly accustomed to that expression on the family members’ faces and what it means. Yesterday held neither the appropriate time or space to let the stories sink in, to let me pay respect to the stories by allowing a human emotional response to all that they hold.
They always hit the next day. I work every Saturday, so often it’s Sunday at church. I’m catching up with friends I haven’t seen in a week. I want to hear about their life and their own joys and burdens. In the pit of my stomach I am nauseous with sadness over the stories that are hitting me. I am singing songs about hope, redemption, and joy, and it is in the practice of trying to form truthful words with my lips that I find the rubber hits the road with what faith in a good and loving God really means. This happens every Sunday for me, this small crisis of faith, as I am reconciling everything I have seen just the day before at work with everything my soul aches to sing with conviction on an ordinary Sunday at church.
I am chasing my healthy children in the church courtyard, taking in the gift that these ordinary moments are – to be able to just chase my healthy children at church. In my mind, I find myself reverently asking the parent next to me, “Isn’t it incredible…that we are here, watching our children play?” But I realize how odd that would sound. I am trying to catch up with friends after a week apart. And I am trying to decide whether to speak of my nausea and sadness, my mini crisis of faith, my weekly reconciling at church of what hope and joy look like for me, what they look like for the families with that indescribable expression that I left at the hospital yesterday. Do they look the same, or are they altogether different? Should they?
This is the navigating that I do as a nurse, between ‘work’ and ‘real life.’ They seem so entirely opposed and contradictory to each other, and yet so deeply and profoundly connected.
There is, for me, no ordinary Sunday.

A Strange Gift

Warning: This post is a bit on the heavier side, especially compared to the silliness of my recent conversations with Siri.

Yesterday was the first time I’ve ever done post-mortem care on a little patient, minus the partial experience I had as a nursing student a few years ago. Surreal hardly begins to describe the experience, from cleaning up a messy room that bears witness to the intense activity involved in coding a patient, to making eye contact with parents who are absolutely raw with grief, to bathing the patient in order to restore some small sense of dignity, to wrapping the patient with a shroud and bringing the patient to the hospital morgue.

Surreal. But it is part of my world. Our world, whether we choose to acknowledge it or not.

I was drawn to ICU nursing because I have a strong appreciation for the depth of issues that we face there, and I see it as an incredibly precious time to be a support for not only the patient but their grieving family members as well, particularly when we are dealing with end-of-life care.

But the weight of it all is substantial. The quiet entrance into a room full of grieving family members is the entrance into a space that has just suffered the most violent of all emotional earthquakes, looking for a foundation, is there one left? A space full of disappointment beyond measure but sometimes also hope, anger but sometimes also peace, and exhaustion… always exhaustion. After all, it takes everything you have and everything you are to say good-bye to the heart of your own heart. It takes all your being to search for light in a very dark place. This is the space that I entered as a nurse yesterday. What could I bring? What could I bring, and would it change anything in this space?

I could bring juice and crackers to parents who have thought very little of their own needs for hours, days, weeks, months, years.

I could clean up the room, quietly, gently, respectfully. There are some parts of saying good-bye that you just don’t need to remember, especially in an ICU. I could reduce the sense of chaos in some small way. I wanted such a clean room for them.

I could bring silence. Of course if they had questions, I would do my best to answer. But in terms of consolation for newly grieving parents, I am convinced that less is more. Maybe I say this out of my own lack of tolerance for pat answers. The movement towards resolution with our suffering is simply not as neatly packaged and bow-tied as some might have us think, and I am convinced we need to learn how to get more comfortable with being really uncomfortable in the gray areas – even as people of faith. I am convinced that the gift of silence to a grieving family is the recognition that they have now been thrust into an extremely uncomfortable, gray area, where they will likely stay for a very long time. Trying to move them out of it with premature clichés is counterproductive and potentially very hurtful.

I was so thankful for the accompaniment of an incredibly tender-hearted, skilled social worker who truly bore the brunt of the family’s grief yesterday. I told her how thankful I was that she was there, and that she did what she did so well. Her response was inspiring, sober, and honest. “Some of us are just gifted for this. And it’s a strange gift to have.” I am not an expert. I am awkward and new and scared as a young nurse facing these kinds of big issues. But by the grace of God, I believe I am gifted and called to this work. And I could not agree more. It is a strange gift to have, but it is mine, and it is what I have to offer.

Reblogged: Can Grief and Joy Coexist?

I deeply appreciate the honesty of this blog. I have lost my stomach for pat answers laden in overspiritualized vocabulary that invalidate the reality of what people experience when life is just honestly, hard. I have a deeper hunger for something both honest and real when we talk about joy in Christ, because of Christ. The same Christ who knew the Father was good, loving, and in complete control when He was broken on the cross and asked why He had been forsaken. He knew He wasn’t back Home yet, and He knows we are not either, not yet. This is the Savior I love, in whom I hope and in whom I can rejoice.

Clearing Customs

There is a phrase in Mandarin Chinese, bei xi jiao ji (悲喜交集), meaning “mixed feelings of grief and joy.” Grief and joy aren’t commonly thought of as partners, but when faced with loss, cross-cultural workers need to understand that one doesn’t necessarily cancel the other one out.

Expressing Grief

Dr. Steve Sweatman, president and CEO of Mission Training International (MTI), says that the call to take the gospel of Christ to another culture “inevitably is a call to sacrifice, to losses, to things that you will have to leave behind or give up.” This sacrifice takes many forms, and MTI has identified five categories of loss experienced by Christian cross-cultural workers. They are

  • a stable home
  • identity
  • competence
  • support systems
  • a sense of safety

In an audio presentation at Member Care Radio (entitled “Good Grief“), Sweatman also discusses the differences between concrete and abstract losses felt by cross-cultural…

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through someone else’s song

In my high school years, my friends and I were young, zealous, and just a little foolish in our desire to do good for others. We didn’t know what we were doing, but you sure had to give us an A for effort. We would go to Denny’s, the four of us, order one serving of toast, and throw all the little packets of jam into our backpacks, only to call over the waiter and ask for more jam. You can imagine, this only worked so well. It was a miracle we never ended up in the back washing dishes. We then made our way to the market where we bought a loaf of Wonder bread, a container of peanut butter, and bottled water. From there, we would seek out any homeless person we could find and give them their pb&j fixings ad nauseum for the week.

Something else we did quite regularly was visit the local nursing homes with my guitar. We just kind of wandered in and poked our heads into any rooms with open doors, asking if we could visit awhile. It was a slightly disturbing miracle that we never, to my recollection, were stopped or questioned by the staff as to who we were or why we were entering the residents’ rooms.

One visit stands out in my memory. We found a woman in her 40s or 50s, sitting next to her aged mother, who clearly suffered from a considerable degree of dementia. She was unresponsive to our questions, gazing at us with a confused look through forlorn eyes. We offered to sing a well-known hymn, “Because He Lives.” We closed the door to her room and sang softly.

Because He lives, I can face tomorrow; because He lives, all fear is gone. Because I know He holds the future, and life is worth the living just because He lives.

The light in the room seemed to grow softer. Peace replaced anxiety. Dare I say, joy came to us. The elderly woman quietly whispered the words of the song. It was as though we had ever so slightly stepped for a moment into that future time and place where sorrow and tears and death will be no more, and our hearts were glad.

Fast forward many years.

I had received an unexpected phone call. A loved one was in a hospital, many miles away. A suicide attempt. Please come quickly if you can.

I had no words for the pain, it ran so deep. I could not utter my prayers, I did not know what to ask or how to ask it. But there was a hymn that a close friend emailed to me. When peace like a river attendeth my way, when sorrows like sea billows roll, whatever my lot, Thou has taught me to say, it is well, it is well with my soul. It was the sung prayer of my soul. For weeks, as my loved one slowly recovered, words continued to evade me, both in conversation and in prayer. I ached, deeply. Did God hear the words I could not find?

One Sunday, I visited a nearby church rather than attending my own. I had no energy to keep up the façade to help others feel less uncomfortable with my pain. The pastor preached on anxiety and trusting the goodness of God because we see Christ, who bore our grief and infirmities, so that we might be healed. I went forward for Communion. The pastor met my tearful gaze. This is His body, broken for you. I returned to my seat, and the very moment I bowed my head, the music team began to play a hymn.

When peace like a river attendeth my way, when sorrows like sea billows roll, whatever my lot, Thou has taught me to say, it is well, it is well with my soul.

What is this love that comes so tenderly from heaven to earth, to this heart that could not pray but through someone else’s song. He heard my cry. Peace replaced anxiety. Even in grief, joy had come.

the strength that comes

I hear it and I say it a thousand times a week in one form or another. “I’m tired.” “I need a vacation.” “It’s been so busy.” We are tired people. It seems to be a given, just inevitable. It’s the pace of our society, and it comes with growing responsibilities coupled with the physical changes of getting older.  Gone are the carefree days of being a five year-old whose primary concern was which toy offered the most entertainment at any given time. What a life that was!

I think a lot these days about the weight of our lives. Heavy issues in my family, heavy issues in my patients’ lives, heavy issues in friends’ lives. Sometimes it’s easier not to think about it. And sometimes it’s important to give myself the freedom not to think about it all for awhile. But the reality is that it’s still there and can’t be ignored forever. Not if I want to live fully and discover the redemptive joys and lessons in character and faith that are to be gained from working through even the most painful situations.

After a particularly harrowing day at work, I commented to a coworker, “I choose to be here, right?” At the start of each day, it is still ultimately a desire and voluntary choice of mine to come into work, even when I know that it can be intense and beyond crazy-busy. The ability to choose our burdens, in that respect, is truly a gift. Because sometimes we find ourselves in situations that are outside of our choosing, from which we cannot escape. I watched the family member of one of my patients carry unbelievable burdens and responsibilities on her shoulders after a horrific accident. She was honest about her exhaustion and deep struggle, and yet she carried on with such fortitude, such commitment. She never would have chosen to be in this place, not for herself and not for her family member lying in that hospital bed. They were so tired. A vacation was not on the radar. But there was and there is a strength that comes.

According to Isaiah 30:15, “This is what the Sovereign Lord…says: ‘In repentance and rest is your salvation, in quietness and trust is your strength.’”

Some days I have to remind myself that for every legitimate complaint I am tempted to utter (and often do) about how tired I am or how hard things can get, I have ten things I can be thankful for. I really do. I’m not trying to be over-spiritual, unrealistic, or dishonest about what goes on in my heart. There just comes a point where I need to let my complaining grow quiet, and let renewed strength come from a grateful heart. To look less to the shadows and more towards what is lovely and good.

Sometimes, I try to escape burdens through busyness. Clean the house, fill my schedule with activities, watch movies. All good and helpful in the right time and right amount. But it is only in the quiet place of prayer before a loving Savior who Himself bore the burdens of a broken world on His shoulders where I can truly relinquish all the brokenness I feel for myself and others to Him once again. Let my anxious heart look upwards to trust that He is still Emmanuel, God with us.

I do not and should not expect Him to fix everything now, to free me of all trouble for the remainder of my days here on this earth. There are a lot of very uncomfortable uncertainties for my life, my loved ones, and for what I see in my patients, that I am learning to live with, and it is hard. But there is too much left for me to learn about resting in His presence, trusting Him more, longing for heaven, and responding to hard situations with better character, for Him to give me less than what I need to grow. Simon Rodia constructed a beautiful testament to what beauty can be brought out of brokenness when he built the Watts Towers, and I am thankful for his reminder.

So I am learning slowly that strength does not ultimately come from venting all my complaints, escaping all burdens, or having all the answers to all my questions.  Let strength come, rather, from the quietness of knowing His hand is over all things, and trusting that His hand is faithful, loving, and good. For my home is with Him now in the midst of a broken world, and my future home will be with Him when the brokenness is no more.