In nursing school, we were taught how to save lives, help manage symptom, cure disease and comfort patients and families. Beyond a day of clinical on a hospice floor and a list of recommended books on the grieving process that were not required reading, death was not something we would talk about.
I did not realize that there was an entire side of nursing and of life that I was not confronting—death and the natural process of mourning that comes after it.
My first nursing job was as a pediatric nurse working with special needs children. I loved my job immediately and developed a bond with my patients. The unit was full of children with heavy charts filled with diagnosis after diagnosis, children that would live on the floor until their death or until they aged out and would be moved to an adult facility. Unlike acute care, my patients were the same day after day and those children and their families occupied an entire section of my life.
As I parceled out hundreds of meds, suctioned trachs and administered g-tube feedings to a unit of chronically ill special needs children, I knew that it was only a matter of time that we would lose a child—in fact that we would likely lose all of them before they reached adulthood. The information in their charts spoke of a lifetime of medications, surgeries, therapies and interventions to try to make their lives better. Many of these children were born into a life of suffering and did not know any differently, others had been in horrible accidents or were victims of abuse.
My First Patient's Death
Regardless of the gravity of the diagnoses and condition of the patients on the floor, the unit remained a happy place. We had brightly colored walls, toys everywhere and our patients delighted us each and every day. Most of the patients were non-verbal but found other ways to communicate with us.
Every patient on that floor had stolen my heart, but one girl in particular followed me around the floor on her electric wheelchair each day and pretending to be a nurse, too. “Kate” was one of my first patients right out of nursing school and, heartbreakingly, was also the first patient of mine to die.
I remember that in the hours after her death, I was simply going through the nursing motions—supporting her family in every way that I could, making calls on behalf of the family and preparing her small body for the funeral home. I felt like a robot completing every task I could think of to make her death easier on her loved ones.
I was told by a nursing instructor that I must never cry and I remember repeating the words, “don’t cry, don’t cry” fervently as I held back all of my tears. I did hold them back. I was strong-until I reached my car in the darkened parking lot at the end of my shift. Then I wept until my contacts fell out and my face was swollen and red. I drove home that night shaking with a new weight on my chest that I had never before felt.
Days later, I still was struggling to stop myself from weeping at everything. I found myself avoiding the room that had been the Kate’s room, praying at every shift beginning that I was not assigned to that room. Even the weight of my stethoscope on my neck gave me pause, as I had used to drape it around Kate’s neck when she was pretending to be a nurse, her giggling with joy at the simply gesture.
I'd Never Thought Nurses Would Mourn
I noticed an older nurse hanging around after a shift later that week. I had never really spoken with her other than to take report from. She was known as someone who never appeared to show emotion but was wonderful and gentle at her job.
She took me to the nurse’s station and asked me how I was doing. I couldn’t help but weep as she put her arms around me, fearing that she would yell at me for my weakness. I explained in a shaky voice how I was feeling. She nodded and assured me that all of this was normal for the mourning period after losing a beloved patient.
I was taken aback. Mourning? I’d never even thought that nurses would mourn their patients. It certainly had never been anything that we’d addressed in the years at nursing school. We were to be professional at all costs and every moment, no matter what happened around us. We were to show much compassion and little emotion. We were supposed to embrace death when it came and usher our patients gently to the other side while comforting their loved ones.
I sat in a moment of quiet with that nurse before the rush of the day ahead. This nurse, an older woman that seemed tough as nails, had given me the gift of allowing my own feelings without guilt. Of course we mourn our patients. We care for them and form incredibly tight bonds in the short amounts of time that we know them. Why would we not mourn them? I went back on the floor that day, still mourning but with my head held high. I had been given permission to grieve without guilt.
After more than a decade of nursing, I have lost too many patients to count. I carry each one of them with me in my heart. Some I only knew for moments, hours or days. Others I cared for over the course of several years. I had deep affection for each and every one of them, even the ones that weren’t so easy to care for. There have been times of great loss when I lost long-time patients one after another and felt as though I was in constant mourning.
My Mourning and Loss Does Not Make Me a Weaker Nurse
In fact, it makes me a stronger one. I am comfortable with death and mourning in a way that nursing school never could have prepared me for. It helps me to understand grief and take care of my patients and their family in the time of their greatest need. I do my best to withhold much of my emotion but there have also been times that tears have slipped down my face in spite of myself. Even those moments of tears have seemed to be appreciated by my patients, not taking away anything from their own emotional experiences. We are human after all, even if we must act as superheroes.
If we find ourselves in need of mourning after the passing of a patient, I hope that we will turn that love onto ourselves and allow that period of grief. Mourning is a part of nursing, too.
“Tears shed for another person are not a sign of weakness. They are a sign of a pure heart.” ~Jose N. Harris