What’s on my mind about practice? Ribbons of Remembrance.

Remembering children and families in a humble moment of service, silence, and song.
Remembering children and families in a humble moment of service, silence, and song.

This weekend I sang in the volunteer choir at the annual memorial service organized by the hospital where I work as a staff nurse.  Having one voice in a choral ensemble is a mighty humbling experience.  Amplified by the emotion of looking into the eyes of an audience of bereaved families, I'm reminded that loss and grief can underpin some of our best efforts to preserve life.  I've written about how saying goodbye to patients at discharge can be one of the hardest parts of the job.  Harder, is saying goodbye at the end of life...to patients, and to grieving families.

As hospital staff, it is a privilege to extend our support to families grieving the loss of a child with the Ribbons of Remembrance service.  I'm so grateful for the efforts of our memorial service planning committee and our chaplains for hosting a service that reflects diverse beliefs and traditions.  Singing in the choir has proven to be a way for me to process the waves of loss, grief, and bereavement that come with this work.  It's not unexpected to witness loss when caring for critically ill children.  Nonetheless, you're never prepared for the moment of looking into the eyes of parents who have just lost a child.

My aunt is a nurse anesthetist.  She's shared a lot of moving accounts with me over her 45 years in practice...some for shock value, others for instructional value.  One case she shared that has really stuck with me was how she was told by colleague to deal with her first loss and move on, because her next case was coming in ten minutes.  She shared that story with me years before I was a nurse, and I remember wondering how she could in fact move on to the next case...in ten minutes, no less.  She explained that there's a job to do, that each practitioner has a responsibility to find ways to grieve these losses, and that hopefully, you're part of a compassionate team that offers a human touch in caring for one another.

The first time I witnessed a death in my nursing career, I documented the details like a slide show in a personal journal I keep. I pulled that journal off the shelf after attending this weekend's memorial service.  I wrote about the loss the day after it happened...right after attending a debriefing for providers. The journal holds a chronological play-by-play of what I witnessed, and the details of each caring and compassionate gesture extended by the mature care-team members who knew that I was witnessing death in my role as a nurse for the first time.

What the individuals on that care team did for me when I witnessed that loss of life was instructional in action.  One nurse got a blanket from the warmer and wrapped it around me with a hug.  Another told me to take a walk around the block, and to find her when I came back inside.  A surgical technician told me that he might look composed in the moment, but that when he got in his car, he would cry; for the team, for the family we were serving, and for the child we lost.

One of the chaplains at this weekend's memorial service held a special moment for the children where he read a story by Ellen Yeomans, Lost and Found.  The story is about death, told through the eyes of a sibling.  This young voice wonders why her parents say that her sister Paige died, but her grandparents say, "We lost Paige."  She wonders if she is still a sister, and if her sister is lost, can she be found?  In the end, she discovers that she will always be a sister, and that her sister can be found in memories of the heart.

Hearing this story while standing among fellow choir members at the Ribbons of Remembrance Service, looking out into the eyes of these bereaved families while singing, I was reminded that grief is processed in waves.  I am still a nurse to those children who we have lost.  These families who came to remember their children shine a light on the places we can find them in our hearts.

After the first rehearsal I attended in preparation for the memorial service, I cried in my car the way I sobbed on the drive home after being involved in my first case that ended in loss.  I was reminded that there's a place we tuck grief that re-opens over time.  I felt it open up again when I recently received a call from a nurse I've had the honor of mentoring over the past couple years.  She was sustaining her first loss in the patient-care setting.  We cried together.

Like so many other aspects of nursing, what helped me feel prepared to process this loss with my mentee was the human touch modeled by members on that care team who helped me begin to process the first death I witnessed.  Digging further back to the instructional value of my aunt's first account of dealing with a patient loss, I heard myself recount the advice that we have a job to do and a responsibility to find a way to process losses.  This journey has not been as lonely as I once anticipated, thanks to opportunities like singing in the hospital's choir and thanks to being a part of a compassionate team who cares for one another.

Editor's note: I've found the article, "Strategies for Teaching Loss, Grief, and Bereavement," in NURSE EDUCATOR, Volume 28, Number 2, March/April 2003 to contain some helpful exercises and resources on how caregivers can work together to process loss and find comfort in these most difficult times. 

I love hearing from readers.  How do you process loss in your career?  How do you practice self-care while extending care to the patients and families we care for in these most difficult times?  Please feel free to comment here or to reach out by email at: natalie@thereflectivenurse.com

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