Nurses crying. That’s what I hear from fellow nurses on the front lines treating Covid-19 patients. A nurse will begin the shift crying and end it crying. Crying. And we are not a profession that cries easily.
Frontline clinicians all over the country are experiencing anxiety, insomnia, a sense of acute inadequacy, and feelings of being betrayed by hospital administrators. Many will likely end up with some form of PTSD. Helplessly watching so many people die, especially when many of them die without their loved ones present, is professionally “untenable.”
These medical workers remain devoted to curing and easing the pain of the desperately ill. But what can be done about their pain? Their feelings of failure?
We know there is no universally effective treatment for the sickest Covid-19 patients. But their deaths are clearly not the fault of the medical team caring for them. Is it possible to ease clinicians’ burdens so that they feel less personally responsible when these patients die? I believe that another type of care situation, that of a hospice nurse may offer some lessons.
The most fragile Covid-19 patients are not unlike hospice patients: There is no cure for their condition. While they differ from hospice patients — their deaths often come on suddenly and cannot be foreseen — clinicians might more easily make peace with their deaths by viewing them through a hospice lens.
Even though we are all going to die, death fits uneasily into the world of health care. Fundamentally, health and healing apply to the living, not the dying or the dead, and helping the living get better is why most nurses and doctors got into this work. When I worked in oncology, I saw this principle acted out by physicians who viewed death as failure, and nurses who equated talking honestly about bad prognoses with destroying patients’ hope.
Hospice care approaches death very differently. Practicing as a nurse in home palliative care/hospice, I understood that patients were going to die. The goal was for them to have the best life possible for as long as possible and to die with minimal distress. Some people associate hospice with “giving up” on dying patients, but that is mistaken. Hospice nurses do not hurry death along. Rather, hospice clinicians concede that curative treatments do not exist or have been declined by the patient, and accept that patients will die soon.
As a hospice nurse, I managed symptoms — pain, breathing issues, delirium —listened to stories from the past and acknowledged hopes and fears for the future. My intention was that all of my patients would pass without suffering, and though that wasn’t always possible, I tried.
A century ago, all of us would have been much more familiar with death than we are now. There were no high-tech emergency departments or I.C.U.s; most people died at home. Modern times have made it possible to hide death in hospitals, behind beeping machines, tubes and wires. But now that a previously unknown virus threatens the entire world, death has once again come closer.
I am not suggesting that health care workers become indifferent to Covid-19 deaths, or that a certain amount of death from this disease should be callously dismissed as inevitable. No. Instead, I’m urging nurses and doctors to feel less responsible when Covid-19 patients die. As a hospice nurse, I never experienced a patient’s death as failure, (unless a young mother with young children – I still have a hard time with that scenario).
Hospital staff caring for Covid-19 patients need someone to help them deal with all the deaths. It is too much to feel responsible for so many lives, day after day, to rub up against one of the most challenging and often unacknowledged paradoxes of modern health care: Even though we work very hard to heal people, sometimes they still die and die only with a nurse holding their hand.