The day was over. A long shift had finally ended and I gathered together my belongings for the brief trip back home to sleep before returning tomorrow. I smiled at thoughts of my children. My six year old daughter had learned to ride her bicycle without training wheels, and though I had missed the momentous event in person, my spouse had been good enough to capture video evidence for me. I looked forward to dinner together, even though I knew I’d be exhausted and ready for bed. The idea of a hot supper and quick sitcom before snoozing made me smile again, but then I didn’t. Because I thought about my day. I don’t guess I had really thought about it. I hadn’t allowed such a thing. You couldn’t.
As I stood behind closed doors, the bathroom door and break room between me and the patient care world, tears began to well in my eyes.
The horror of it.
I swallowed hard trying to dislodge the lump of emotion that had taken up residence in my throat, but that exercise was as futile as trying to will the tears not to flow down my cheeks. The emotional heaviness of such a horrible happening for my patient had left me deflated. I hadn’t realized it before. I couldn’t.
And as the empathetic emotions reared their ugly head, the raw tears streaked my face in frustration. I couldn’t change my patient’s circumstances anymore than I could have prevented the befalling of such tragedy, for the patient and their family. I wiped a stray tear away. It had snuck up on me, this emotional outpouring. I hadn’t felt it all day while I was in the thick of the awful. I hadn’t. I couldn’t. That’s not how it worked.
Nurses see a lot of pain, their beyond, fair share of heartache, but also occurrences so terrible that words can’t even begin to describe. You wouldn’t know it by their face, though. In death, work continues. In patients’ and families’ grief, condolences and support are given, but efficiently. To some it might even appear aloof. It’s not that.
We feel pain. We know pain. We know it so intimately that we wish we didn’t. We have held hands, heard prayers, and passed out Kleenex more than you can imagine. We’ve held shaking daughters who never got to tell mom goodbye, and we’ve picked up inconsolable mothers off the floor when their only son passes suddenly. We know pain.
We’ve stood there silently, back against the wall, hands wringing behind us, silently praying while the physician delivers the news no parent of a toddler wants to hear. Cancer. We’ve made the long walk down the hall to the waiting room. The one where the family all look up at the sound of the door, like a group of deer caught in the headlights. We hope our face doesn’t betray the sentence the surgeon is going to have to say.
Your dad didn’t make it out of surgery.
We watch your pain, we see your tears, we hold you up so you don’t hit the floor. But our tears seldom fall. They don’t. They can’t.
Not yet.
As I stood in the private bathroom I allowed my tears to fall, tears that had been there for thirteen hours, tears that I had hidden so well, they were hidden even from myself. I let them fall, I felt the pain of the horrible things my patient had experienced, and my heart broke for my patient. I suppose it had been breaking all day; I had just been to busy to allow it to surface.
It wasn’t that we didn’t feel. It wasn’t that we didn’t care. I think, in my own personal experience, it’s that we care so much. We care so much that we keep our own emotions in check. We do this so that our patient can have all of our effectiveness and thorough care. Yes, we empathize. And yes, we support their turmoil. Our turmoil, though, it stays below the surface. The thing is, we’ve seen so much pain, year after year, that if we let in the fullness of the whole lot, we’d crumble. It’s not just understaffing or overworking that leads to burnout. Sometimes you can only hold so much pain before you must step aside. With this in mind, we have a bit of a fence in place.
We joke, some often times inappropriately. We laugh, we sing, maybe we seem distracted or detached. But maybe that’s just how we cope. It’s how we cope with the pain, the grief, the patients who cause their own demise. It’s how we hold all the awful within without toppling over. Although, sometimes we spill over. We spill over the hot tears behind closed doors. You can only hold so much behind a fence, even if it’s built for your own protection.
I cried about a patient today. I know I will cry again. Maybe not tomorrow, the next day, or even the following week. But I will. I’ll cry, and I’ll probably do it when they can’t see me. You see, when they’re looking at me, I’m too busy looking at them, ready to help with their tears. That’s just how it is, and how it has to be.