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Thursday May 11th, 2023
I remember during the height of the pandemic, we had just finished our very first workshop series and our group wanted to keep meeting together. We realized it was our connection to each other that was offering us spaces to reflect and a lifeline that did not exist anywhere else. One of the nurses told us a story, she said, “The other night I had a patient in the ICU and this patient was dying. It looked like the patient didn’t have much longer to live and so their family had said goodbye to them over Facetime and now I was tasked with being the patient one on one until they passed. I look back on the night and I thought I was doing everything right. I monitored their vital signs and IV’s and caught up on all my charting. I clearly remember listening to the ticking of the clock and the ticking of my typing in the otherwise silent room when I realized the patient was gone. Once they passed I had a sense of panic rush over me. I began to feel as if I had done everything wrong. I realized I never held their hand, I never told them I am sorry it was ending like this, I never said I’m sorry that their family could not be with them as they died. I just checked their lines and charted. It felt like I left my humanity at the door and hardened because that was what I saw everyone else doing around me. I thought that was what I was supposed to do, to get through one more death, one more human who had to die alone. I had not been trained to know how to be with a patient who was dying who had to die alone because of COVID precautions. I was still trying to figure out how to tend to my own needs, my own fears, my own anxiety of possibly dying as I took care of COVID patients day after day. It was only after the patient died that I wished I would have done more, only it was too late. Looking back, I wish I would have held his hand as he passed away so he knew he wasn’t alone. I wish I remembered his family names so I could tell him they all wished they could be with him as he died and that they would have been if they were allowed to be. I look back and can’t help but feel like I did everything wrong. I can’t sleep at night anymore, I keep replaying the night and focusing on the ways I was not able to truly care for him. I am angry that this was what was asked of me with no supportive care or follow up.”
I remember holding this story with our other colleagues and thinking how brave she was to share this. To name her anger, her guilt. As nurses we understand this guilt as we have all been there before, we understand the constant gnawing at our hearts that we could have and should have done more. Although necessary to stop the spread of COVID -19, this was not a situation this nurse should have been in, in the first place. To be with another human as they die when no other family is allowed causes moral injury. The impacts of doing something that we believe doesn’t serve our patients is catastrophic to our hearts and our souls. This is what we were asked to do during COVID. We did things that were not right but we had to do and in some cases it was for the greater good, however we were not supported and cared for as we were asked to step into and hold these experiences.
As nurses we hold these stories of loss, of guilt, of shame in our bodies and we do not have many courageous spaces to honor them. I think of Debriefing the Front Lines and the work Tara Kosmos is doing to create spaces of debrief, of care, to help us all remember we are not alone in our feelings of grief, inadequacy, and as she calls it system betrayal. I think of the work we do in our workshops to help nurses and other healthcare professionals name these feelings through movement, the arts, and play. It is naming the ways we have been betrayed, being used and taken advantage of and naming what we need to heal that allows us to soften and connect with one another.
When we are hailed as heroes we are stripped from our one true superhero power. Our humanity, our frailty. Our humanity is what saves us, saves each other and connects us to this world in healing ways. When we are stripped of this connection, we are isolated and experience loneliness leading us to think something must be wrong with us because we cannot bounce back like everyone else.
Courageous care brings us back to our beating hearts, it reconnects us to the rhythm of who we are and what we need. Courageous care brings us closer to our humanity as we connect and walk alongside ourselves and other human beings in their pain and suffering and also their joy. Courageous care is leaning in, not away, it is choosing connection over isolation, it is being curious and ensuring we offer more compassion and less judgment for ourselves and others. The thing about courageous care is it can also feel scary and uncomfortable to many of us. However, courageous care is revolutionary and is, I believe, what we need to heal ourselves, our systems, our colleagues, our profession, and our patients.
What I love about courageous care is it is not something we need to do more of, in fact in many cases we need to do less. Courageous care is about our presence, courageous care is about being, receiving, giving, listening, softening, holding, healing, and experiencing our joy together in relationship. I hope you join me in my next blog as we look at the first step of Courageous Care together. Until then I wonder who has cared courageously for you? What did they do that was different, why was it so impactful for you? What do you remember about it?
Tara Rynders, The Dancing Nurse Educator and Nightingale Luminary, is the CEO and Founder of The Clinic, an arts and play-based immersive theater company that offers workshops and keynotes to create more sustainable, (Re)Brilliant, and equitable healthcare systems.