Lessons from the Bedside: Life After [a Patient's] Death

Recently I took care of a patient who died.

The patient went quickly and without pain, but for some reason the death shook me more than usual. The next day, I found out a different patient had decided to go hospice. At home in my bed, I cried as I thought about how I'd gotten to know these dear people, and how their lives had or were coming to an end. Not in a painful or sudden or traumatic way, but coming to an end nonetheless.

Admittedly, lately I've been working extra shifts at the hospital and have been slightly overwhelmed by nursing in general, and maybe that's why these deaths seemed to affect me more than usual. Saddened by the loss of life, I sat in my bed begging my body to fall asleep while tears slid down my face. Sickness, sickness, death, sickness. Though I love my patients dearly, I was worn out.

Stock photo from Adobe

All I wanted was to help people succeed. It's what gives me the most fulfillment and satisfaction in life. In high school, I played competitive soccer. I only scored once the entire time I played, and the one time was sort of a fluke! I didn't care, though. My favorite position was center mid-field, where I could receive the ball from our defense, take it up field, and set up a scoring opportunity for our forwards. I may have scored only one goal myself, but I couldn't keep track of my assists. When I could create space on the field and send the perfect pass—just the right position, speed, and timing—for a goal, I was just as thrilled as if I had scored myself. Their success was my success. Nothing brought me more joy.

These setups for success were the kind of work I wanted to do every day, and working in a hospital, staring sickness and death in the eye every day, felt like just the opposite.

These thoughts swirled in my brain the next day as I drove around town after dropping by the hospital to say goodbye to our now-hospice patient. I cried in the car, and I told God I was sad, and I questioned what role I had as a nurse in helping others succeed.

In the car at a stoplight, tears slipping down my face, I wondered. I wondered if I had a limited view of success. I wondered if to the patient and to God, success didn't mean staying on this earth. I wondered if it meant them crossing over into eternity and feeling His embrace. I wondered if being one of the last faces someone sees, one of the last hands they hold, one of the last voices to say a prayer for them on this earth—I wondered if this was helping them succeed in moving to the next place they were meant to be, the place we were really all made to be: the presence of the Most High God.

This realization crushed me. I wept like a baby at that stoplight, and I can't help but cry a little now as I remember that sweet moment. We can only see part of the soccer field, and perhaps sitting with someone at the end of life is akin to assisting them with the most epic goal of their existence, the moment they see God face to face.

To be frank, though this perspective helps me process the experiences of this week, it doesn't make death any easier. It doesn't mean I won't cry the next time I have a patient who dies or who make the difficult decision to go hospice. It's easy for others to remind me it's special and important work to care for people in their last months, days, and moments, just like it's easy for others to tell me my work as a bedside nurse is honorable and impactful. Speaking or hearing these words is not the same as living out the moments at the bedside. People like to say nursing is a calling, but even if it is a calling for some, it's still a job. There is still the wear and tear of cleanups, medications, assessments, the moment-by-moment deepening of relationship between nurse and patient in every interaction, and the moment-by-moment decisions and realizations a patient is declining. The sweetness of helping someone succeed does not remove the deep sorrow of death.

Yet, I am thankful there is sweetness and not only sorrow.

Today, I'll keep hoping. Hoping for what's to come, for the day we'll all be on the other side of death, when there will be no more sorrow, only the sweetness of the presence of Jesus. Yet until then, I'll keep praying, and I'll keep crying. And I'll keep doing my best to be a part of the setup for success.

Beyond the Smiles (Part II)

(For Part I, click here.) 

I remember him laying there. The bare white mattress in the Emergency Ward. The blanket stained with sweat and dirt wrapped around his waist. His ribs protruding from his thin, malnourished frame.

I remember him turning onto his side, obviously in pain. I remember his mother standing at the bedside, anxiety and fear written clearly across her face.

A group of American healthcare workers, part of a medical mission team I was working with, flocked around him and hooked up an ancient ECG machine to confirm a diagnosis of pericarditis—a diagnosis for which nothing more could be done in this rural Cambodian hospital. 

As they gathered around the bed adjusting ECG leads and talking among themselves, I stood in the back. Listening, observing, and praying.

I took in a deep breath, and I let it out. This young man was dying. There was nothing we could do about it. With all our knowledge, with all our experience, with all our compassion and good intentions, there was nothing we could do to prevent this man’s suffering and death. 

There was a time when seeing a patient like this young man broke me. It led me on a journey of desperate brokenness and incredible healing. It led me to face truths concerning what I believed about God and myself. Ultimately, it led me to rest in knowing I don’t have to be enough.

This time, as I stood near the patient's bed, everything was different. Outwardly, I was surrounded by Americans, and I was grateful to be with so many whose education and experience exceeded mine. Things had shifted inwardly, too; I found I had courage to reach out to this patient in a way I was too timid to do before but was incredibly important.

When I close my eyes, I am back in the hot, humid, Cambodian Emergency Ward. I breathe in deep, and I choose to rest in this truth: I don’t have to be enough, for Christ is enough. When I stop worrying about how much I can’t do because I am not enough, I hear Jesus’ quiet invitation to sit in His presence, even in the midst of such deep suffering. And I accept. 

I sit in His presence and bring this young man to Him, praying he would know the peace of Jesus’ presence, too. I sit in His presence and bring myself and my broken heart to Him, finding space to grieve and freedom to be sad because when I’m with Jesus, the lie that “I have to be the strong one” crumbles. Jesus is the strong one. I never have to act like I have it all together—because I don’t. Jesus knows this. He's okay with this.

The Americans clear out, and it’s just my dad and me left. With the help of our friend and translator, Dad explains why the American team is there, to teach and work with the local doctors. The patient’s mother looks up tearfully and asks if her son will live.

All our knowledge, all our diagnostic powers, all our education and good intentions—it means nothing in this moment. We have nothing to offer this woman and her son. Nothing except Jesus. So we ask if we can pray, and I reach out my hand to touch this patient’s dirt-smeared blanket and lift him up to Jesus.

And I know in all our heartbreak, in all their heartbreak, Jesus is enough, and He is with us. 

His presence is so strong. It always is, if we'll just acknowledge it. If we'll just accept His invitation and stop our striving to be everything, fix everything, and know everything. Perhaps this is the most important thing I’ve learned about poverty in the past few years. Poverty and suffering highlight our sense of helplessness, and so often our response is to push this uncomfortable feeling down and ignore it or to grit our teeth and take it upon ourselves to eliminate disparities. Yet I’ve found no freedom there. 

No, freedom is found in Jesus' presence, in trust. It's found in trusting God is enough, trusting He cares and is big enough for all the hurts in the world and my grief over poverty and suffering and death, and trusting God is, indeed, good.

He is good. Even when everything around us seems to be wrong and impossible and heart-wrenching and clouded with evil. He is, indeed, good, and He is enough.

Why I Won't Go to Africa to Help with the Ebola Crisis

As a nursing student, each month I participate in a small-group, interdisciplinary ethics meeting with nursing students, medical students, a chaplain, a nurse, and a doctor.  Last week the topic for discussion was the ebola crisis; the question posed was, “Would you go to Africa to help with the ebola crisis?”  Some people said no, with the reasons ranging from “I don’t feel qualified” to “I don’t want to go in blind – we don’t know enough about the virus and how it’s transmitted.”  Some people said yes, they probably would go, because as healthcare professionals we are to help and care for people.  I said I would consider it. 

After some discussion and after others in the group had elaborated on why or why not they would go, the doctor who was facilitating turned to me.  “Allison, you said you would consider it.  Why did you say that?”

My heart started beating fast, and my face was warm.  Not because I was nervous, but because this topic gets emotional for me.  I began slowly and almost made it through my reasoning without my voice quivering and giving away my emotion.  You see, I learned a lot about caring for peoples’ health needs in other countries this summer.  You may have noticed I have been absent from blogging for quite a while, and that is because when I came home from Cambodia in August, I had much more to unpack than dirty socks and underwear.  I had a summer full of memories in a foreign hospital that was severely under-resourced in many different ways.  The past few months have been a season of emotional unpacking, wrestling with the “why’s” of seeing preventable suffering and death, and questioning God’s goodness.  This summer I felt completely overwhelmed by the sickness and brokenness in the hospital, watching a beautiful people group made in God’s image lay on metal bed frames in sickness and suffering.  I have never hit my breaking point and then been pushed past it so many times in my life.

But God is faithful.  After some nudging from a counselor, I explored the “why” questions that so bothered me about this summer’s experience in the hospital.

First, why did God let me see what I saw?  What was the purpose of seeing the suffering, the deaths, the tears of family losing a loved one to what I knew was a preventable disease?  The cold reality is that the suffering would have happened if I had seen it or not.  So why did God choose for me to witness it?

The answer came quietly one day while I sat weeping and remembering the patients I had seen.  I was sitting alone – because the weeping was easier alone, and no one in the world knew exactly what I had experienced, seen, observed, worked in.  I felt desperate and detached much of the time with my emotions and memories and grief.  It was too big for me, and it overwhelmed me.  I could not comprehend the suffering or the health disparity between developing countries and the United States.  As I sat on the floor with tissues beside me, I asked over and over again, “Why? Why did you let me see that?”  And the Lord answered.

Because I am there.  I am there in the hospital.  I see the suffering, and I grieve.  Yet I am bigger than all the suffering and all the good.  For years you have marveled at My love because your mind cannot comprehend it.  Now, you marvel at the amount of suffering that exists and My ability to grieve compassionately for each and every person.  I am bigger than all of it, Allison; the suffering is too deep for you to grasp, and so is my love.  On both ends of the spectrum, I am bigger.  I hold both things in my heart: intense love and intense care for the suffering.  You saw these things because I am there, and I have invited you into this part of my heart, too: the part where I see each person’s suffering and pain and grieve for them.

Leading up to the summer it was my prayer that each day I would know the Lord better at the end of the day than at the beginning.  He granted that prayer.  I never would have asked to be ushered into this part of God’s heart, but He chose to bring me in anyway. 

And I know Him more intimately for it.
 

The second “why” question I asked was, “Why does suffering like this happen at all?”  I knew the church answer: because humans sinned, and the world is broken.  But when the images of beautiful Khmer people hurting and memories of suffering came back to haunt me, this answer was far from enough.  I believed God was sovereign.  Never did I doubt that.  But since He was sovereign, why did He allow this suffering?  I only saw an inkling of what goes on in Cambodia, much less the world.  He could not let this happen and still be good.  He was sovereign.  He could do something.  So I sat there on the floor praying through tears again, asking why, and rejecting the answer that it was just because of sin.

Again, the answer came quietly. 

Because you – the world – need Me.

How was this different from the answer that the world is broken due to sin?  The explanation is simple.  My answer – “we sinned and the world is broken” – ends with us.  It ends with our sin and our brokenness.  It ends with frustration, helplessness, and hopelessness.  The answer the Lord gave, though, did not end with us or with the consequences of our sins. 

It ended with Him. 

This world and all that it holds – the evil, the suffering, the good, the joys – is not about us and our brokenness.  It is about Him.  The Lord’s answer was one of hope: it ends not with us but with Him.
 

Back to ebola.  My voice wavered and my heart pounded and my face flushed because talking about healthcare in other countries stirs up strong emotions.  It brings back memories that will never be erased from my mind of people dying and ill who could have been alive and well. 

The reason that I would consider going and would not just go to Africa is because seeing people suffer and die in a developing country is extremely hard emotionally, mentally, and spiritually.  When you know just as much as physicians about medical care for a disease, and you still do not know what to do to treat someone…that is one of the most helpless and overwhelming feelings that exists.

I would consider going, and I have considered and prayed about going.  Yet for now, I will not go to Africa to help with the ebola crisis because my heart is not ready for it.  After a summer in Cambodia, I am still recovering.  Maybe in the future I will go (and I believe I am called back to Cambodia in the future), but for the time being, I have to let my heart finish grieving and healing. 

Perhaps when we talk about going to Africa and the reasons we would or would not go, we are mistaken about the hardest parts of being there.  Perhaps the hardest part would not be the fear of contracting the virus or not feeling qualified to treat a patient. 

Perhaps the hardest part would be the grieving it would demand from our hearts. 

Should we shy away from this kind of grief?  No!  As I said before, I know the Lord more intimately for it.  Should we prayerfully seek the Lord as to whether we should go or stay?  Yes.  For whichever way He leads, I believe this:

We will know the Lord more intimately for it.