From time to time, people will ask me how I deal with the saddest, hardest patient cases I encounter as a pediatric ICU nurse. Related questions also take the form of, “How do you separate your personal life from your work life?” or “How do you keep working in an environment with so much suffering and death, and not completely fall apart both at work and outside of work?”
First, I have to say I personally believe we are aiming for an unattainable goal if we think we can actually draw a hard line of separation between our professional and personal lives as healthcare providers. We do intimately personal work with the sick, suffering, and dying, which means our professional life takes us on a fast track in dealing with all the biggest questions and issues of life. What is quality of life? Who is vulnerable to death (cue the mirror)? What does deep suffering do to our hearts and our relationships? What is hope? How do we care for each other meaningfully when we have time with each other? These are the starkly real, in-your-face questions we encounter with every patient. Unless I pretend that these questions somehow do not touch down in my own personal experience as a fellow human being, there is really no denying that my professional life will bleed over to my personal emotions, beliefs and relationships. If we insist upon aiming for work/life separation in this context, we are cutting ourselves off from a part of our very hearts, and if that part is hurting from work, we are being unkind to ourselves if we are not caring for ourselves well.
I once clocked into a shift where I could see my little patient from outside her room, breathing tube in her mouth, connected to a ventilator, lying very still as she was so incredibly weak from her illness. I’ve cared for so many cases like her; there was nothing especially startling about my first glance at her from outside. But as I entered into her room, I found myself entering into her story. Photos of her and her sister were taped around the room; they were both radiant and they were clearly very close to each other. My mind immediately went to my two daughters at home, two peas in a pod. My patient’s mom woke up for the morning and I saw her interact with her frail daughter with such sad, aching tenderness, and I saw myself in this mom. “I think that’s how I would be too, if it was my girl in that hospital bed.” I teetered that day emotionally as the intimacy in that room caught me off-guard, and for the next few days at home with my family, I was particularly heavy-hearted and especially affectionate with my daughters. Work life was bleeding over into home life. This is the reality of being human.
And so, I’ve stopped making it a hard-and-fast goal to create a strict separation between work and home. This doesn’t mean I go to sign up for every extra shift I can out of emotional obligation. It doesn’t mean I allow myself to ruminate obsessively over each patient case. But what it does mean is that I acknowledge that my work-related emotions will show up in my home life, and I hold space for those rhythms of professional grief when it wants to show up.
The first primary thing I’ve learned about my rhythms is the following:
When I’m at work taking care of that especially painful patient case – a previously healthy child who drowned at a family party; a horrifying child abuse case; a sudden infection that ravaged a vulnerable body without mercy – I have learned to recognize that I don’t usually feel intensely emotional while I’m doing the nursing work, though some moments of emotion may show up here and there. Generally, I tend to feel quite numb and sober, but I am primarily others-focused on my patient and their family, and I am very task-focused as I ought to be. I don’t cry on the drive home, but I want absolute silence. When I arrive home, I want to clean up, hug my family and go to sleep.
I now find that 95% of the time, the emotions related to a case like this will show up the next day, usually within the first 3-5 hours of the morning. I wake and start off feeling numb and sober, much like the day before. Then as the morning goes on, I might be dropping my kids off at school, running errands at the store, or doing housework, but I find myself suddenly and surely overcome with a deep need to cry. Knowing this moment is likely coming, I’ve learned to go about my day in such a way that I can accommodate space for this rhythm of grief. If I can’t avoid going to the store, I’ll bring tissue just in case and let myself go to a quiet corner of the store and cry if that’s where the emotions show up. If I’m at home, I’ll do quiet work so that I’m not overly distracted and there is mental, emotional, and spiritual space for the necessary processing. My family has gotten used to me saying, “Mama had a hard day at work yesterday and I just need to have some tears about it.”
Recognizing and validating the way my professional grief tends to show up in my home life the day-after has allowed me to intentionally make space for it. I can acknowledge its presence in me, give it the catharsis it demands, and from there I am able to go about my day and home life with a lighter burden because I’ve given it a place through lament, mourning and prayer.
This is the first part of how I’ve learned to approach separating professional and home life when it comes to the grief I encounter from work: I don’t. In this post, I’ve acknowledged the way I allow for my grief rhythms to show up the day after a particularly intense work shift. While these rhythms will likely show up differently for different people, I’m quite convinced they’re always there; we just need to pay attention to them.
I’ve also learned to recognize longer-term rhythms beyond the morning after, which I will cover in a future blog post. I’m curious to hear from any readers what rhythms you may have identified in yourself when it comes to work-related grief?
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