Let’s talk about YOU for a minute.
I know this is uncharted territory, but bear with me. Some of these items may not be true for you, but if you’re in healthcare or some other helping profession, I’m willing to make the following assumptions:
YOU are human. There is a chance you are a robot, but that hasn’t gained much ground yet.
YOU care about people. If this is not true now, it was probably true when you started your career in healthcare.
YOU want to heal people.
YOU don’t like to watch people suffer.
Because of all of the above, YOU will also experience GRIEF.
But what is grief and how does it apply to you in the context of delivering healthcare?
The most basic definition of grief is this: “Grief is a reaction to loss.” Grief is not exclusively tied to the death of a loved one because loss can mean many things. Loss is highly individual in any circumstance, but sometimes we have grief reactions to seemingly small losses. In fact, many people have grief as a result of a loss that no one else even notices. Double in fact, people can be experiencing grief and not even know it. That’s where you come in.
In your healthcare training, you were probably taught to have professional boundaries.
As a child protection worker, this meant we were not allowed to take children home. As a physician, this means not handing out your home phone number. Obviously there are endless examples of how a boundary might look. Boundaries are important and will deserve their own blog post at some point, but when it comes to grief, boundaries will only hold up for so long. Boundaries are not impermeable suits of armor. When you are working in healthcare, day in and day out, you WILL experience losses, big and small.
Here are a few ways in which loss might show up in your day:
The obvious: your patient dies.
You removed a patient’s limb in order to save their life.
You completed a SANE exam for a patient who was sexually assaulted.
You provided information to a patient about how ALS will change their life forever.
You sent a homeless patient back out onto the street.
A patient lost a loved one and you were the bearer of bad news.
You inserted a feeding tube, knowing that your patient will never again eat solid food.
You administered chemotherapy to a patient.
You admitted a suicidal teenager to your mental health facility.
You performed a double mastectomy. Or provided after care.
You delivered a baby born with a disability.
You reminded your patient they are not allowed to get out of bed on their own.
No matter your role in healthcare, you are experiencing loss. Sometimes you are the face of loss. Sometimes, your relationship with a patient becomes deep enough to feel like a friendship. Sometimes a patient’s diagnosis triggers past losses you have experienced. Sometimes you witness a loss that rocks the foundations of your own sense of security. And where there is loss after loss after loss, there is grief.
Grief is sneaky.
It can manifest in physical ailments that could be related to any number of things. You can find a thorough list of symptoms here. You may attribute exhaustion, insomnia, or lack of appetite to your weird work shifts, but these things could also be a result of grief. In healthcare, there is a work culture of toughness, wherein workers are expected to put their head down, push back their emotions until the shift is over, and keep moving. There is little time to use the bathroom, let alone stop to feel your feelings. I call this a culture of toughness because while you can’t have a meltdown in the middle of another patient’s appointment (that would be bad), few workplaces offer dedicated time for you to process your day. You are expected to deal with it on your own. Even people who have lost a loved one can be hard-pressed to realize that a physical ailment is tied to their grief. When grief is tied to a loss that is “smaller” than the loss of a loved one, it may not even be on the radar. Your physical and mental/emotional ailments will likely not be attributed to the grief by you or your healthcare providers (who are also experiencing grief).
Beyond the general lack of attention to the role of grief in the healthcare workplace,* the culture of toughness creates a scenario where grief is minimized or completely denied by individual healthcare professionals and the healthcare employer. Denied may be too strong of a word. Ignored may be better. Overlooked? Regardless, grief that is overlooked, ignored, or denied is a form of “disenfranchised grief.” Dr. Kenneth Doka defines disenfranchised grief as “grief experienced by those who incur a loss that is not, or cannot be, openly acknowledged, publicly mourned or socially supported.” One word: HIPAA. The duty of confidentiality adds another layer of complexity to a culture that already avoids the topic. You don’t have time to process grief at work and you aren’t allowed to talk about it at home. Doka also says, “Isolated in bereavement, it can be much more difficult to mourn and reactions are often complicated. It is important to recognise [sic] and try to meet the needs of those whose grief is not acknowledged by society, whatever the emotional or financial costs.” What I’m trying to get at here is this: if you feel like you’ve lost your mind and you are always having nebulous physical ailments, you may want to investigate the role of grief.
*Some employers are acknowledging the role of grief. Planetree Certification requires that an organization provide grief support for staff. Way to go Planetree!
Nerd Alert! Here is a link to an article by Dr. Doka. He also has several books on this topic.
The topic of grief is a big one.
This post is just the beginning of our exploration. There is a proverb that “grief is light that is capable of counsel.” I think this is true, but you have to realize that grief is happening before you can seek its counsel. I’m hoping that naming the issue will help you see your compassion fatigue or burnout in a different light. You wouldn’t fault a new widow for acting differently than before the death of her spouse. Likewise, you should be gentle with yourself. In the words of New Kids on the Block, “hangin’ tough” is not going to help you be a better healthcare practitioner.
The moral of this story: give grief a chance.
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