Canadian Nurse

https://www.infirmiere-canadienne.com/blogs/ic-contenu/2021/04/19/surmenee-davoir-accompagne-des-mourants-je-me-suis

Apr 19, 2021, By: Barbara Morris

As patients approach the end of their life, chaplains in North American hospitals are often called to their bedside. The patients’ loved ones are usually there as well. But these are far from usual times, and there aren’t enough chaplains to go around.

A chaplain, Naomi Tzril Saks, at University of California’s San Francisco medical centre recently said, “I’ve never in 15 years experienced the multiple layers of loss that we are experiencing now.”

Because of COVID-19 restrictions, nurses are holding up iPads so that families can say goodbye to their dying relatives. One exhausted nurse I saw on Twitter said that she had held the iPad and witnessed anguished goodbyes four times within two hours. After that, she was likely alone with the patients until they took their final breath.

These heartbreaking scenes are common today and causing widespread burnout in the nursing profession. I want to share what I’ve learned about how faith, whether you have it or not, can help you “be the right person at the right time” for your patient.

Being the wrong person at the wrong time

For 15 years I worked as a massage therapist, holding the hands of war veterans as they died. Sometimes the veterans appeared to wait until their families left the room before dying, as though they wanted to spare them the pain of their final moments.

But sometimes no family arrived, as would be the case today with hospital restrictions on visitors. It would be just me with the patient; I was the final witness, and a meagre substitute.

Over the years, deaths became harder to bear. It’s difficult to describe the anxious feeling that would come over me. Maybe there was some final thing I should have said or could have done, but didn’t.

It became increasingly more difficult to be the one — the only person at the bedside at the end of their lives. I felt wrong: the wrong person at the wrong time. I struggled to find enough meaning and reason for my presence, with only that simple final connection to offer. An emptiness crept in.

Fading out of relevance

I was left with haunting questions. Why me? Why not die when family is present? Why had some people chosen to die with me at their side, instead of a loved one? Maybe I was easier to overlook in the room, easier to leave, someone meaningless to their larger lives. There was also my grief and sadness of loss — the silence in the room when they were gone.

As the Second World War veterans aged, I was losing a veteran every few months. I can’t imagine going through that intense experience several times an hour, as many brave caregivers on the front lines are doing during this pandemic.

After a decade, my feelings of ineffectiveness in the face of death got the better of me. I felt broken and I had to leave. I was burned out.

The insidious wave of burnout

Burnout is a state of emotional, physical, and mental exhaustion, caused by excessive stress over a prolonged period. You feel overwhelmed, drained, and pushed to meet demands beyond your capability.

Burnout’s close cousin, post-traumatic stress disorder (PTSD), is a psychiatric disorder that can be the result of witnessing or experiencing a traumatic event.

After a decade, my feelings of ineffectiveness in the face of death got the better of me.

Studies have shown that burnout and PTSD share many of the same symptoms, such as severe anxiety, dissociation, flashbacks, nightmares, intrusive thoughts, and the avoidance of activities that remind you of traumatic events. Burnout is like PTSD in slow motion — a slow, rolling tsunami that washes over you but doesn’t recede.

Searching for the cure

I wasn’t sure what I was looking for when I left, or where to look, but I knew I had to leave. I needed to find a way to feel more useful, or to justify my role of being at the bedside of the dying. I was fortunate enough to have the privilege of going to Thailand to recover from my burnout, where I could look for meaning within the traditions of Buddhism.

While in Chang Mai, I found a monastery that was arranging scheduled conversation hours with young monks in training, so they could practise their English language skills with foreign visitors. It was an opportunity for them to share their knowledge and to discuss their beliefs.

That’s where I met Souk, a monk from Laos. He was 25. I had wanted an older monk to talk to, and I found one in Souk, who, despite his age, had ancient eyes. We spoke for many hours over several days.

Souk’s gift to his sister

When I told him about my burnout and the questions that led me to Thailand, he told me a deeply personal story that had changed his life, and was about to change mine.

Souk’s younger sister had died suddenly when she was only five years old. They were very close. Souk was 10 and away at school in a different part of the country at the time. He had to be brought back to his village for her funeral.

When Souk arrived, everyone was crying and wailing. As he approached the chaotic gathering, the music was stopped and the coffin lid was opened so that Souk could see his sister. At the edge of her tiny coffin, he stared at her lifeless face.

Suddenly a huge force came up against him, paralyzing him in place. He couldn’t move. He just stood there, frozen. He didn’t cry. He couldn’t cry. He stood silently, pinned in place, and couldn’t move from her side until her coffin was closed and the mysterious force ended.

Why hadn’t he cried? He had wanted to cry, but it wasn’t possible. After his sister’s funeral that question shamed and disturbed him.

In order to manage his grief, and plagued by his behaviour, he decided to serve the monks in a nearby monastery. He cleaned, swept, and cared for the temple for 10 years before going to Thailand. He was completing his four-year monastic training there the month we met.

Souk told me that I could be steady for the veterans as they faced death.

Souk had gloomily pondered for years the reason he hadn’t been able to cry over his sister. One day, while talking with one of his teachers about his sister’s death, he finally got an answer.

The elderly monk told Souk that he hadn’t cried because crying confuses the soul. It doesn’t know which way to go.

The monk said that Souk’s sister’s soul may have been confused by the chaos before he arrived. Her spirit could not settle.

“You were steady and calm,” he said. “Only then could her spirit settle and find its way out.” This explanation made sense to Souk and allowed him to let go of the guilt he’d carried for so long. His sister had needed him to be a safe channel — a steady connection for her passage out of life. He was a gift.

With a gentle gaze and wisdom beyond his years, Souk told me that I could be steady for the veterans as they faced death.

Is it necessary to believe?

Maybe that was my job — to be steady for the departing soul. But I wasn’t sure how I felt about souls or spirits. Did I have to believe in an afterlife to do this work? And if I didn’t believe, could I still act as a conduit for a departing spirit, if the dying person held those beliefs?

Souk proposed that regardless of my faith in the unknown, it would do no harm to hold my hand above the top of a dying person’s head. “The crown of the head is where the soul escapes the body,” he said. “Your steadiness and your hand can guide them.” He spoke softly and I listened carefully.

Being the right person at the right time

Later that evening, alone in my room, I wondered: are we really just blood and bones? Science and medical training would tell you “yes.” But does anyone know for sure?

I decided, as Souk implied, that I didn’t need to decide. What mattered most was believing in the possibility that this wasn’t true, and the fact that many people at the end of their life believe that we are more.

This conclusion rejuvenated my sense of purpose and confidence to resume my place at the bedside of the dying veterans. I had already been a witness, but even before, I wasn’t only a witness. I would touch them, hold their feet, and stroke their hands. Now I could also place my hand over the crown of their head and offer a calm space and a guided channel — just in case.

Faith was outside my scope of practice as a registered massage therapist, as I believe it is for nurses and for most Western medical health-care providers. But faith was the salve I needed to heal my burnout.

Souk helped me imagine that I could actually be the right person at the right time. I believe that nurses can be as well — be the gift that you are in the perfect position to give.

Barbara Morris is a registered psychoanalytic psychotherapist in Toronto, Ont., with 25 years’ previous experience working as a registered massage therapist. www.barbaramorris.ca