How I came upon this phrase is something I’m still trying to process. It’s Latin and typically inscribed next to autopsy rooms, which always share basement space with the morgue in a hospital. ‘Let conversation cease. Let laughter flee. This is the place where death delights to help the living.’
I work in a hospital as a hematology/oncology nurse on the Bone Marrow Transplant Unit (BMT). The unit’s name is a bit of a misnomer since bone marrow transplants are rarely performed on adults anymore. Technology has given us the ability to collect stem cells in the peripheral blood of a donor so a more precise name is peripheral blood stem cell transplant (PBSCT). But medicine is a field steeped in history, stress, and brevity. BMT rolls off the tongue a lot easier than PBSCT. It’s an acronym that endures, even if it isn’t entirely accurate.
I’ve worked BMT for close to three years. It’s the first job I got out of nursing school. My midlife career change, I spent most of nursing school feeling like the baby bird from the displaced nest in Are you my mother? I couldn’t find the nursing specialty that felt like home to me. Until I found heme/onc. Of all things, I felt at home in the world of blood cancers. Due to the nature of blood cancers, I frequently see the same people on my floor and am able to establish long-term relationships with them. I know their first and last names; their loved ones names, whether they have leukemia, lymphoma, or myelodysplastic syndrome, and where their central line is located. The circumstances under which I see these patients so frequently are dire; initial diagnosis, neutropenic fevers, failed inductions, relapses after a transplant, but I feel that the better I know my patients, the better I can help them. I understand what particular kindnesses they need to get through their stay on our floor.
I struggle caring for these people when they suffer so. A physician I work with told me I have a savior complex, that he used to be the same way when he first started practicing. But I think he’s wrong. I am well aware of my limits. I think I have a suffering complex, in that I cannot bear to watch someone suffer without trying to take that pain away. It’s something that has led me towards God. When I was in nursing school up through my first year working as a nurse I considered myself a hopeful agnostic. But if you work in a field where a considerable percentage of those you care for die, it changes your perspective. At least it changed mine. How could I truly believe in my heart (which I did and still do) and tell these people, things would be alright, it’s okay to let go, something better awaits you?
Many of those I care for die. But usually at home while on hospice, or inpatient hospice on the floor above us, or in the ICU. No one ever died while I was caring for them, until recently. I had never seen a dead body, aside from my ex husband’s grandfather. One dead body, in a casket, was all of my experience with seeing death. It’s hard to believe given my age (40s) and my field. The circumstances under which this person died were tragic. I am still trying to cope. HIPAA prevents me from saying much but this patient was far too beautiful and suffered far too much in such a short life. Even before the leukemia. There was too much suffering. The only thing that brings me comfort is to know in my heart that she’s finally at peace.
The blessing, the joyful suffering, that comes with my job is the kindness extended to me by these patients and their loved ones, even when they’re at their most vulnerable. It’s heartening. As her loved ones were preparing to leave we hugged one more time, and the uncle told me the patient had said to him, ‘You need to take her home.’
I was confused at first. I pointed at myself, ‘You mean me?’.
‘Yes. She said you were always so kind.’
All I had done was care for her. She made it remarkably easy to do.
I cannot recommend Atul Gawande’s new book Being Mortal: Medicine and What Matters in the End highly enough. I see this conversation put off or avoided far too often and the repercussions are shameful for a field based on a moral obligation of healing and care.
Truth never damages a cause that is just.
~ Mahatma Gandhi