by Rebecca Gagne-Henderson PhD, APRN, ACHPN
I must admit, until recently, I have found that the word resilience had become a bastardized cliché. Resilience is a characteristic of those who thrive and find value and meaning in their lives in spite of horrendous circumstances 1,2. The concept was once reserved for those who have been through traumas, such as rape, witnessed brutal atrocities during war, holocaust survivors, torture victims, or survivors of drought and famine. This research began as early as 19713. In this work, Garmezy ponders the possibility that the antithesis of resilience is mental illness for those who have experienced trauma. In popular culture, resilience has come to signify thriving after normal events, such as losing a loved one to death, getting a divorce, or having a bad day at work.
Until the last couple of years, that is. For health care workers there has been a new appreciation for resilience. The COVID pandemic made the concept of true resilience all too real. Because of the pandemic, I had an epiphany that resilience is what hospice and palliative care workers have been “practicing” all along.
About 20 years ago I worked per diem at night in a hospice house with 6 beds. One night, I sat at the bedside consoling a young husband and father as his wife lay dying of leukemia. That very morning, they had found a bone marrow match as she lay obtunded and actively dying. I listened to him, shed tears with him and much of the time we spent in silence. She died shortly before the end of the shift. The next morning, I went home emotionally exhausted.
I returned to work the next evening and as I tucked all the patients in and gave them their comfort medications an old woman told me that she couldn’t sleep. I asked her if she would like her sleeping medication. She said, “No, I just think I would like someone to talk to”. I went to the med cart and brought her an Ativan. My emotional reservoir was running on fumes, and I was unable to be there for her. I gave notice at the end of the shift.
I went home and I wept and prayed. I picked up my book of wisdom which, unapologetically, happens to be the Bible. I prayed that I may open it and find a word meant for me. I opened the book and put my finger in the middle of the page. It was a verse in Psalms that I had never read before. It said, “Lord, when will you comfort me, for I have become like a wineskin in the smoke” (Psalms 119 82-84). “What the hell does that mean”, I asked myself. So, I began to research. In the days of David, their caravans would pitch huge tents. In the middle of the tent, there was a hole left in the roof, and they would build a large fire below the hole. They hung the wineskins in the hot, poorly ventilated tents. In the heat and smoke, the wineskins would become dry, brittle, fragile, and eventually become useless for their purpose and break. I had, indeed, become a wineskin in the smoke.
Early on, as a hospice nurse, I was asked, “How can you do this work, isn’t it sad?” I answered “no”, but then upon reflection, I recalled that there was someone in the office crying daily. Serial grief is a part of the work. We had monthly debriefings, but it did not curtail the sadness.
Subsequently, I decided to change my working milieu by taking a position as the house supervisor in a psychiatric hospital. WOWSERS, talk about going from the frying pan into the fire. I was back into the hospice arena lickety-split. The next time I needed a break I worked for a year in post-Partem. A much better choice, but then since I was the hospice nurse, they would give me all the demises…I don’t do sick or dead babies. PLEASE, give me my 90-year-old man with a PEG tube. Yeah, that’s the ticket. I honestly do not know how pediatric hospice and palliative care clinicians do it. They have my undying appreciation (pun not intended).
Back to hospice I went, with a new appreciation for learning to pace myself. Not to become less sensitive…I always say that when you find that you can no longer cry or be sad, it is time to leave. There is much to be said about finding something you truly love. I have a palliative care friend who hang-glides all over the world…I have vertigo and cannot hold up my own weight, so that is not for me. During the pandemic, I once again became a wineskin in the smoke. I left my job and found my solace in growing vegetables and a pollinator garden. There is a wonderful juxtaposition between planting seeds which give birth and then life to other creatures, to being present for death and dying. Birds, butterflies, even aphids, voles and chipmunks have their place in my garden. However, I must say that I cursed the unknown critter who chewed into my only cantaloupe of the season this year. Oh well, I am sure he enjoyed it.
About resilience for those clinician survivors of the pandemic, yes, what is required is resilience, more than ever. You have borne witness to the horrible trauma of people being forced to die alone. You’ve watched as old, frail people have been put on futile ventilation enmasse. You have watched as colleagues died or fell to the wayside. If you continue to feel exhausted and traumatized it may be time to take a break and do something that pulls you away from the relived memories of those traumas, at least, for a while. I don’t suggest working nights as a house supervisor in a psychiatric hospital. As nurses, this is an easy transition. Unfortunately, for physicians, who require fellowships and special training this is easier said than done.
IMHO, a spa day will not cut it. You will need something which gives meaning and is life-affirming. This is not to diminish the beauty we frequently encounter as we watch someone die well. Watching someone come to reconciliation, graceful surrender, and bid their final goodbyes is a privilege and brings a strange joy.
To my non-hospice/palliative care colleagues, you owe this to yourself…and to your patients.
1. Frankl VE. Man’s search for meaning. Simon and Schuster: 1985.
2. Antonovsky A. Health, Stress, and Coping. Jossey-Bass: San Francisco; 1979.
3. Garmezy N. Vulnerability research and the issue of primary prevention. American Journal of Orthopsychiatry, 1971;41(1):101, doi:https://doi.org/10.1111/j.1939-0025.1971.tb01111.x