Mourning the Death of Patients

The reason I went into oncology nursing was for the relationships. I knew the patients I cared for would become part of my life, unlike an orthopedic unit where they are here today, gone tomorrow. I would grow to love and truly care about these people as the days and years passed. On the downside, I knew I would likely lose those relationships prematurely due to the inherent nature of cancer.

I first started out as an oncology nurse on a hospital unit. There I quickly experienced the emotions that come with caring for a dying patient and what it feels like to watch a patient die right in front of you. I wept with loved ones of the deceased and had to prepare the patient’s body for removal, which is a unique and humbling experience. I remember different moments of personal breakdown both at work and at home in those early years as I dealt with losing beloved patients.

After working in that capacity for four years I went back to school for my Master's and have now worked as an oncology nurse practitioner in an outpatient setting for six years. The transition away from the hospital and advancing in my role changed my experience with death dramatically. Now I watch as a patient slowly declines and/or the cancer progresses through another therapy. I have difficult conversations with them during office visits -- over maybe an hour rather than a day -- about how they physically cannot handle any more therapy. We discuss end-of-life care. Perhaps a week or a few months pass, and then I will receive the list of obituaries on my desk and learn that the patient passed away.

Another typical scenario is one in which I will admit a patient to the hospital who is very sick (e.g., a progressive leukemic in whom we can’t seem to control the fever) and learn a few days later of the patient’s sudden passing. Rarely is there a final “goodbye” or the chance to also hug the family with whom you have become close along the way.

So now, after 10-plus years of being in this field, which I truly love, I am struggling with grieving. I have often said that, in order to do this job well, you have to disconnect yourself to a certain extent from the situation, in order to function. You can allow the death of patients (which is commonplace) to consume you, or you can find a healthy way of dealing with the loss while also moving forward. It’s that part about dealing with death in a “healthy” way that’s nagging at me the most.

It seems I have almost become numb to the repeated deaths at this point. I may tear up, but gone are the days of gushing buckets over a patient’s loss. And it’s not because I don’t care. I suppose I have come to expect death in this field of medicine, and thus it doesn’t shock. I make a point to write cards to loved ones of patients with whom I was particularly close, and, if I’m really lucky, those family members will come back to the office to visit, which of course is hard for them, but good for me as a means of closure and healing.

So I ask you, healthcare professionals, specifically those in the outpatient or palliative care setting: Am I experiencing compassion fatigue, or have I learned how to cope better? Maybe I’m fine and I’ve just matured in my view of death? The thing is, I don’t feel burned out. I come to work loving my job, have meaningful interactions with my patients (both those on my schedule and those just here for treatment), have great relationships with co-workers, go home to a family I love and who love me. So then I think, “What’s the big deal?”

But since I felt compelled to write this blog, I suppose there is something internally eating at me that I need to let surface. What are your thoughts?