The Rule.

Coping with death is hard, period. There’s not a single easy thing about it. I’ve been relatively fortunate in my life thus far to have not gone through a tremendous amount of loss. I have had some very hard moments - I remember learning of the death of my grandmother, Violet, when I was 10 I believe. I never got to know my grandmother incredibly well, but I will always recall fond memories in her Naples condo, playing with Barbies, trying wheat germ for the first time, and visiting grandma at the Publix bakery where she worked. I'd always send my grandmother letters and she'd send cookies and the sweetest gifts back. I remember the last letter I sent, with new easter photos; ones with a real white bunny. Mom had reminded me to do so. I remember that my grandmother got the letter the week she died. Mom told me when I got home from school that day, and I spent the afternoon crying in my closet. I'd experienced a few other deaths from that point on - but none from people terribly close to me.

The environment I work in is a difficult place, in this respect. Life in a nursing home brings you face to face with people oftentimes in the last few years of their life. Or months. Weeks. Days. I remember my first patient to pass away - I remember his incredibly kind daughter, sobbing as she carried his belongings out. I didn't know him well. He had just arrived. But he was there one day, I told him good evening - and he was gone the next. I've had many other patients pass since then. It still hits me with sadness. I think that this is a natural and good thing. I've been told in clinicals to be careful with this; told I have an empathetic heart and to guard it. Not take things home with me. This is good advice. I care for all of my patients who walk through the door. I also know that the nature of my setting is going to bring loss across my path more often than not. Over the last two weeks, I've lost several more patients. One of them was found unresponsive and the paramedics tried to revive them for 45 minutes in the building before giving up. The door to the room was shut all day until the coroner came. I had to help him open the fire exit door to wheel the body out. I hated it. I think I am like every other person who hates death. There is always some kind of loss it leaves behind. Someone hurts, whether it seems obvious or not. I couldn't shake that last one off for a few days. I lost another one to pneumonia last week, and she was incredibly kind. I had just done her evaluation. We laughed in the gym together as I showed her how to do a TUG test to measure her gait speed. I never saw her again after that day.

This post is getting to seem really morbid. I'm not actually sure if it's socially acceptable to talk about all this, but I feel that it's a good way to let some of it out. Because the truth is, it is sad, and it is hard, and it helps to talk about it. Especially as a new grad, I believe it is particularly hard. I think we tend to get more invested than others who are more seasoned and experienced. I think we might take things a little harder. It's part of learning. I believe that I will get better at coping. I believe I cope fine now - but, honestly? Part of me doesn't ever want to get to the point where I shrug off death as though it isn't a big deal. I guess I've just spent so much time seeing how lovely and beautiful the lives of the elderly are to ever truly stop myself from caring and connecting with people. Don't get me wrong, I don't get along with all of my patients, but I believe that being sad is also a way to show respect towards someone's life and someone's memory. And I believe all of us deserve that when it's our time. Someone to think of us. Someone to care.

My own opinions aside, this week was the hardest I've experience so far, though. It hit me like a train I was not prepared for. Obviously, HIPAA prevents me from getting into great detail, however, there was a patient I have been treating since the beginning of October up until now. Really complicated case - multiple medical conditions making it impossible for them to return home alone, but perhaps, if enough progress was made, to an ALF. I picked this patient up following a PRN evaluation a few days into their time at my facility. I was one of the sole therapists working with this patient - for the most part, I ensured that they were on my schedule, as we worked well together and built a good camaraderie. I watched this patient go from not being able to roll over in bed, lift their head off the pillow, or lift their legs, to walking with a walker, over the course of months, because so many obstacles were in their way. The progress was incredible, and it was so enriching for me to see how hard work, dedication, and time spent investing in a patient could truly make remarkable things happen. I remember the first day standing in the bars. Then marching. Stepping! Triumphantly walking across the gym with contact guard assist. This patient took a lot of patience, and a lot of time. They frequently asked for some assist with setting up their room, making sure the heat was on, that their table was in the right place - things I was completely happy to help with (unbilled, of course). When they needed clothes, I'd go down to the lost and found and scour them for clean ones that would fit. I advocated for this patient when others wouldn't. They told me about living through things such as communism. We talked about traveling through Europe. I learned about their whole life over the course of months and was completely in awe of what an incredible array of experiences this patient had had. I remember so clearly the last time I treated them on Friday. I had just learned about the death of one of my other patients, and was reflecting on it sadly. I lingered for a moment at the door as I left my patient's room. They smiled, bowed their head a little, thanking me for my patience. I smiled in return, telling them I'd see them Monday, and we'd try to get out of bed and walk again next week. But... I'm sure you already know where this story is going. I came in Monday and they had gone out to the hospital. I asked, concerned, what had happened. Nobody seemed to hear me, so I didn't get an answer. But they'd been out once before... surely they'd be back. But Tuesday, I came in, and I saw their family cleaning out the room. Nurses hugging them. Crying. And I worried, but I tried to tell myself that it just meant that... maybe they would be in the hospital longer. It wasn't the case, of course. I did find out that they had passed away. I was silent for most of the rest of the day, sullen, trying to hold back tears. That Monday session never happened.

You're always going to have patients that touch your life if you're in health care. This patient was one of them for me. Just... an incredibly kind person. Someone who showed me how important it is to listen. To invest time and to truly care. And if you do that, you watch people flourish so much more than if you didn't show them you actually care. Someone who showed me how meaningful my work is. My coworker, who has been in this world of snf's so much longer than me, chided me a little. "It's the first rule of working here. Have empathy... but not too much empathy.
Or else you'll become old far before your time."

I tried to hold back tears. "I know," I told her."It's just hard. It's just so hard." And I did - I do. I know that's the rule. You can't get too invested. You can't care that much. I have a habit of wanting desperately to fix everyone that I encounter. I know I can't. I also know that I tend to try anyways. And I give things my all. I find it both a gift and a flaw. I think it can make your work incredibly meaningful. I also think it can make you susceptible to a lot more hurt. I'm not afraid of hurt - I know how to handle it. I know stress relief and work life balance is important. Hurt and I have a functioning relationship. I believe that it is healthy to feel it - it reminds us of our own human-ness. It reminds us that we are on this earth to love others and to show them kindness and to care deeply and that no matter how much hurt there is, a kind work or a listening ear or someone to believe in you is always going to be needed. It's how we get through another day. And that's why I'm willing to invest a little more. Hurting means that something mattered to you.

I know that I'm still a young therapist, and I have a lot to learn about loss and handling it and guarding my own heart so that I can have a long career of caring for others. I love my profession and I particularly love this setting a lot because there is such a capacity to touch people's lives in the geriatric setting. I firmly believe that it is a very special opportunity that some of us, not all, are called to do, and I just feel it on my heart at this time in my life, and perhaps always (who knows?) to do so. But it still hurts. And it's still hard. I was hurt. I teared up. I was angry. What's the point?, I thought for a while, even. Is it naive to think that the progress we make with people in this setting matters? Is it helpful if they end up here one day, gone the text. I remember this proverbial question from the first day I entered a nursing home as a student, and my CI told me confidently, of course it does. Anything that betters someone's quality of life is meaningful. I believe that, but it's hard not to feel bitter sometimes at the world. It's hard not to feel angry about the loss. I feel good in my heart about always doing what I felt was right in this case. But I still walked past that room today, glanced in at its emptiness, now sterilized and devoid of any life at all, and that Friday afternoon as I walked out the door following that last session is going to stick with me for the rest of my life.
I'll miss them.