by Robert J. Lanz, LCSW
The combination of skills, not just professional but personal and social, that it takes to deal with death on a regular basis leaves us in a psychological Catch 22. To survive, we have to be so strong that most people believe they could never do what we do. They believe they would succumb to the pain, that they would end up emotional basket cases or that, in order to get through the night, they would have to turn it all off. They believe they would have to learn how to go through a set of physical motions and a seemingly canned speech, in order to get the job done without investing too much in the way of feelings. For them, the investment seems like it would be too painful.
Of course, they would be totally wrong. Dealing effectively with death takes a lot more than a performance. It takes a sensitivity that is equal to the strength required, and many people don’t believe they have that. Or maybe they fear the sensitivity because they think it will eventually open them up to greater pain, which, after time, will make them numb to it. Then they’ll start performing instead of feeling.
It is easy to see why these fears exist. The ER can be a painful place, because it is a place where people die on a regular basis. Sometimes they die when you are touching them. Sometimes they come in talking and you have enough time to see them as people before they go. Sometimes the family is there and they do what people do in the worst of circumstances. They cry and scream and faint and accuse us of negligence and fall over or throw chairs. They vomit; they tear at their clothes. They tear at our clothes. They beg us to try harder, to try longer, to bring their loved one back for just a few more moments so they can tell them something they forgot, maybe a last “I Love You.” They accuse the dead person of deserting them. They do almost anything. And some just sit and do nothing.
This range of behavior is frightening when first observed, but over time, we in the ER come to view each different response as a just a different, yet necessary action. Most people hope they never have to be confronted with these behaviors even once in their lives, but in the ER, we accept them. It is at the moment of a death that life seems to become most important. Sometimes, at the worst possible moments we see people at their best. Other times, we see them at their worst and it is our job to help them to be their best and to find a way out of the emotional morass they’ve been tossed into. If we do our jobs well, we won’t get sucked into the morass with them. Their loss doesn’t become our loss. Their pain won’t become our pain, their grief our grief.
For me, a way to avoid being either too callous or too sensitive is to put things into absolute time frames. No matter what is happening to whom, the patients and their families get 100 percent of me when they have me. When I am with them, I am only with them. I feel their pain and share their sorrow and grief. And when they are gone I let them go, or at least I try to. There will always be someone who gets through my defenses or someone who attaches so strongly they get to come home with me—someone I think about or dream about or write or tell stories about. Someone who looked too much like a person I loved and lost, bringing with them a memory that is just too strong to ignore.
Sometimes, that can be a good thing, that people can actually have such an effect on you that you do bring them home. You just can’t let it happen very often, not simply for your own self preservation, but because of the way it will affect your job performance. Too much involvement leads to system overload, followed by burnout, after which you aren’t going to be able to help anyone. I refuse to let that happen to my patients and I refuse to let it happen to my friends, family and co-workers.
To survive, I think you have to let it all in, let it all through and then let it all go. That way you can give what you need to give at the time when it’s needed and still have enough to give the next time. And there will always be a next time.