by Robert Lanz, LCSW
“The softest things in the world overcome the hardest things in the world. Through this I know the advantage of taking no action.” – Lao-Tzu.
It was 1:30 in the morning and I was dog tired. Another night of violence and frustration—too many of them and not enough of us. It was one of those nights during which my mind gets so twisted that I actually think, “If I was a woman I could at least sit down to pee.” One of those nights in which I’m glad to have a couple of Power Bars stashed in my briefcase, because in twelve hours of feet pounding on a cement floor, it would be the only thing I’d get to eat.
The nurses are allowed to take a break every two hours and they get a half hour for lunch just like everyone else-everyone except the docs and the social worker. The docs get paid about five times as much as I do, but between the long road they took to get to be an ER physician and the long nights on the job, they’ve earned every penny of it. The nurses earn their money the same way everyone who works in the ER does. Taking a beating on a regular basis is part of the job.
Another one of those nights—no slacking, everyone fully earning their paycheck. Well, not everyone. My friend Ricardo, who overworked all the time as part of his job as the ER tech, wasn’t at a hundred percent. The ER tech has to do what the rest of the staff doesn’t want to do or doesn’t have the time to do. But tonight he wasn’t doing any of that and was actually laying down on the job. Ricardo was passing a kidney stone. I was almost envious.
He got to lay down. He got to take drugs. He got to lay down and take drugs in his own room with the lights out! He got to say no to all work requests. He got to have his own nurse fawning over him and tucking him in and frequently squirting a little morphine into his IV. Night-night, Ricardo. I probably wasn’t the only one there who was envious.
In addition to being way too stoned to work, Ricardo was way too stoned to get himself home safely, so when it looked like it had finally gotten to the point where I could leave, I volunteered to give him a ride. I knew it was a mistake not to leave the ER when I had a chance and that I should have made my getaway two hours earlier when I finished with my last patient, but Ricardo was my friend and he would have given me a ride home if I was too stoned to drive. The nurses told me he would be ready to leave in about twenty minutes so I waited in my office with my cell phone and beeper turned off, the curtain drawn over the little window in my door and the lights out. It was as close as I could get to not being there.
But it wasn’t close enough.
At precisely 2:00 AM, I heard a brisk knock on my door and I froze, hoping my silence would convince the knocker I’d already gone home. Officially, I wasn’t in. Technically, I was hiding. It was dark and late and I just wanted to help a friend and go home, but the persistent knocking was from the only person in the whole five hundred bed hospital who could actually make me do any work.
Being summoned by the hospital administrator at two in the morning brings with it the same sense of foreboding as getting a phone call at home at that time: the chances of there being any good news involved are minimal. More likely, someone has died, or is in jail or has taken a turn for the worse. No one calls at two in the morning to tell you that just you’ve won the lottery, or that they have free tickets to see Jimmy Buffet at the Hollywood Bowl, or that they want to pay back that money they owe you. Two in the morning is bad news time. Bad news for me, not getting to go home. Bad news for Ricardo, whose kidney stones turned out to be too big for him to be released. But 2:00 AM brought really bad news for the woman who died suddenly in the ICU while her family was down in the cafeteria eating and thinking she was recovering from surgery. For them, 2:00 AM was the time they came back to her room and found her dead.
I walked into the ICU nurse’s station, into the bedlam you might expect to find when a husband loses his wife and parents their daughter while they had been away from her only for a brief peaceful dinner. A quick check of the patient’s chart showed that there had been significant warning signs of the patient’s worsening condition. Someone should have seen these signs and steps should have been taken. Perhaps late stage cancer surgery provokes some denial in all of us, especially with a youthful patient. At the very least, though, the family should have been made aware of their loved one’s deteriorating condition.
As any family would do, these folks used the defense of denial and choose to search for some semblance of hope for their loved one, who was still in her twenties and recently married. On this night, hope wasn’t going to be found, and the family was understandably confused and angry. Although their reactions were normal and expected, they were still very difficult to watch—all anger and pain and lack of direction. It didn’t take a genius to realize that at some point, probably soon, some of that anger would be directed at us. My job was to let that happen only to the point where any sort of physical attack was imminent. Right up until that point, their actions would fall within the parameters of normal behavior, including blaming someone else for their loss.
These people were religious and educated, with a very solid family structure. They were stable, normal folks trying to cope with a very abnormal situation, and part of my job was make sure the rest of the staff didn’t become impediments to the natural flow of their grief, no matter how loud or disruptive it became.
This was a problem, of course, at two in the morning when there were several sick, although still living patients who needed to have a quiet night of rest. It was made more difficult by the nurse who felt as if there was something she could have done but didn’t, so she was crying hysterically while everyone else looked at me like I was supposed to be doing something.
“I am doing something,” I wanted to shout. “I’m doing nothing. That’s the something I need to be doing right now.”
Doing nothing was torture for me because my inclination is to try and stop pain whenever I can, but sometimes, inaction is better than action, particularly when grief is involved. I’ve learned that there is no way around grief, only through it. Trying to avoid grieving and the pain associated with it only makes it worse and longer lasting. But at that time of night, after a long, punishing day, it’s hard to remember the lessons learned in school or from a colleague—lessons that can give you the confidence and strength to let the situation flow. Lessons that allow you believe that things will get better when they are ready to get better. Not when we want them to get better or need them to get better, but when they are ready to get better.
After all the screaming and shouting and tears, the family finally came to accept the fact of their loved one’s death and they were ready to go home and begin the next step in the mourning process. They thanked the nurse for her kindness. They told me how much they loved the doctor that had taken care of the patient and how they knew it was better that she died and wasn’t suffering any longer. With that understanding, they were ready to go. We told them about funeral arrangements and they left. I looked at the clock: Three-thirty.
Pretty late at night or early in the morning to go through all that we’d gone through. On top of it I felt guilty because I had been hiding and knew what would have happened if I hadn’t been there. The grief reaction confirmed everything I had ever learned about grief reactions and the fact that I was willing to go through the process when I really wanted to be home did affirm for me the strength and depth of my commitment to what I do.
The hospital administrator stopped me in the hall and thanked me. I think he understood what I did: nothing, which was the right thing to do. But under those circumstances, doing nothing was nearly impossible and to have spent that hour and half doing nothing was the hardest nothing I ever did.
By the time I got home I wasn’t envious of Ricardo any more. I felt good. I helped a family begin the process of dealing with their pain and I really didn’t do anything.