“All fields have occupational hazards, and for medicine, sadness is certainly one of them… What matters is how sadness is navigated, something that is influenced by both the individual personality of the doctor and the surrounding environment.” (Ofri, 2013: 98)
On my way to the hospital where I conduct my research, I was walking through a community park that is often used by hospital staff to park their vehicles. While passing a row of vehicles I noticed a man in a white coat sloping over the steering wheel of his car with tears streamed down his pale face. I wished to give the man his privacy and continued walking, when a few steps later I heard the man’s chilling scream of what I interpreted as emotional pain and anger. Hours later in the hospital I saw the same man, his face tired and worn, and walking lethargically towards a patient sitting on a gurney. I was informed by a nurse that the doctor had lost one of his patients earlier that day.
Death is surely an event that healthcare workers in the hospital must encounter, some more often than others. The loss of a patient – although not the sole reason – is a primary cause of sadness in the hospital. Of course, not everyone deals with loss the same way and not everyone expresses their emotions overtly. Some healthcare workers hide their pain and sadness, while others have become indifferent or accepting of death. How healthcare workers perceive and respond to loss in the hospital is partially influenced by the types of patients they care for, the context of the situation, their gender, and their understanding of death. Certainly, there are other factors involved, although what I present here are but a few observations of the complex and multifaceted experience of loss in the hospital.
What does gender have to do with it? From my research, the perspectives surrounding sadness and death between the male and female nurses were very different. The male nurses tended to be accepting of death and viewed it as a normal part of life. A male nurse told me that “people are born, and people die. The hospital is filled with both birth and death, and both of these things are natural and normal parts of life.” He also told me that if a nurse is not alright with death then they will not be alright with being a nurse. The female nurses also viewed death as a normal part of life, although viewed it in context. Patient’s dying too young, fears of having missed something that could have saved the patient, and their closeness with the patient and their family are things that female nurses consider in death. Male nurses have told me that, while they feel bad for the loss of a patient, they do not get emotional or feel sadness. Two female nurses in the ward had told me that they have experienced intense feelings of sadness, although they are expected and trained to not be sad. According to them, expressions of sadness is considered unprofessional. The female nurses believe that their male counterparts feel sad although they hide it much better and do not discuss it. In general, men have been socialized early on to mask and suppress their true emotions (Connell, 2005). This socialization may perhaps provide men with more emotional management practice than women. Furthermore, male healthcare workers may also be shielded from interactions involving emotions such as sadness, as their female counterparts will often be given such tasks (Cottingham et al. 2014). Gender differences are difficult to assess and compare since many wards do not have any male nurses. Context on the other hand is something much easier to observe.
I observed three deaths in the hospital, all in different wards and with different contexts. In the intensive care unit, I witness the death of a middle-aged woman. The associated sadness with this death was due to the absence of the patient’s family. The nurse in charge of the patient’s care was to be the dying patient’s last human contact. For whatever reason, the patient’s family had decided to pull their family member off life support and did not want to be there for the final moments. The nurse had an extremely emotional time as she was frustrated with the family and sad that the patient had to die without friends or family. The second death was an elderly man in long term outpatient care. This man, due to his deteriorating condition, chose to die through the medical assisted death program. The patient did not want to die slowly and watch his body cause him pain and fail him. The sadness of the doctor came while trying to decide whether to sign the request for the assisted death. Once the physician made a decision, she no longer felt sad and was actually happy for her patient. She felt relieved because she knew that he was in pain and that it was what he wanted. The third death came from a premature birth in neonatal intensive care. There was a large team of healthcare workers tending to a newborn, trying very hard to save her life. Even before the newborn arrived in the ward, the nurses were all on edge and stressed out while waiting for her arrival. It was difficult for me to witness a newborn the size of my foot hooked up to wires and with a tube down her throat. After some time, the newborn was lost, and the room fell silent. Emotionless healthcare staff all returned to their roles, and a ward that is relatively pleasant and talkative was quiet and still. I went to speak to some of the nurses and when asked how they were doing, two said that they had no choice but to be fine until their shift ended, while another said with an lifeless face “I am definitely not doing ok, not at all.” The nurses focused quietly on their jobs and did not speak to one another unless it was specifically about patient care. What I have found is that the reason for any sadness, or lack thereof, with a patient’s death changes from one context to the next, although regardless of context, healthcare workers tended to respond in similar ways.
According to Ofri (2013), there isn’t any time to engage with emotional experiences. Instead, healthcare workers find themselves “…stuffing traumatic experiences way down in the consciousness” (Ofri, 2013: 102). Healthcare workers in all three deaths have reported that they do not have time to be emotional, and that they tend to deal with things once their shift ends. Unfortunately, these workers tend to find a place to cry and grieve alone, as to not bring the burden of their day home with them to their families. Some grieved in their car, some have cried in a closet, while others have wept along side a lake. There is no place for them to grieve in their job, and no time during work for them to morn or engage with experiences of loss. It seems healthcare workers want to care for everyone by not burdening anyone else with their emotions. They do not want to burden their patients, their colleagues, their friends, or their family members. Unfortunately, holding back and supressing their emotions have been found to bleed outside the walls of work. In one study for example, numerous doctors have reported that the emotions compartmentalized from the loss of patients tends to spill over into their personal lives (Granek et al. 2012). In what form and to what extent emotional experiences negatively impact the lives of healthcare workers remains to be seen, although it will be addressed in the later stages of my research. In the meantime, whether you are a patient or a visitor experiencing loss in the hospital, know that your healthcare workers are likely grieving too.
Connell, R. W. (2005). Masculinities. Berkeley, CA: University of California Press
Cottingham, M., Erikson, R. and Diefendorff, J. (2014). Examining men’s status shield and status bonus: How gender frames the emotional labor and job satisfaction of nurses. Sex Roles, 72(7-8): 377-389
Ofri, D. (2013). What doctors feel: How emotions affect the practice of medicine. Boston, MA: Beacon Press.
Granek, L., Tozer, R., and Mazzotta, P. (2012). Nature and impact of grief over patient loss in oncologists’ personal lives. Achieves of Internal Medicine, 172(12): 964-966