East of Eli

Closeness in Caring

Closeness in Caring
Nurses shown: Ceri. Maire. Pam and Karen: “People think there’s something wrong with you if you can work in a place like this.” Photographed by Caroline Brayne and Angie Trunchion.

A few years ago while writing for a British women’s magazine (‘She’), I interviewed a team of nurses about their experiences in life and death. The word angel doesn’t come close to describing these wonders of humanity. We reprint the interview here… —Tim Quinn

Maire O’Donnel, Karen Wallis, Pam Colley and Ceri Sutcliffe all work at the Wheatfields Hospital for Cancer Patients in Leeds. Maire is matron, Pam and Karen sisters and Ceri a staff nurse. All are involved in nursing the terminally ill, and coping with death is an everyday challenge. TIM QUINN, tape recorder in hand, joined
them for a coffee break.

Maire: I never wanted to be a nurse. I didn’t know what I wanted to do except that I didn’t want to work inside, be stuck in an office.

Karen: I always wanted to do something in a hospital. I was always fairly certain about that. So I went all through dietetics, physios and medicine and decided that nursing was what I was interested in. It was the involvement with the patient that I wanted, rather than being one step removed, as you would be as a dietician or doctor. It was the closeness.

Pam: It’s impossible not to get involved with the patients.

Ceri: If you really enjoy it, you’ve got to be involved. Even though the people here are terribly poorly, that person they’ve been all their lives still shines through. They still give a lot to you. I think we’re so near the fundamentals of dealing with people that they tend to give more to the nurses. They talk more deeply.

Karen: You get very close to people, don’t you? Right to the basics of what matters, more than you would in a conversation with someone in an office.

Pam: There’s also something to be said about actually physically touching a body as we do in nursing, when you’re washing somebody. There’s a kind of bond there that you don’t get in a normal job.

Karen: It’s an accepted thing in society that nurses only get satisfaction when they see somebody get better and able to go home. I don’t think that’s necessarily true. If you know you’ve made somebody comfortable and that their relatives have been looked after, then although you’re sad and you grieve for them, there’s a comfort in knowing that you’ve given something to them that they wouldn’t have had otherwise. That helps you to cope with the sadness.

“YET ALTHOUGH WE TALK ABOUT BIRTH A LOT, WE DON’T TALK ABOUT DEATH. WHY CAN’T WE HAVE MORE EMPHASIS ON NATURAL DEATH, AND MAKE THAT AS GOOD AND AS POSITIVE AS NATURAL BIRTH?”

Pam: There are a lot of positive things that happen, even when somebody doesn’t get well. Just in everyday things and relationships, such as keeping pain under control so that people can get about and do their favourite things right up until their last days. And that’s something very positive. I’ve read a lot of articles recently about natural birth. It’s the big thing now. And birth and death are two of the most natural things. Yet although we talk about birth a lot, we don’t talk about death. Why can’t we have more emphasis on natural death, and make that as good and as positive as natural birth? The initial reaction of people to our kind of work is, “Oh, it must be terribly depressing.”

Karen: It’s certainly a conversation stopper. If you’re out with people you don’t know well and they ask what do you do for a job, it’s like saying you work in a mortuary. It just cuts the conversation dead, and you don’t know what to say next.

Maire: In fact, you learn not to say it.

Karen: Yes, you tend to just say “I’m a nurse” and not pursue it any further because people don’t really want to know. People don’t want to talk about death, they think it’s depressing and that there’s something wrong with you if you can work in this kind of place.

Maire: Yes, they think we’re odd, and they can’t cope with that.

Karen: They don’t understand what satisfaction you can get. I don’t think nursing has changed my personal beliefs. When you’re nursing, you recognise needs in people whether you have these needs or not. Not just in the religious sense. You’re aware that they may need to talk or get somebody in to talk to them.

Ceri: I find that what I think religiously is completely different from how I treat the patients religiously. I mean, I can be completely detached from religion. If somebody says they need to see a priest this moment, I get straight on to one. I wouldn’t think, how stupid.

Maire: Has it made you question your own beliefs? In my early days of this work I used to find that when I went to church and heard some idiot minister talking about suffering being good for you and death being beautiful, I felt like standing up and screaming at them, “You don’t know what the hell you’re talking about! You want to go and do the work I’ve just been doing!” But that wasn’t anger at God, it was anger at the person for preaching about something that they really had not experienced first hand. We were experienced in it. But I never found that I questioned that there is a God, or my own religious faith, because my personal faith would be tested at various times throughout my life anyway. I don’t think it’s been particularly questioned because of this work. I feel that I have a bit more acceptance of death being a natural part of living, and it’s a gateway to an after-life. So in that sense it hasn’t made me question my religion. It’s made me question the people around me who profess to have that religion or any religion, because you sometimes get angry with so-called religious people.

Karen: I think that doing this kind of work makes you sure there’s something after death, because you actually see people leave their bodies, don’t you? When you watch so many people die it’s as if there is the person in the body, and, next moment, here is the body without the person in it. And the actual person has gone somewhere else.

Maire: Not even in the same format, maybe not even in a body but the essence of the person, the real person, the soul or whatever else has moved on.

Karen: So many people don’t see death at all, and they’re quite frightened about it. They don’t see it as a natural thing.

Pam: That reminds me of my first experience of death as a student nurse. It was really just as you describe it. The person leaving the body and the body being just a shell.

Maire: When I worked in intensive care, especially in accident work or overdoses where the patients were young, after everything was finished I would go back into the room where the body was, close the door and stand there to get that moment that Karen has described. I got great peace and a sure knowledge that there was something else, or I couldn’t have gone on. I would have had to get out then. Now that didn’t come because of my nursing, but it’s been added to because of the experience. It must be there beforehand.

Karen: We often do that here though. I mean, if somebody dies, they’re not bundled straight off to the mortuary. If they die when you’re here on duty, often I will go just to see them and say goodbye.

Maire: To let them know that you’re still with them or still thinking of them?

Karen: I don’t know that I do it for their sake, I think I do it for mine. It’s a comfort to go and say your goodbyes.

“THERE’S NOTHING FRIGHTENING ABOUT THE ACTUAL ACT OF DYING. IT’S PEACEFUL AND CALMING.”

Maire: Because that’s probably your only moment of grieving over the bereavement, and we are bereaved each time we have a death here. And that’s not normal for people. We’re talking about coping. Certainly we have our beliefs. We had our beliefs before we started nursing. There’s nothing frightening about the actual act of dying. It’s peaceful and calming. I often get the feeling that in our own little way we’re handing the person back to God. Whatever they’ve done in their lives and families, we’ve had a little part to play in helping them through.

Karen: I don’t know that I think of it as being God. I’m not sure of what happens afterwards but I just feel that something must do. I don’t believe a person stays dead.

Maire: I happen to believe in a Christian God and therefore l’m saying, “Here you are, Jesus, back to you.”

Karen: I find it very hard to say, well, it’s Christian and that’s the only thing, because I can’t believe in a God that excludes people.

Maire: Well yes, the Hindus, the Muslims and the Jews, yes.

Ceri: Whether you’re religious or not, I find when you’re with a dead body, it’s like when you go into a church and you whisper, because everybody whispers in church. And it’s the same sort of aura that I get when I’m with a dead body. It’s something you just know.

Maire: ls it something more basic than that? ls it an aura because we realise by looking at that body that we are also human and are going to end up like this at some stage? If we take away our middle-class beliefs and backgrounds and get down to the primitive, is it because at that moment we are as vulnerable as that body was a short time ago?

Karen: There are certain ones that make you more vulnerable. If a young woman dies; it faces you with your own mortality. Or someone who reminds you of your father or your mother. It gives you more of a jolt.

Maire: Somebody with things left undone. A young wife or mother. You can get very sad, almost at times weighed down with the sadness.

Ceri: And go home and cry.

Maire: Which is another coping mechanism which does help.

Karen: What sometimes happens to me is that there will be quite a few deaths and I’m not too bad, and then perhaps one person l don’t feel I’ve been that close to dies and suddenly I seem to be more upset for no particular reason about that patient, and it’s as if all the others come out at the same time.

Pam: It’s curious.

Karen: And you think, “Why should I be so upset about this man?” but it isn’t really that man, it’s all the other people that you cry for all at once.

“AND THE ACTUAL ACT OF CRYING RELEASES BOTH THE EMOTIONAL AND THE PHYSIOLOGICAL TENSIONS INSIDE. IT’S A DOUBLE VALVE OF A COPING MECHANISM.”

Maire: And the actual act of crying releases both the emotional and the physiological tensions inside. It’s a double valve of a coping mechanism.

Karen: I’ve always cried. I cry easily.

Maire: I have.

Karen: I cry when I’m upset anyway, even when it’s nothing to do with work.

Maire: Of course, it’s not as simple as that for everybody. I don’t do it now, because as matron I’m not as close to the patients, but certainly in the early years of my work I’d go home and perhaps get my supper ready and then I’d suddenly find myself sobbing until I couldn’t see what I was doing. And it was a great release.

Ceri: Yes, you might just see something on the telly that’ll start you off.

Maire: That’s right, and that’s what you’re supposed to do when you’re in this line of work. You’re actually supposed to look at sad films if you can’t release it otherwise. Oh, I’ve sobbed my way through Beirut and all the disasters of the last few years. I can still be moved to tears by… It sounds like we’re all crying all over the place (Laughs). We don’t do it that often, but when you do it really is a big catharsis and then you’re all right again for a while. I don’t know what men do, because I don’t think they can do that quite so easily. Perhaps they go home and kick the dog or whatever. I garden. I do vegetable gardening and I walk my dog over the moors and clean the house. That is an ordinary way of coping for most women anyway. When you can’t do that, there are problems.

Ceri: Sometimes you can get angry if you can’t release it. Someone might say, “I made a pullover and it wouldn’t fit”. and you say, “So what, I lost so many patients today.” Then you’ve got to stop and think and say no. That’s when you’ve got to face it.

Maire: You can go home to whoever’s there after a bad day, and the kids might say, “Look what I did at school today, Mum,” and you could scream because it’s so irrelevant to the three people who have died that day and all that distress. Then you really have to get hold of yourself.

Karen: You pick up a lot of anger from relatives as well, when they’re angry about it happening to their family. Somehow you take it off them and put it on yourself and you end up shouting at somebody. And you think, well, where have I brought this from? I wasn’t like this before. That can be quite difficult. When you recognise the cause, it’s not so bad. You can say, I’m sorry, it’s not really the fact that you left your dirty socks in the drawer. I’m actually angry because of something that happened at the hospital.

Maire: As long as you can say that, and a lot of people can’t.

—T.Q.

QUESTIONS ON COPING

  1. Is there a right way and a wrong way of coping with grief?
  2. Is there such a thing as a ‘normal’ grieving time period?
  3. Can other people help get you through grief? If so, how?
  4. Are there stages of grief?
  5. How can you help people suffering from grief?

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