The span between life and death can be as quick and sudden as a puff of wind that blows out a candle. But the candle does not suffer after the darkness comes. It is the person left in the dark room who gropes and stumbles.
– Helen Duke Fike
We have all experienced life and we have all experienced death in some way, shape or form in our years on this Earth – whether it was a family member, friend or pet.
But what if the devastating emotion of life lost, is a lovely, happy and physically ailing human being: your patient?
I have been a physiotherapy student for four years of my 23 years of life. That amounts to less than one fifth of my time here. Yet, in my first week at my very last clinical placement of my student career, I experienced this utterly raw and indescribable feeling of losing a patient.
Mr F was a very compliant and happy man, even though he was not able to speak due to his stroke, his cheerfulness was palpable. He was diagnosed with a Right MCA and he had a hemiplegic left side, expressive aphasia and he was not able to swallow, so he tended to aspirate a lot. His family was (coincidentally?) there for every session I had with him – very supportive. After each rehabilitation session, some aspect of his deficit improved, so I had the world’s hope for him. Until the fourth day. I remember the sun shining so brightly that day and I wanted to see him first so both our days started well. It was when I walked into the ward that I felt chills, saw familiar faces filled with tears and etched closer to see a pale body. I immediately turned around and walked away – I have never felt so vulnerable in my profession. I was shaking, teary-eyed and professionally asked the nurses what had happened, “He passed away early this morning in his sleep with no medical reason.” Like the above quote, this candle’s suffering was over and the light was gone.
The following two weeks, four more patients of mine had passed. The very last one had been praying for hours just before her soul left the Earth. I felt numb.
Nothing, really prepares you for this, even if you have experienced death before. The feeling of sadness, hopelessness and doubt. But should we, as physiotherapists, realise that this is norm and we should get used to it? Or are we supposed to invest ourselves so much into protecting each of our candles so they do not get blown out? What does that leave for us?
Jane Toms (2016) stated in her study that the most efficient way for students to deal with death was through professional counselling at the placement of occurrence. This appears to be impossible in South Africa, because our resources are already extremely limited.
On moral standards, I feel our clinicians should be prepared to help students be ready to experience all the emotions surrounding death of a patient without feeling ‘silly.’ But we, as students, should then prepare ourselves with the necessary coping strategies to adequately react to patient loss.
I do, however, feel that it is possible that we can in a sense ‘get used to’ losing a patient to a medical condition – which can also be dangerously disguised as numbness to feeling. But every experience will be different. Therefore, we need to allow ourselves to feel all the pain that goes along with the cold winds of death.
We must protect our candles to the best of our professional abilities, but when their lights go out, we must allow ourselves to shine on. Because we must keep believing that we have the aptness to make another candle’s light shine even brighter.
4 thoughts on “The Candle and the Wind – Meaningful Death and Life”
Hi Sune,
I’d like to start off by mentioning how much I loved the metaphor you used to start off your piece with. The comparison made fits so well with what you spoke about.
One of the reasons I found myself so intrigued by your piece was that I, myself, have trouble with this exact issue. I feel that we as students are not prepared enough or given access to the right kind of help when it comes to dealing with a patient death. But as you’ve mentioned, we don’t have the resources at our placements that provide these services.
But I do believe we are paying for a degree that prepares us to manage the health of our patients, and if not, then at least we know the referral process. But what about managing our own health? What about our emotional and mental health? Why are we not taught how to deal with these types of situations or at least told about services that could possibly be available to help us?
According to Thiemann, Quince, Benson, Wood & Barclay (2015), Although health care professionals encounter death and dying frequently, failure to deal adequately with their own reactions may affect the quality of care they give to terminally ill patients.
Therefore, It is important to address death and the anxiety thereof during medical education to enhance student’s psychological health and the quality of their future practice.
Reference:
Thiemann, P., Quince, T., Benson, J., Wood, D., & Barclay, S. (2015). Medical Students’ Death Anxiety: Severity and Association With Psychological Health and Attitudes Toward Palliative Care. Journal Of Pain And Symptom Management, 50(3), 335-342.e2. doi: 10.1016/j.jpainsymman.2015.03.014
Good day Sune
Let me start by complimenting on the opening statement that life can pass on just like a blown out candle, and the fact that the people that suffer the most are those that are left behind in the dark. And I love the connection between the statement and the picture.
Loosing a patient is one obstacle in a students life where I feel like no-one is fully equipped or ready for it, probably it gets better with experience. From an article that I read, it was asserted that patient death experience differs from patient-to-patient, being influenced by a number of factors such as: age of the patient, cause of death [treatment errors], and relationship with the patient. In your situation, you might have felt the grief the way you did, due to your relationship with the patient, and the progression in his health.
One thing that we lack, is student preparation or rather grief coping mechanisms for patient loss, which could be due to the fact that as individuals we deal with grief differently.
Your statement about ‘us’ as therapist letting our light to continue shining stood out for me, because even after loosing a patient I believe that we should pick ourselves up and better the lives of those that are dependent on our therapeutic services, rather that focusing on one death and end up loosing even more patients. However I believe that senior physiotherapist should offer counselling sessions after patient loss.
Your piece was easy to follow and actually challenged my mind on how can we reach out to students that have experienced a patient loss, and as an individual what coping mechanisms can be used.
Please read up on “Physicians Grief with Patient Death” by Randy A, Lori A Sunsone (2012), and ‘Dealing with Death’ by Pessago.
Hi Sune
Thank you for sharing this piece. I think this topic is very relevant to many students, because I agree with you, we are not prepared for this. There are some students who deal well with these situations, then you get other students (like me), who just don’t know how to react. I think my biggest flaw is that I get attached to my patients when I build a bond with them, so that when they are gone, my heart aches and my mood is disrupted for that day. This also affects my patients because my mood is altered and they can also sense that. However, is it really a flaw if I am just being human?
According to Whitehead (2014), he states that the professional’s experiences of dealing with death of a patient can impact them (personally) and also the way they communicate with their patients. Therefore, it is important to deal with these situations so that no negative impacts come from the experience.
According to Smith, Robinson & Segal (2018), dealing with death should not involve ignoring the situation. The best way to deal with death is by acknowledging the situation and pain felt, accepting that it has happened and the person will be in a better place and then lastly seeking comfort from a friend, another individual or professional (Smith, Robinson & Segal, 2018).
I have tried using these management approaches but sometimes I still struggle to accept that they have left. However, I do find a lot of comfort after speaking to a friend or clinician about it.
I think your writing piece has opened up a lot of emotions in me and also reminding me of actually how quick life can be taken away from us.
Your writing piece is good and is easy to read. Feel free to look up the above mentioned references on how to deal with death. Hopefully, that can assist you. The references are good.
Thank you.
References:
Whitehead, P. (2012). The lived experience of physicians dealing with patient death. BMJ Supportive & Palliative Care, 4(3), pp.271-276.
Smith, M., Robinson, L. and Segal, J. (2018). Coping with Grief and Loss: Dealing with the Grieving Process and Learning to Heal. [online] Helpguide.org. Available at: https://www.helpguide.org/articles/grief/coping-with-grief-and-loss.htm [Accessed 12 Oct. 2018].