Behind the curtain: A narrative on dealing with death and grieving .

The night I lost you
someone pointed me towards
the Five Stages of Grief
Go that way, they said,
it’s easy, like learning to climb
stairs after the amputation.
And so I climbed.
Denial was first.
I sat down at breakfast
carefully setting the table
for two. I passed you the toast—
you sat there. I passed
you the paper—you hid
behind it.
Anger seemed so familiar.
I burned the toast, snatched
the paper and read the headlines myself.
But they mentioned your departure,
and so I moved on to
Bargaining. What could I exchange
for you? The silence
after storms? My typing fingers?
Before I could decide, Depression
came puffing up, a poor relation
its suitcase tied together
with string. In the suitcase
were bandages for the eyes
and bottles sleep. I slid
all the way down the stairs
feeling nothing.
And all the time Hope
flashed on and off
in detective neon.
Hope was a signpost pointing
straight in the air.
Hope was my uncle’s middle name,
he died of it.
After a year I am still climbing, though my feet slip
on your stone face.
The treeline
has long since disappeared;
green is a color
I have forgotten.
But now I see what I am climbing
towards: Acceptance
written in capital letters,
a special headline:
Acceptance
its name is in lights.
I struggle on,
waving and shouting.
Below, my whole life spreads its surf,
all the landscapes I’ve ever known
or dreamed of. Below
a fish jumps: the pulse
in your neck.
Acceptance. I finally
reach it.
But something is wrong.
Grief is circular staircase. (Bacharach, 2016)

http://justadream.tripod.com/pastan/15p.htm

It was a cold rainy day, there was a chill in the air but it was a Tuesday which meant I had to get out of my warm bed and start my day at block. So I put my brave face on and got ready for work and made my way to Groote Schuur hospital. My mornings at Groote Schuur hospital usually started with the entire physiotherapy department meeting in front of the white board to discuss patients, provide feedback and allocate new patient’s. After this we would all begin our day in the wards. This was the pattern I had become accustomed to but little did I know that today was going to be a day like none other.

This particular morning I was allocated a repeat patient by my lead clinician due to the fact that the patient had an extremely increased BMI and most of my female colleagues were not be able to mobilise or transfer the patient. Due to the fact that I had already treated this lady and developed a good rapport with her I agreed to take the patient. I normally leave my more difficult patients for the end of day so that I can ensure that I have enough time to appropriately treat them. So there I was 1:30 in the afternoon, an hour before the end of my day, on my way to ward G17 to go and see my patient. As I entered the ward I asked the nearest sister’s if I could please see their patient list for that day so that I could locate my patient and begin my reassessment and treatment session. Once I found out which bed my patient was in I made my way there and began to reread her file to familiarize myself of her case.  Once I was done reading my patients file at the nurses station I made my way to her bed as eager as ever to begin my assessment because I knew even though she is a difficult patient to handle we always tend to have a good laugh. Upon arrival to her bed I noticed that the patient curtain’s around her bed were completely drawn. This was unusual due to the fact that the curtains are normally not drawn unless the patient is being dressed or dressing themselves. But this couldn’t be the case because there was no noises coming from behind the curtain. This made me feel a little uncertain due to the fact that I recalled that this patient was quite chatty. My uncertain feeling caused me to open the curtains ever so slightly just to see what was going on and to inform the patient that  I was going to be the  physiotherapist who would be seeing her that day.  To my surprise there was my patient lying under her covers fast asleep. This was somewhat expected due to the fact that it stated in her file that she had a severe infarct after the last time I treated her therefore affecting her GCS score. According to recent literature a patients who have low GCS scores tend have a low level of consciousness therefore causing them to sleep more than usual (B., Sagarkar, & Sakharkar, 2018). Therefore my first instinct was to wake up my patient as cautiously as possible so that we could start the session. As I tried to wake my patient I noticed that her skin was very cold and that she had no response to any of my shaking and talking, not a single grimace, not a twitch, nothing at all. Then it hit me like a ton of bricks, this lady was dead.

At first I couldn’t comprehend what was happening and started feeling so overwhelmed and I didn’t know what to do. My next thought was who do I tell. I became so engulfed in anxiety and shock that I immediately made a bee line out of the ward but on my way out my ethical compass told me that I need to inform someone that this patient had died. So I went to the sister in charge of the ward and informed her that the patient pasted away. She replied as cool as a cucumber by saying “I know darling, didn’t anyone tell you”. At this point I was still experiencing an overwhelming feeling of shock and heightened anxiety but fortunately it was already the end of my day and I could go home.

When I got home I couldn’t believe what had happened and I was still struggling to process the horror that laid behind that curtain. It was bothering me to the point where I needed more understanding of how to deal with what I had just experienced and just by chance I stumbled across the Kubler Ross model on the cycle of grieving and dealing with death. According to (Kubler-Ross, 1969) the cycle of dealing with death begins with denial first followed by anger, bargaining, depression and finally acceptance.(Kubler-Ross, 1969)

Denial is defined as the refusal to accept the sudden change of reality couple with feeling of shock and anxiety and obviously denial. Anger is defined as the feeling frustration and upset coupled episodes of lashing out. Bargaining is defined as the process whereby a person tends to bargain with themselves and their deity in hope to come to some sort of compromise. This is then followed by depression whereby the person goes a phase of severe sadness. Lastly there is acceptance whereby the person accepts the loss of someone and find comfort in knowing that that person’s journey is over.(Kubler-Ross, 1969)

As I made my way through the various stages of grieving and finally accepted that my patient had passed I found a sense of clarity in knowing that this patients battle was over and it made me feel more comfortable with dealing with death. This experience has allowed me to view death in a different light and has given me a new perspective therefore allowing me to be able to deal with death in a more calm and accepting manner

References:

B., N., Sagarkar, S., & Sakharkar, A. J. (2018). Epigenetic Mechanisms of Traumatic Brain Injuries.Progress in Molecular Biology and Translational Science Epigenetics and Psychiatric Disease,263-298. doi:10.1016/bs.pmbts.2017.12.013
Bacharach, D. (2016, May 04). The Five Stage of Grief. Retrieved from http://www.deborahbacharach.com/poemsilike/2016/5/4/h56gaowjtlibf9ww8p4ue4sl2e63eq
Kubler-Ross, E. (1969).5 stages of grief[PDF].

4 thoughts on “Behind the curtain: A narrative on dealing with death and grieving .

  1. Hey Dylan, thank you for sharing this experience. Although I have never had a patient die during my treatment I can relate to your experience in the sense that I feel a sense of guilt when I treat patients and they do not get better. I think it is good to accept a certain level of accountability we should hold ourselves responsible as we only facilitate the patients the best way we know how.

    The content of your writing does reflect the ethics module but it is not obvious what topic or topics you are focusing on. I think you should try to include a title or tags that highlight your topic better. Most of your content is more about the events rather than your experience of it and the ethics behind it. To improve the quality of your content try to read up on dealing with a patients death and incorporate the literature of that in your content.

    There are no apparent arguments made in your writing. A suggestion of a possible argument is exploring what the difference would have been if you have arrived 30 minutes earlier as you question in your writing.

    There are no references used in your writing. Attempt to find literature concerning the personal responsibility which health care workers feel regarding the death of patient they are treating. You also made a few statements which require a reference such as the one in the 2nd paragraph about how patients with a low GSC sleep a lot and the statement in the last paragraph about the healthcare workers response to being unable to provide a cure.

    The common grammatical errors I have identified in your writing are using too many conjunctions in one sentence and a few capital letters which should not be there. Make the following changes regarding spelling and grammar (paragraph=P, line =L);
    P1L4: white board= whiteboard
    P2L2: mobilise= mobilize
    P2L12: to what was going on = to ”see” what was going on.
    P2L12: T o= “To”
    P2L12: Women=woman
    P2L12: Wad= “was”
    P2L13: patient= patients
    P2L16: At first = At first”,”
    P2L19: pasted= passed
    P2L21:Groote shour= Groote Schuur
    P3L1: plaques= plagued
    P3L2: continously= continuously
    P3L2: ihad= I had
    P3L2: carlier= earlier
    P3L3: Partloners= practioners
    P2L13: Therefore= Therefore”,”

  2. Hi Dylan

    Thank you for sharing your draft with us. This topic is something that everyone of us might struggle with at one point, since the passing of a patient it something a lot of us students take personally. Thank you for sharing this with us. I suggest that you add references to make your piece stronger and to link it with the topics we discussed in class. I also suggest that you break up your paragraphs to make the flow of your piece better.

    Below I copied and pasted your piece and added suggestions in brackets next to grammar mistakes. Please consider them.

    It was a cold rainy day, there was a chill in the air but it was a Tuesday which meant I had to get out of my warm bed and start my day at block. So I put my soldier face on and got. -/ (delete this) ready for work and made my way to Groote Schuur hospital. My mornings at Groote Schuur hospital usually started with the entire physiotherapy department meeting in front of the white board to discuss patients, provide feedback and allocate new patient’s (patients). After this we would all begin our day in the wards. This was the pattern I had become accustomed to but little did I know that today was going to be a day like none other.
    This particular morning I was allocated a repeat patient by my head clinician due to the fact that the patient had an extremely increased BMI and most of my female colleague would not be able to mobilise or transfer the patient. Me being chivalrous and eager I agreed to take the patient. I normally leave my more Difficult (difficult) patients for the end of day so that I can ensure that I have enough time to appropriately treat my patient. So there I was 1:30 in the afternoon, an hour before the end of my day, on my way to ward G17 to go and see my new patient for the first time. As I entered the ward I (ward, I) asked one of the nearest sister’s (sisters) if I could please see their patient list for that day so that I could locate my patient and begin my treatment session. Once I found out which bed my patient was in I (in, I) made my way there and read her file. At first I (first, I) noticed that the patient curtain’s (curtains) around her bed were drawn. This usually indicates that either the patient is washing or getting dressed. So I opened the curtains ever so slightly just to inform the patient I am the physio who she will be seeing today. Usually there would be some sort of response by the patient but this time there was just silence. I then looked into the cubicle to what was going on. T o my surprise the wad (was) a women lying under her covers fast asleep. This was expected due to the fact that In her file it stated that the patient had a low GCS score. Therefore according to (…) patient who have low GCS scores tend to sleep a lot therefore my first instinct was to wake up my patient so that we could start the session. As I tried to wake my patient I (patient, I) noticed that her skin was very cold and that she had no response to any of my shaking and talking, not a single grimace, not a twitch, nothing at all. Then it hit me like a ton of bricks, this lady is dead.
    At first I couldn’t (could not) comprehend what was happening and started feeling so overwhelmed and I didn’t (did not) know what to do. My next thought was why always me. This wasn’t (was not) my first incident with a patient of mine dying. I became so engulfed in anxiety and frustration that I had to immediately remove myself from the Situation (situation) and let someone more experienced handle this. So I went to the head sister in charge of the ward and informed her that the patient pasted away. She replied by saying “I know darling, didn’t anyone tell you” I then immediately packed my stuff and made my way back to the department to report to my head clinician but no one was there. By this time it was the end of my day at Groote shour (Schuur). So I made my way home.
    The thought “of this lady’s life and how it ended plaqued (plagued) me to the point where I started to feel to blame for her death. I continously (continuously) thought to myself what if Ihad ( I had) just come 30min carlier (earlier) maybe I could have done something to save her . According to… this is a common response among health care partloners (practitioners) and that it is due to the fact that we as healthcare professionals are so used to providing a “cure” to someone’s problems therefore when they die it is seen as a failure on our behalf. Which I now know is not true. We as therapist need to protect ourselves by developing a sense of professional distance between and the patient so that we do not feel as it we are guilty for the death of the patient.

    I look forward to reading your final piece. Good luck with the rest of block.

    Deone ?

  3. Hi Dylan
    I really enjoyed reading your piece. I had one experience where one of patients died last year, but i dealt with it in a different way. It is good to get to know how someone else have dealt with similar experiences.

    It is not clear to me on which topic you decided to write about to reflect the content of the module. With what you writing about here, there are many options you can choose to incorporate into your writing that reflect the module.

    You have clearly explained your clinical practical experience and how this affected you. It is not clear to what you incorporated it with, as your topic of choice is not clear. If you make it clear to which topic you have chosen to write about, then we can link your clinical experience much better to the ethics module, rather then just reading a story with no connections.

    There is no art incorporated into your piece. Including a picture or art that suits what you are writing about can only enhance your piece of writing. The picture I got when I read your piece is someone opening the hospital curtain to the literal word “UNKNOWN” behind it. When finding the picture/art you want to include, explain what you see in the picture and then connect it to your clinical experience.

    In your piece of writing you make a few claims that is not supported by any evidence. I know this is a rough draft and you probably forgot or did not get the chance to add your references. Please insert the necessary evidence to support the claims you make in paragraph two and three.

    The piece is very interesting but it is a bit difficult to read. To make it easier to read, divide the piece into appropriate paragraphs. You have more than a few grammatical and spelling errors. I am only going to mention a few as I am sure that you will see where you made your mistakes after re-reading your piece.
    P1S2 (Paragraph 1 Sentence 2): Remove the first “and”. “So I put my soldier face on, got ready for work and made my way to Groote Schuur hospital.”
    P1S3: Last word in the sentence. Not patient’s, but patients.
    P2S1: “female colleagues”
    I noted much more errors in your piece, but the above comments made by Mfundo and Deone noted down all the errors as far as I can see.
    Another suggestion is to try to not start your sentences with “So”, as this is informal.

    I hope these comments helps. All the best with the final submission.

    1. I also wanted to mention that you categorize your writing piece under “Term 2 (2019)”
      This will make it easier for Michael to find, as he suggested in one of his previous emails.
      Thank you.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.