Last Class

Last week I was walking to my health care practice class and ran into my dean. We chatted for a few minutes and I told him I was about to do a class on grief which always felt not quite right. Spending three hours, one class day talking about a subject that permeates work in health care seems a little weird, redundant, perfunctory, etc. and I told my students as much at the beginning of class. But onward we went and with this group, nothing is perfunctory or redundant. They are thoughtful, reflective new social workers and so basically everything I am supposed to teach, teaches itself through their insights and discussion.
In the course of our three hour class, the conversation took an interesting turn which I’ve been reflecting upon ever since. One student talked about recent experiences in her intensive care field placement that had shaken her. The sudden death of teenager, the realization that a child with cancer will likely not survive until the fall and her awareness of how she was changed by these experiences – changed in ways that are hard to talk about and permanent. Many of us are lucky to reach adulthood not having to confront the profound spiritual and philosophical questions that arise in the face of severe crisis, loss, and grief. When we enter this line of work, as a doctor, a social worker, a nurse, or other health care professional, our illusions about safety and control are quickly shattered. At that point we must make a critical choice. In a follow-up journal, this student wrote that she sought counsel from another professional about how to live with what she was feeling. The person told her that over time and more exposure she would become “desensitized” to these experiences and it would not be so difficult. I cringed when I read this and a memory from my own early days in the field came flooding back.
My second year field placement brought me in contact with a five year old boy from overseas. He was desperately ill and in the U.S. seeking last ditch experimental treatments. I was 23 and remember the absolute shock of first meeting him. He had been in bed for year, not outside for year, and had to go through painful treatments every afternoon that left the halls of the unit echoing with his screams. He was also full of life and mischief and managed to give everyone on that unit a run for their money. His parents were interesting and kind. They let me into their experience for what reason I’ll never know. In the time that I knew him, things got better. His father and I snuck him outside in his hospital bed to see squirrels and stars after CT scans. The medical team got on board and he got to go outside most days, IV poles and all. But his condition was not curable and things got worse, then still worse, and he died. Everyone involved was devastated, relieved, conflicted, angry, and sad. I grieve him still.
Several months after his death, I was working in my first “real” job in an emergency room in a different hospital but one that had been involved in a consulting basis in this little boy’s treatment. His parents were there for some follow-up meetings with doctors and called me for coffee. We sat outside and talked about their son, my new job, etc. I rambled on about this and that and said something about my supervisor helping me learn about keeping professional distance, not letting the situations I was involved in overtake me, etc. etc. The father paused and looked at me with a penetrating, almost stern stare, and in accented English said, “Don’t learn that. Whatever you do don’t learn that.” At the time, I thought, “maybe he doesn’t understand exactly what I’m saying. Or maybe he doesn’t know what I’m dealing with every day in the ER.” But, of course, he knew exactly and that is precisely why I cringed when I read the advice given to this student. I want her to be able to do this work and be able to experience the joys and happiness that life offers. But if she is “desensitized” to the sorrow she sees in her work, she will be desensitized everywhere. She will suffer and so will her clients. It is a strange and difficult balance to find ways to fill up our own wells so that we can pour the water out again for others. And the struggle to allow ourselves to be changed but not desensitized is on-going not something that can be answered in a three hour class session, a semester, or a year. Indeed, it is a challenge for a lifetime.