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Writing this, I’m currently sitting in a sauna. It’s not on. It’s just after five in the morning and it’s a quiet place to hide. A place where my being awake at such a ridiculous time on a Saturday morning is not disturbing the six other people I am currently sharing a house with. I’m awake because it’s been a bad week, I’m in the wake of the ‘horrible awful’ and now that I have stopped, and stepped away, it’s all right there. I’m processing… and I like to think I’m wise enough to know by now, that I actually need to let this happen.

Death and dying in healthcare exists on a continuum from the good and peaceful, through to what I call the ‘horrible awful’. There’s probably a curse word or two between the horrible and the awful if I’m really honest. If you’re lucky, you might only get 1 or 2 ‘horrible awfuls’ in your career. Unfortunately, for those of us who work in certain specialties (or who are just plain unlucky sh*t magnets) the ‘horrible awful’ may actually be a slightly more common event than that – and you know when you start a continuum all of its own, for all the ‘horrible awfuls’ of your career, you really have seen too many people die in ways that your mind tells you they just shouldn’t have.

In my experience when healthcare professionals talk about good death and bad death (whether that perspective is related to patient factors or team performance factors) it often comes down to two things: control and sense making. If we feel like there was control, that we ourselves had some sense of control, and, or, if we feel like we can make sense of the situation, how it happened and why it happened, rationalize it in some small way, that processing comes a little easier, a full cycle of reflection can occur and we can move on.  

The ‘horrible awful’ of this week really was the pointy end of horrible awful, so I know there’s really no getting out of this sauna this morning without some deep reflection. Writing has always been a kind of therapy for me. It started in my childhood with my mother recognizing that I internalized…a lot. She handed me a journal and told me that if I couldn’t talk about it and couldn’t have a good cry about it, to a least write it down, and get it out that way.

Today, as I write, start that process of reviewing what happened and how I feel about it, I realise that while all my thoughts and feelings are tainted with extreme sadness, those thoughts and feelings do vary depending on which lens I view it through.

My very human and individual response is that I am heartbroken for the patient who is no longer here, for the life lost, for the family who learned in a second that their lives had changed forever and were forced to say good-bye. The relatability of what’s happened it so tangible that the effect is rippling for everyone involved, including those on the periphery, and even for those who hear the story second hand. It stirs the mortality within us all, a hard reminder that the time we have is finite.

As a colleague, I am devastated for my co-workers. Watching senior clinicians questioning their decisions and actions, considering all the what ifs, should haves and could haves, grappling with the fact that despite all their experience and know how, they couldn’t save this one, is hard. People find fault with themselves, even when it wasn’t there. Watching more junior clinicians, who are being confronted by mortality in a manner much like walking head first into a brick wall. The injustice of the situation reminding everyone that there is nothing fair in the way in which death comes for us.

I remember that I was that junior clinician once. I still remember the event that shook me to the core of my soul, and I know that even though I can process these events to a point where I can functionally move on, it’s moments like these that tend to open the vault, to all the ‘horrible awfuls’. The names, the faces, the families begging for an answer as to how it got to this, all right there again, just for a moment.

I’m sad that my newer colleagues might have just started their own vault; because despite those who claim that service people (healthcare or other) know what they are getting into when they chose their careers, knowing theoretically what might happen and remembering forever a moment you were in, where something did happen, are not the same thing.

As a leader, and people manager, there is a deep-rooted sense of responsibility I feel towards the staff in the department in which I work. Work Safe Australia calls these events ‘Psychological Hazards’, and how organizational leaders respond has real impacts on the people involved, in ways that can change the trajectory of careers and lives. It’s a horrible reality in healthcare that the ‘horrible awfuls’, among other things, predispose our staff to vicarious or secondary trauma.

As leaders there comes a responsibility to identify such psychological hazards and ensure they are managed appropriately. A responsibility to minimize occurrence and exposure where-ever one can. A responsibility to ensure our workforce understands what psychological hazards are and how to recognize and respond to any distress or trauma they may generate.

As an educator, there’s an unfortunate knowledge that so much of what we do in healthcare is experiential learning. So there’s a drive to understand the succession of events, to determine if, in the aftermath, there is actually some sense to be made through a learning process. Hindsight can’t ever help this person, but it might help another person, and if that’s true, then maybe we are capable of making meaning from disastrous events, and gaining some control again.

Is there something collectively we can take away from this? Is there something we can put through a process of analytical reasoning to embed in our memories that we might recognize in another patient or situation one day down the track? What issues can we find in the system that we can fix or modify to recognize or prevent this happening again in the future? It’s the best we can do to honor a life lost.

But it’s important to consider the way in which we undertake these educational and review processes, whether that be through debriefing, teaching or critical incident reviews, or combinations thereof, because they must keep those involved safe and not create further psychological hazards.

I want to finish by saying that in the wake of every ‘horrible awful’ of my career, I have seen things that restore my often lost faith in humanity. The innate goodness in people; the way in which team mates rally around each other, the bonds that strengthen between people through shared experience; the kindness and generosity of giving to others. And this week has been no exception to that. For me, these ‘horrible awful’ moments almost always serve as a reminder that life is so precious, and there is much in life to be grateful for.

It reminds me that we should take the opportunity to do things and say things while we can. I’ve always said that being a critical care nurse has been good for at least one thing, and that’s been the life perspective it often imparts. It’s on that note, I must now sit my pen down and get out of the sauna. I’ll make a cup of tea, smile and laugh with my waking friends and watch the sun as it begins to rise over the hills.