Twenty-four nurses trailed into the room. They found seats within the circular configuration of chairs, where I sat.
A mound of rocks rested in the middle of the circle. Interesting, I thought. The neat formation of rocks waited on the floor as if they belonged there. Speckled patterns mingled among hues of gray, tan, and brown. The grouping appeared grounded and peaceful.
Hushed voices leaned into one another with conjecture. Why were chairs in a circle and rocks heaped high?
My curiosity faded as my feet’s fiery soles screamed for attention. It had been an especially long shift at the cancer center where I work as an oncology nurse.
A few hours ago, I didn’t think I could muster enough energy to take one more step—emotionally or physically. I glanced at the clock: 4:45 pm. Another two and a half hours before my drive home.
I scanned the conference room, looking to see if anyone else’s behavior mirrored my lack of enthusiasm. On the periphery, I glimpsed a nurse lugging herself into the room; she looked more prepared for pajamas than a two-hour meeting.
Normal nurse talk picked up, passing the time until the start of our staff meeting: the chemo reaction in chair 15, the terminal patient admitted to hospice care, a pancreatic cancer patient’s favorable response to chemotherapy, and the recent dress code policy changes. Others engaged with their cell phones, reading text messages and browsing social media.
Sometimes I wonder if the distractions protect us.
We try to prepare ourselves for life’s inevitable. Recently, an unusual number of patients died. Others are at end stages of life. Coping with the losses holds a unique challenge as we find little opportunity to grieve. Instead, we push through to care for the living patients before us.
Each day, patients uncover their hardships behind drawn privacy curtains. A mastectomy patient spills her load: “I can’t bear to undress in front of my husband.” Covered in an unsightly rash, the colorectal patient confesses, “It’s embarrassing; people stare at me like I am a freak. I can’t handle the side effects of this chemo.” The leukemia patient, too ill to drive, mourns her loss of independence.
There are times when patients and families share enormous issues that can’t fit into tiny exam rooms. I have heard cries follow the doctor’s words: “Your cancer is not responding to the chemotherapy” or “It may be time for hospice.”
I try to process other heavy moments:
- I received a call from a husband who tells me his forty-year-old wife with brain metastasis is more confused, sleeps twenty hours a day, and can’t control her bladder or bowels. He exhaled the words like a load he has long carried: “We’re ready to talk about hospice now.”
- I watched the oncologist place his hand on Leo’s frail shoulder and gently released the words like a bomb he didn’t want to detonate: “Leo, I am afraid we’ve run out of miracles.”
- One Monday morning I started an IV on Pam, a patient with metastatic lung cancer. She spoke through gasps of air, stopping several times to inhale oxygen through the cannula in her nose. She told me she had just gone to her beloved camp for the last time. Five days later she died.
- I hugged the solemn husband who returned to the cancer center for his own bladder cancer treatment one year after losing his wife to breast cancer. He died four years after his wife.
- I walked into the waiting room and startled at the sight of the young mother. With no hair and grape-colored stains under her eyes, she forced a smile as she leaned toward the infant seat to check her baby. The baby cooed, not yet realizing her future in the world of cancer.
Within the same workday, we celebrate increased blood cell counts and applaud improved PET scan results with patients. We serve up balloons and cake on a patient’s last treatment day, hoping and praying for cure. We honor patients once a year at our Cancer Survivor’s Day celebration, because every patient is a survivor. We rejoice with the ones in remission, all the while remembering the ones who are gone.
Each day I receive email messages listing the names of patients who have passed away. I’ll be writing a triage note when a message box pops up in the corner of my computer screen and fades away—like the life of the person who died. I feel guilty when I don’t stop to honor the deceased.
Information comes at me from every direction: emails, triage calls, IMs, critical lab results, doctors’ orders and patients’ side effects. Activities generated from the needs of living patients. Nonetheless, the needs of the living deserve my best.
I am reminded how my patients’ cancer co-exists with paying their bills, grocery shopping and doing their laundry—just as honoring the dead co-exists with my delivering care to the living.
I attempt to arrange my emotions like neatly folded laundry—precisely stacked and organized by color, even though I know emotions are more like the assorted mound of laundry in the basket, needing to be pulled out and handled.
Our monthly staff meeting was about to begin.
Deb asked each of us to take turns retrieving a rock. “Bring it back to your seat with you, and wait until each person has a stone.”
She didn’t tell us why.
With uncertainty, each nurse stepped toward the pile, selected a stone. My hand reached for the rock with one scalloped edge, its entire surface covered in crevices. The scalloped edge fit nicely in the curves of my fingers’ grasp. My thumb rubbed along the edges of the empty trenches.
When every pair of hands held a rock, Deb acknowledged the losses and our need to grieve. She spoke of our compassion and what we give to our patients—and what our patients give to us. Knowing we hurt and needed to heal, Deb suggested that each story offered healing. She invited each of us to share a story about a deceased patient who has been on our heart, and then place our rock in the large glass bowl she had since set in the middle of our circle.
At that moment, I viewed the rocks in a different way. Each stone represented a burden to release, yet a memory to hold.
As each nurse released her story, she unloaded her weight.
Our staff meeting became a memorial service.
I don’t recall every story shared, but I do remember the feelings of love, the reconciled losses, and the special power of story. Memories poured out to live on. In the vulnerability, we were brave. Nurses hugged one another. Sniffles scattered through the room. Someone—I don’t recall who—handed me a tissue.
The moment paused. It lingered lovingly, like the empathy in the air.
I will always remember their names and how alive they were even when they were dying: Marcia, Owen, Randy, Donald, Charles, Ruth, Jeanne, Betsy, Brian, Brenda, Sue, Millie, Nancy, Pam, Mark, Colleen, Michael, Arlene, Willard, Gary, Colby, Linda, Joy . . .
Every patient leaves pieces of themselves with us. Brenda cried when she learned that her third round of chemotherapy would probably cause her to lose her beautifully manicured fingernails. As I accessed her mediport one day, she said, “I’ve lost my hair and my job; now I might lose my nails. It’s the only thing I have left to make me feel feminine.”
I remember that Joy and Pam loved quilting, Jeanne adored batiks, and Betsy enjoyed fishing. Randy, wheelchair-bound from his cancer, was determined to take his daughter down the aisle on her wedding day—and he did.
Our staff decided to create a space, the Meditation Room, for the remembering, the honoring.
Recently, I slipped away into the Meditation Room. The air set me at ease the moment I entered the room’s tranquility. An infusion of soft natural light bathed me. Calming shades of grays and tans grounded me, colors that reminded me of the rocks we had used in our memorial of our patients.
I retrieved one of the two overstuffed albums from the table in the corner of the room and sat to place it on my lap. My fingers felt the irregular edges of the pages. Corners of cards and letters poked beyond the sheets.
I lifted the padded album cover. Handwritten messages from nurses and family members surrounded taped-down obituaries and photographs.
As I looked closer at the faces in the pictures, I could see the ways they faced cancer—how they all ran toward it and not away from it. In the running into the cancer, they ran toward life.
I turned the page to a collection of folded letters tucked in an envelope. As I unfolded and read the letters, I felt each author’s longing to connect. In the spilling of sentiment and memory on paper, they said more than what was written. These letters told others, “This cancer patient lived, and what happened mattered.”
Yes, those who have died matter to me, even when my workday’s multiple distractions don’t allow me to grieve at work. Most times now, when the email notification pops up on my screen, I remember the rock and how dying people can heal us in unusual ways.
Then I take a deep breath and move on to live and help live.
Sharon A. Gibbs is an oncology nurse, blogger, and writer with a passion for how our stories connect and heal us. When not tending to her patients, she tends to write stories. She also loves to collect memories with her husband, cook for family and friends, and curl up on the couch with a good book.