New Release Excerpt: Grief on the Front Lines

Posted by – July 11, 2022
Categories: General Health & Healing

From Grief on the Front Lines: Reckoning with Trauma, Grief, and Humanity in Modern Medicine by Rachel Jones 

Introduction: Facing Our Mortality

For as long as I can remember, I’ve been interested in death and dying and in how we humans treat each other. I’ve long found death intriguing—after all, what is it?—while suffering affects me deeply. When I was growing up, my family didn’t have a television, and I recoiled in horror when exposed to violent local news stories, images of Hiroshima after the bomb, or advertisements seeking to support starving children in far-flung countries. How, I would wonder, did we get here

Later, in my undergraduate sociology studies, that question prompted my thesis—a comparative analysis of the genocides in Rwanda and in Bosnia. My research only left me with more questions, but I felt strongly that a lack of media attention had contributed and was determined to become a journalist. After obtaining an MS from Columbia University’s Graduate School of Journalism, I made a beeline for Venezuela, where I spent more than four years as a reporter. It was a couple of years in before I began to question my impact. Was I really helping people to understand each other, to explore viewpoints other than their own? Or, by reporting on the most contentious aspects of both sides of the political spectrum, was I only contributing to conflict? Eventually, I stopped, and returned to the US, where I took a job at the Downtown Oakland YMCA—one I felt certain would benefit the well-being of those around me.

Toward the end of my time in Venezuela, I stumbled across a life-changing article written by journalist Kira Salak called “Places of Darkness: Africa’s Mountain Gorillas and the War in Congo.” Published in National Geographic Adventure in 2004, the story explored the complex, ongoing conflict in eastern Congo. My revelation came in the form of Father Jo, a bespectacled Belgian priest who had managed to retain his humanity in the midst of the terror. He told her: “People here believe they will be killed, and so they do the same thing to others that they’re afraid others will do to them.” That’s it, I thought. That’s how we get here—how we do these things to each other. We’re scared of our own deaths. 

Psychiatrist Elisabeth Kübler-Ross, in her revolutionary 1969 book On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families, reached a similar conclusion. “Groups of people,” she wrote, “from street gangs to nations, may use their group identity to express their fear of being destroyed by attacking and destroying others. Is war perhaps nothing else but a need to face death, to conquer and master it, to come out of it alive—a peculiar form of denial of our own mortality?” Drawing on her famous, and controversial, seminars at the University of Chicago Medical School, Kübler-Ross emphasized the need for clinicians to face terminal illness and death in order to better serve their patients. At the time, it was common for physicians not to tell patients that they were terminally ill or dying, and both doctors and nurses responded with anger and defensiveness when Kübler-Ross broached the subject. “Doctors who need denial themselves will find it in their patients,” she wrote. “Those who can talk about the terminal illness will find their patients better able to face and acknowledge it.”

Kübler-Ross is widely credited with promoting the hospice movement and nurturing a growing understanding of what it means to die well. More recently, access to palliative care has grown exponentially across the US, though some states, populations, and rural areas remain underserved. While much attention has focused on how clinicians’ acceptance of death improves patient care, there has been little recent discussion of the impact on doctors, nurses, EMTs, hospice workers, and other healthcare staff whose patients suffer from chronic and terminal illnesses or traumatic accidents. Without denial, what do they have? Do they experience grief when a patient they’ve connected with is diagnosed with a deadly disease? How do they feel when forced to perform CPR on a ninety-year-old woman with stage-four cancer who, if she survives, will only suffer more? What is it like to witness suffering and dying in hospice every day? When bombarded with the additional stressors of workplace violence, bullying, moral distress, and health disparities, how do people cope?

I was able to explore some of these questions when, as a staff writer for SevenPonds, a small but determined end-of-life website whose editors’ strength of character and tenacity to serve I never cease to admire, I had the opportunity to interview healthcare workers for an article about the traumatic nature of code blues in hospitals. Several I spoke with expressed gratitude. One woman cried throughout the interview: “I’m an emotional person,” she said without apology. It seemed that the more doctors, nurses, and others were able to acknowledge their grief and face the reality of death and dying, the more they were able to connect with their patients, the less stress they experienced, and the more resilience they exhibited. This despite challenging work environments, minimal resources to support them, and limited literature dealing with death and trauma in healthcare—and even less related to grief.

This book attempts to help fill that void, while bringing all of us to a deeper understanding of our shared humanity and mortality. Sigmund Freud believed that humans are unable to conceive of their own deaths; recent evidence supports that. In 2019, a small study by researchers at Bar-Ilan University in Israel found a “self-specific neurophysiological death-denial index” in our brains, which makes it easier for us to associate death with the faces of strangers than our own, suggesting that we may be hardwired to fear and deny the possibility of our own deaths. It’s no wonder, then, that our demise may be hard for us to imagine. “Whenever we attempt to do so, we can perceive that we are in fact still present as spectators,” Freud wrote.

That may be, but by acknowledging the grief and trauma experienced by healthcare workers, we can implement programs and develop systems to support them. By addressing the difficulties around death and dying as a larger community, we can, perhaps, move closer. After all, we’re all in this together.