How do you process and cope with all the sadness that you face in work?

[anon456, BSN, RN]

I just got off of a very, very difficult shift. I work peds and my floor deals with a lot of very chronic, neuro damaged kids who got that way through accidents, child abuse, cardiac conditions and codes, or rare chromosomal syndromes. Most of the time, no matter how sad the case may be, I am able to keep an emotional distance and do my work, have compassion but not take it home with me. But last night the patient really got to my heart. There were lots of similarities between my family and that family, and it was just horrible bad luck what happened to them. It was so sad and I was able to do good care but did not leave it at the door like I usually do. It hit me right in the heart and stuck with me.

I called a nursing friend and we shared some funny stories and gave updates on our lives and by the end I felt better.

Why is it that I can see probably hundreds of patients and some I remember and wonder how they are doing, and many of them have awful horrible stories about how they got to their current chronic state of being. But I am able to put up that professional wall. And why was that wall not working so great with this family? As a human being I have feelings. As a nurse I have to keep those feelings at bay. What is the best way to do that, and how do I cope when those feelings creep in and hit my heart so badly?

The second thing that strikes me is how my nursing has affected my faith. I see these children and very nice families in horrible, awful situations that human beings were never meant to be in. And many of them have a faith in God that is beyond my comprehension. If I were in their situation I would be very shaken in my faith, wondering how, if God is in control (a common statement I hear families say) how did God make this happen or allow it to happen? Does your experience as a nurse -- seeing the unfair and bad things that happen to people-- shake your personal faith in God (if you believe in God)? Or does it make it stronger? And if so, how?

Thanks for listening. Most of my non nursing friends/ family would not be able to relate to this topic at all.

[nurseprnRN, BSN, RN]

I think you hit on the two most important supports you can have: Friends/colleagues who are nurses and will understand exactly where you're coming from, and your faith community. "Why bad things happen to good people" has agonized humans trying to reconcile with a just and merciful God since forever, and far better minds than mine have devoted a lot of study to it. We can vent and listen to others' vents; as you noted, you did feel better. Your pastor/rabbi/priest/counselor, if you have one or know one, has the skill and ability to help you sort it out too.

As nurses we have to learn to be great at "professional distance" and "boundaries," of course we do. But in the end you still have to be human. I had a great therapist once who made a point of teaching me to feel any pains that came my way; bundling them off to the back of the closet for avoidance's sake does not make them go away, it makes them stronger. Also, if you don't learn to feel your pain, you inevitably lose your ability to feel joy, and life becomes pretty sucky. In our business, we call that "burnout." Been there, done that, won't ever do it again.

Fears and pain grow in darkness. Opening that closet door and hauling them out in the sunshine takes courage but the rewards are huge, because as Florence told us, sunshine is the best disinfectant. I learned to look at my calendar, pick a day that wasn't busy and that I could have all to myself for a few hours, and schedule a time for myself to go to a private place-- beach, car parked in the woods, something like that-- and haul them all out and have a good whopping cry. Even if it was a week or two away, that made me able to move through the intervening time safely. My head knew I would be taking care of it and seemed to let me have that grace period. This kept me functional in times of great stress. Soon I learned not to wait so long, and now I find I need only do this about every year or so.

My impetus for therapy wasn't nursing, it was a bad marriage; I learned to get out of bad interpersonal relationships, because they cause unnecessary pain. I think the best thing I did to have less pain over agonizing patient issues was to get out of bedside care. There are days or weeks now at my age where I don't even read the court report or the obits (and I never, never watch those trashy TV shows about crime and death) because I can't bear to internalize/empathize too much with other people's pain; as a fairly average human being with normal social and family contacts I have enough of my own to deal with and manage in my life. I can empathize just fine with strangers' pain but I have to do it at a somewhat greater distance now.