The Sacred Space

Being in the presence of death is powerful.  It is a sacred thing to be at someone's side when their life comes to an end.  To be there in that moment is a great responsibility and honor.  It happens so often in the course of work in the ER.  But it is difficult to pause and be present in that moment.  It is difficult to "force time" as my mentor suggests.  Force time to slow down and be human for a moment before entering into the fast lane of the ER again.

Today was a tough day.  A young man lost his life in a horrific and sudden fire. We were there at the end of his life. In one moment we're following the ACLS algorithm, discussing options and performing tasks.  The room is calm but the activity is frenetic. Clinicians are finding IV access, performing chest compressions, checking for a pulse, intubating.  When it's apparent that resuscitation efforts are futile, everything just stops.  Time is elongated.   It feels like time has one pace in that room and another pace in the hallway outside.  

In the code room everything goes quiet. It's calm, almost silent.  People often crack a joke to let off the tension. Those who were performing chest compressions catch their breath.  There is always this moment where nobody quite knows what to do or what to say.  

Today I tried.  I tried to implement a debriefing but I realized I am woefully unprepared.  I just paused and asked everyone how they were.  We talked about how this is really tragic and really hard to see.  I explained to my very young students that they would probably cry tonight, or tomorrow.  Sometimes these things creep back into your mind when you least expect them.  It is OK to be human, it's OK to feel overwhelmed.  My most experienced nurses said it was the worst thing they'd ever seen.  The grief was real.  We paused. 

As we open the door from this sacred place to the hallway of the ER outside, it feels like accidentally walking onto a freeway.  Somehow it feels noisier and more cluttered and banal.  It is difficult to step out of that room and face the responsibilities that keep coming in the rest of the department.  Everyone seems to know how important it is to keep the door to that room shut.  We implicitly know how important it is to preserve the sacred space from the chaos of the living.  

I wish I had paused a little longer.  I wish I had invited my staff and students to be quiet in that place, or pray, or cry if even for just a moment. Soon the family will come in and we will hear their tears.  It is their grief now.  But for that moment, it is just him and those of us who tried to save him.  We stand quietly with him.  We were comrades in this fight for life.  

I was reminded of the time Jesus went to see his friend Lazarus who had just died.  The family had begged him to come and heal Lazarus sooner but He did not.  (Why He didn't come sooner is a question for another time).  Jesus knew He was going to raise Lazarus from the dead.  He was going to raise him from the dead that very day.  But He stopped when He met with the family.  He witnessed their grief and He grieved with them.   "Mary said to Him, 'Lord, if You had been here, my brother would not have died.' When Jesus therefore saw her weeping, and the Jews who came with her also weeping, He was deeply moved in His spirit and was troubled, and said, 'Where have you laid him?' They said to Him, 'Lord, come and see.' Jesus wept."

To be in the presence of grief and death and feel "moved" is to be human.  To enter into that place of shared experience with our fellow humans is powerful and real.  It is good to pause and feel the weight of grief and loss.  It is healthier to force time and let that experience be strong and engage it face to face than to ignore it and pretend we feel nothing.  

"Suppressed grief suffocates, it rages within the breast, and is forced to multiply its strength." - Ovid

We cannot and should not grieve like the family of the patient, but we should grieve. We all grieve this moment in our own way.  It cannot and should not last long.  ER people are experts at putting things behind them and moving on.  But grief that is not recognized tends to show up in strange ways.  We see the news story that night and it all comes back.  I play with my kids and have a moment of fear about all the terrible ways people can be injured.  I cry at a beautiful piece of music and find myself thinking of that case.  Or worse, we build walls that separate us from our own sadness and stress and we become less human.  In separating ourselves from this grief, we will separate ourselves from others.  If we think we can just walk out of that room and never deal with the trauma we witnessed, we are fooling ourselves.

It is good to pause.  It is good to stand and be present in that sacred space.  It is good to be human.