Death, Dying and Grief with Lea McInerney & Carole Arbuckle

Mark Aitken
Nurses and Midwives aren’t immune from the effects of grief, compassion fatigue and vicarious trauma. Mark discusses those effects with guests Lea McInerney and Carole Arbuckle in this new episode of our podcast.
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nms podcast artwork episode 16

In Mexico and other parts of Latin America, people build altars to remember lost loved ones on Dia De Los Muertos (Day of the Dead). This holiday celebrates life and death with colour, delicious food, and dancing.

Listen to Episode 16
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Podcast Details
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Episode: 16
Guests: Lea McInerney and Carole Arbuckle
Duration: 42:29
Tags: Death, Dying, Grief
SoundCloud: Episode 16 with Lea McInerney and Carole Arbuckle

Introduction
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Note: this podcast was recorded before the escalation of COVID19 which is why we don’t specifically mention it.

Nurses, midwives and students navigate the complexities of caring for people while dying, in death and while grieving. Sometimes, we have to remind ourselves that we are not immune from the effects of grief, compassion fatigue and vicarious trauma.

I discuss those effects with guests Lea McInerney and Carole Arbuckle in this new episode of our podcast. I have called this the STORY podcast:  nurses and midwives have many stories related to caring for people who are dying and supporting the grief of those around them — sometimes their own grief. In this episode we share our stories.

My guests Lea and Carole have many years of experience as palliative care nurses.

Lea trained and worked as a nurse and midwife who now works in policy with the Department of Health. She wrote and first published Field Notes on Death in 2013. We were so touched by this beautiful and poignant memoir of witnessing and caring for people while dying and in death that we included it in the Autumn 2020 edition of our newsletter.

On the podcast, Lea shares the story of writing this heartfelt piece and discusses the importance of taking care of ourselves when we care for others, and creating space in our lives to deal with grief.

Carole is an experienced RN who has 25 years’ experience in oncology and palliative care. Her main passions have been communication and cancer. Carole is now a nurse clinician with Nurse & Midwife Support. Carole shares her career journey working in cancer care and palliative care and recalls an important insight she gained from a young boy as she cared for his dying father.

Carole outlines why it is important for all nurses and midwives to reach out for support if they are troubled or challenged by their work. She also wrote this wonderful companion piece ‘How to enjoy life in the presence of death’ about dealing with drama and trauma in a helpful way and how to look after yourselves.

Carole and Lea believe that it is time nurses and midwives told their stories as in their telling we heal, learn and grow. All OUR STORIES MATTER. 

It was my pleasure and privilege to talk to these inspiring experts.

Mark Aitken RN
Stakeholder Engagement Manager
Nurse & Midwife Support

About Lea McInerney and Carole Arbuckle
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Lea McInerney

Lea trained as an RN and midwife in the early 1980s. She wanted to specialise in palliative care, which at the time was a new area of practice. The UK was a few years ahead of Australia, so she moved there for two years. First she studied oncology at London’s Royal Marsden Hospital, then palliative care at Sobell House in Oxford, under the clinical leadership of Dr Robert Twycross.

On her return to Australia, she worked in one of the many new palliative care services springing up. As the public became more aware of this different way of supporting people with advanced cancer, demand grew. More staff were needed and Lea discovered she had a knack for writing funding applications. The service grew rapidly and after some very busy years, Lea took a breath and made a sideways step into a health policy role. She’d always enjoyed writing (even the daily nursing notes on the wards!) and this new work involved lots of that. Lea also found that core nursing skills like observing, listening and problem solving were just as useful in the new job.

In the 1990s she did more study, this time in facilitation skills, and was mentored by several highly experienced facilitators and trainers. That led to a job in a staff development unit, where she ran courses in leadership and management skills. 

In the 2000s, Lea left the public service and set up her own business as a facilitator and writer. Increasingly she was being asked by people to help them write complex policy documents in a way that would make them easily understood by the public. Her writing skills were pretty good, but she knew she could do it even better. She studied professional writing at RMIT for two years, adding ‘plain English specialist’ to her skill set. 

The RMIT course also covered creative writing and Lea saw this as a great way to be able to tell important stories about health care and people’s lives. She’s now had a few stories and poems published. Two that come directly from her nursing experience are ‘Field Notes on Death’, the piece featured in this podcast, and ‘Routine Transfer (Maternity Ward, 1983).

Transcript
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Mark Aitken: Hello and welcome to the Nurse and Midwife Support podcast, your health matters! I’m Mark Aitken, your podcast host for today. I’m the stakeholder engagement manager with Nurse and Midwife Support and I’m a registered nurse. Nurse and Midwife Support is the national support service for nurses, midwives and students. The service is anonymous, confidential and free. You can call us anytime about any issue you need support for: 1800 667 877 or contact us via the website at nmsupport.org.au  

Today we discuss dying, death, grief and how nurses and midwives navigate the complexities of caring for people at this time, understand and connect with their emotions, feelings, and reactions and know about the type of support available. We could also call this podcast The Story Episode, as this topic involves so many stories from nurses and midwives. Today, we plan to tell a few of those stories. To do this, I have two fabulous guests, hello Lea and Carole. 

Lea McInerney: Hello.

Carole: Hi Mark.

MA: So, Carol, would you please tell us a bit about yourself? And why you’re here today?

C: Well first of all, thank you very much for inviting me Mark. I really am very pleased to be able to do this, as this is an area of great importance to me and to our service at Nurse and Midwife Support. I also would like to welcome Lea, who I’ve just been talking to and it’s spelt L E A but pronounced Lee (not Lea). So, if I say Lea, please forgive me. Just a little bit about me, my background is mainly in oncology and palliative care. After that I did a post-graduate course in counselling and psychotherapy. My main passion has always been around communication, which I think is at the absolute heart of what we do.

 I try to live by three things, and however I don’t always achieve the three criteria.

  1. That’s allowing people to feel heard
  2. berespected
  3. and holding people in regard.

 That was a great way to work as a nurse. What I didn’t really realise was that something needs to underpin that in order for me to be able to provide the kind of standards that I wanted for myself and for the people that I cared for. So, actually, quite late in my career I came to recognise the importance of self-care. Or, looking after yourself. Whatever term you feel more comfortable with, and we’ll talk more about that later. Thank you, Mark.

MA: Thank you very much Carole. Lea, welcome. Would you tell our listeners a bit about yourself please?

LM: Sure, and thank you for inviting me to be here today as well. That’s great. So, I, in the 1980’s and early 90’s was a palliative care nurse specialist. I worked in that area for about seven years. It was a very rich part of my life. Then I did a bit of a swerve to policy writing. I sort of got noticed as a senior, experienced nurse, writing submissions to the state government at the time on developing palliative care services. I got noticed by the senior health policy person, who invited me to come and work with them. I was actually ready for a change, we might talk about that a bit more later too. So, I did that, which got me into writing. I really do love writing. So, bit by bit I was doing that work. Then, I had another bend in my career and wanted to be able to tell stories. My policy and nursing work had so many good stories, but often, good policy writing is really dry. I thought that those stories deserved more than just the kind of factual policy type papers and that sort of thing. So, I took myself off to do a writing course and learnt how to write memoire pieces and things like that. So, these days I work as a freelance writer and I also work as a workshop facilitator. So, that’s my quick story. 

MA: Thanks Lea, that’s a really great story. I think that so many nurses and midwives will connect to that. Many nurses start off as nurses or midwives, then they go and find another career. Sometimes they come back to nursing. But, also, I meet lots of nurses and midwives who have done something and then come to nursing or midwifery as a career. So, there’s so many great stories out there. We’re hoping that you’ll feel comfortable after this podcast to share some of your stories with us. 

Lea, you published Field Notes on Death in 2013. This is indeed a beautiful and poignant memoir about being a nurse, witnessing and caring for people while dying and in death. Observing, and supporting grief. Connecting to love, relationships and the universe. You had me at the first paragraph:

“I WAS IN a foul mood a few weeks back. In a flash of bleak insight, I wrote on a scrap of paper: I hope I don't die today, this would be a very bad mood to die in.”

What a great opening Lea. Lea, would you please tell our listeners a bit more about this story and listeners will be able to access this story from our website as a part of this podcast.And, what is really the story behind this great story and memoire?

LM: Thanks Mark. I had made this shift to learning how to write memoire-type stories. So, this was about 12 years ago and I moved to Melbourne and began studying at RMIT and did their writing course. One of their, many wonderful writing courses. This one had a lot of creative writing in it. Every week, we would have 15 minutes to just write something. Sometimes we’d get a prompt from the teacher: jobs you’ve had, or something like that. Just write for 15 minutes about that. Then we would go into small groups of about four and just read our work out and talk about it. Give each other feedback about the writing. I had written this piece which has ended up, actually, a few of the pieces have ended up in this memoire that I wrote. One of them was about sitting with a woman as she was dying. An older woman, and I was just describing what I had seen happen as she actually died. So, I wrote that piece in this class this day. This young guy, ( about 30) as I read it out and (for me it was very quotidian)  said, “Do you know, I have never, ever, heard a story like that before. You should keep going with this.” It was an important story to me, but I thought that it may be important for other people to hear it as well. So, then I kept doing little bits in the class. One day, another 15-minute writing piece was just about sitting at the laminex table in my parent’ kitchen. I was just thinking about death one day. So that kind of ended up in the piece as well. So, I was doing this at RMIT and I realised that I was thinking about death a lot. Subconsciously. So, that was the bit where I had probably written about four or five little pieces that made it into this longer story. I just woke up and I was in a really grumpy mood, obviously thinking about death as well and then going, “Oh goodness, oh. I hope I don’t die today! This would be terrible!” I was in such a bad mood and I don’t know what I was in a bad mood about. It wasn’t anything significant. So, that’s where it all came from. Yes.

MA: It’s great, and if you haven’t read Lea’s story, perhaps you will want to pause the podcast and do that first. I think that what we’re going to talk about today will make a bit more sense to you, but it’s up to you of course. And we’ll hear more about that story shortly. Carole, you’ve been in palliative care, cancer care and now a Nurse and Midwife Support nurse for many years. I know you have many stories, would you please share one of them with our listeners?

C: Thank you Mark. A story I really wanted to highlight today, and I think it has a lot of themes about what we’re talking about today, was a story (I’ve changed the names obviously, for privacy reasons) of a young boy who would have been maybe four or five years old. His father was dying, at home. I would go and see them regularly, as a palliative care nurse. Over time, I developed a relationship specifically with his mother and she became very open with me. As most palliative care nurses know, you develop a very strong bond with the family. She became very open with me and one of the issues that was bothering her the most was speaking with her son, Jamie, about the fact that his father was going to die. This is a number of years ago, and there was a lot of conventional wisdom (mainly in the public forum) that talking to children about dying was something you simply didn’t do. Understandably, parents are here to protect their children. However, it became obvious and certain how things would go. When I’m unsure about practices, I’m reading and reading and looking at what the experts are saying. What’s the evidence? All of the evidence came out that actually talking to children, in an age appropriate way, providing a safe space and making them feel heard was incredibly important. 

So, of course, there’s no rule book about how you go about this. So, there was a lot of talking with Jamie’s mother and getting a sense of how he was. We both felt that we would wait for Jamie to start asking questions, and she would continue to see how his behaviour was. She had noticed some changes in his behaviour, he wasn’t sleeping well. He talked about having nightmares, etc. We knew that something was going on. So, I got there one day and it was actually fairly obvious that his father was going to die within the next couple of days. Jamie, almost on cue, came in and said, “What’s going to happen to Daddy now?” He seemed to know. So, we talked about that and went through a couple of levels of safe-type questions. We sort of said, “Jamie, you know how people get sick? Well, you know, you get sick and you get better? Don’t you? Mummy gets sick, and she gets better. Doesn’t she? Daddy got sick, and they’ve taken him to hospital and tried to get him better. But he still didn’t get well, did he?” He said, “No.” So, we took him through it very gently, step by step: “Everybody that knows Daddy and cares about Daddy has tried to help Daddy. But Daddy’s body is not working. And one day, Daddy’s body is going to stop working. That’s called dying.” 

At that point, he looked so engaged it was absolutely extraordinary to see this child feeling heard and feeling like someone was taking notice of him. So, the next question he asked (which parents feel is a very important way of learning how to cope) is how to deal with the situation and what you say when your child asks, “What’s going to happen?” It’s about being very clear, and being able to say very openly with a lot of sense of being confident about how to manage the situation, that his Dad’s heart would soon stop. His eyes won’t be able to open, and his chest will actually stop moving because that’s how you breathe. So, he took all of this information in and he was a four or five-year-old, ran off. The next day, I visited and his father had deteriorated quite significantly. Jamie came in, and he said, “I think that Daddy might die.” I replied that I was starting to think that too, and asked him what he thought about that? He said, “I think it’s really sad.” So, I asked what he would like to do? He said, “I would like to climb up on the bed with Daddy.” I looked at his mum, and his Mum nodded. His Father was unconscious at this point. He got up on the bed and played with his Dad and played with his face. 

The next time I visited, he was just at the point where his Father was dying. His Wife told me, “I want Jamie to come in, is that ok?” And I said, “As long as he is ok.” He came in, and his Father died. As Jamie got up on the bed, the same way he had done the day before, he held his Father’s face, looked at him and gave him a big hug and said, “It’s really sad Daddy. I’m so sad you’re going.” Then, as only four-year-olds can do, he tried to open up his eyes and listened to his heart and couldn’t hear anything. Then he ran down the hallway at 100 miles an hour to his family, and proudly announced, that “Daddy is dead.” They already knew, but he was telling them that he had also observed and knew because his heart had stopped, “And I can’t open his eyes.” It may have seemed to some people to have been a very difficult and very sad experience, but his Mother told me how important it was to her that he had been able to make that connection. He had been able to emotionally connect with that and he had, as a four or five-year-old can, processed that it had happened. 

So, that left me with a lot to think about. I found that to be an enormously important part of my practice and understanding the importance of being open. It also had often made me reflect on how we are a death denying society. We find it difficult to talk about death. Yet, we find that when people are given the opportunity, even as early as four or five, the opportunity of safety we can actually reduce a lot of the fear and secrecy around grief and dying. I didn’t know it at the time, but one of the most indicative factors for me to stay in the profession and deal with death and dying, is being able to have what they call “compassion satisfaction.” That’s when a nurse has positive feelings associated with having been able to contribute in some way to a situation around death and dying. So, that’s just a really quick story about the importance of being able to work through some of the things that can be very difficult but can ultimately sustain your practice.

MA: Thank you so much for sharing that lovely and heartfelt story Carole. Really appreciate it. What it reminds me of, is that nurses are so pivotal to the experience of people having a good death. Or having a good process around dying, and I think that what you did is you created a space where you made death a part of life. This is true for all of us. It’s a part of life. To be able to do that for a young child; I’m sure this would have supported him throughout his life and when he thinks back to that time. So, well done and thank you for sharing that story. Lea, in Field Notes on Death you write:

“WHEN I FINISHED school at seventeen I decided to do nursing, a job that would allow me to escape the small town I'd grown up in and work anywhere in the world. What I hadn't anticipated was that it would also make me a regular witness to the extremes of life – birth, death, great joy, deep suffering.”

That’s another amazing part of your story. How can we better prepare nurses and midwives for their early career experiences of caring for people who are dying? Those who die on their watch? And the emotions that they may experience?

LM: I think talking about it helps, and there is a big shift in this. I’m now 60-years-old and I look back over the generations, from when I started, we are a death denying society but that is changing. It’s a slow change. Palliative care, when I first moved into that field in the 1980’s, it was very new. It was pioneering, I ended up going over to the UK to study. They were just ahead of Australia by about 10 years at the time, because of Dame Cicely Saunders who started the hospice movement. So, that was why I wanted to go over there and study at the Royal Marsden, at Sir Michael Sobell House in Oxford. If you think about that, that that was really only in the 70’s that there wasn’t specialist palliative care and now there is. A lot has shifted. We’ve got a long way to go. I haven’t worked in hospitals for a couple of decades now, so I can’t speak to how it actually is, but I suspect that it’s still quite busy on the wards?

MA: Yes, it is.

LM: My experience, that I write about in this memoire piece too, is that the first time I saw somebody die I was 17-years-old. I had gone in to give an older lady a mouth wash, as she was unconscious. You’re learning to give the unconscious patient a mouthwash, if you remember that procedure. I had the tutor nurse, she was there to supervise me and observe me doing it, but she was actually at the door. She didn’t come in, because the woman was being barrier nursed because she had an infection. So, I was in there on my own, all gowned up and about to give this woman a mouthwash. I’d been reading my procedure manual carefully, trying to do it all correctly and then I figured out that something was not right. It was a bit weird. I signalled to the tutor nurse to come in, what do we call them now?

MA: The educator.

LM: The educator, we did call it that then. The educator, she gowned up and came in and told me that the woman was actually dead. This was my first experience of death in a hospital. I had had family who had died, but that’s quite different. You know the situation. It was really busy in the ward that day so it was frantic. I’m back there, I can feel how busy it was. We had to lay her out, and the supervisor had to go off and supervise somebody else. So, she said that we’d find somebody else to help me do the layout. There was a refresher nurse, she hadn’t practiced nursing for 10 years or something and had come back to the ward doing the refresher course. Do they still have those?

MA: Yes! Definitely.

LM: Ok, so the two of us have got the procedure manual on the bedside table and we’re both looking at that going, “How do we lay out the body here?” We were just stumbling our way through it. Also, both of us were really respectful. I really did feel the dignity that we both felt towards the woman who was now dead. But we both felt very fumbley, I think. So, the busy morning continued and a few hours later I finally got a break. I went off to the tea room and just sat there with a cup of tea. Literally sat there and went, oh my goodness. What was all of that? I was on my own in the tea room, just staring into space. I felt quite dazed by it. The thing that interests me is that it’s one of the first stories that I wrote, when I had space to write about it 30 years later. It was still very vivid to me. I’ve been thinking about this, in preparation for it today. I don’t feel that I was necessarily wounded by it, but I feel like it was a great lost opportunity. The fact that it stayed with me means that I was curious about it, like, how come there wasn’t more support? I did have people outside of work that I could talk to, which was great. As well as a very supportive family and everything. Just, in that work setting, it didn’t happen. What did I need? What would have been great is if someone just came and had a cup of tea with me. Or even in a busy environment there are people that are able to, just in one minute, be deeply present with you. Actually, what I needed was to acknowledge that that was the first time that I had ever seen a dead body. So, to acknowledge that yes that’s what happened. It was a little bit unusual, not everybody sees that in their job at 17. Then, the other thing would have been for someone to just say, “Hey, how are you? Are you ok? Anything you need?” Those things can happen quite quickly. So, when I think about now with young nurses, I think that you should let yourself expect that it will be acknowledged and that there is support available. If you don’t get it the first time, just look around until you can find that support. For the more senior nurses, you know, everyone is busy. If you can find a moment though, just to actually give that moment and your attention to that young nurse. Well, they’re not necessarily young, but early career nurses to just help them know that they’re supported. I think that’s it.

MA: Great advice Lea. Thanks very much for sharing that. If any nurse or midwife is listening to this podcast and you need support, just a reminder that you can call Nurse and Midwife Support anytime: 1800 667 877. It’s a 24/7 service, so please don’t hesitate to call us and talk about anything that you need support for.

Carole, further to that, when a nurse or midwife contacts Nurse and Midwife Support and is troubled by their emotional response or mental health as a result of caring for those that have died or dying, how do you support them?

C: Well, I would like to lead in from what Lea was just saying there. I think it was a really good description of what it can be like: the franticness, the busyness There’s so much to unpack, while knowing that you’ve still got a big day ahead of you. As you say, that’s still inside of you. You can still remember that. I could see your eyes, for the benefit of the podcast listeners, as Lea was reading the story you could see that it still stays there. I know, having spoken with oncologists, nurses and students that we often do carry these things. It’s incredibly important if you’re experiencing those feelings to know exactly what Lea has said. Getting back to the question that Mark has asked us, I think that the crucial thing we do at Nurse and Midwife Support is that we listen. We listen to what’s being said. We listen to what’s not being said. We listen to the signs pertaining to whether the person is comfortable with that. We know that it’s actually not easy for people to call. I’m really grateful to see and hear that we have many more graduate nurses calling us now. They do have a sense that this is something that they should do. But, there’s still a slight feeling from graduate nurses of, “Should I be doing this?” absolutely, 110% it is ok to call us. A very senior and experienced nurse, who may have dealt with a lot of grief and loss, may still find it very very challenging. It’s really important to know that the breadth of experience people have, or lack of, doesn’t impact the need to feel heard. 

I really also just wanted to be able to highlight that the service is  a really safe space to say exactly what you’re feeling. We recognise that nurses and midwives, they bring their own history to their profession as well. The most important thing is, despite what you may or may not hear in conventional circles and even within professional circles, nurses and midwives grieve. We can experience very high levels of anxiety, fear, worry and concern around death and dying. Our callers often worry about the questions, “Did I do enough? What could I have done differently?” They worry about if they said the right thing, or the wrong thing. Sometimes, people just have a simple question. It can be, really, very varied in terms of what people want and what their needs are in terms of calling us. Often, I think, one of the things that callers tell us the most is that sometimes just talking is one of the most important things. It really helps and makes a big difference. The other thing that I wanted to focus on, too, was recognising that each student, graduate nurse, manager, nurse, midwife, is an individual. I think it’s vital that the people who reach out to us understand this, and that we work towards finding support that works for them. There isn’t an agenda, there isn’t a script, it’s a different system to an assessment or what nurses or midwives might experience at work. There isn’t a template, it’s about finding out who you are and what is really going to help. The most common thing I hear from callers is that it’s really good to talk to a nurse colleague who gets it.

MA: Yes, thanks Carole. Something I really connected with in regards to the ways in which our service operates is that just as nurses and midwives are out there caring for patients, clients or residents and delivering person-centred care. That’s exactly the way that we operate at Nurse and Midwife Support. We hear your story, and we treat you as an individual. So, thank you very much Carole. Lea, something you wrote in Field Notes on Death that particularly resonated with me was this quote:

“But there would be little time then, or later, for reflection, or questions, or answers.”

 It made me ponder why we don’t always create a space for nurses and midwives to reflect and ask questions about their experience of death. Perhaps this is why some of us get compassion fatigue and burn out, what are your thoughts on that?

LM: It’s great listening to Carole, actually, talking about the service that is available. That would have been wonderful back then, to just know that you could call somebody and anything you say is ok. I think that’s something that holds people back, the fear that they’re going to sound stupid or needy or something. To just normalise that reaction that we can have is good. I think that a part of your question there, Mark, about this risk of compassion fatigue is related to the business. Shift work is tricky too. I used to play netball, before I started nursing. Then when I started nursing, shift work just made it really difficult to get to games regularly. So, I stopped doing that. I think you have to be quite artful about how you keep yourself living a balanced life as a nurse. 

This has kind of made me think of what’s happening in Australia at the moment with the bush fire situation as well, and what we’ve been seeing. If you think about it, this podcast is about dying and grief. Really, what’s happening collectively across the country is a lot of loss and grief that people are dealing with. In terms of how you keep people going, through difficult times, it’s this bit where we just kind of need to remind each other to look out for each other. A couple of bits of inspiration that I’ve heard this week, that I think speak to your question Mark, are the other night Andrew Constance (who is the member for Bega which was affected by the fires) was on Q&A. He spoke beautifully, you can still see the pain in his face. He allowed himself to be very vulnerable on national television. That was an amazing gift to us, I think. He spoke about how important it has been for him to be able to speak with his fellow community people. He lives in that community, he’s  part of that community. It was lovely to see a politician not just being a politician, but being a person. He spoke about how they’re helping each other, they’re talking to each other and acknowledging that this is really hard. But, also acknowledging that they need to go on, because it’s not over yet. I thought that that was very powerful, because he said that he himself would be seeking counselling because he recognised that he needed it. I thought that that was incredible, to give people permission to go: “yes, I actually really need to talk to somebody as well.” So, I think to be able to either find someone to talk to or accessing counselling, it’s great to have all of those options available so that you don’t burn out. The other thing I would say from my own experience of actually seeking counselling at one point. If you’re seeking counselling, and the counsellor doesn’t feel like the right fit for you. Then, move on and find someone else. You will move on and find someone else, but it isn’t always the right fit the first time around. So, that’s important to keep in mind. 

The other thing that has come out of this difficult time (regarding bushfires) is that everyone would have seen Shane Fitzsimmons. He’s the Fire Chief in New South Wales. It’s just been extraordinary to watch his beautiful mix of authority and compassion, it’s put together so well. I heard him just this morning talking about how what we need to do is look after ourselves. So, each of us needs to take care of ourselves and look after each other. I think that’s such a beautiful way of putting it, and I’ve noticed that Mark actually finishes his podcast by saying: to each and every one of using this service, to look after ourselves and each other. It’s a beautiful way to think about that. So, I think that that’s the way forwards, for us.

MA: Thanks Lea. I’d like to give a really big shout out to nurses and midwives living and working in bushfire affected communities. Some of us have been directly impacted and affected, while some of us are observing that. It can be, and is, a very difficult time. So, if you need support in relation to that, please know that Nurse and Midwife Support is available. Other support services are available and they include Lifeline and Beyond Blue. There are many others as well, so please reach out. Carole, do you have anything to add to that?

C: Yes, I suppose the thing that I have certainly been aware of, professionally and certainly since I’ve worked at Nurse and Midwife Support, is how hard nurses and midwives can be on themselves. They can have very high expectations regarding their ability to cope with grief and loss. It’s probably not surprising to most nurses, but just putting in some evidence to show that what we are feeling as nurses is replicated in research, most nurses receive little or no training in terms of how to cope and/or recognise their own grief. We wouldn’t administer chemotherapy without education. We wouldn’t give medication without getting education. We wouldn’t look after a patient or client without education. But, we take these enormous risks with our own sense of knowledge and how to manage for ourselves. We also know that nurses and midwives are often (on top of grief, on top of working in bushfire crisis areas) they’re juggling challenging workloads and conflict in the workplace. Bullying, personal difficulties. Any grief or loss that you’re experiencing will certainly put you at an increased risk for burnout and compassion fatigue. 

I think, also, nurses worry about being vulnerable. As Lea was talking about. Having a place where they actually feel that they can be vulnerable is, I think, incredibly important for a lot of people. Importantly, as a profession, we don’t always ask for help. We feel that we should be able to cope with grief and just be able to get over it. We put on the nurse face. The professional mask comes down, and we look like we’re coping and it’s all happening under the water like a duck. Certainly, in the past, this was my experience. Not knowing how to recognise my own grief or how to articulate my own feelings and finding a space in which to reflect on those thoughts and questions were challenges that I experienced as a nurse. I think the issue around what Mark was talking about, when he said, “We don’t always create spaces for nurses.” I found a really interesting quote that I thought was very interesting. It’s talking about grief and loss and creating a space. It matters. The space between what we’re experiencing is important. That means that we do have to find ways, and I know that it’s not easy. I’m a nurse too. Finding that time between patients, that time for lunch, that reflection or just chatting with colleagues. That culture that we all deal with the busyness is incredibly powerful. It has an incredibly impact on us, and you don’t have to deal with that on your own. 

MA: Thanks Carole, great advice. So, important. Lea, as this is a story podcast, and you’re a fabulous storyteller, do you have another story to tell?

LM: Can I read you a little bit from the memoire?

MA: We would absolutely love that.

LM: Ok, thank you. A part of the memoire is about my own father, who had cancer.

I returned to the small town I grew up in to help care for him. Mostly, I was very careful about being his daughter and not being his nurse. I had a palliative care colleague who actually knew that I was going back, to help care for him. She told me to just be careful and be his daughter, not his nurse. It will be easy to have this mask of, “I’m a capable nurse,” but I actually needed be there in that reality with him. So, I cared for him. I write about that at length in the piece. It’s short, but detailed. What happened was that then my father died, and I write this little piece about my experience of that grief. I was prepared for him to die, it was 11 months from diagnosis until when he died. But I was shocked by how it actually felt, when it was someone who was that close to me. So, I write a little bit about that and the conflicting feelings. Feeling ok one minute, and then desperately sad the next. Then feeling really angry, resenting him for dying when he was only 72. It was always going to be too soon. I had been feeling all of that, but then one day, I decided to go to his grave and just spend some time there. With him. I actually wasn’t feeling particularly stormy or sad that day, but I wanted to go. This is a little bit that I wrote about that:

“A few weeks after his death, I went to the cemetery ten minutes’ drive away. Mum had a red rose bush in bloom by the side gate, and I picked one to take with me. I stood by his grave searching my brain, trying to work out what I was feeling, what I should be feeling, whether what I was feeling was what I thought I should be feeling.

Dad had a lovely wit and was always strong in a crisis. He could be uptight in a non-crisis, or make a crisis of something that wasn’t one, but he was definitely very calm, centred and strong when something truly awful was going on – his kids drinking kerosene, setting fire to car seats, choking on apple peel; Mum ill for a while. Around him in those times, I always had the sense that we would get through whatever it was that was happening, that it would all be alright.

These two qualities, his wit and calm lightness in the face of true difficulties, came to me this day, as I stood at his grave with my red rose, trying to be suitably sombre and meaningful. As I bent over to poke the stem in the dirt, I heard him speaking behind me. I knew he wasn’t actually there, but his presence was clear, his voice mischievous and loving as he said, “And rose from the dead.” I cracked up laughing.”

MA: Thank you so much Lea, that really reminds me of the great capacity nurses and midwives have to inject humour into these types of experiences. I would say that that’s the way that we actually cope, by using humour and sharing these stories. Thank you very much for that. Look, I can’t believe we’ve come to the end of this podcast. You’ve been so much fun, and there’s so much to talk about. Today, we’ve talked about Nurse and Midwife Support. We’ve shared stories about caring for those who are dying, in death and those who are grieving. The emotional responses of those that are caring for people at this important time, and it’s potential and actual impact. We’ve shared stories related to this inevitable part of life, and tips for looking after yourself while doing this work. Any final words of wisdom, Carole?

C: Look I think that there’s just a couple: one is that I just really wanted to say that in terms of this being a story podcast it’s interesting to reflect on the fact that we have so many stories. Nurses are often in a position where they don’t have time to be able to tell those stories and need an opportunity of being able to find a way to articulate their experiences. Our stories matter. This is the year of the nurse, 2020. Let’s start sharing our stories with each other, or finding a safe professional environment in which to do it. 

MA: That’s great Carole. Happy international year of the nurse and midwife! Whatever you’re doing, I hope you celebrate in style. If you’ve got a story to share, please contact us at nmsupport.org.au. Lea, any final works of wisdom from you?

LM: Telling stories can be very transformative. So, yes, I would encourage that and to be gentle on yourselves and others. Gentleness can be a very powerful way to be. That’s probably it.

MA: Thanks very much. Well, thank you both for being such great and generous guests and sharing your stories. If you found this podcast useful, please share it with other nurses, midwives, graduates and students. As I said, if you’ve got a story to tell (and I know you have) please contact me mark@nmsupport.org.au or call the service for support: 1800 667 877. Look after yourselves, and each other, and I’ll speak to you next time.