When Death Comes: An Oncology Nurse Finds Solace in Mary Oliver
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“From the earliest age, we must learn to say good-bye to friends and family. We see our parents and siblings off at the station; we visit cousins, attend schools, join the regiment; we marry, or travel abroad. It is part of the human experience that we are constantly gripping a good fellow by the shoulders and wishing him well, taking comfort from the notion that we will hear word of him soon enough. But experience is less likely to teach us how to bid our dearest possessions adieu. And if it were to? We wouldn’t welcome the education. For eventually, we come to hold our dearest possessions more closely than we hold our friends. We carry them from place to place, often at considerable expense and inconvenience; we dust and polish their surfaces and reprimand children for playing too roughly in their vicinity—all the while, allowing memories to invest them with greater and greater importance. This armoire, we are prone to recall, is the very one in which we hid as a boy; and it was these silver candelabra that lined our table on Christmas Eve; and it was with this handkerchief that she once dried her tears, et cetera, et cetera. Until we imagine that these carefully preserved possessions might give us genuine solace in the face of a lost companion...” ― Amor Towles, A Gentleman in Moscow
I came across Mary Oliver's poetry only a few years ago and I've found it inspiring and, particularly during this past year, comforting. Simple and accessible, but with huge depth. As the best poetry usually is.
For the attention to detail required by oncology nurses. I bet they would make excellent programers and make a lot more money. If I ever end up in their care, I hope I remember to be filled with enormous gratitude that they could have chosen an easier path, yet instead chose to care for me: a stranger.
And those of us who do work long hours have generally chosen it to some extent. You can easily find six figure jobs in the US anyway that don't expect more than 40 hours from you or impinge on your free time.
Just say nothing, and be there for the longest time, silent and knowing.
The moment will be stronger. You will have been of more assistance.
You can't be "knowing". Whether you have experience of grief has no bearing at all on whether you can understand someone else's immediate experience of it. You cannot. You would be a fool to imagine you could. There's a lot of foolishness around these days. That doesn't make this kind any less culpable.
"The moment" will not "be stronger" for any action you take. It is not your moment. You are no part of it. There's no way you can be. Stop trying to be.
You aren't the main character in this movie. You're not even an extra. There is no movie and, in this circumstance, you do not matter.
Except as follows: You can either be someone who intrudes on the grief of another with some kind of weird unhelpful behavior that needs to be managed, and whom everyone accordingly sees and remembers to be a jackass. Or you can not be that.
If you want to not be the jackass, do this:
1. Say "I'm sorry for your loss. If there's anything I can do to help, please let me know."
(And mean it. That offer of help is a promise. If you don't mean it, don't make it.)
2. Fade into the background.
This actually does help. It helps by not making it necessary for the person who is grieving to interrupt that in order to deal with you somehow. If they need anything from you, they'll ask - after all, you've just invited them to do so. Until then, for pity's sake, leave them be. They already have problems enough without you being another one.
> Whether you have experience of grief has no bearing at all on whether you can understand someone else's immediate experience of it.
That is absolutely untrue. There's a line in a Buddhist text that captures the experience well for me: "When two thieves meet they need no introduction: They recognize each other without question." People who had known loss, especially that of a parent, were often a balm to my soul because they could be present in the experience of loss with me.
Which I'm sure sounds vague to many HN readers, so imagine that you and a friend go to visit an art museum. You spend a couple of minutes contemplating the same painting, which you both find moving. As you turn to walk away, you exchange a look and know you don't need to say anything, because you both recognize you had the same experience.
> You aren't the main character in this movie. You're not even an extra. There is no movie and, in this circumstance, you do not matter.
You have something there, but you take it too far. Consider the Ring Theory of Grief: https://www.latimes.com/opinion/op-ed/la-xpm-2013-apr-07-la-...
As the article explains, people definitely cause problems by making the moment about them, so you're right about that. But where you're wrong is that the only alternative is to vanish. Often, that is also somebody making it about themself but in a quieter way. Their anxiety and failure to process death leads them to hide away. I took people behaving the way you describe as ones I couldn't trust to be present with me. The correct choice is to be sensitive to circumstances and the inner-ring person's needs and act accordingly. Which does not have a simple heuristic, but sometimes that's the best you can do.
> If there's anything I can do to help, please let me know.
Having heard that a fair bit, I mostly took it as a sign of people either not sincerely offering or not really thinking about the situation. Which was fine; not everybody understands grief yet. The best replies to this for me were people who also made specific offers based on what they thought I needed and what they were able to give.
In that model, the advice I'm giving is directed to people in the outermost ring and maybe also the next-outermost. I'd expect anyone closer to the bereaved to have a more concrete sense of how they actually can help, and to be already doing that or at least trying to figure out how to.
That advice is also directed to people who basically don't have any idea what the hell to do, and feel some internal pressure to do something anyway. I'd assume that someone with a materially similar experience of grief, who has reflected enough on that to have some understanding, wouldn't need telling by me or anyone.
if you don't know how to help, just say "i'm sorry" and offer a reassuring hug. touch is powerful, especially around strong emotions. if you feel the need to speak further, give them fond memories of their loved one, like "i remember when your mom taught us how to make lamb vindaloo. it was amazing. she was so determined and funny..." try to forget yourself and your own concerns completely for that moment.
Sorry, where exactly did you do that direction? I have read it a couple times and can't find it.
But as someone that recently lost my mom, I can tell for a fact: real, practical help makes a real difference. Common sense things like help with sorting out the affairs of the loved one, cooking meals or shopping for the bereaved person, help with planning a memorial, etc. And you don’t know to do these things by asking: “If there is anything I can do, please let me know...” Especially if you are close to the bereaved person, the about one of the worst things you can say. You usually know about some things you do to help without being a busybody. I took those who said that as being unwilling to provide any help whatsoever.
Somebody like that can still help, for sure. If nothing else, there's always at least some unskilled setup and teardown work to do for a funeral and a wake. If someone is the kind of person who looks for ways to be of genuine help, they'll find them no matter what anyone else says. They don't need this advice. If someone isn't, at least this advice, if taken, might stop them doing harm.
I can tell you anecdotally that when I heard this from people after the death of my mother, the euphemism -- something i'm pretty sensitive against, anyway -- of 'loss' enraged me.
Softening the blow isn't something that a death deserves -- it's important and soft language makes it no easier to deal with the practical realities of a death other than in some psychological sense that it may reduce the cognitive burden of the idea of death.. but that wanders a bit too much into escapism and denial for me.
Not only that, but the (almost always) empty gesture of the promise of 'help' -- whatever that ill-defined help may be -- was also offensive.
The best sympathies I received were simply things like 'I'm sad that your mother died, she was a great person and I enjoyed my time with her.'. Direct language; she died, and they would rather she hadn't -- Perfect.
Here's George Carlin expressing a similar sentiment against euphemism in the face of death[0]. I don't know if he's a great role model or not -- but his ideas and sentiments regarding the topic reflect mine , so I suppose that people like us (irritated by euphemism) aren't as few as one would think.
'You know, people say things like "You know, I lost my father." , "Ahh! He'll turn up! Have you checked the dumpster out back? He likes to take naps back there." ' [0]
About the offer of help I don't know what to say except that it's not empty when I make it. I guess if it would be, don't say it? And I should go back and edit "and mean it" into my earlier comment. That seems like something that should be able to go without saying, but so does "don't insist on yourself at someone else's funeral", and that needed saying so I guess I can't be surprised this does too.
It occurs to me also that maybe I should explicitly note that the opportunity to say something like this to the bereaved isn't to be sought out.
edit: From 2:06 in the video -
> You know what you tell a guy like that who wants to help? "Well fine, why don't you come over this weekend, you can paint the garage! Bring your plunger, the upstairs toilet overflowed and there's shit all over the floor up there. You drive a tractor? Good! That'll come in handy; the north forty needs a lot of attention. Bring your chainsaw and your pickaxe, we're going to put your ass to work." He wants to help? Fuck him, call his bluff.
Yeah, I mean, if you're not going to help, don't offer to help. Why do that anyway? If it feels good to think of yourself as the kind of person who offers to help someone who's grieving, doesn't it feel bad to have to think of yourself as the kind of shitheel who goes back on that offer when it counts?
It depends on the person, the relationship as well as the person being their vulnerable self. Being real and being in the moment is what I feel made it relatable.
And no, it will not make the pain any better. But the interpersonal connection will nonetheless help.
It was that way at least for me when my father passed away as well as when my stepdad passed away not so long ago.
What I found most disturbing were random strangers giving condolences when they recognized that I was taking about a person having passed away. Think terminating the telecommunications contract.
But, I did appreciated tgat people said it, it did made me feel acknowledged and somehow better. I just could not react to show it.
Please don't do this.
It’s about being selfless.
We arranged for hospice care while they were still lucid, both of us hoping that my partner would have enough time to at least hear from most, if not all, of their friends and family. Before this decline, they had expected to live for at least another 3-5 months, enough time to try one last-ditch off-label treatment, coordinate safe in-person visits, settle their affairs. When we arrived at the hospital, their oncologist said they might have weeks left is they responded to treatment to reduce their calcium levels. When that didn't work, they told us days, plural. They barely made it 36 hours. It was like watching them age 5 years every day over those 10 days, as their speech and cognition slowed, and their expectations went from being able to move with a walker, to with a wheelchair, to being too weak to do anything.
Because of COVID, there was no such thing as round-the-clock shift care for critical patients in at-home hospice care. If a patient didn't require in-person intervention or assistance, it was done over the phone. I was given enough pain and comfort medicine to last a month and instructions on how to administer it. Neither of us had any local family; my parents were dealing with their own health crisis, and my partner's was racing to make plans that didn't have time to even get off the ground.
The one thing hospice care did do was prepare me for what the author of this article faced. Everything about the process described in it was as it was for us, except for having nurses and family there in person. It all happened alone, the two of us, no monitors or equipment or staff. I called for help when my partner's breathing started to slow, knowing from orientation that it might mean anything from minutes to days were left. The nurse on call took about 40 minutes to get to me, which was 30 minutes too late. In the meantime I gave my partner pain and comfort medicines as directed with no way of knowing if they were working, if it was enough, if it was helping or hurting, if they wanted them or not.
I also don't know how to share this process. It was a different nurse each call and visit. The oncologist has been AWOL and not returning calls since my partner was sent home. Reading the article I'm struck by how easy it is to take having more than one visitor in a dying patient's hospital room for granted; I'm shocked that it's dated during the time we were in the hospital. I'm being looked after, by friends and neighbors who are close enough, and by a social worker attached to the hospice service. But I'm struggling to cope with things that I might not have had to even think about had I not been the only person there for my partner through this decline, and also primarily responsible for the minutae of their care, and also their sole legal representative once they became incapactiated.
The hospice service gave me a crash course in adminstering pain medicines, and observing their breathing and heart rate manually. I performed most of the task as close to the letter as I could, but did I do it right? People tell me I "did a great job" caring for my partner at the end — nobody who says this was there, or could have been there, and my partner couldn't communicate in the last 6 hours. How could I possibly know and qualify "great", or even call it a "job"? I can't know if they weren't suffering, or if what I did or didn't do caused it.
I also had to transition, without a chance to process what happened, from caring for my partner to helping clean them to being their legal representative and enacting their wishes, coordinating their cremation and picking up the remains, distributing their favorite things to friends and family, canceling services, recovering and backing up their online accounts, writing their obituary, preparing probate filings, getting death certificates, planning a virtual memorial, planning another one when travel is easier... all while doing what I had already been doing before, taking care of the pets, managing the house, fighting with insurance, listening to friends and family cry and offer condolences on call after call. Taking care of myself is at the end of the list, not out of self-punishment but because everything else has to be a higher priority.
The only reason I'm even writing this is because the only effective mechanism I have is a journal — I'm writing this anyway, and in 9 months of looking for ongoing help coping with this disease I've never even gotten off a waitlist for any therapist covered by my insurance. And like at several points in my partner's suffering, places like this feel relevant, that anything I've experienced might resonate with or help anyone else. Otherwise I'm screaming into the void of my partner's absence without so much as an echo, avoiding bottling up these feelings only by pouring them out in a mess onto the floor.
How is this the way of things? Every day I wake up exhausted, with too many things to do to stop and grieve. In every task I do, all I can think of is how fundamentally broken reality itself seems to be, how it all feels like a glitched-out world where nothing works as designed and every person I _have_ to talk to and every thing I _have_ to do, are just rat-kings of mitigations and hacks covering systems broken by design, all cascading into one another until the fantastic horrors of my sleeping nightmares blend into banal waking nightmares that drag on for what feels like weeks every day.
Some of the first words out of everyone's mouths are "how can I help?" and if I was less kind I would tell them that if they don't already know how, then that's a meaningless question to ask. If you could help me, you would be here; I would have invited you here a week ago, and you would've been able to accept that invitation. We'd already be working through this together. Instead, I have flowers through the roof — nobody recognizing that having beautiful living beings that I don't know how to care for slowly dying in the same room as my partner _isn't helping me_ — and I have enough delivery service gift card credit to live off lukewarm garbage food leftovers for months in the knowledge that these universally horrible companies my partner both relied on and hated are banking interest in their name.
The only help I actually want is to be held, even for a moment. There are maybe two people on this planet who are both close and comfortable enough doing that right now, and I never feel deserving enough to essentially take over any part of their lives and ask for it.
So I steal moments of sadness between exhausting Zoom meetings, socially distanced errands, phone calls stacked on top of one another until I'm so numb I stop answering the phone when it rings.
And I know when I run out of all these things to do, all these micro-tortures of doing anything but coping for everyone but myself, all of this backed-up grief will crush me. And I'll have to let it crush me, and survive it, so I can honor my partner's life by not doing what they feared most about leaving — that I would give up.