The Boundary of My Empathy: A Nurse’s Experience With Death and Dying

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Below is a personal essay I wrote in 2014, reflecting on my experience as a neurocritical care nurse. It communicates what I wish I could tell the loved one of my dying patient but will not.

Dealing With Death and Dying as a Nurse

I just saw the doctor walk out of the room…the room of your husband on a ventilator, who, after 12 days of no improvements, has had setback after setback. I talked to the doctor before he walked into the room. I know what he told you.

Forgive me. I have to avoid you for a short time. I’m going to go do something else for a little while.

You see, I’ve seen that look before, that look on someone’s face where they are about to sob uncontrollably and throw up from the sheer emotional pain. People usually put on a strong face when the doctor delivers the news. And as soon as the physician has vacated the area, they allow themselves to break down.

But guess who is still in the room?

The nurse.

Through their tears, they ask us the questions they were either too shocked or too scared to ask the doctor. Somehow, what we say stings even more.

Shift after shift, we see lives permanently altered. We see people walk into the hospital with hope, and we see them walk out with despair.

It never gets easier to do this. You just get used to it. You figure out how to do it.

So, I’m sorry. I know you have questions you want to ask me. Questions you didn’t think to ask the doctor. Questions you didn’t want to ask him because you didn’t want him to think you were stupid. Things you want me to explain. I know you want my honest opinion.

I need to collect myself first before I walk into your husband’s hospital room. I need to put up my wall. I must mentally prepare myself not to compare you and your husband to my mother and father. I need to disconnect the dots.

I have to do that because as soon as I’m done being there for you, I have to go see my other patient. My patient will probably recover from the massive stroke he suffered, but he is a little down today. I have to go in with a smile on my face and tell him that he’s doing great. I have to be happy for him. I have to motivate him. I have to inspire him.

So, please forgive me. I know that because I’m not emotionally upset with you right now, I may look cold and heartless. I promise I’m not. It is out of self-preservation that I am not going into that deep, dark pit of despair with you right now. I’m going to get as close as I can without losing it. I’m going to take a ladder down into that pit with you, but I’m going to stay on that last step. I’m going to stay on that step because I have to be able to quickly climb out on a moment’s notice for the man in the room next door.

You see, I’ve gotten pretty good at that. I’ve gotten really good at lowering myself into that pit and getting as close as I can to your pain, but not quite there. And I’ve got even better at running up that ladder and out as fast as possible.

I’ve gotten good at that because I’ve had to. If I take that last step, I cannot continue. I cannot do my job. I cannot be there for any other patients. I cannot talk to physicians and coordinate your husband’s care or the care of any others. I cannot hold myself up. All I will think about is my husband dying. Or my father.  Or my mother.

So, I put up my wall. My boundary of empathy. I will get as close as I possibly can for you. I want to support you. I want to be there for you. I want you to feel cared for. So I will give you as much as I can bear. I pray that will do, for I have no more left.

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Author’s note: Please check out my follow-up post, Why I Can’t Cry With You.

Here are a few great books that discuss empathy, compassion, death, and the human experience:

• Being Mortal
• With the End in Mind: Dying, Death, and Wisdom in an Age of Denial
• Self-Compassion: The Proven Power of Being Kind to Yourself
• When Breath Becomes Air
• Diary of a Death Doula: 25 Lessons the Dying Teach Us About the Afterlife
• The Art of Dying Well: A Practical Guide to a Good End of Life
• The In-Between: Unforgettable Encounters During Life’s Final Moments (written by a hospice RN)

More FreshRN Resources on Emotional Support, Death and Dying

• When Your Patient Starts Crying
• FreshRN Podcast: Dealing with Patient Deaths
• Something You’re Dying to Talk About
• Comfort Care Conversations

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