- Email: [email protected]
When Joy and Grief Collide
Reflections on Women’s Health
I
When Joy and Grief Collide
Illustration © Rasica / thinkstockphotos.com
I’m a seasoned nurse on a birthing unit, and much of the day-to-day nursing care I provide is routine. But every now and then a clinical situation challenges my skills, knowledge and beliefs. The truly unique situations etch a permanent memory in my heart and my soul. On a cold day in January, as I rounded the nurse’s station I was immediately greeted by Jen*, a nightshift nurse. She stepped toward me with her hands resting on a rolling baby bassinet. “I’m sorry for the quick report on your assigned couplet. This baby’s mom is in the ICU and she needs to breastfeed. Mary is a G2P2 who had a rapid, spontaneous vaginal delivery followed by a severe postpartum hemorrhage. She was rushed to the OR. No retained placenta was found, and the doctor was unable to determine the reason
*All names in this essay have been changed.
440
© 2014, AWHONN
KAREN TOWNE
for the hemorrhage. The disseminated intravascular coagulation (DIC) protocol was followed and she was taken to the ICU for observation and close monitoring. Her husband died suddenly 2 months ago, 3 days after being diagnosed with metastatic colon cancer.” Stunned, I found it difficult to process the information. As I pushed the crib through the swinging doors into the ICU, I struggled to regain my composure. OB nurses are known for their ability to keep a straight face during the most trying situations. A worried, panicked look on a nurse’s face triggers alarm in the patient and family members. Mary’s ICU nurse met me and gave me an update on her condition. She had received
continued on p. 439
http://nwh.awhonn.org
continued from p. 440
Caring for a family in crisis requires
on Women’s Health
October | November 2014
affect her postpartum recovery. I worried about the impact on her extended family—her mother, sister and daughter and now newborn son. I arranged a social worker visit and gave Mary’s mother the addresses of local grief counselors. Caring for a family in crisis requires a bit of a high-wire act; I strive to keep my balance while crossing the deep chasm of grief. Each step on the high wire I sway side to side, afraid of stumbling. How much private time does the family need? How do I cluster the nursing care and assessments around family visits? Mary’s mother was facing the same dilemma. I heard her ask Mary if she wanted her to pick up Adelaide from her sister’s house or leave her there so could play with her cousins? Mary’s response was honest and genuine. “I want you to stay here with me tonight.” I was grateful that Mary was able to express her own needs. Another nurse and I moved a hospital bed into the room so her mother could be nearby and rest comfortably.
Reflections
multiple blood transfusions during the night. We entered the room and she introduced me to Mary. A ghostly pale, dark haired woman sat upright in the bed. I asked Mary how she was feeling and if she felt up to breastfeeding. She replied that she felt weak, but ready to see her son. And yes, she would like to breastfeed him. She started to cry as I tenderly placed him in her arms. I gently placed my hand on her shoulder. I reassured her that it was OK to cry. “I’m here to support and help you and your family in any way I can, Mary.” I turned to her mother and sister who sat at her bedside. They looked disheveled, exhausted and emotionally spent. Her mother looked up at me and said in a worried voice, “We almost lost Mary last night. We’re still grieving the sudden loss of John 2 months ago. John went to his doctor when he wasn’t feeling well. Three days later he was dead.” Her mom explained that she had closed up her own house in another state and moved in with Mary to help her care for her 3-year-old granddaughter, Adelaide. Her sister lived in a nearby town with her own family. As I listened, thoughts raced through my mind. How do you cope with the loss of a partner followed so closely by the birth of a son? How do you cope with watching your daughter and granddaughter go through the loss of a husband and father? How do you cope watching your sister become a single parent overnight? Later that day, Mary was considered stable enough for transfer back to the postpartum unit. Once she was settled, she carefully arranged a photo of John, a handsome, smiling, athletic looking man on her bedside table. She told me that John had been so excited when the ultrasound revealed a boy. He’d chosen the name: Colin. A hematologist had been consulted to rule out any bleeding anomalies. He came to her room and explained to Mary and her mother that he had ruled out any blood anomalies as the cause. The blood tests were normal. He had consulted with colleagues in Boston who told him of a rare situation when fetal blood enters the woman’s bloodstream as the placenta delivers. Mary’s body reacted by setting up an autoimmune hemorrhagic response and DIC. Now reassured that Mary was physically stable, I became more concerned about her emotional and mental status and how it would
a bit of a high-wire act; I strive to keep my balance while crossing the deep chasm of grief The following day, Mary and her mother seemed brighter when I entered the room. They were both eager to share how well Colin had breastfed. I smiled as Mary held her son skinto-skin and stroked his soft hair. A hint of color had returned to Mary’s face and she had eaten breakfast. She remarked that she had more energy and was relieved to learn that she didn’t have a blood disorder. The day of Mary’s discharge was fraught with mixed emotions. It’s difficult to juggle the joy of giving birth and the grief of losing one’s life partner, a loved and valued family member. As I said goodbye, I hugged Mary and then her mother. I wished them both strength and grace in the days ahead. I often wonder after caring for a family in crisis if I said the right thing, if I met their needs to the best of my ability. Days, months, years later the faces and stories of these families visit me at unexpected times. When it happens, I wonder how they’re faring on their journey. When it happens, I smile inwardly and send them healing thoughts. NWH
Karen Towne, BSN, IBCLC, RNC, is an obstetric nurse who lives in Barrington, NH. The author reports no conflicts of interest or relevant financial relationships. Address correspondence to: [email protected]. DOI: 10.1111/1751-486X.12155
Nursing for Women’s Health
439
I
When Joy and Grief Collide
Illustration © Rasica / thinkstockphotos.com
I’m a seasoned nurse on a birthing unit, and much of the day-to-day nursing care I provide is routine. But every now and then a clinical situation challenges my skills, knowledge and beliefs. The truly unique situations etch a permanent memory in my heart and my soul. On a cold day in January, as I rounded the nurse’s station I was immediately greeted by Jen*, a nightshift nurse. She stepped toward me with her hands resting on a rolling baby bassinet. “I’m sorry for the quick report on your assigned couplet. This baby’s mom is in the ICU and she needs to breastfeed. Mary is a G2P2 who had a rapid, spontaneous vaginal delivery followed by a severe postpartum hemorrhage. She was rushed to the OR. No retained placenta was found, and the doctor was unable to determine the reason
*All names in this essay have been changed.
440
© 2014, AWHONN
KAREN TOWNE
for the hemorrhage. The disseminated intravascular coagulation (DIC) protocol was followed and she was taken to the ICU for observation and close monitoring. Her husband died suddenly 2 months ago, 3 days after being diagnosed with metastatic colon cancer.” Stunned, I found it difficult to process the information. As I pushed the crib through the swinging doors into the ICU, I struggled to regain my composure. OB nurses are known for their ability to keep a straight face during the most trying situations. A worried, panicked look on a nurse’s face triggers alarm in the patient and family members. Mary’s ICU nurse met me and gave me an update on her condition. She had received
continued on p. 439
http://nwh.awhonn.org
continued from p. 440
Caring for a family in crisis requires
on Women’s Health
October | November 2014
affect her postpartum recovery. I worried about the impact on her extended family—her mother, sister and daughter and now newborn son. I arranged a social worker visit and gave Mary’s mother the addresses of local grief counselors. Caring for a family in crisis requires a bit of a high-wire act; I strive to keep my balance while crossing the deep chasm of grief. Each step on the high wire I sway side to side, afraid of stumbling. How much private time does the family need? How do I cluster the nursing care and assessments around family visits? Mary’s mother was facing the same dilemma. I heard her ask Mary if she wanted her to pick up Adelaide from her sister’s house or leave her there so could play with her cousins? Mary’s response was honest and genuine. “I want you to stay here with me tonight.” I was grateful that Mary was able to express her own needs. Another nurse and I moved a hospital bed into the room so her mother could be nearby and rest comfortably.
Reflections
multiple blood transfusions during the night. We entered the room and she introduced me to Mary. A ghostly pale, dark haired woman sat upright in the bed. I asked Mary how she was feeling and if she felt up to breastfeeding. She replied that she felt weak, but ready to see her son. And yes, she would like to breastfeed him. She started to cry as I tenderly placed him in her arms. I gently placed my hand on her shoulder. I reassured her that it was OK to cry. “I’m here to support and help you and your family in any way I can, Mary.” I turned to her mother and sister who sat at her bedside. They looked disheveled, exhausted and emotionally spent. Her mother looked up at me and said in a worried voice, “We almost lost Mary last night. We’re still grieving the sudden loss of John 2 months ago. John went to his doctor when he wasn’t feeling well. Three days later he was dead.” Her mom explained that she had closed up her own house in another state and moved in with Mary to help her care for her 3-year-old granddaughter, Adelaide. Her sister lived in a nearby town with her own family. As I listened, thoughts raced through my mind. How do you cope with the loss of a partner followed so closely by the birth of a son? How do you cope with watching your daughter and granddaughter go through the loss of a husband and father? How do you cope watching your sister become a single parent overnight? Later that day, Mary was considered stable enough for transfer back to the postpartum unit. Once she was settled, she carefully arranged a photo of John, a handsome, smiling, athletic looking man on her bedside table. She told me that John had been so excited when the ultrasound revealed a boy. He’d chosen the name: Colin. A hematologist had been consulted to rule out any bleeding anomalies. He came to her room and explained to Mary and her mother that he had ruled out any blood anomalies as the cause. The blood tests were normal. He had consulted with colleagues in Boston who told him of a rare situation when fetal blood enters the woman’s bloodstream as the placenta delivers. Mary’s body reacted by setting up an autoimmune hemorrhagic response and DIC. Now reassured that Mary was physically stable, I became more concerned about her emotional and mental status and how it would
a bit of a high-wire act; I strive to keep my balance while crossing the deep chasm of grief The following day, Mary and her mother seemed brighter when I entered the room. They were both eager to share how well Colin had breastfed. I smiled as Mary held her son skinto-skin and stroked his soft hair. A hint of color had returned to Mary’s face and she had eaten breakfast. She remarked that she had more energy and was relieved to learn that she didn’t have a blood disorder. The day of Mary’s discharge was fraught with mixed emotions. It’s difficult to juggle the joy of giving birth and the grief of losing one’s life partner, a loved and valued family member. As I said goodbye, I hugged Mary and then her mother. I wished them both strength and grace in the days ahead. I often wonder after caring for a family in crisis if I said the right thing, if I met their needs to the best of my ability. Days, months, years later the faces and stories of these families visit me at unexpected times. When it happens, I wonder how they’re faring on their journey. When it happens, I smile inwardly and send them healing thoughts. NWH
Karen Towne, BSN, IBCLC, RNC, is an obstetric nurse who lives in Barrington, NH. The author reports no conflicts of interest or relevant financial relationships. Address correspondence to: [email protected]. DOI: 10.1111/1751-486X.12155
Nursing for Women’s Health
439