Abstract
I hope your passing was painless and you did not feel alone at the end of your life.
I miss you mom, hope you had a nice birthday in heaven.
To those families in the Middle East whose lives have been devastated by the earthquake there. May you find relief and comfort in the coming days.
Black Lives Matter.
Dear Editor:
Grief work includes activities that allow bereaved individuals to remember the deceased while adjusting to life without them and forming new relationships. Our palliative care team and many other clinical teams make grief work for patient losses a priority by taking time before rounds to remember and share memories of patients who died. Our institution also offers other forums for clinician grief work, including Life and Death Rounds for physician trainees, “Refresh and Reflect” for nurses and other clinical staff on particular units, and the multidisciplinary Schwartz Rounds.
Although some clinicians engage in and enjoy these in-person reflection times, some reluctantly participate, some do not have time, and others ignore them. Lack of opportunity to express grief when patients die can increase physicians' risk for depersonalization and burnout, especially if we have experienced recent loss in our personal lives. 1
We developed “Dedicate a Candle” on the institution's intranet in an attempt to overcome barriers to grief work for the many losses we experience. “Dedicate a Candle” is an easily accessible way for clinicians and other clinical staff to do grief work by virtually lighting a candle and including an anonymous message.
Many messages on the “Dedicate a Candle” website are in memory of a loved one who has died, such as, “I've been struggling with a lot of stuff lately and sure wish I could talk about it with you Dad. I miss you.” There are thoughtful dedications that honor patients and their families, including “Honored to have the privilege to care and share life here.” The virtually lit candles and messages burn for 14 days as symbols of staff's thoughts, concerns, and grief.
This is a moderated website and we expected to edit it occasionally, but we did not anticipate how challenging this would be. We were not that surprised that we have to occasionally remove humorous requests for food, rude comments from people having a bad day, or religious expressions meant to convert others. One example of this is, “I'd like to honor my lunch that kept me full for the first half of my shift.”
We were more surprised by the large volume of political comments expressing grief and anger over current events. It has not been easy to decide which of these messages should be removed because they may distract others and sabotage their efforts to honor a patient, loved one, or a colleague.
We decided to remove the comments “Make America Great Again” and “R.I.P U.S.A, born July 4, 1776, died January 20, 2017” from the website because we felt they were mostly political, only loosely related to grief, and might discourage others from making a dedication that helps them do grief work.
We have decided to keep dedications that we feel are genuine expressions of public grief—for the lives lost in natural disasters like Hurricane Maria in Puerto Rico, in mass shootings like in October 2017 at a country music festival in Las Vegas, and in the police shootings of people of color. Losses from public tragedies, including events that signify leaps backward in social justice progress, may weigh heavily on us and cause grief and emotional distress.
“Black Lives Matter” messages are common on the candle website after the police killing of a person of color. Some have strong reactions to messages related to public tragedies since they are often associated with contentious political issues—gun safety, racism, and disproportionate police violence against people of color. We keep “Black Lives Matter” dedications as expressions of grief for the deaths of people of color like Charleena Lyles in Seattle. 2 We have decided to remove the “All Lives Matter” messages that often follow, because we feel they minimize this grief.
Grief work is an essential part of resilience, given all the different losses we face in the world and in our work. We hope to promote resiliency and improve patient care by offering in-person grief work activities and the “Dedicate a Candle” website for our clinicians and other clinical staff to reflect on patient deaths, personal losses, and tragic public events. It has been challenging for us to moderate the “Dedicate a Candle” website so the focus is on grief work. In an age in which the president proposes policy on Twitter and people express condolences on Facebook more often than in a handwritten card, maybe it should not have surprised us that our colleagues would use our virtual candle site to express many sentiments. Perhaps grief and clinician wellness were always this complex—but they seem more so in this particular political moment. We attempt to allow ourselves to grieve—our personal losses, our patients, and Charleena Lyles. We light real and virtual candles, and encourage you to do the same.