Hui-wen Sato: How grief helped me become a better caregiver

In May of this year, Jimmy Kimmel delivered an emotional monologue on his show, "Jimmy Kimmel Live," about his newborn son who was diagnosed with a rare heart defect after an astute nurse noticed something wasn't quite right with the baby just hours after his birth. Kimmel sang the praises of this nurse and the entire healthcare team who cared for his son through the process of open-heart surgery. His monologue highlighted the reality that no one, not even a celebrity, is immune from unexpected health crises. At some point, each one of us will be profoundly affected by illness, be it in you, or in someone you love. And every health crisis benefits from an open-hearted nurse who is willing to come alongside the patient and family in some of the most challenging times of life. I'm a critical care nurse, and like many of my colleagues, I went into nursing because I wanted to be a therapeutic presence for others. I envisioned the profession to be one where I lived on the highs - not from being elevated by a celebrity's monologue, but from feeling like I was always doing something meaningful and helpful for others. I thought that the highs alone would be enough to help me cope with the intense stress and heartache that come from taking care of so many sick and sometimes dying patients. But as I rode the roller coaster of suffering with my patients and their families, I quickly understood that I was going to need something more than the intermittent feel-good moments to sustain me through the lows. And this isn't just true for me. Recent literature shows that nurses everywhere are battling this challenge. Currently, 25 to 33% of critical care nurses show symptoms of severe burnout, which is not just emotional and physical exhaustion but also a feeling of personal detachment from their job. Current annual turnover rates among critical care nurses range between 13 to 20%, which is higher than the overall turnover rate for other professions. These statistics can be disheartening, given that many of us will rely on a nurse at some point in our lives. In our times of weakness, vulnerability and helplessness, we need nurses who have found a way to preserve meaning, and commitment to their work. While many external factors contributing to burnout have been studied, I've been asking what we nurses are to do with the internal issue of grief - not in terms of caring for others in their grief, but working through our own grief on a deeper level as we are affected by the suffering of our patients and their families. How do I endure through the lows that come with this profession? I endure by allowing my natural response of grief to teach me its life-giving lessons. Grief kind of has a bad rap. It's seen as something unnatural, something to be avoided as much as possible in order to survive. It's seen as a thief of life. But consider this: When I spend an entire 12-hour shift with a patient who, just a few days prior, was a healthy, free-wheeling teenager who jumped into a pool the wrong way and has now been told that he will never use his arms or legs again because of a severed spinal cord, grief will be one of the most natural and predominant emotions for him, his family, and for me as his nurse. We can think of this grief like a river running downstream, and as the nurse, I'm on this life raft together with my patient and his family. Grief is strong, it's scary, and no one really knows for sure where it's going to take us. But for this patient, his family, and for all of us, when we find ourselves in this kind of situation, it's natural. So if my endurance strategy as a nurse is to try to swim upstream against grief by way of suppression, and against the next stream and the next stream, I'm not going to win. Eventually, I'm not going to last. Rather than resisting grief and saying, "It's just too hard to think about these issues," I can choose a different perspective as I accept the inevitable fact that I will be affected by grief. I can embrace my grief as a natural teacher about the deeper things I need in order to endure as a nurse. Resilience in the midst of exhaustion. Meaning in the midst of despair. I can redefine my purpose. When my initial idealism about life has been shaken, I can instead transform my grief and choose to use it to cultivate greater empathy for my patients and their families. These are the life-giving lessons of grief that can ultimately empower me to endure as a nurse. Research is slowly growing on the topic of grief in healthcare professionals. Marion Conti-O'Hare is a nurse researcher who developed this perspective into a theory known as "The Nurse as Wounded Healer," where the nurse learns to transform and rise above grief such that the nurse is all the more able to care for others. Along these lines, another researcher who studied post-traumatic stress in nurses has concluded that staying self-aware in grief and working through questions about the meaning of suffering can eventually grow the nurse in maturity and wisdom, both of which are life-giving tools for endurance. I have two daughters; they're two and four years old. About a year ago, I took care of a patient who reminded me a great deal of my younger child. No one could explain, beyond a suspected brain infection, what had made this child so sick to the point that he was not expected to survive. I was with his family in his final moments before we withdrew his life support. It was a privilege for me to be with his mother in her grief because I could very much imagine myself in her shoes, so in the moment, it was very intuitive to me how to care for her. But for a few weeks after that, I was shipwrecked by grief. It was difficult to function normally at home, and it was very difficult to go back to work. It was the kind of low in nursing that I simply couldn't anticipate, much less really prepare myself for, even years into the profession. I hadn't yet learned, at that point in my life and my career as a nurse, how to manage my own fairly new maternal instincts as they collided with this mother's grief. I couldn't navigate those new waters alone. It was a shipwreck moment for me. But it was also the moment when I learned my next life-giving lesson from my grief. I learned to develop new levels of life-giving relationships. Specifically, I've slowly begun to find people in my life who courageously look at grief with me through this new lens, who look at grief not as a thief of life to be avoided at all costs, but as a difficult - yes - complicated - yes - but a natural, powerful, and irreplaceable teacher of endurance for my life as a nurse. There are amazing highs in nursing, like being able to walk with Jimmy Kimmel and his son through successful open-heart surgery. The purpose and joy in those experiences are clear. But when the lows come, the stress and heartache can be so strong that they can muddle motivation and make you question your ability to endure in the profession. But burnout does not have to be the inevitable result of constantly giving oneself to the suffering of others. Allowing my natural response of grief to teach me its life-giving lessons may very well be the way in which I as a nurse can rise up and move forward with purposeful endurance in my profession. Thank you. (Applause)