Rachel Jones on Grief
In the Healthcare Front Lines
by Sandra Yeyati
After earning a journalism degree from Columbia University, Rachel Jones spent four years as a reporter in Caracas, Venezuela, including a year and a half as a correspondent for The Associated Press. Her articles have appeared in Time magazine, The Lancet, The Delacorte Review and Scientific American. In her book, Grief on the Front Lines: Reckoning with Trauma, Grief and Humanity in Modern Medicine, Jones examines the emotional challenges that healthcare workers face in hospital emergency rooms, hospices and other front-line settings.
What are your most surprising findings about healthcare heroes?
That they’re humans, just like the rest of us. They can make mistakes. Their work affects them, and they take it home. We have this impression that they’re emotionally cut off from their work, and this couldn’t be less true. Also, healthcare workers don’t have all the answers. We have this fantasy that if anything goes wrong, we can go to the doctor and have it fixed, but they can’t save everybody. Even the concept of a hero—that they’re going to swoop in and save us—does a disservice because it feeds into that false impression.
What are the most pressing challenges in these medical settings?
There’s a stigma where it’s considered weak if you need mental health care, even though you work in a stressful environment dealing with death and traumatic incidents. Many doctors and nurses don’t access mental health services for fear that when they renew their licenses, they’ll have to reveal that and be further investigated—even in states where that’s not the case.
Another problem is the shortage of doctors and nurses that we’re experiencing and will be experiencing in the next decade as Baby Boomers age. Many places are short-staffed, heightening the burden on those that remain, which doesn’t help retain people. Patching things with travel nurses for short-term contracts isn’t sustainable, and we don’t have enough new people coming into the system.
How do these challenges affect patient care?
Medical errors increase when healthcare workers haven’t slept or eaten, which seems to be the standard, especially medical residents who work insane schedules or hospital nurses who don’t have time to take breaks. Also, mental health issues and depression closes them off from colleagues and patients, giving them tunnel vision. Then there are issues such as bullying where because of the toxicity of the work environment, maybe doctors and nurses aren’t sharing information in the way that they should be, and that can have a very detrimental impact on patients.
Why is it important for healthcare workers to remain emotionally connected with patients?
Traditionally, doctors and nurses are taught to keep an emotional distance, but that can cause them to compartmentalize and numb out feelings, which then spreads to their personal lives. They may be less able to engage with loved ones and feel disconnected from patients so their work isn’t as meaningful. Most healthcare workers care about people. They want to help patients and want to feel connected, so that disconnection is harmful to them and to their patients who don’t feel seen or cared for.
At the opposite end, some healthcare workers take on their patients’ suffering, bringing it home and obsessing about it. The idea is to find a balance—remaining open enough to connect, but not seeing yourself as the sole responsible person for a patient’s recovery. You’re not entirely in control, so realizing there are other forces at play when things go wrong, even if you made a mistake.
What coping strategies can help practitioners?
It’s essential that healthcare administrations provide space and time off for staff to heal and grieve, encouraging staff to speak with chaplains or therapists—normalizing mental health care—and ensuring that therapy is covered by insurance and widely available in safe and confidential settings.
Jonathan Bartels, a nurse in Virginia, came up with The Medical Pause—a moment of silence after a patient dies to honor their life, think about what they meant to you and understand you did everything you could to save their life. Honor walks for organ donors are where everyone lines the hallway and watches as a patient is wheeled into the operating room after they’ve died and are going to have their organs transplanted into others. Stepping back for a brief moment of mindfulness is a powerful way to set down emotions, rather than letting them lodge in your body.
Self-care—things like yoga, exercise, journaling, taking walks—and peer support are important, but administrations need to make time for them to happen. At Johns Hopkins Hospital, a project called RISE [Resilience In Stressful Events] allows practitioners to page a peer after a bad outcome. Sometimes, talking to someone like you that has been there themselves can be more helpful than a therapist.