Many caregiving organizations support staff rituals for grieving the loss of patients who have died. Our hematology and medical oncology staff has kept the same ritual for more than 12 years. This practice has survived multiple managers, administrations, philosophies and employee changes. It has survived outside attempts to reduce the number of minutes we take for this ritual at the beginning of every monthly staff meeting. But more than the survival it claims for itself, this practice has helped staff members “survive” and remain buoyant in meaningful ways. This long-standing practice includes a time-limited, structured process and room for reminiscing, ingredients seen as beneficial for staff bereavement rituals (Running, Tolle, & Girard, 2008).

Our meetings begin promptly at 7:00 a.m. We dim the lights in the room. The leader, a social worker, distributes little slips of paper on which is typed the names of the patients who have died during the month prior. Month after month, the leader begins with the same introduction:
“As is our tradition, we stop and remember those we have been privileged to care for and walk with in the last chapters of their lives. This is a time we stop and remember the preciousness of life and our work together. Please read the name you have and then, after waiting 2-3 seconds, the person next to you will read another name until we are finished. At the end of this reading of names, I will ask you if you know of others we have missed. Finally, we have an opportunity to share our memories. These memories or stories can include many things—funny, sad, touching or even frustrating, the good, the hard, and the memorable.”

After the names are read the leader asks if there are others, waits a moment and then says, “What do we remember about these people or those who cared for them?” The sharing begins. We honor an average of 19 patients monthly, recalling often, as well, those who accompanied them. In all, this takes 15 minutes.

These minutes have become sacred for our large multidisciplinary staff. There is laughter, poignancy and sometimes respectful imitation. Often there are tears. We remember patients who have been receiving treatment for years and those who only started coming to us in recent months. We remember the quirky, the candid, the kind and, sometimes, the not so kind.

Without a doubt there is healing but also learning and surprise. Every single month there are revelations about patients on the list. "I didn't know she was a concert violinist.” “I didn't know he cared for his developmentally delayed grandchild at home." But the learning is not only about the patients. We learn about ourselves and we learn about each other.

In querying others about the benefits of this practice, one staff member told of a patient remembered at this ritual many years ago. “I found out that he did a late night jazz show as a DJ on a local radio station. If I'd known that while he was alive, he would have gone from being an irritating guy who always wanted his prescriptions early, to an actual intricate human being, which is what I never really saw him as. I was a much younger nurse then and he taught me an important lesson that I've never forgotten. Behind every initially irritating patient might be someone happily spinning discs late into the night."

Another cited a lesson learned in a particular bereavement session. She discovered that while some staff members are familiar with some patients, those at the front desk and those who check patients out after clinic visits know them all. Additionally, these key members often know things about patients no one else knows. A front desk staff member told us how she would miss the patient who had worn a different pair of “crazy” socks every time he came in. It was with her that this person had chosen to reveal this portion of his cancer journey. She was clearly grieving this loss.

Other beneficiaries of this practice spoke of closure, grounding, recognizing our own mortality as well as the importance of an opportunity to see those with whom we work and their idiosyncrasies as more human. Some remarked that that this practice contributes to a more hopeful and resilient organizational culture. This type of culture creates an atmosphere of sustaining inspiration for helping professionals “in spite of the despair around them” (van Dernoot Lipsky, 2009). One stated that this is one time a month when all have a shared experience, the whole is greater than the sum of individual experiences. We find in common what we have and what we value. We see not only what our patients mean to us and what our roles mean to them, but also what we all mean to each other.

But perhaps the most universal sentiment shared by staff is that during these 15 minutes we recognize profoundly that we are a team and that our buoyancy depends on our teamwork. One nurse, reflecting on the acuity of our individual roles and what our sustaining work together means as symbolized by this simple bereavement practice, described the image of a crew team. She remarked, “We all have a job in the boat to keep it afloat.”

The work of caring for those at the end of life is often referred to as helping fellow travelers get from one shore to the other. We all know that cancer can bring rough seas for everyone in the boat. Twelve years ago we didn’t know what we better understand now. We didn’t know how much of the rowing our patients and those who love them and their stories would do to help us, their caregivers, reach various other shores—as individuals, but especially, as a team. To them, we are so grateful.

References

Running, A., Tolle, L.W., & Girard, D. (2008). Ritual: The final expression of care. International Journal of Nursing Practice, 14, 303-307.

van Dernoot Lipsky, L. (2009) Trauma stewardship: An everyday guide for caring for self while caring for others. San Francisco, CA: Berrett-Koehler, Inc.