Grief at Christmas. Liz Crowe at St.Emlyn’s

Managing bad news in emergency medicine and critical care at Christmas. St.Emlyn’s on Grief at Christmas.

Grief at XMAS

Whether you are a person of faith or not for many people around the world Christmas is a time of celebration and fun.  It is often symbolic of the end of the year and a good excuse to get together with family,  friends and work colleagues to celebrate what was and what wasn’t.  Even the most diehard of Grinch’s will sometimes be found in critical care with a bit of tinsel discreetly worn or a pair of reindeer ears on their computer.   Children are often a special feature of Christmas as the excitement builds for Santa and presents and so when families find themselves in the critical care setting it can be confronting for both them and us.

So what does happens at Christmas time in critical care?  For those of us who have to continue to work 24 hour shifts with those who are injured, sick, dying or just plain silly?  Is working in critical care harder during the Festive Season and are there things we need to be aware of for both ourselves and our patients?

Have a listen to the accompanying podcast with Liz Crowe and Iain Beardsell.

FAMILIES IN CRITICAL CARE AT CHRISTMAS

For our patients experiencing tragedy in the Festive Season can be particularly distressing.  They may worry that Christmas will be forever tainted with a sadness, loss and heaviness rather than a joyous time to celebrate the  ‘silly season’.   It is important to acknowledge that we are sad for them and that it is Christmas.  If they choose not to engage in this conversation – that’s okay we have demonstrated a level of understanding that it is Christmas time and the loss may be more overwhelming.  If a family asks ‘How will we ever enjoy a Christmas again after this?’ acknowledge that Christmas will be forever changed and that maybe over time new rituals and experiences will evolve.  For the many families in paediatrics I work with following a death we encourage families who struggle with Christmas to do something that makes sense for them.  Many will still buy their precious deceased child a gift and then give it to a charity. Some will light a candle and place it on the table during Christmas meals, some people may even set a place at the table as a means of acknowledging that someone loved and important is not with them.  Some families choose to ignore Christmas particularly in the first year following bereavement however for others with other young children this may not be an option.  For anyone who has a loved one die over Christmas many choose to delay the funeral until the New Year or after Christmas to try and separate the two events. All very normal coping mechanisms under such tragic circumstances.

CRITICAL CARE STAFF AND CHRISTMAS

Most Units will still put up Christmas trees and decorations to recognise the Festive Season and for the families and individuals who find themselves in your Department with less serious ailments  they will enjoy staff still being jolly and ‘Christmassy’.

The majority of staff I have worked with over many years report finding sadness and tragedy even more difficult to cope with over Christmas.  I also find sadness more confronting and the contrast between the excitement of Christmas in my own home and community and the intense nature of serious critical care work even more exhausting.  To sit with tragedy and then come home and do Christmas lights and wrapping presents with the kids feels like such a privilege.  However life and happiness will often feel even more fragile.   If you are dealing with tragedy at work over this Festive Season here are some suggestions:

1.     Acknowledge that the sadness is a little more intensified over the Christmas period

2.     It may be a little more confronting to identify with families who are similar someway to your own.  The fact that you will still celebrate Christmas while they are left with tragedy

3.     Acknowledge these feelings as a team and talk about how you will manage these emotions and situations.  I suggest giving that little bit more to the family at the time and then having lots of treats and silliness in the staff room to make the contrast greater and remind yourselves that you still have a right to enjoy this Festive Season.  That work and people are important but so are you and your team.  You give 100% at work so to give 100% to yourself and your family and friends is a protective factor to ensure you are still here next year.

4.     On Christmas Day or in Christmas week  give a small treat to patients.  We have bowls of chocolates and sweets on the counter for everyone to share to acknowledge the ‘shared experience’ of Christmas in the hospital.

5.     If something very tragic occurs take a little extra time before going home and having to immerse yourself in the ‘joy’ of Christmas.  Go for a walk, have a moment, cry, feel the sadness and then give yourself time to transition back into life.

6.     Maybe let your family know that it may take a time to really feel like its Christmas. I always shower as a transition back into family life, metaphorically washing away the day.

7.     Celebrate as a Department or Unit.  Drinks and shared food with colleagues works wonders for team building and celebrating what was achieved and shared during the year.

8.     You work exceptionally hard and deserve to have any breaks you do have over Christmas.  Try not to carry your sadness with you in a sack, fill it with other emotions of gratitude and humour.

Most people outside of critical care struggle to really understand the impact of the work – both the miracles and the tragedy.  This Christmas take a moment to reflect on all your work experiences and congratulate yourself on being there for others in their time of need.

Merry Christmas everyone we hope it is blessed with people you love.

Liz Crowe

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Posted by Simon Carley

Professor Simon Carley MB ChB, PGDip, DipIMC (RCS Ed), FRCS (Ed)(1998), FHEA, FAcadMed, FRCEM, MPhil, MD, PhD is Creator, Webmaster, owner and Editor in Chief of the St Emlyn’s blog and podcast. He is Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in adult and paediatric Emergency Medicine at Manchester Foundation Trust. He is co-founder of BestBets, St.Emlyns and the MSc in emergency medicine at Manchester Metropolitan University. He is an Education Associate with the General Medical Council and is an Associate Editor for the Emergency Medicine Journal. His research interests include diagnostics, MedEd, Major incidents & Evidence based Emergency Medicine. He is verified on twitter as @EMManchester

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