Podcast – Grief at Christmas

Welcome to the St Emlyn’s podcast. I’m Iain Beardsell, and I’m delighted to have with me again Liz Crowe from very sunny Australia we’re going to spend a little bit of time today talking about the festive season and how we might deal with some of those things that we face in the emergency department or intensive care unit at this particular time of year So Liz, it’s a jolly time of year over here in the UK.

We’ve got carols. We’re hoping for snow. Everyone’s dreaming of a white Christmas, But it’s not particularly an easy time, perhaps for some of the people we see in the hospital, and it may not be for us as healthcare professionals, either. If you’re working in your emergency department over Christmas, how do we deal with some of those things that we see that we’ve talked about in the past, which are just frankly tragic?
Do we do anything different at Christmastime? Or is it just the same work as normal?

I think, firstly, it’s important that we acknowledge that Christmas is a Christian tradition. Initially, though, lots of people will still get in the festive season of things, and there’s likely to be tinsel around and people wearing Christmas earrings or Christmas T-shirts.

So even if you’re not a person of faith or that Christmas doesn’t have a religious symbolic meaning for you, I think that Christmas can still be a time when lots of people are. Reflect on the year that’s gone past and have a series of celebrations. I think that’s conflictual because most people who end up in the emergency department or in an intensive care unit are obviously going through extremely difficult times in their lives.

The nature of our work is it has to still be fully staffed even during these festive seasons. We all want to acknowledge That it’s Christmas time and that we’re still trying to enjoy ourselves, even though we’re at work. And on the other hand, we may be faced with people who are going through really serious or difficult time on what’s supposed to be a really wonderful occasion.

For me, it’s that stark difference, perhaps at this time of year more than any other between happiness and sadness. And we’ve talked before about how you communicate bad news, how we talk to each other. Families will come in. On Christmas day and around that time and they will be dealing with awful things Christmas is a time when you go to work and you hope to have a jolly time and then you go home but for these people their lives change forever and change even more at this particular time of year have you got any hints and tips for how you approach.

The same communication things that we talked about in the past at Christmas time. Do we acknowledge it’s Christmas? I presume you take the reindeer antlers off and take off the Santa jumper when you’re going to talk to people. But how do you adjust from those two different times from the happiness to the absolute dreadfulness?

It’s really important to actually acknowledge that it is Christmas. A week out from Christmas, we’ve had five deaths in our unit in the last several days. So Christmas is particularly usually about children, and we know that there are several. Families just in our unit who have actually had their child die.
So I think it’s important to acknowledge that it is a special time of year when people would have been expected to be filled with excitement and hope and wanting to really inject something wonderful into their family life. I don’t think we can ignore that. I think it’s important to say things like, I’m sure this is not what you’re expecting to do at this time of year, or this is such a difficult time of year for this to happen.

This means that Christmas now will be difficult for your family. Something just to acknowledge the time. Now if people pick up on that and say, how will we ever have a good Christmas again? Or how will we ever be able to enjoy Christmas again? Then you can continue on the conversation. If people choose not to pick it up or to say this would have been awful whatever time of year that had happened, then we can just leave it.

We’ve put it out there. In terms of whether you take the reindeer ears off and whether you still wear the Christmas jumper, it depends on your role. if you’re a consultant for instance and you have to go and give particularly distressing news, I wouldn’t wear something that looks comical. I wouldn’t wear something that’s really based on humour.

But if you just had a little bit of tinsel tucked into your pocket or you’re wearing earrings that have a Christmas tree on it, then I don’t think that we can strip it all away because families will notice that as well, particularly if they’ve already met you wearing that. I think that there’s ways that we can tastefully celebrate Christmas.

in the emergency areas without ramming it down people’s throats. And lots of people will acknowledge to staff, I can’t believe that you have to work on Christmas day, or I can’t believe this is your life on Christmas day. It can be a joining thing, but I do think it’s important to acknowledge.
And that leads us on to the other group of people who we perhaps need to think about, and that is our colleagues and our staff.

Over the Christmas period, we may have difficult conversations. How do you go from having that happen at work? And maybe you’re doing a day shift in the ED and you have something bad happen and then you clock off and you go home and everyone’s all jolly. How can we deal with those sad times and still enjoy Christmas ourselves?

That’s exceptionally difficult. I think like any time at work when you’ve had something really distressing and then you’re entering back into your family home where the issues might be that you’re late or that everyone’s waiting for you for dinner. or if it’s Christmas time, people are really looking forward to welcoming you back into the family life, it’s important that you take a little bit of time to reflect on what’s happened and to approach how you’re going to re enter normal family life.

If you’ve had a particularly difficult time where it doesn’t feel like Christmas, where it feels like the world is a sad place, or where your mind is really sitting uncomfortably or sadly with a family that you have connected with during the day. that you just take a little bit of time. And I think it’s a time that we can feel particularly sad, where staff say to me, how can we be doing this at Christmas time?

That we, again, we acknowledge it, but also just give yourself a little bit of space. If you only live five minutes from the hospital, instead of driving straight home, maybe park somewhere a little bit, or take some time with your colleagues to say, how This didn’t feel like Christmas, or it feels unfair that we now get to walk away from all of this and re engage with our families who are safe and well, or to just be sad, to just cry and think, the world is sometimes a sad place and people sometimes really suffer. I think it’s really important that we say today, even though it was Christmas Day, or it’s Christmas Eve, or it’s Boxing Day, or it’s the week before Christmas, that we still gave 150 percent today. Right?
What we did was still really important. We engaged with people at difficult points in their life, that it would have been much harder for them if we weren’t there during this time. Whatever happened, we did it to the best of our ability. And now, in order for us to be able to re-engage and return to work, whether that’s tomorrow or in a week’s time or a month’s time, we allow ourselves to say what we did was important, but so is having a break and so is our families.

So are the people who enable us to go to work, or the people we choose to go to work to have money for so that our families can live safely and enjoy Christmas and have presents. Sometimes, last night I said to my own kids that I was feeling particularly sad. There’s a very sad case that’s weighing heavily on my mind.

And I said to them, I feel really sad tonight. I feel really blessed that you guys are well. And even though you drive me crazy, because kids do, that I really love you. So I think it’s sometimes okay to bring it a little bit into the house, but we don’t come in at Christmas time in particular and really share it with our family so that they share our burden and sadness.

I think it’s important we do that elsewhere, but to the best of our ability, we come in. I remember we had a really tragic death at about 6 30 AM on Christmas morning, about six years ago. And the nurse is talking really hard about how hard it was to go back in and then go and open Christmas presents with their own children.

Knowing that family left without their child. And they spoke about how they really, they took an extra hour before they got home, even though their partners and children were really angry at them. And when they came home, they had to say, I’m really happy to be home, and I’m really excited it’s Christmas, but it’s going to take me a little while to feel happy inside.

Just so that there wasn’t this false pretense that nothing had happened at work. And that the family were aware of it, but not something then that was going to really destroy Christmas in their own homes. So it sounds like the message is both at work to be open and talk about it, probably with more urgency than we might do on another day, because these are people you’ve shared that experience with on that special day. And then to be open with your family when you get home and just say, just give me a minute, but I will get to it. And then. Like the professionals we are we put on a show sometimes and I guess there are times when you have to put on a show for your family. So we’ve got this difficult time. hopefully, we’re talking about this. It would be nice if lots of people who listen to this would have nothing happen like that on Christmas day.

A couple of people who trip over a turkey and sprain their ankle and one or two people who have too much sherry. Hopefully a big chap with a big white beard won’t fall off a roof and hit his head because that would be a tragedy. So Liz it always seems to me that you and I Talk on the podcast about very sad things.

We talk about communicating bad news. We talk about how we deal with grief. And even now at this happy, jolly, joyous time of year, we’re talking about sad things, but there is a lot we have to be thankful for not least the idea that in 2016, you and I will do some happy podcasts. What is the best way to get something good out of your colleagues at this happy time of year and make sure everybody remains as cheerful as they can as I’m a big fan of humor, and I think it’s really important to always carry a joke or a ridiculous story in your pocket. I will say the month of October and November, I really overcommitted myself, and I had too many conferences to present at, and my kids had assignments due. I was really getting no sleep and I was on the train to work and I was feeling exceptionally stressed.

I even had chest pain and I was thinking maybe I’ve lost it. Maybe I’ve pushed things a little too far and 1130 we sat down for quite a serious family meeting and I looked down and I was wearing two completely different shoes. One was black and one was navy and they didn’t even look the same. there was nothing about them that looked the same.

I’d been walking around like that. All day. And I nearly cried because I thought it meant I’d had a nervous breakdown. And I was thinking of ways to hide it from my colleagues. But then I decided, I’ve been an idiot and a fool. I should actually share that with everyone. And so I walked around just quietly by each bedside and I said to the nurse, How’s your day going?

And they’d say, oh, not so good or it’s good. And I’d say, look down at my feet. And everybody killed themselves laughing because I was an idiot. And I think, if you make it, if you do something foolish, it’s always important to share that with your colleagues. You should never hide it.
People should be able to laugh at your expense. I moonwalk really poorly around our unit all the time to make people laugh. Every Friday, I bring a song to work and we have a little dance in ward round afterwards. There’s always the opportunity to laugh and enjoy things. That we shouldn’t, you can’t sit with sadness.

You won’t survive in this job if you can’t be silly if you can’t have fun. And this is a great time of year to actually celebrate things. I’m glad that all my family is well and healthy. I’m glad that we have the opportunity to even enjoy Christmas. And I don’t bring the sadness of from home, from work into my home all the time.

Sometimes it’s there, but go for a drive and look at the Christmas lights and get a little tipsy with the neighbors and just think of all the fun things that have also happened this year. Just make the most of every opportunity because those fun times are what sustain us and Christmas more than ever really gives you a celebrate to be a little bit naughty and a little bit nice.

So listeners, if you’re having a tough time over Christmas, all I want you to do is close your eyes and picture a rather crazy Australian in odd shoes. Moonwalking in a paediatric intensive care unit, and I’m fairly sure that will bring a smile. Liz, as ever, it’s a joy to talk to you. Happy Christmas to you.
Happy Christmas to you and your family, and I’m sure we’ll be talking again in 2016, perhaps with some more jokes next year. And thank you as ever for sharing your insights into how we can deal with some of the most tricky, difficult parts of our job.

Thank you very much, and a big Merry Christmas to everyone, and for all of you who are freezing, it’s Six o’clock in the morning in Australia.
It’s already 27 degrees. So, some of us will definitely not be having a white Christmas.

Take care everybody.