Terran Williams and Jen Little-Reece

00:01 Hi, my name is Jen little Reese and I am 50 years old and I am recording from Portland Oregon on 336 20/20 and I'm recording here with my partner Taryn.

00:19 Hi, I'm Taryn Williams. I'm 36 years old here in Portland, Oregon and I'm recording and interviewing with my partner Jen.

00:30 So so Jen you worked in the hospital at the Cancer unit when you encountered death and dying and I know that's what we want to talk about today, right? Yes. Okay, so I'm curious. Did you did you do that alone? Were you there with others the beautiful thing about my work is I never had to do it alone. I think what's an important caveat before we begin is to make sure that I tell you that I'm going to tell these stories in general terms and I cannot because of confidentiality use names or specifics the stories have to be made clean enough so that they can that that I'm not breaking any confidentiality. Of course, there's always this kind of tough balance between

01:23 Yeah, they're not my stories that show process of death and dying is is very personal and very intimate and I think that's why in our world. We don't have those stories grandparents don't tell grandchildren about their experiences when their parents died or their friends died or they saw traumatic death or those kinds of stories don't get old because they're very personal. And so the balance is that they are the stories that belong to the patients. However, I have for many years been witness to these stories and the stories have impacted me profoundly. My life is changed and transformed by these experiences and who I am today's greatly informed by the experience of living 12 years taking care of people who were going through the dying process and people who have died and their

02:23 All of that work has impacted me and the work of being present with a team in that experience. So sometimes when you're taking care of patients who are experiencing death and dying it's very intimate, it would be really primarily just me and the family and the patient and it's very it's always an intimate experience. But in those times sometimes was mostly just me but I was never alone. So I was given the opportunity to really focus and take care of people when I was at primary attendant because my team would pick up the slack and other places. I would have a lighter assignment my other patients that didn't require so much in-depth attention would be giving attention by other people on my team the time on death and dying became a team process. That was when

03:23 It was an unexpected experience or a big emergency experience. I worked on the cancer floor for about 12 years and I work night shift. So one of the things about night shift is the team is so tight we rely on each other so much because there are not resources. There are not doctors who are awake. If you have to wake them up. There are not dietitians. There are not there. There's a lot of services that happened during the day that are not available easily at night and therefore the nursing team becomes this big tight group that helps take care of each other. We had a

04:10 So I started as a new grad working on the oncology floor and then my whole career was spent on the oncology floor until I got this new job. I have a brand new job but the stories I want to tell her from the time that I was in the inpatient world. So I started as a brand new grad and by the time I finished my Inpatient time, I was a charge nurse on night shift. I did all that time on night shift 2

04:38 The time that I'm remembering that they are that teamwork was required. We had a patient who very unexpectedly just collapsed and he didn't have a pulse and he didn't have a heart and a pulse and heartbeat. It's the same thing. I promise I'm a nurse. He wasn't breathing and he didn't have a heartbeat. And so there's a bunch of emergency interventions that we prepare for we practice and practice and practice and practice and practice these kinds of emergencies all the time and everybody practices as a team and we know who's supposed to do what and I'm just like I was in charge and one of the the nurse who was his direct care nurse meaning she was the one responsible for taking care of him was in the room. She helped into the bathroom. She helped him back to his bed. He said I don't feel really good and then he just fell over in the bed unconscious with no pulse and not breathing. And so there's there's buttons you can push to get people's attention.

05:38 Really on night shift the best way to get people's attention is to yell. And so that nurse did exactly the right thing. She yelled I need help in this room and she yelled the room number and I heard yelling because I'm night shift noise travels and I came running I walked in and I will I will always remember my whole career is full of snapshots that I have blazoned in my mind interested. Okay where I can just like see this moment in time just like the photograph in an album and this moment I came into the room and she was leaning over the patient checking his pulse and she looked into my eyes and she there was so much in those eyes. I'm terrified. I don't know what's happening. I don't know what I'm supposed to do. I do know what I'm supposed to do. I'm so glad you're here. You have to help me. I don't know what to do.

06:33 And I put my eyes back into hers and I said you do know what to do. We're going to be okay. We're going to get through this together.

06:43 Silently there was no jerking. It was just the connection that we had and then we started doing the emergency intervention sweeter. All the emergency interventions. We did them all perfectly the patient didn't live.

06:57 Oh, we we we started chest compressions. We got the artificial defibrillator on him. We called the code team. We had the he put a big heavy plate under people's back. So you can do good chest compressions on a squishy bed. We called the right people. We got the right people there. We called the patient's family. We had the priests there. Everybody had, it was all the whole code team. Did everything really beautifully and

07:29 And the patient died and so the thing about the teamwork that happens is that there's a there's a there's a hole through line that continues after a patient dies. So after a patient dies the nurses are still responsible for taking care of that patient. The nurses are still the one that the family members are going to come talk to the nurses are still the one who's going to feel the calls from the kitchen in the morning. Hey, I'm bringing up so and so's breakfast, you know, do they want orange juice or milk? The nurses are still the ones who were involved in like that.

08:10 The shadow that exists the hospital shadow that exist that is that is shed after the patient is he's gone often times. The the team is responsible always the team is responsible for doing post-mortem care, which is a real technical term for we make sure that the patient's body is clean that tubes and wires are taken out of their body that they're ready to be sent to the morgue.

08:40 And that whole process is a it's a very it's a big process.

08:48 I have watched many many new nurses.

08:52 Have the experience of putting a human being in a body bag it is it is a big deal music closed that moment when you zip close to that body bag, but the experience of really having to have toe tags, you know, like it's a it's kind of a literary thing that you've so the experience of putting a toe tag on a person's body things have changed over time, but there were there were plenty of times in my career where I had to be the person to call the family and let them know but there are many really big things that no one ever prepared for you. Don't talk about the experience of zipping a body bag closed in nursing school. You don't talk about it if I school you don't talk about it with anybody. It's not in movies. It's not on it's not

09:52 Not a thing that is like in the common world. So as we navigate that we navigated all of that as a team. So I was there with that nurse. This was the first time she had ever had a patient in a code situation. So I was there after he had died a we reviewed the story and the story is the most powerful think that's why I'm here because it is telling of the stories together with people who have experienced trauma with you it is that experience that helps you on the pathway to Healing.

10:29 Do the whole lot of nursing research about?

10:32 You know, how are we going to support the nurses through the traumatic things that they experiencing over my career. We've had experts brought in at least bring in an expert expert wasn't there and the expert doesn't know when the expert doesn't know my team in my people in my experience in my story and I can tell it to the expert but that's a stranger. So for this night, we were all back on the next day. So this was like a Saturday. We were all back on Sunday or Friday. We were all back on Saturday. So I ordered Thai food.

11:05 I ordered for everybody and that next night. We all just we we sat down and we ate and everybody told their story the CNA who heard the yelling first to the nurse who got the code card to the nurse who couldn't get the meds out of the pics of thing cuz of a code that isn't it still I can't we all just talked about the whole experience and we all talked about how we did everything. We could we really did we reviewed it. We chewed up that story. We picked it up part everybody at the end of that Thai food.

11:46 Could keep going because we did it as we did it together. That's beautiful. I couldn't ever do it by myself and I would never want to and I just I honor all those nurses I worked with all those years, of course.

12:06 So you've faced a lot of death and dying and obviously hear your teams have as well. How do you deal with all of that sadness?

12:18 Yeah, this is a question. I get asked a lot in my life. There's nothing like there's no party killer in the world like I'm an oncology nurse.

12:28 Nice to meet you, too. What do you do? I'm a nurse. That's cool. Then the conversation goes beautifully but it's the next question is what kind of nurse and then I say I'm an oncology nurse and they owe for you. And so a lot of people view me like as a victim of my career choice, which I have never felt. I have always felt more blessed than cursed by my job. That being said there is there is sadness attached to my job and but a foundational belief that I have is that it is always better.

13:12 To love and then experience sadness and brief then to not love.

13:20 Sure, and my job afforded me the opportunity to practice love.

13:27 Got within a set of professional boundary course, right? Like there are there are rules and I am not friends with the people I take care of I am but I am able to be very present in and and connected in ways that I couldn't be if I worked in your job sure your guy in theaters yet. I wouldn't be at you know, I got a lot of presents being able to be authentic being able to be present being able to be witness to these incredible stories and lives.

14:05 Those are blessings that I was given being able to make a difference when people are so scared blessing being able to be helpful, like practically helpful to ease pain to literally ease pain. Those things are blessings that I take from this this job. And then then you kind of I kind of made friends with sadness. Okay, we all have those kinds of friends that you love very much but spending time with them live like a finite ability to spend time with them. And this is like that I would be like, oh, okay. We're going to have tea now come on over and we would just have this time with me that I left sobbing.

14:55 But but sadness is mitigated by telling your story. So we have we have all the Privacy constraints. So I had to find outlets for my stories and there's it's hard because when you tell stories to people who do not experience trauma who have never experienced trauma, you can write so as you know, it's hard, right, you're very good at not so, you know finding people who I can tell my stories to he has been very important to me in and healing from the sadness and keeping the sadness from being overwhelming keeping it as a as a friend who I spend time with and not as an enemy that I resist.

15:55 I mean I can I can feel that from your answer. I asked about sadness and then really one of the things you really started with was talking about a blessing and so I feel like you perform to sort of magic trick there that says a lot about that time keeping it close instead of resisting it. That's what I heard. That's wonderful. Thank you. See this is why I tell you this way does a beautiful thank you. I think that's true. The sadness is a blessing to have learned so much about myself. I also think that sadness has it has to come with a foundational belief about dying and living and those so when I have new nurse is coming oftentimes their new grads right out of college and they're in their early twenties, and we have to have big conversations about death and dying.

16:51 The thing about taking care of patients who are in the process of dying. Is that something you the nurse does will inevitably proceed f

17:03 So I pulled down the sheet or I gave the medicine or I turn them or I turn down the oxygen right turn up the oxygen or I went to the bathroom for 5 minutes. There will always be a Last Action before right and it's very difficult for a lot of nurses to not think I had an impact by I ended this person's life. I impacted that because I I pulled down the sheets. I went to the bathroom. I have some kind of volition in this process. And so there's a there's a lot of really deep human work that has to happen for you to be able to be present in that place with exquisite boundaries that no cancer kills people.

17:47 And I am not someone who kills people I am someone who cares with the highest integrity and the the the the greatest care that I can and so the talking about how you feel about death and dying is part of that kind of pulling apart process. There there you have to have really clear boundaries about other people's lives other people's experiences other people's deaths my life my experience as my death when I think about death that were

18:19 Really sad they're the deaths of the people in my life. Of course. Yeah, and it is super different when it's you, you know, I ended and I think that those are some boundaries that are difficult it to tug out that you do walk into the space and you you give people from yourself you give care and you give a piece of your heart and you you are loving in that care but there's a Clarity that that that that is not mine. I don't own that the piece that I own is the Thai food that the piece that I own is the fear that I felt when the scary things started the piece that I own is is my experience and I don't own the stories of these people's lives. They owned them in their families on them and it

19:19 Their world so there's

19:23 Part of mitigating the sadness is that it's that I recognize and I very clear boundaries that it's not mine. It's not mine degreef. It's mine to be present in the moment and have my own experience with it. But but I get to grieve.

19:42 The people who are in my family, that's where I I am allowed to have the profound sadness that accompanies death as opposed to my friends sadness who comes over and we have conversations your friend sadness. Yeah, I think of death. I think just thinking about my my own experiences. I feel fear and I'm wondering what it was like in your in your role to feel fear in in those considerations mean you you hit on it a little bit but talk about being scared.

20:26 Yeah, I think.

20:28 In 12 years there wasn't ever a death.

20:32 That I wasn't I had some kind of fear about the emergent ones the ones that were not expected. Those were the scariest ones in there are again snap shots in my career of

20:52 Being present witness to deaths that were really traumatic and buy any any account terrifying and those are things that I will be healing from

21:07 Forever. Yeah. Yeah, so

21:18 Anytime anyone's yelling. It's scary.

21:23 And we had a patient who really if you're an oncology nurse who works in an inpatient setting there are several really traumatic death experiences that happen. So I was in that place for 12 years and one of the worst things is when people bleed to death and so having witnessed a couple of those kinds of death. That kind of trauma is is it it's it's scary. It's terrifying and there's so much

22:09 About being present in that trauma and having to keep going.

22:17 Right that is hard. You know you are here quaking from fear and you have to go give the less acute patient to Tylenol cuz right time to do that you have to roll you have a carry-on. And again, it looks back to being in a team. We all took very good care of ourselves. We as people who have experienced traumatic death we have been able to be present for each other in a team setting in ways that a lot of people

22:52 Can't can't be present right when when something traumatic like that happens. I don't come to you. I love you, right but I would come to someone who could understand that kind of fear. That is present when you're you if you can't save somebody and you just have to be there when I need you don't want to traumatize someone that makes sense editing now like

23:33 Being present with with gruesome death is is not something that I want to put on someone who doesn't have the same kinds of experience understanding boundaries Etc clipping others, but also to take care of me like, you know, I can if I say a super technical medical thing.

24:05 You aren't going to be the person who can help me tug out my experience around the super technical medical thing. This is correct. This is the same thing like when you're dealing with this kind of death and dying from a if I really need to check something out. That's really impactful for me and very intimate for me. I need someone who really has been there and had that or you know adjacent to that experience, right? Yeah, you need those need that Community around that okay.

24:34 So can you tell me about a time when you're facing death and dying and the experience made you angry? What was that? Like anger play in dumb? I hate cancer cancer makes me angry. I hate cancer. I hate it. I hate everything about it.

24:57 And I also believe that it is that death and dying is part of life. Okay, and I'm going to say probably.

25:07 80% of the deaths that I attended were very peaceful. They didn't make me feel angry. They might have made me feel sad but they didn't make me feel angry but then then when the young people died, I feel angry. I don't understand. I can't I my little tiny human brain is too small to grasp the divine.

25:35 Reasons. I personally just Jen I believe there are Divine reasons for the most horrible of things that I can't understand. I still can say okay. I'm too little I can't understand this. I sure don't I don't get it just like a toddler doesn't understand why we have to leave Disneyland same I get that I can't get it. But those times that I don't get it. I I feel mad feel angry. Why is it this way? We had a patient who we all love young man in his 30s had

26:16 I'm going to say lymphoma could have been leukemia one of those big blood kinds of cancers and he was on our in and out of our department for a year-and-a-half getting treatment trying to get him ready for transplant. What are we going to do work work work work work work and during that year and a half we got to know his mom and his dad and his sister him and we all as a team. We're very connected to him every time he was admitted, you know, everybody wanted to take care of him. We all knew that we were putting our hearts at risk because he was this young guy and then he died and when he died, we all mass grief. We were all heartbroken. We his family was there we spend time with his family we

27:12 We were all just really impacted and that that is true on the oncology floor that there are there are times when the entire team is very invested and then becomes as a team heartbroken that that happens this was one of those times.

27:31 But it made me mad at me sad mad, but one year later almost to the day within a week. His dad was admitted to the hospital.

27:44 Yeah, and his dad had a similar cancer.

27:49 Oh my gosh, and his wife I was like, oh my God, this woman is having to do this again. It was her father know her.

28:03 There's a tree first patient whose name I can't say, we'll call him John and then there was the patient's dad to the patient John died at

28:18 No patient. No. No, we're going to do this. Okay. Okay, John the young man 36 years old. He has parents Sarah and Bob died. We were all sad.

28:33 A year later Bob is admitted to the hospital. So Sarah now has lost her son and is facing the death of her partner. However,

28:46 This guy Bob was adopted but he found siblings. So he was a potential for a match for a transplant. So maybe we had life-saving ability for this guy. It was so exciting that that maybe we are going to save him it was going to be hard but we could do it and I went home on a Friday when I came back on a Monday. He was dead. He had a heart attack.

29:17 Naruto related to his cancer. He just had a heart attack.

29:21 So angry I didn't say goodbye. I didn't I didn't do any of the kind of processing work that we all are good at doing as we see people heading towards the end of life. I didn't do any of that processing work. I just went home and I came back and he was gone. I was so mad. I felt like I had been cheated out of my process. I felt and I and poor would I name her Sarah or Sara? I mean

29:54 She lost her son. She lost her husband was horrible.

29:59 That's heartbreaking. And I mean you just said like cheated out of the process and it was almost like you didn't have that story. You weren't there to tell the story. Yeah. Yeah.

30:13 I want to ask one more question, okay?

30:17 I'm can you tell us something about your experience with death that surprises you.

30:24 Well, I guess it doesn't or surprised you once upon a time. I think it's surprising and it's surprising to me. It's surprising to others. It's surprising often is that little miracles happen in the dying process they happen all the time. And you know you like this is kind of in literature people would be like, oh she waited till her uncle arrived or wait until anniversary or died on the birthday of Susie's birthday age. Whatever. I think there's like there is magic miracles around the death and dying process that I am so blessed to be able to to witness and sometimes participate in we had we had a patient who she was old and she was dying and she had a stomach cancer. Okay, and all she wanted was apple pie and she couldn't eat

31:24 Apple pie would go into her stomach and out into the rest of her in wrong and bad ways. So we wouldn't let her eat and so finally when she says listen team I am done. I want to go I'm ready to stop working so hard to keep me alive. I don't I don't I don't want to stay alive. I'm ready to go. I've had a great life. I love my family. I love my grandkids. You are all beautiful. You going to be fine without me. I am just ready to stop having all this medical intervention. So one day and every bite of pie she was like, this is the best pie. The first one was cafeteria pie cuz that was all we could get for her but we got it right away. The second one is a piece of beautiful homemade pie shared it with your grandkids. Talk to everybody those

32:18 People spend a lot of time praying for miracles when they are surrounded by death and the Miracles that people pray for our always I want this person to live. I want the cancer to go away. I want it. I want it going but often times people don't see the Miracles that are really there that Miracle of a piece of apple pie. There's this is not those kinds of things happened all the time. There's so many peaceful beautiful deaths in the world that people figure out how to navigate without stories. So I feel like part of my work in the world is to help people.

33:00 Find those stories of the the beautiful lovely natural process. That dying can be.

33:12 Thank you for telling me your story. Thank you for listening to the best. I love you. I love you, too.