Most Believe in Some Kind of Afterlife : Cancer Nurses Help Patients Face Death
A terminal leukemia patient under the care of cancer nurse Sheila Evans died a pleasant death a few days ago.
Use of the word “pleasant” in talking about death might strike a non-nurse as bizarre, conceded Evans, a nurse at the University of California, San Diego, Medical Center.
But the woman told Evans of feeling prepared to die, of having seen a white light, of achieving peace. Evans herself had been able to help the woman prepare for her physical end because of Evans’ own philosophical consideration of dying and mortality.
“You must be comfortable with the idea of death, of having thought about your own mortality, or you won’t last (as a cancer nurse),” said a colleague of Evans, Linda Meixter, nurse coordinator at the university’s cancer clinic. “Patients will ask us: What will death be like? Will it be painful? They know when it is time to die, when not to fight the pain any longer.”
Not Popular Topic
Death will never be first on society’s list of dinner conversation topics. Most people show their discomfort when discussing the inevitability of dying, of their own mortality.
But for cancer nurses, the frequent exposure to death forces them to confront their own beliefs about death more often, and to a far greater degree than the general public, in order to deal both professionally and compassionately with their patients. Most of the patients have illnesses that are life-threatening, and many have a short time left to live.
At a 1984 nationwide seminar for cancer nurses at Scripps Memorial Hospital in La Jolla, the American Cancer Society surveyed 185 nurses on their views about death, using questions developed for the periodical Psychology Today and asked of that magazine’s readers in the early 1970s.
The results, released recently, indicate that 71% of the nurses believe in a life after death, contrasted with 43% of the Psychology Today audience. Among the nurses, 53% said they strongly believe in a life after death, and 18% tend to believe in it. In addition, 73% said they strongly wish that there is a life after death, regardless of whether they personally believe it exists, compared to 55% in the magazine survey.
‘A Coping Tool’
“I can well understand the results,” said Scripps cancer nurse supervisor Kathy Diss, a remark echoed by colleagues at several hospitals. “A belief in a life after death is a coping tool for us, to deal with the different perception of death that we have, our much greater familiarity, compared to the general public.”
Not that all cancer nurses have uniform views on religion and death. To the contrary, each nurse approaches the topic a little differently.
“I think you can say that the majority of nurses I work with have a sense of spirituality, a belief in something more than just themselves,” said Joan Krogmeier, a member of Mercy Hospital’s chaplaincy services department who works with cancer nurses and patients. “Whether or not they express that spirituality through religious belief, that is neither here nor there. But they do acknowledge the spiritual part of the body.”
Scripps nurse Lucie Lavoie-Smith, a longtime cancer specialist, differentiated between religion and spiritualism in attempting to define life after death.
Belief in Spirit
“I think you can believe in a life after death without it being part of organized religion, that a God or someone else is necessarily waiting for you,” Lavoie-Smith said. “You can believe that a spirit comes back in the cycle of life, or something like that, which to me is more spiritual than religious.”
Diss said that nurses become vulnerable to the added stress of facing death regularly when they first come into the area of cancer treatment. As a result, they look for a philosophy that can help them deal with the problem, drawing upon their own religious upbringing, previous nursing experience and special seminars designed for dealing with dying.
“I was raised a Catholic and, of course, from that I believe in a life after death, but now (after having worked with cancer patients) I believe in it a heck of a lot more,” Veronica Stone of Scripps said. “I don’t consciously think about this day to day, but probably my work in oncology (cancer treatment) has had a subconscious influence on me.”
Added colleague Cheryl Kosits: “Now, I am not afraid of having a relationship with a patient who is going to die. I don’t say to myself, ‘What will I do if I take care of them and they die?’ That fear is gone.”
“The first time that someone dies, you think, ‘Is the soul there? Can they hear me? Can they not hear me? ‘ “ UCSD’s Evans said. “But I had thought about that somewhat before I became a nurse here. I don’t feel that I grapple daily with the concept of life after death. I’m not trying to decide; I have my own view that I work with.”
Don’t Force Views
The nurses said they do not attempt to force their views upon patients. They do not initiate conversations about death with a patient but instead remain ready to share their thoughts should the person want to talk with them.
“We let the patients take the lead on matters of spirituality, of ideas of life after death,” Mercy Hospital’s Krogmeier said.
In many cases, the patients are more concerned about the process of dying, to get reassurance that they will not be left alone and in pain, Barbara Cash of Mercy said.
“At first, it was hard for me to talk with a patient about death,” Cash said. “But they need to talk to someone, and many patients are not really free to talk easily with their families about dying.”
Cancer nurses, particularly those who work in the outpatient clinics, see patients over and over during a period often spanning several years. As a result, personal relationships often develop that, when the patient dies, can challenge even the most prepared of nurses.
‘Develop Real Closeness’
“We know our patients much, much closer than, say, a nurse in the emergency room, who may see a person only once briefly,” Kosits of Scripps said. “There can develop a real closeness before they do die.”
“You can’t get attached to everyone personally or you would go crazy (after they die),” UCSD’s Meixter said.
UCSD Clinic nurse Carol Horton has a policy of not visiting a longtime clinic patient when and if that person is admitted to the hospital for the terminal phase of illness. “I want to remember them as I saw them in the clinic, not in the final days with tubes in them and the eyes not focusing,” Horton said.
“A couple of times I have broken my own rule and regretted it later since I became depressed after seeing someone I had taken care of for three years.”
‘All of Us Grieve’
The nurses cope with their work in part by trying to leave it when they go home at night. “I do know when to clear my mind by going jogging, by taking care of myself, if I find myself getting too close with someone,” Kosits said. “But there are times when all of us grieve.”
