Unknown and unseen by the cancer patients who receive treatment there each day, a nurse places a small stone in a bowl tucked in the corner of the staff break room of Deaconess Hospital.
The small ritual provides a constructive way for those caring for cancer patients to grieve those they have lost and overcome the “compassion fatigue” inherent to the job, leaders of the hospital’s oncology unity say.
“When someone out there loses somebody to cancer, it’s their first, second or maybe their third time. When an oncology nurse loses someone to cancer, it’s their 100th, 500th, their 1,000th time,” said Assistant Oncology nurse manager Matt Ortiz.
Deaconess’ cancer clinic and infusion center sees more than sixty patients in a day, and between two and five of those patients die each week, Ortiz explained. After developing often close relationships with these patients, nurses and other employees in the unit often struggle to cope with the constant grief they feel.
“You don’t want to turn off the empathy or put up walls because that will just bottle it up. You actually will want to acknowledge it and press into it and go through that experience,” he said.
To facilitate that “compassion satisfaction,” Ortiz introduced the bowl-and-stone memorial to the nurses he manages at the beginning of July. The display is not a requirement. But employees can go into the break room and place a stone into the multicolor bowl as a way to “take a moment to pause and think of a memory of that patient who passed.”
“It can allow you to reflect on the meaning you have had in taking care of them and say goodbye to them,” he said. “This can be a very long-term relationship. So when we say goodbye to them, we really are losing someone that we love.”
Ortiz has been employed at Deaconess since March. Before then, he served a similar role at Sacred Heart oncology, where he developed and introduced the same display seven years ago. According to a Providence spokesperson, the memorial display is still in use and “speaks” to their “Catholic heritage.”
Rather than an ad-hoc response to grief, the memorial display is a product of research conducted by Ortiz.
In 2016, he participated in a task force focused on the concept of “compassion fatigue” in medical professionals. Coined in the ’ 90s, the concept describes when a professional takes on the suffering from their patient, which over time can make it more difficult to empathize with those patients. It can also create mental health impacts on providers, such as trouble sleeping, negative self-image, decreased job satisfaction or depression and anxiety, according to Rockwood Clinic psychologist Kimberley Chupurdia.
The way to overcome compassion fatigue, according to Ortiz, is to create moments of “compassion satisfaction,” such as the stone ceremony.
“And one of the most key elements of having compassion satisfaction is creating moments that matter,” he said. “Because that brings meaning to what we do.”
Indeed, a study conducted by Ortiz and others saw a “statistically significant increase” in compassion satisfaction following the introduction of the display.
“It helps to have routines and strategies to put in place when you’ve lost a patient and to deal with that grief,” Chupurdia said. “You put the stone in the bowl and then you can walk away, leave the stone and go back to your living patients rather than continuing to think about the loss.”
Ortiz christened the Deaconess memorial with a stone placed in the memory of his own sister, who died of cancer when he was 17. By the next morning, five stones had been placed in the bowl.
One of those stones was placed not by a nurse, but by receptionist Shelly Egeland, who does not provide medical care for the oncology unit patients but develops very close and personal relationships with them. The day Ortiz introduced the stone memorial, Egeland had just lost “a special patient.” She described him as a “grumpy old man” who reminded her of her father. Despite his gruff exterior, the two became very close over the course of his cancer treatments.
For his last treatment, Egeland knew the patient was near the end. She can often tell, after seven years working in oncology, even if the patient does not know themselves.
“Sometimes I know they know. Sometimes they don’t and they think they’re gonna get better. And so that’s hard for me, because they become such family to me, and it’s hard. But I just keep giving them positiveness and joy and happy and laughs,” she said.
But that day, he knew it was his last chance to see his “best buddy.”
According to Egeland, the patient came in that day and yelled, “Where’s my goofball!?!” Pulling her in close, he whispered it was his last time, and he wanted more than anything to give her a hug.
“To me, I can’t get anything better out of this job – those patients loving me the way I love them. And that is true. They are my family. They become my family, and I become theirs,” Egeland said through tears. “I’m not a doctor. I’m not a nurse. I don’t give them infusions. But I have one small part of my life that I get to give them each time they come in to make them better or to get them where God needs them to be.”
Soon after Ortiz introduced the memorial, Egeland placed her first stone in memory of him .
“That was so, so precious, because it was my ability to put the rock in there and, like, put him to his final resting place,” she said.
“I wear my feelings on my sleeve, so I cried because I miss him. I miss his laughter and I miss being able to encourage him. I miss just the light that we make together. But it was such a letdown, the stone. It helped me to be able to let him go completely, but know he was OK, know there is a part of this place that will always be him.”
In the three weeks since the display has been up, Egeland has placed four stones in the bowl memorial. And it has helped her process her emotions each time.
In those three weeks, fourteen stones have been placed in the bowl.