Grief – and Lego in ears – the extremes of an A&E shift

http://www.theguardian.com/healthcare-network/2016/mar/31/grief-lego-in-ears-extremes-ae-shift

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One of the most satisfying things in the world is removing small bits of Lego from ears. One swift pluck. Smiles all round. Perfect. So satisfying is this task that there is a scuffle – albeit discrete – when “foreign body in ear” flicks up on our screens in the emergency department. Only ultrasound – when we can tell anxious mothers-to-be after a few short minutes that, despite what their body is telling them, their baby is just fine – comes close. Moments like these are the ones you learn to treasure.

I’ve also been the one to break bad news. I’ve told a mother that her baby isn’t there any more. I’ve broken news to a wife of 40 years that the love of her life may not hold on to his. Dealing with those people who are left with grief is a privilege that not many get in their lifetime.

Grief is a noun of metaphor, not definition. It is a canvas bag full of mosaic pieces that gets put into the hands of the bereft, who are expected to make some sense of the whole with each day’s lucky dip of broken shards. Over time the bag does get emptier; surviving starts to give way to living. But pieces keep coming, triggered by unforeseen events, flooding back with a little less sting than the last time.

Grief is simultaneously elusive, awakening, depressing and defining. Something to be avoided. Or maybe not.

A while ago a couple attended the emergency department together. Charles had been found unconscious by his wife, Mary, who had started CPR. The CPR had triggered her angina. He, usually a healthy and active man, arrived unconscious smothered by the telltale smell of impending death. She lay in the opposite bay having a heart attack. We couldn’t work out right away what had caused Charles’s collapse. While we investigated, I discussed with Mary whether or not he would want to be brought back to life should he deteriorate further.

This was not quite Lego in ears.

A lot of good medicine later Charles stopped smelling of death and started to step back towards life. Every hour as I checked back in with his wife I had more good news. On this occasion a full hospital with no available beds was a blessing in disguise: the length of my shift permitted me to remove every last shred of the grief that my earlier news had caused and turn it first into cautious hope, and later celebration. It was a beautiful thing.

Walking through grief is an exercise in trust, in faith and in mystery. The opportunity to study it from beginning to resolution that day in the emergency department was an eye opener. It was clear that Charles and Mary’s relationship was more alive at the end than it was before. Even after many years of marriage there was an expansion of love that wasn’t there before.

As children, we learn that the good turns up in colours and bright melody, and the bad in shades of black with menacing music to match. We learn to put experiences in boxes and avoid the one marked “painful”. That day was a gift. It helped me to appreciate that grief, for all its pain and helplessness, is also an invitation, that only dense colour lights up against black and that the decision to live is, therefore, a decision to colour densely. I learnt that it is colour-by-numbers and our only job is to deal with the little patch in front of us well, because the picture is far too big for us to see the whole.

Charles and Mary went back to normal life. Their time in hospital gave us the opportunity to adjust their medication so that their hearts beat better, their arteries are clearer, and their bodies are able to do what they should. A side-effect of our care was that their love grew and their appreciation for life is greater.

Quite possibly, Charles is also grumbling at Mary for breaking one of his ribs. Mary probably won’t let Charles out of her sight, which means fewer biscuits for him.

“See you soon” is not something you want to hear from your emergency department doctor, but I’d like to think that perhaps if they do return it’ll be for a grandchild that they have lived to see.

Maybe one with Lego in his ear.

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