After the 1995 bombing in Oklahoma City, the search and rescue response included specially trained cadaver dogs. Their job was to help detect and retrieve the missing. With each discovery, the dogs initial excitement quickly vanished, and the person was found to not have survived the incident.
Hours turned into days of pulling human remains from the rubble. According to the FBI, no act of domestic terrorism has exceeded the death toll of this attack.
In the days following, search and rescue teams started to observe the dogs becoming more sluggish until they eventually refused to enter the scene. The dogs appeared depressed.
Unsure what to do, one of the volunteers suggested that they "bury" a few first responders in the rubble. Responders hunkered down in the rubble and one by one the dogs entered the scene and retrieved "survivors." The acts of discovering live bodies eventually helped the dogs resume their search.
This story was shared with me by a volunteer first responder from that scene. It poignantly conveyed the importance of the need for hope. Perhaps hope is needed in the same way as the need for attachment.
Unfortunately, reasons abound for feelings of hopelessness in those working in healthcare right now. Contributing factors exist at every level. At the systems level, before COVID, healthcare facilities in my area began integrating to create a larger, coordinated system. I imagine there were many benefits to doing this, eg, shared resources, cost savings, etc but there were downsides for my healthcare professional patients. As the larger system made improvements in efficiency, my patients who required the highest level of care found themselves in the academic medical center while those requiring lower levels of care remained in the outlying hospitals. In a short period of time, my patients performing clinical duties appeared more stressed and overwhelmed.
Presentations from leaders confirmed my observation. The case mix index had jumped for the academic medical center. My patients were now caring for the sickest and most complex patients from across a three-state area.
At the individual level, improvements in efficiency meant everyone was expected to "practice to the top of your license." For one specialist, already the last stop for her patients, this translated into follow-ups with a good prognosis being scheduled with the nurse practitioner while she continued to evaluate patients in dire situations.
"Oh, and they turned on a notification in the medical record so now every time a patient I've seen dies, I get a pop-up notification," she shared with sarcasm.
Cynicism and Despair
Without exception, every caregiver that I have treated has shared the desire to improve the lives of their patients. Carrying this belief is one of the ways in which societies have come to see healers as symbols of hope.
During COVID, many have experienced with greater clarity the degree to which we emotionally rely on healthcare teams, either as the frightened family member separated from their loved one, the terrified patient in quarantine, or the healthcare provider barraged by calls from patients' families.
Countless times, healthcare professionals have arrived in my consultation room, holding the pain of their team or a particular patient and their family. Their empathy fused with feelings of desperation, helplessness, and unbearable loss.
In their book Transforming the Pain, Saakvitne and Pearlman describe this reality when caregivers are left untended too and coping with vicarious trauma:
Unaddressed vicarious traumatization, manifest in cynicism and despair, results in a loss to society of hope and the positive actions it fuels. This loss can be experienced by our clients, as we at times join them in their despair; by our friends and families, as we no longer interject optimism, joy, and love into our shared pursuits; and in the larger systems in which we were once active as change agents, and which we may now leave, or withdraw from emotionally in a state of disillusionment and resignation.
The Restoration of Hope
As I write, I am sitting with the recent knowledge of a young, female attending in our system who died by suicide. Of course, we can't fully know what was happening in this person's life.
Healthcare providers within my care are shaken. Session time is spent creating space for tender recollections of loneliness, being overwhelmed, or despair. Old pain resurfaces. In each encounter, I allow for the space to expand, holding the pain, and then inevitably the space contracts as stories are shared where hope was restored. Chairs of departments sending a kind and encouraging note. Colleagues taking note and generously offering to lighten the load. Leaders offering relief in the form of time away.
Perhaps paradoxically those who we strive to show our best self too are also the ones most positioned to care for us in our worse moments.
As my peer group and I collectively grieved the loss of a colleague we did not know, a friend and colleague shared the poem "Wild Geese" by Mary Oliver from her book Dream Work: "Whoever you are, no matter how lonely, the world offers itself to your imagination…"
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: M. Chase Levesque. The Importance of the Need for Hope - Medscape - Nov 08, 2022.