The ones who stay with us

By Nettie Reynolds, MDiv, hospital and hospice chaplain, retired

Every spring, when the sunflowers start appearing, I think about a patient I cared for years ago. She loved gardening and told me about sunflowers she’d planted for people she loved. The patient hoped they would bloom the following year, even though she knew she might not be there to see them.

During my years working in hospitals, I encountered more patients and families than I could possibly remember now. Some I knew only briefly, while others I spent much more time with. And every so often, something brings one of them back. A song, a photograph, or just something said in conversation. For this patient, it’s sunflowers.

I’ve wondered why that happens. Why do certain patients stay with us long after our role in their care has ended? Healthcare requires boundaries, as it should. We can’t carry every patient and every family home with us. But being affected by another human being doesn’t necessarily mean we’ve crossed a boundary or cared too much. Maybe it’s simply part of what happens when our work brings us into some of the most vulnerable moments of others’ lives.

Anyone who has spent time in healthcare knows that sometimes the hardest part of an encounter isn’t the illness itself. Families may be frightened, exhausted, angry, or divided about what should happen next. At the start of my career, I carried more of those types of encounters home with me. I replayed difficult conversations and wonder if I could have said something differently. I took someone else’s anger personally, even when, with some distance, I knew that it had little to do with me. Over time, I began to recognize what belonged to me and what didn’t, and understand that someone’s fear, anger, or family conflict didn’t necessarily have to come home with me.

Another question is what happens to the experiences that do stay with us. How does remembering certain patients influence the care we give to current and future patients? A challenging family may teach us not to personalize another family’s conflict. A frightened patient may help us recognize fear a little sooner the next time we encounter it. Someone who generated significant frustration can help us become more patient.

The patient who was a gardener taught me not to presume what will matter most to someone nearing the end of life. What they want to leave behind can take many forms—instructions, stories, photographs, family traditions, or something entirely their own. For her, it was a garden filled with sunflowers.

There’s a difference between remembering someone and finding that an experience is becoming difficult to leave behind. During my years as a hospital chaplain, my job was to support clinicians as well as patients and families. Clinicians need someone to share about the patient they can’t stop thinking about, like a death that was particularly difficult or the family encounter they keep replaying.

Chaplains are trained in empathic listening, and part of what we offer is the opportunity for someone to tell the story. Not to fix it or tell them how they should feel, but simply to listen as they work through what happened and begin to understand the impact it had on them. Being affected by a patient is part of caring for people, but that doesn’t mean we have to process every difficult experience alone.

Talking with someone isn’t the only way to process an experience. Psychologist Dr. James Pennebaker has spent decades studying expressive writing, or what happens when we put difficult experiences into words. In “Opening Up by Writing It Down: How Expressive Writing Improves Health and Eases Emotional Pain,” he explores how writing about emotionally significant experiences can help us make sense of what happened.

For clinicians, writing privately can offer another place to reflect on an encounter. This isn’t writing for publication or for anyone else to read. Patient privacy still matters, of course, so identifying details should not be included. Here are three ways to begin:

1. Write what you remember.

Set a timer for 10 or 15 minutes and write about the experience without worrying about grammar, structure, or making it sound good. What keeps coming back to you?

2. Write about what stayed with you.

Begin with the question, “What am I still carrying from this experience?” Then follow wherever the answer takes you.

3. Write about what you want to carry forward.

What did this patient or experience teach you that you want to bring into your care of someone else? What are you ready to put down?

Every spring, when I see the first sunflowers, I remember the patient who gardened and what she wanted the people she loved to know. That her love would be in the blooms.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.