Caregivers learn to cope with death, life

Sheila Frascht will never forget the day she held a dead child in her arms as the hospital chaplain performed a baptism.

The baby had died earlier that day, and the baptism was the parents' final wish.

That was the same day, Frascht, a pediatric intensive care unit nurse at the University of Iowa Children's Hospital for more than 23 years, accompanied a set of siblings to a funeral home to say goodbye to their parents, who had died in a car accident that day.

'There were kids without a mom, and a mom without her kid,' Frascht said.

When she has days like that, she needs time to process the events and reflect. A glass of wine helps, too, she said.

'I can still be amazed,' Frascht said. 'I think about how someone was just here — and then their heart has stopped beating when in my mind they're whole and here.'

About 2.5 million people die each year in the United States — suddenly in unexpected accidents and slowly from long-lasting diseases. They're cared for by thousands of health care workers who offer physical as well as emotional comfort.

But dealing with death and that kind of grief day in and day out is emotionally exhausting.

'It's our job to help people face what they're going through,' said Lorrie Prasil-Holcomb, community hospice supervisor at UnityPoint Health-St. Luke's Hospital. Prasil-Holcomb has spent about 13 years providing grief support to those with a family member in hospice.

The grieving process starts long before a death, she said, for both the family and the person in hospice care. Prasil-Holcomb helps them deal with secondary losses — activities such as no longer being able to eat or walk on their own. And once the family member has died, she helps those left behind figure out what life will look like now.

'It's a privilege and an honor to do this work — to really meet people where they are,' she said. Death 'is something that everyone will experience.'

Hard Days

But there are some days when Prasil-Holcomb wants to go 'underground,' she said. She'll walk into a home and the family she's there to support reminds her of her own.

'Several years ago, I had a patient who was the same age as my husband, his children where the same age as my children,' she said. 'Those similarities — I was impacted by that. ...

Your personal experiences, there's overlap.'

Over the years she's had to learn to put on a face that looks different from how she really feels inside, she said, because she's there to support the family not herself.

'You have to keep your composure there,' she noted.

There are days when she feels as if she couldn't help someone grieving find hope, she said. There are times when her emotions get the better of her on the drive home. There have been a few instances when she's needed to take a vacation to reframe her mind-set.

'I look again at why I am here — what is my purpose?' she said.

On hard days, Jenny Hohneke, a hospice nurse for more than 10 years at Hospice of Mercy, takes the long way home. She does that so she can unload her burdens, she said, because it's important to be present for her family.

Hohneke works with 10 to 12 families at a time, visiting them one to two times a week on average. She can work with a patient for only a few days or weeks while she'll work with others for more than a year.

'You get connected to families and become part of the family,' she said. 'It's appropriate to cry at times. I have cried before.

'You can feel it in your voice. But it's part of our job to not fall apart.'

Coping

Long walks, prayer and talking through emotionally heavy situations with co-workers or family members are some ways the women interviewed for this article deal with the stresses of their jobs. It's important to find the joy, they said, and to reframe their perspectives.

Hohneke gets a massage every month. She also likes to spend time in nature, kayaking or camping, which she said helps replenish her energy.

'I give a lot here every day. I need something left when I go home,' she added.

But it's her belief in God that Hohneke attributes as the biggest reason she is able to get through the sadness and grief. She thinks those with a strong faith and belief in an afterlife have an easier time making sense of the death and sickness that health care workers can face.

'God has called me to do this and brings peace to me,' she said. This job 'is a way to bring love and grace and forgiveness to people.'

Dianna Gilchrist, a paramedic for 27 years at Area Ambulance, has showed up to shootings, stabbings, car accidents, suicides and hundreds of other tragedies over the years, she said, but the hardest calls always involve children.

She likes to talk to her son to deal with her hard days. He's also a paramedic and he understands the stresses and frustrations of the job, she said.

'Some times it's a little harder to (go on), but you go on,' she said.

When Frascht, the pediatric nurse at UI's Children's Hospital, first began her career, she had very disturbing dreams. It wasn't until she learned how to fully process the day's events and grapple with the difficulty of children dying so young that the dreams stopped.

'I had to reconcile that,' she said. 'I would think, 'They didn't deserve this.''

The nurses in the PICU meet and talk with one another when they experience a hard or difficult death, she said. She also will speak with her mother, who is a retired nurse.

'And I have three kids. Sometimes I go home and hug them really tight,' Frascht said. 'They're old enough to know what that means.'

Frascht has standardized the Children's Hospital's bereavement program, giving parents and their children a way to make happy memories even in some of their darkest times, she said.

A professional photographer takes family portraits. Children can make handprints to serve as keepsakes for their parents. Families can decide how the final moments will look — such as when a young boy with a heart defect that kept him inside for most of his life got to die outside, in his parents' arms.

'The fact we can come to them in their darkest hour and help them find a sacred space, that is the definition of grace,' she said.

Views on death

Over the years, helping so many patients and their families come to terms with death has reshaped how each woman views her own life and eventual death.

'You go into each person's life and there is something they give you back, or something you take away,' Prasil-Holcomb said. 'So many patients have a positive outlook on life even as they're facing death, even though they're in pain and struggling.'

They've taught her how to die with dignity and grace, she said. They've also taught her that everyone wants to be heard.

'I want someone to do that for me when it's my turn to die,' she added.

Frascht said she appreciates her life more, even when she's faced with hardships. Her young daughter has Down syndrome, among other health problems — she needed heart surgery when she was younger — while her husband was recently diagnosed with cancer.

No one knows how long they'll be on the planet, she said, so it's important to make the most of the days you have.

'Death is something to not be afraid of,' she said. 'Sometimes living can be worse than dying.'

Hohneke has learned that death is not up to her.

'I don't have control over it,' she said. 'And someday, this will happen to me, either through an accident or an illness.'

Being around death helped her figure out what she wants in death — to be comfortable, to be surrounded by her family and to not worry about the rest.

'Patients have said to me, 'You're going to be in heaven before you know it and we'll see each other again,'' she said.