Building Community Around Serious Illness and Death

Lindsay Brant, RN, BSN, CCRN, EOLD, MFA, has worked as a critical care nurse in the Cardiothoracic Intensive Care Unit at UCLA Health for more than a decade. She is also a trained integrative therapist, death doula, and artist.

Lindsay founded and chairs COMMUNITY, a nurse-led committee dedicated to promoting inclusivity, transparency, and resilience in the CTICU. Its work begins with a central question: How can we show up for one another as we serve our patients and protect their dignity and autonomy?

“Whether I am manipulating a material to achieve a moving effect or harnessing love and wonder to inspire a patient’s recovery, nursing and art are ways of seeing and being that promote curiosity, connection, and change.”

EW: Death is often considered taboo. Was there a defining moment that ignited your passion for discussing end-of-life experiences openly?

Lindsay Brant: When I was little, I had a bird named Hot Shot. Much later, I learned that Hot Shot had died six times before I was finally the one to find her at the bottom of the cage. The other birds had been quietly replaced to avoid a conversation about death, loss, and the impermanence of life.

When I found the seventh Hot Shot, I wasn’t scared or devastated. I can still see her face, the kernel stuck in her throat, and remember the feeling of holding her still body in my hands.

I think I inherently knew that life was impermanent. Life is what it is until it isn’t, and even then, it should be held. The silence surrounding Hot Shot’s deaths was the problem. Life changes.

Surgeons, whose optimism we want and need when they are our only hope, often suffer from the Hot Shot problem. They want to fix.

Early in my ICU career, I cared for a patient with a wound that nearly split her in two. It wasn’t healing, but the surgical team insisted on debriding it daily, an excruciating procedure. Because of her unstable condition, they wanted to use as little pain medication as possible.

She had endured this and put up a tremendous fight. Eventually, she was ready to stop. She was ready to die and became as adamant about her death as she had been about fighting to live.

The surgeons couldn’t hear her.

I stood in front of her ICU door and refused to let them enter until her voice was heard and a clear conversation had taken place about her prognosis and a palliative plan of care.

From that moment forward, I was determined to advocate for patients’ right to stop treatment and their right to die on their own terms.

The dying process is often denied or pushed aside in critical care because we have so many tools that can delay death and, ironically, extend it. I am determined to honor this process as sacred. Death should be respected rather than ignored.

There is so much meaning and opportunity for transformation that can be lost when death is left unacknowledged.

EW: How does your work intersect with conversations about the end of life and grief? What will you be discussing on the End Well stage?

Lindsay Brant: I am an artist and a sculptor who works with illumination and transparency.

In 2009, my mother had an accident. After three months of advocating for her through surgery, recovery, and rehabilitation, I decided to become a nurse as well.

The change surprised many people. Although I had to rewire my brain to develop a new kind of expertise, my underlying interest remained the same: How do you communicate in a way that creates meaningful transformation?

Whether I am manipulating a material to achieve a moving effect or harnessing love and wonder to inspire a patient to take the necessary steps toward recovery, nursing and art are ways of seeing and being that promote curiosity, connection, and change.

I have now worked as a nurse in UCLA’s Cardiothoracic Intensive Care Unit for 11 years and am deeply familiar with the extremes of what modern medicine can do to extend life. The recoveries I witness and help make possible each week are miraculous.

When every Herculean medical and surgical measure fails to return a patient to wellness, however, communication often begins to falter. The sterile medical environment can become alienating and unceremonious just when it is time to reorient care toward the end of life.

I am inspired to transform this failure, this lack of clear, warm language and heartfelt ritual surrounding the death and dying of our patients.

Learning how to be present with dying patients and their families has always been a natural interest and ongoing investigation for me.

In 2015, I trained as an integrative therapist so I could offer comfort and support through practices such as reiki, body scanning, and essential oils.

In 2017, I took Roshi Joan Halifax’s Being with Dying course, taught with Cynda Rushton and Tony Back. The retreat grounded me more deeply in the work of supporting patients facing uncertainty and impermanence. It also introduced practices that helped me maintain resilience and an openhearted, open-minded approach to care.

Roshi Joan and the brave, brilliant people gathered around Upaya continue to be a profound light along my path. Through presence, connection with colleagues, and the integration of alternative therapies, I became the nurse people turned to for support during the dying process.

Then a more difficult period began.

On January 17, 2019, the day the brilliant poet Mary Oliver died, I first heard the tapping. A red-headed house finch was pecking at my kitchen window.

Day after day, he kept tapping. Worried that he would injure his beak, I learned that he might have mistaken his reflection for a competitor. My partner and I covered the window with fabric, but he continued.

What was he trying to say? What was he preparing us for?

A few days later, while the tapping continued, my 12-year-old dog, Miss B, stopped eating. She had hiked five miles in the Verdugo Mountains the previous week, but when we took her to the veterinarian, we discovered that cancer had spread throughout her body.

Within days, she let us know she was ready to die by refusing to come inside.

I called an in-home veterinarian and gathered all her human and animal friends. Her life ended in the garden, surrounded by their love.

That was the day the finch stopped tapping.

A little while later, I dreamed about Miss B. We were in the Sierra Nevada on a familiar mountain trail.

She said, “I am here and I am everywhere, always.”

As she spoke, I looked across the meadow toward a horizon filled with scattered boulders and alpine lakes. She began to multiply, running, leaping, and sleeping. She was everywhere, integrated into the landscape like the boulders.

My older brother Ryan died two months later.

My best friend Cory died the following year.

My brother Harry died the year after that.

By then, COVID had ravaged the country. My unit cared for some of the sickest patients in Los Angeles County.

COVID became an inflection point. The scale of loss, distress, and upheaval exceeded our ability to cope. We were exhausted and, at times, infinitely sad.

The pandemic created a rawness and heartbreak that were devastating, but also profoundly opening. Our collective vulnerability could no longer be denied.

COVID also demanded collaboration. There was no way to manage it alone. We all benefited from the creativity and teamwork the moment required.

That simultaneous vulnerability and connection raised a question: How can we do this differently? How can we show up for patients and families? Perhaps even more importantly, how can we show up for one another so that we can become better clinicians and more openhearted, compassionate caregivers?

At the beginning of 2023, I joined 34 extraordinary people interested in the dying process for Alua Arthur’s Going with Grace course. I wanted to formalize my role as a death doula and learn more about death and dying beyond the hospital.

The course showed me how a diverse group of people with a shared interest can have a transformative effect on one another.

After completing my death doula training, and with the brilliant leadership of my unit director, Katrine Murray, I founded COMMUNITY. It is a 12-member, nurse-driven committee working to change how death and dying are handled in our hospital while nurturing the well-being of patients, families, and staff.

COMMUNITY’s first concern is how best to be present with, honor, and support patients and their families.

This requires open and transparent conversations about values, what gives a patient and family meaning, and which health conditions would feel intolerable to them.

Nurses spend intimate time with patients and are often best positioned to understand their evolving wishes. COMMUNITY empowers nurses to advocate for patients’ goals of care and ensure that those wishes remain aligned with medical and surgical plans.

Transitioning a patient to end-of-life care can require great courage. It means navigating denial, grief, and feelings of failure among both families and medical teams while protecting the patient’s dignity.

We now have a team and an established process to support nurses in this work, helping them remain present with grieving families while collaborating with medical teams with transparency and equanimity.

COMMUNITY’s second concern is transforming the medical environment into a place of tenderness and warmth that can hold the end-of-life process.

We educate nurses about the logistical responsibilities surrounding a death so that tasks can be delegated and colleagues can support one another. This allows the patient and family experience to remain more important than paperwork.

Dying calls for a ceremonial space, a ritual space, and a creative space that can initiate closure and encourage healing.

Guided by the wishes of patients and families, COMMUNITY facilitates this transformation and encourages greater intimacy with the dying process. Our intention is to provide compassionate, meaningful end-of-life care so that patients and families feel held as they grieve.

COMMUNITY’s third concern is the well-being, cohesion, and resilience of our team.

Our colleagues are constantly exposed to stressful and demanding experiences, placing them at high risk for burnout and moral distress.

COMMUNITY developed a series of open forums called SHOW UP and SHARE, where team members can examine the complex ethical dynamics they encounter alongside the extraordinary wonder and connection they experience while serving patients.

By creating another opportunity for open and honest conversation, SHOW UP and SHARE promotes courageous transparency, compassion, and cohesion.

EW: Cultures around the world have different practices and beliefs surrounding death. How has your cultural background influenced your understanding of the end of life and grief?

Lindsay Brant: The church I grew up in was green.

It celebrated the slippery sensation of a tadpole moving through your hand, the effortless way water striders cross the surface of a pond, and life’s perpetual emergence from death and decay.

It sanctified the visceral joy of running through the woods and sitting silently high in a tree, where no one could find me except the bugs and birds.

That connection to nature, the feeling of ending every day of play covered in dirt, gave me a grounding that no trauma, conflict, or sadness could take away.

Nature understands and teaches through paradox: grief and love, tragedy and magic, stillness and change, individuality and indivisibility.

Nature is always present and always changing, part of an endless continuum.

Death is natural. It extends beyond religion and culture because it undeniably connects all of us.

We are one, inextricably connected through the experience of living and the process of dying, which inevitably leads to the beginning of something else.

EW: What is the most significant societal norm or belief about death and dying that needs to be challenged or redefined?

Lindsay Brant: Failure, silence, and shame