Helping Patients and Staff Live with Dying: A Nurse's Perspective

When I was little, I had a bird named Hot Shot. Much later, I found out that Hot Shot had died six times before I discovered her lifeless at the bottom of the cage. The other birds had been quietly replaced to avoid a conversation about death.

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

In that moment, I understood that life isn’t permanent. Life simply is what it is until it isn’t, and even then, it deserves to be held. The issue wasn’t the loss itself. It was the silence surrounding it.

As an artist and sculptor, I have always been drawn to illumination and transparency. I was pursuing a career as an exhibiting artist until 2009, when my mother suffered an accident. After advocating for her through surgery, recovery, and rehabilitation, I made a surprising choice: I decided to become a nurse.

This bewildered many people, but my central interests remained unchanged. How do we communicate in ways that foster meaningful connection and transformation? How do we respectfully hold life’s mysteries, especially at the end?

After 11 years as a nurse in the Cardiothoracic Intensive Care Unit at UCLA Health, I regularly witness remarkable recoveries made possible by extraordinary medical technology.

Sometimes, though, recovery is no longer possible. At that point, our sterile medical environment can feel alienating and unsupportive of the dying process.

Physicians and surgeons, whose optimism people so desperately rely on, often struggle with the Hot Shot problem. They are trained to fix what is broken, even when faced with the unfixable.

Early in my time in the ICU, I cared for a patient named Marble who had a surgical wound so severe that it nearly split her in two. Her healing had stalled, yet the surgical team insisted on continuing an excruciating daily procedure.

Eventually, she voiced her wish to stop.

The surgical team wasn’t ready to hear her, so I took a stand, literally. I stood outside her door and refused to let anyone enter until her wishes were acknowledged and a palliative plan was put in place.

That moment with Marble crystallized my commitment to advocating for patient autonomy and the right to die on one’s own terms.

It also raised a question: How do we better honor the voices of those we care for? Are we truly listening, or are we caught in a cycle of treatment that overlooks the humanity of the people we serve?

In 2017, I took Roshi Joan Halifax’s course Being with Dying, which she teaches alongside nurse ethicist Cynda Rushton and physician Tony Back. The retreat changed my life.

Ever since, I have said that I would follow Roshi Joan to the ends of the earth. In reality, I have regularly followed her to the top of it, serving high-altitude Tibetan communities through Nomads Clinic, a medical outreach program and pilgrimage in the Himalayan mountains of Nepal.

Roshi Joan’s wisdom and the profound teachings of this service have made me the nurse I am today.

As my practice evolved, I became a go-to colleague for patients nearing death.

After one particularly moving experience, I helped Elizabeth’s mother bathe, hold, and honor her daughter. Their nurse turned to me and said, “That was so beautiful. I never could have made that happen for them.”

I emphatically disagreed, but her comment made me wonder: How do we institutionalize love? How do we formalize intimacy, compassion, and reverence at the end of life for all providers, clinicians, and caregivers?

In 2023, I enrolled in Alua Arthur’s Going with Grace course to explore my role as a death doula.

Inspired by that training and the death doulas I met, and with the extraordinary encouragement of my brilliant and benevolent unit director, Katrine Murray, I founded COMMUNITY, a nurse-led initiative at UCLA dedicated to transforming how we approach death and dying in the hospital while nurturing the collective well-being of patients, families, and staff.

The groundwork for this transformation was laid during the pandemic.

Together, our ICU cared for some of the sickest people in Los Angeles County. It was a time of collective loss and upheaval that challenged our ability to cope. We were exhausted and often deeply, deeply sad.

But that undeniable vulnerability fostered a new commitment to transparency, interdependence, and collaboration. We realized we could not do this work alone, and we all benefited from the creativity and teamwork that COVID demanded.

COMMUNITY is a 12-member nursing committee in the CTICU. Our first goal was to bring tenderness and reverence to the dying process.

Through classes, rounding, reference sheets, and videos, we train nurses in every aspect of end-of-life care, including grief, a critical component often omitted from nursing and medical education.

Grief, like the Hot Shot problem, doesn’t disappear when we ignore it.

Resources from Dougy Center help us become grief-informed so that we can better support our patients, their families, and one another.

For dying patients, COMMUNITY has reimagined the ICU as a place of ritual, where music plays, candles glow, and intimacy with the dying process is encouraged.

The healing voices of Threshold Choir sing three-part harmonies at patients’ bedsides every Thursday. The Three Wishes program allows us to create deeply personal end-of-life experiences.

We helped Jose and Irene get married in the ICU before Jose died. We helped Maricela plan her Mardi Gras-themed farewell. We helped Quan and Karen take some of their final breaths outside, surrounded by their families.

Honoring the dying process is vital to patients and families. It is also inseparably linked to reducing distress and burnout among clinicians by allowing them to see the end of life as a profound transition rather than a failure.

Jeannie Meyer, our palliative care clinical nurse specialist and a wellspring for COMMUNITY, connected me with Heather from Don’t Clock Out, who introduced me to the Pause, a ritual created by nurse Jonathan Bartels at the University of Virginia.

In our unit, we call it the Moment of Silence.

Clinicians gather in the room around a patient who has died. The moment is often followed by an outpouring of emotion and gratitude between the patient’s family and the ICU family, our family.

Before this initiative, the providers who placed the comfort-care order and had sometimes cared for a patient for weeks rarely returned to the room after the death. They missed the opportunity for reflection and mutual gratitude.

Five months into the initiative, 92 percent of our staff reported feeling more connected to patients and their families. Eighty percent said it brought greater cohesion to our team, and 85 percent found closure in these moments of honor and respect.

Protecting the dignity of a patient’s dying process sometimes requires great courage.

COMMUNITY also addresses ethically complex family dynamics that can cause distress, particularly when a patient’s wishes are unclear.

Our Goals of Care initiative promotes open communication about patients’ values and tolerances. It empowers nurses to ask, listen, and document what patients want so they can advocate for plans of care aligned with those evolving wishes.

Goals of Care elevates the voice and role of nursing while breaking through the silence and fear surrounding death with humble curiosity and kindness.

We each have our own way into these conversations. Mine is often: “Besides the people in this room, what do you love most?”

Supporting one another is also central to COMMUNITY’s mission.

SHOW UP and SHARE is the name of our open forums, where our interdisciplinary team can decompress and discuss recent challenges and losses.

SHOW UP and SHARE is where we learn to care for one another and build trust. It is also where we celebrate our compassion and resilience, along with the inspiring and sometimes extraordinary strength we witness in our patients.

Our patients are always our greatest teachers.

Finally, COMMUNITY is committed to fostering a spirit of inquiry. Through data collection and analysis, we are measuring our impact on patients and clinicians alike.

Our early results are promising. With several applications submitted, we hope to share our findings at conferences and grand rounds, demonstrating that intentional end-of-life care benefits everyone: patients, families, staff, and the healthcare system as a whole.

Through this work, I have come to understand that true care is not about fixing. It is about meeting one another with acceptance, compassion, and clarity, especially when there is nothing left to fix.

In a healthcare system built to cure and save, death often appears to be a failure. But when we shift our perspective and embrace death with tenderness and transparency, we can build resilience, connection, and a true sense of purpose.

I have also come to understand that distress and burnout are inseparably connected to how we treat the dying and the dead.

By honoring them, we honor our role as caregivers.

Holding Hot Shot’s body in my hands taught me about impermanence and the beauty of honoring life.

Let us treat the dying process as sacred. Let us be present together in ways that allow clinicians, caregivers, families, and patients to find meaning and dignity at life’s end.

We are not separate. We all suffer. We all love. We are all connected, the living and the dead.

In the end, we all need one another. We need COMMUNITY.

Your family, your loved one, your unit, and your hospital need COMMUNITY, too.

Thank you.