Why We Must be Better at Death

Well, hello.

I’m going to be talking about the orchestration of death.

To orchestrate something is to manipulate the elements of a situation to achieve a desired effect. So today, I’m talking about shaping the elements surrounding a death to create a story we can heal from. To create a good death story.

Who am I?

I’m Jessica Hansen, and I’m a nurse. I’m a trauma nurse in Flagstaff, Arizona. I’m also an instructor. I teach advanced trauma nursing, advanced cardiac life support, and CPR.

Most importantly, and the reason I’m here, I am surviving the death of my youngest son, Mason.

When I told my family and friends that I was going to speak about this, they thought I was crazy. I don’t know whether they’re wrong.

But I told them, “I have to tell the world. I have to tell everyone that there’s a better way to do this.”

So here I am.

I have the perspective of a trauma nurse who has witnessed death since I was 18 years old. Now I also have the perspective of a mother whose child died traumatically.

I’m here because I truly believe that everybody in this room has the power to make a difference.

Everybody in this room has the power to create a death story that is incredibly beautiful, even when the death is traumatic.

I’m here because I believe Mason’s death story was the gold standard. It was perfect and completely beautiful.

I also recognize that the way I handled death as a healthcare professional was completely inappropriate and deeply unhealthy.

And in that recognition, I saw that the way I dealt with death directly affected how my patients’ families would heal.

This is the part of the presentation that makes me really nervous, because I’m going to tell you that I was a horrible nurse.

And you’re going to think, “Why are you standing here teaching us about death when you clearly sucked at it?”

So this is where I tell you, yes, I kind of did.

I wasn’t explicitly taught to handle death inappropriately. I think I saw one slideshow in nursing school. It was basically, “Here are the five stages of grief. Bam, bam, bam, bam.”

That was essentially all I got.

But once I started working, I learned a couple of things.

I learned that we needed to hide resuscitation efforts from families because they couldn’t handle them. It would be too traumatic.

That isn’t true.

I learned that I needed to be stoic and show no emotion, because showing emotion would somehow take away from the family’s grief.

That isn’t true either.

I learned to practice this ABC, 1-2-3, robotic form of nursing. It stripped nursing in general, and especially the experience of death, of its humanity.

I completely dehumanized the death experience.

I’m going to give you an example of how incredibly judgmental I was. I’ve changed since then, so hear me out. I’m on the other side of this now.

I was the charge nurse in our operating room when I received a call from the emergency department.

They said, “We have a gunshot wound to the head. It was a gang fight, a drug deal gone wrong.”

I hung up the phone, and I was pissed.

I thought, “God, I don’t have time for this today. I don’t want to take care of somebody who doesn’t want to take care of himself.”

So, being the judgmental nurse I was, I gathered my thoughts and went down to the emergency room to get the patient.

I brought him into the operating room. He was actively herniating, meaning his death was imminent, and we needed to perform a craniotomy to try to save his life.

Once we got into the operating room, we quickly saw signs that things were not looking good.

We prepared him for surgery, and the neurosurgeon looked at me and said, “Jess, can you please tell the family that we’re doing everything we can, but it’s not looking good?”

I said, “Sure.”

I didn’t stop for half a second to think about what I was going to say to this family.

Nonchalant, stoic, arrogant, judgmental Jessica walked into the waiting room.

What was I expecting to see? Maybe a girlfriend with a neck tattoo. Maybe more gang members.

I walked into the room and said, “I’m here to speak with the family of so-and-so.”

Thirty members of his family stood up.

His mom and grandmother walked toward me.

I simply said, “Yeah, well, we’re doing everything we can, but it’s not looking good.”

No emotion. No feeling. Nothing.

His grandmother dropped to her knees and began crying. His mother just stared at me in disbelief.

On March 31, 2016, everything changed.

This is Mason.

Mason was run over by his father in our front yard.

I am a relatively competent human being. I looked at my son, and I knew there was no way anyone could survive something like that.

My very next thought was, “Do you want to save him or don’t you? Start CPR.”

So I did.

Think about the psychology of that. My head was telling me there was no way anybody could survive something like this. My heart was begging for it not to be true.

My head and my heart were on two completely different levels.

I needed to let them catch up. I needed to let them reach the same place.

I performed CPR on Mason all the way to the hospital in the back of a truck.

I got out and ran as fast as I could through the emergency department to Trauma Bay 3. I knew exactly where I was going.

I was yelling, “Bring the pediatric code cart. Call a neurosurgeon. We need help. Please help me. My baby is dying.”

I reached Trauma Bay 3 and placed Mason on the gurney.

I made eye contact with Dr. Jennifer Cotton and said, “My baby is dead.”

She looked at me and initiated CPR.

She told her team, “Start CPR.”

That was it.

She initiated the orchestration of Mason’s death.

How lucky am I?

Had she said, “Yeah, you’re right. He’s gone,” and turned away, there is no way I would be able to stand in front of you today. There is no way I would have been able to take a deep breath the next morning.

The way she initiated that orchestration was a gift. A beautiful gift.

I am so grateful.

We performed CPR in the emergency room. And by “we,” I mean I climbed onto the gurney and performed CPR on my son.

I needed to feel the warmth leave his body. I needed to know that he was truly dead.

I needed to know, professionally and personally, that I had done everything I could to save my baby’s life.

So I tried.

At one point, Dr. Cotton looked at me and said, “We’re going to do two more minutes of CPR, and then we’re going to pronounce his time of death.”

Those two minutes were incredible.

They were the final 120 seconds of attempting to save his life.

There were about 75 people in the room, and everybody was completely silent.

It wasn’t a busy silence. It wasn’t the kind of silence where people are thinking about someone or something else.

It was an eerie silence. Deep and painful, yet completely beautiful and appreciated.

After she pronounced his time of death, the orchestration did not stop. It simply continued.

Mason was dead, and there were things I wanted to do.

I sang to him one last time. I sang his goodnight song.

I cut some of his hair and placed it in a specimen cup so I could smell him later.

I held him for four hours after he died.

Then I took a picture of his hand resting on my chest.

Some people might think it’s morbid to photograph a dead baby’s hand on his mother’s chest.

I have that picture, and I’m going to show it to you.

It’s intense. I think it’s very clear that this is a dead baby’s hand resting on his mother’s chest.

But when you truly look at it, holy cow, it’s beautiful.

It validates that I had a son who lived and died. It validates that I struggled and survived.

This picture is everything.

My son has been dead for 980 days. I have looked at this picture every single one of those days.

In fact, and this might sound a little strange, I love it so much that I asked one of my friends to draw it. I have it hanging on the wall in my home.

This picture is everything.

It isn’t weird.

Why am I telling you this story?

I’m not telling it so you’ll feel sorry for me. I don’t want to be pitied.

I’m telling you because, by the time we leave here, I want you to believe that a traumatic death, even the traumatic death of a child, can be beautiful when someone like you is there to orchestrate it.

So I’m going to ask you to do something morbid. It won’t be fun.

I want you to go home and have a conversation with your loved ones. Maybe your husband, your wife, your mother, or your father.

I want you to imagine that somebody you love with every piece of yourself has died.

Maybe it’s your child. Maybe it’s your spouse. I don’t know who it is, but imagine someone whose death would steal your breath away.

They have died.

Now create your gold-standard death story.

It may look nothing like Mason’s.

But once you create that story, place it in your toolbox. Save it for the day when you may be able to help orchestrate someone else’s death.

How lucky are we that we’re human beings and get to do this?

We get to enter somebody’s life, make a profound difference, and create a solid foundation for healing.

How lucky are we?

I have some ideas about what you should place in that toolbox and what should be part of the gold-standard death story you create.

Invite the family into the room.

Get them in there. I don’t care how traumatic the death is.

Saturate their senses.

This is a really important one.

We have five senses. Think about saturating all of them so the family can understand that the death is real.

They are not going to believe it.

You could be the most competent person in the world, but when someone you fiercely love is dying, you are not going to believe it.

Help them understand that it is true.

Empower them. Empower them to make their own decisions.

Once they are in the room, they will feel empowered.

Prepare.

Have that conversation with your loved ones. What would you want that death story to look like?

And most importantly, I want us to heal.

This isn’t only about the patients and their families. This is also about us, the people orchestrating the death story.

How can we heal?

We can heal by orchestrating beautiful death stories.

How can patients’ families heal?

By having us there to help orchestrate beautiful death stories.

Thank you for your time.