Gracie's been having a hard time again.  Work is getting to her and she doesn't have much in the way of coping skills other than drinking or weed or whatever else she takes from time to time, ativan I'm guessing.

She's working at a homeless shelter and one of her clients died of an overdose today.  Everyday, somebody there overdoses but today it was a woman whom she talks to on a regular basis.  This woman was about the same age as Gracie.  This woman died, sitting at a table with her back against the wall, with people around her, nobody noticing that she had stopped breathing until it was too late.

They tried to resuscitate her but they weren't successful.  The paramedics took her out of the shelter in a body bag and it was the first time Gracie had ever seen a dead body.  Gracie was crying as she told me this.  I told her it wasn't her fault but I worry that Gracie will take it on, that she will carry it and that she won't know how to deal with this death.

People die.  I remember some of the codes I've been involved in and it's always horrific.  There is blood and garbage on the floor.  People are yelling and ribs are being broken with each compression.  It's awful and I hate them.  The first code that I saw was stopped after about thirty minutes but the patient continued to have agonal breaths after she was pronounced dead.  She was my patient and had only been admitted two days previous but she also had metastatic breast cancer that had never been treated.  It was a violent death and I remember it still thirty years later. 

I imagine the attempted resuscitation that Gracie witnessed today was equally violent and shocking.  I'll have to talk to her tomorrow to see what kind of debriefing they had, if any.  I think I'll tell her that I carry these people with me still and that it's okay to grieve their deaths, I did what I could for my patients and she did what she could.  I always say a prayer for my patient's soul.  I don't know if that makes any difference but it helps me to believe that the divine will now care for this person's soul.  

I hope that the shelter has some process in place for both clients and staff to deal with these deaths, to help everyone cope with the deaths.  For me, I always try to just stay with my patients, to find a way to give comfort.  But a code is not a normal death, it is an interference and regardless of the outcome, it doesn't feel good.  

I also hope that Gracie doesn't spiral down again because of this.  It's Christmas, it's a pandemic and it's death.  I wish I knew how to help her to be more resilient but there are days I can hardly get through.  I have the big guy who helps me build resilience, I guess we'll try to be there for her because if she does better, the little guy does better as well.