Death, Grief, and Loss

Writing this editorial has not been easy. I have thought for many weeks and long evenings about how to meaningfully talk about death and the associated grief and bereavement that result from the loss of people and things that are important to us and loved. Part of my concern is that I absolutely do not feel qualified to talk about this topic, while also acknowledging that the topic itself is not comfortable for most people to even start thinking about, nevertheless much less to discuss thoughtfully and publicly. And yet we all experience loss in multiplicity through life. It warrants our further conversation. The considerations about death and loss affect us both personally and professionally. It is my sincere hope that most of us involved in dermatology nursing are not experiencing patient death and loss too frequently, but I know that expectation is not always realistic. The experience of working with patients is that we are often interconnected with their lives, even outside the context of their dermatology diagnoses or conditions. Dermatology nurses know that we are connected to our patients, as well as their experiences of their dermatology diseases, but also so much more so including knowing about their families, jobs, hobbies, and volunteer work, as well as knowing about their other health conditions. This relationship is simply part of our jobs. Consequentially, we do have those moments when we find out someone we have been caring for has died. Sometimes that knowledge comes directly from the healthcare system, sometimes directly from the patient's family and loved ones, and sometimes I know that the information about a patient death comes more indirectly. One of the, um, benefits of practicing somewhere for an extended time in a smaller community is that this information often comes to me through reading the obituaries in the local paper or finding out through a coworker who incidentally heard about the patient death in other venues, whether in a community organization or through religious organizations. Regardless, even if perhaps not unexpected, the news always catches me off guard, even if just for a few seconds. I know in my office we make sure to take a few moments to remember the patient, say a few warm thoughts about them, and be sure to comment that we hope their family is doing okay. How does your office deal with this type of situation? Do you do something similar? Do you have a more formalized process, for example, perhaps sending a sympathy card on behalf of the office? I'd be curious to know how different offices handle this situation. The problem with death and loss is that it is not limited to the professional sphere. Most of us have had loss personally, as well. This loss is often harder, simply for the fact that it is a little more personal, can affect us differently and more profoundly, and tends to be more pervasive and takes longer to adjust to. Grief is different for each person and can be severe and intensely personal. How does that affect us as nurses? Most of us probably want to offer comfort and support, but sometimes, even with our best intentions, it can be difficult to know how to best help friends and loved ones during these situations. This is likely in part because each situation is unique and the act of comforting and offering support would have different meanings for each person. I think most of us are just trying to do the best we can for each other. I like the idea that even if we might not get it “just right,” there are people who love us enough to try and keep showing up even if they don't get it quite right. We should be very thankful for the people who walk with us through the grief process. What makes this writing even more difficult is that writing about this topic is not just abstract thought. As many of you know, the Dermatology Nurses' Association (DNA) President, Nancy Smail (Figure 1), died on November 20, 2024. To see her obituary, please go to: https://www.lombardofuneralhome.com/tributes/Nancy-Smail. Nancy has been a long-standing DNA member and volunteer and loved this organization with her whole heart. She was proud to represent dermatology nurses, and her voice was one of passion and support for dermatology nurses and the DNA. I am proud to have had her as a colleague. Please join me in offering condolences to her family, friends, and colleagues as we mourn her death. Hoping to get a bigger picture of her volunteer work with the DNA, I asked her friends and colleagues for personal statements about their interactions with her.FIGURE 1.: Nancy Smail, RN.Here is what they said: Angela Hamilton, DNA Board member: “I loved getting messages from Nancy that said, ‘Can we talk.’ I always enjoyed our ‘fixing the world talks!’ It cleansed the dermatology soul. Networking and friendship has been the best part of DNA and Nancy was a true friend.” Blake Bryant, DNA Board member: “Nancy was always, refreshingly clear and authentic. It was a pleasure learning from her experience, and her unique style and approach was very impactful.” Mary Anne Hitt, coworker: “I worked with Nancy for 11 years in the research department, and thought of her not only as a coworker but also as a friend. She was the most caring, reliable, funny, and honest person I have ever met. Every patient she encountered she left a lasting impression on. You could always count on her to have an extra-large coffee on her desk each day, and years of wisdom and knowledge to share with the new generation of nurses in our office. She would help out anytime, and anywhere she was needed. She definitely put us all to shame with her work attire, fancy nails, and blue hair. We NEVER saw her in the same outfit twice. I would enjoy listening to her on the phone with her loved ones who she would do anything in the world for, and when the conversation was about to end she would let them know how much she loved and cared for each of them. She left a lasting imprint on all of our hearts and will be missed greatly.” Dr. Robert E. Kalb, coworker: “She was kind enough in the latter part of her career to venture into a completely different field, dermatology, to provide a temporary 3-month reprieve for Mary Anne's maternity leave. I joked around with her that she was the first person I hired without actually meeting or reviewing her resume (which was true, I trusted those who worked with her). Little did we know she would become an expert in general dermatology, clinical studies and phototherapy. Her 3-month stint tuned into 11 years, her late in life switch to dermatology was a godsend for our office. She was an amazing woman and a major cog in the day to day functioning of the office since she could fill in every possible nursing role. Then amazingly, she became President of the Dermatology Nurses' Association and coordinated a world class educational program for their annual meeting. She was a no-nonsense person who would get right to it. Her short and sweet morning greetings were memorable ‘Hey Ash’ for Ashley or ‘Hey Stace’ for Stacie. I will be trying to continue those AM hellos in her honor.” Beth Jonas, coworker: “I've known Nancy for almost 40 years, we raised our sons together. We lived on the same street in North Buffalo my son Daniel was always with her and her son, Sam. Nancy was a huge influence in the lives of myself and my children. We had so many fun times together with our kids going to the same grammar school, taking turns driving. I remember teaching her to drive her stick shift Jeep she bought. The laughs!! We would meet almost every day after the kids got out of school for coffee. Usually it was at Nancy’s house, her house and pool were always open to us. Nancy was the quintessential Kool-Aid mom. Nancy never became flustered, she had the patience of a Saint. Nancy was a fashionista. The kids all loved playing in Nancy‘s closet and dressing up in her clothes. That was a trait that followed her through her entire lifetime. Nancy made friends everywhere she went. She was probably the most open, accepting, nonjudgmental person I've ever met. She seemed to draw people to herself wherever she was. I remember her saying, ‘I don't need another friend I’ve got too many,’ however that didn't stop her from being friends! With her background in psychiatric nursing there didn't seem to be much that shook Nancy. She was always had a calming response, listening and rationalizing to help you sort through and make clear decisions. One of her favorite expressions was ‘Ok, let's not get hysterical here.’ I heard that so many times, usually follow by her laugh! She was a voracious reader, loved to travel and always seemed to have a social engagement or a place to investigate. We took lots of trips with our children. There was always something interesting to do or see. Travel was a big part of her life, as well as her family. She has one brother, Tom. They were close, frequently traveling to be together for holidays and vacations. She was close with her parents, especially her mother, something that translated to the same close relation with her children. She was a devoted mother to Sam and Rachel and grandmother, babysitting as often as she could. Nancy could be spotted in a crowd with her brilliant blue hair—a trait that was always commented on whenever we were in public. Nancy was passionate about her causes. If she believed in something she didn't hesitate to get involved, and sometimes drag you along with her. She loved the DNA, and being president with all its challenges. She stepped up to the need to remain in office. She gave of herself whenever there was a need. She had other volunteer positions within the community as well. She was proud of her Italian heritage, volunteering at the Italian cultural center and taking lessons in Italian. Working with her was a pleasure. She was always quick with a smile, seeing her research patients with a cup of coffee in hand. Having to break the news to some of them has been difficult. Tears have been shed, she touched their lives and she was an advocate for them. The thing that stands out the most that will be missed in our office was her laugh! I can't tell you how many times at home or at work that I've thought of something I needed to share with her and the loss of that stings. It is difficult to believe that a light that shone so brightly has been extinguished. She was just such an amazing person, it's difficult to even write down everything that she was.” Robin Inabinet, DNA President and Immediate Past President: “Nancy was always so appreciative. No matter when I reached out to her for assistance with filling in for her as President, her would be ‘Thanks so much; I really appreciate all your support and help these past months; it's no bother at all.’ I always enjoyed my conversations with Nancy. She was good at making you feel at ease with her humor during difficult conversations. I will greatly miss her friendship, conversations and support!” Again, please all join me as we celebrate Nancy Smail, RN, her well-lived life, and her dedication to the DNA. Her enthusiasm for dermatology nursing will be greatly missed. Here's to hoping that as you continue your work as a dermatology nurse, you grieve the losses you encounter but remain resilient enough to keep coping, both professionally and personally, in ways that are healthy and purposeful. Wishing everyone the best as we move forward. As always, looking forward to hearing from you, Angela L. Borger Editor-in-Chief [email protected]