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I'm Bargaining for Courage: A Director of Care’s Thoughts on Leadership in Hospice

by Jane Slemon, RN

Where am I these days of global pandemic, of a virus coming towards us that may kill off those I love? Where am I as a director of care, running a hospice whose 10 beds are filled with vulnerable people, people who desperately need their own people to be close at this time of their lives and cannot. What place am I in? What does it fill me with?

I'm tossed into reluctant leadership. I’m bargaining with the world. That's where I am.

The attachment I opened after the meeting of long-term care directors, many of whom were already dealing with outbreak on their sites, was called “Resilient Leadership” and was headed with the bright orange words, The Stages of Grief. In the 70s, I remember my delight in the brilliance of Kübler-Ross. We students of nursing ate it up—she’d given us something we could use, something hopeful. Since then, the concept of stages has been healthily bandied about in academic circles and generally refuted as overly prescriptive of the human heart. Decades later, the world of health sciences accepts grieving can embody such stages, but not necessarily in any order or to completion. Stages of grief might tumble in on one overlappingly, incompletely, repeatedly, combinedly; stages of grief might be culturally and individually specific. And grief itself might be about a whole heap more than any of us knows—not having been through this global pandemic yet.

Don’t tell me what I already know, I was thinking when I glanced down the page. This is a deadly pandemic, and I was never meant to be a leader in a time like this, much less in a health care facility for vulnerable people with a fragile and worried staff. But I thanked who ever had seen to reach back to Kübler-Ross to help us with the present moment, I perused the list—anger, denial, bargaining, depression and acceptance—and I realized I'd already seen elements of each of these within the staff. A question had seemed to come from a place of assuming the worst: "When did you know she'd been exposed?" The answer was simple, "10 minutes before I told you, but 8 minutes after I fought to get her swabbed although she doesn't fit criteria." One staff member dwelled on the rudeness of a neighbor who'd taken her parking spot. Another comment was about a stranger who spit on the sidewalk: "Should be illegal." I'd heard, "You people are getting so uptight about nothing." I’d heard, "God has planned his time for me. I’ll go with that."

Denial is tempting, I'll admit, when new information flows so fast that it's in contradiction with itself. The virus only spreads by contact and droplet. The virus can come from those without symptoms. The virus can linger in the air of the staff bathroom. No one who is asymptomatic will be swabbed, even if they have been exposed to the condition. Can someone who’s asymptomatic spread the virus? No, they say. Then yes, or maybe. So, we protect anyway. I'm told, "Fit everyone in the hospice for N95 masks." Then I hear, “I cannot justify such a waste of masks needed elsewhere in fitting your staff. The need is not a present need.” I send an email to reflect the loop of arguments that circle me. I say, that’s over, but I know another voice will offer reason to spin me once again, send me into useless activity.

People tell me to go get some rest, but then text me you tube clips or ply me with articles I should read, evenings, weekends, articles I’m not strictly allowed to be governed by because they contradict the present BCCDC mandates. So, opposing positions about what’s happening sit among us, seeding distrust. I can’t deny the points have been made, and navigating our team between the early science and the hearty speculation is about combining firm steps and light ones. I can’t be in denial that they sometimes are in doubt.

Sadness comes in surges, like gratitude, and brings me to tears that dry almost as quickly. Each evening at 7 pm, when the neighbourhood bursts into cheers for health care workers, I am cheering for those who manage to stay home another day in safety. The tears arrive, then they go. Acceptance drifts by me as I watch the golden green buds on the branch in the space of a single breath; like sadness, it doesn’t stay long. I don’t stay in those places. They take the energy I need to keep my sights on the goal: to get us through this.

Bargaining is where I live most fully these days; the place is called If Only. If only these fine nurses can stay healthy; if only they’ll continue to do their best, be compassionate, be willing. If only that day doesn’t come that swells their own fears past being able to cope, and the overtime stretches the whole weekend. If only the visitors really are self-isolating as they say they are. If only I can do my best, stay informed, affirm the hospice is willing to stay full, be of tremendous use to the community of those who are dying. If only we can let them come to us instead of having to go to the hospital when they can’t cope at home any longer. If only the community sees we can’t do any of that if we are exposed to the virus, if we take in those who have been exposed, even if they are asymptomatic, if we can just get them tested before they come—if only they’d change the criteria. If only the supplies last. If only society truly values our work here and sees that, even in the midst of surging numbers in hospitals, our pride is in having a place for people to die—fearlessly, comfortably, naturally in our caring and professional hands.

If only someone would tell me how to do all this.

We set our Seder plate with a ginger root to represent a lamb shank for the journey out of slavery, an orange for renewal of all that Passover means, salted water and horseradish for the tears and bitterness of leaving all that had been familiar, parsley for new growth. On our family’s Zoom Passover meeting, we shared what the year’s narrow places have been for each of us. We let the dark times of the past and the present nourish our minds, and we took in the light of the candles to encourage new light: dedication, generosity and creativity.

And on this Easter Sunday (a live-streaming of virtual Unitarian church) we honoured Emily Carr’s paintings of dark woods, paintings deeply criticized when they were first shown and, years later, widely admired: late in her life, she learned how much richness had been in the shadows, of the woods, of her life. With a children’s pageant patched together with clips filmed in separate homes, we in our separate homes acknowledged the darkness of worry, regret, fear, anger and denial, and we pushed away the stone to let a new light and hope flood in. Still in a place of grief for what the world is going through, I can acknowledge this darkness has nourished me too. It gives me direction. I am tossed into leadership. But I don’t need to be reluctant.

So, I've decided I'm grieving. And, of the five stages, most firmly mine is bargaining. Bargaining lets me balance the lights and darks of this pandemic. Perhaps it gives my fingers a purchase on the granite, on what I need as a leader to have the slightest effect: to believe in my team, to nourish them where they need support, to take every single question or accusation as a valid sentiment, a helpful point, letting us all stand stronger, safer, more assured by our trust in our leaders and in one another. When the candle’s light defines the shadows, we know what fears and struggles we have carried to this moment. When we take in the light of the candle, we feel the strength of it added to us and we ourselves send it into the world.

Taking time to note what the darkness gives us before pushing the stone and letting the daylight pour in, we are all the more ready to consider the path we step onto. And surely, it will take courage.

I'm bargaining for courage.

Jane Slemon, RN, MA

Jane Slemon, RN, MA, is Director of Care at Rotary Hospice House, a 10 bed free-standing facility in Richmond, BC. She is also a Sessional Instructor teaching Science Courses at Emily Carr University. She is a writer of creative non-fiction and a musician, playing in the folk band JEStrio.

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