My first experience with death, live and up close was on my second shift as a cardiac technician. I was 20, and had already worked in healthcare for 7 years, starting as a candy-striper, then as a CNA in a burn and HIV unit. I thought I was prepared to face end of life. I was not.

During regular rounds, a call came in for a cardiac arrest arriving in the ER. It was a 95 year old nursing home patient who had been found asystolic. The paramedics had responded and utilized a new piece of technology called the thumper. This was a hydraulic CPR machine that would maintain compressions while the paramedic administered oxygen. The design was great in theory, except in this case the ambulance had turned a corner too quickly, and the plunger had been dislodged. I did not know  this. When I began to administer my own compressions, her chest went down,..and didn’t rebound.  I could feel that her ribs had been broken from her sternum.  We couldn’t do anything.  So, there she was.  Battered from the thumper, bruised and bloody from the tubes and needles, nightgown cut open displaying her body, and an open eyed, open mouthed expression of desperation. I probably could’ve handled that, had she not looked like my grandmother, and I swear her spirit asked me to help her. I covered her, touched her cheek and hand. Said I was sorry, and walked away.

An hour later, I was still in a fetal position on the floor of the bathroom, when the sister who was on duty that night found me. She bundled me up and took me to the chapel where she sat quietly with me. Once the heaving sobbing had stopped, and I had found center, she took me to the sleeping chamber for the nuns of the hospital. Over each small cot hand burnished wooden plaque. I am paraphrasing, but the general idea was “If you find me here, and I am not breathing, please wait 20 minutes to cal for help. I am with God.” This is my first introduction to an informal living will, and the start of a lifelong dialogue with myself and others about death. I never want to see another person suffer the indignities that I saw that night.

A few years later, I was in a head-on collision. I walked away pretty beaten up, but alive. What struck me wasn’t a sudden awareness of my own mortality, but the impact the accident had on my loved ones. The collision and aftermath itself seemed quite a matter of course. Any trauma that I felt it was physical. My family’s reaction was much more profound, and I realized at that point that the mechanics of death are very different animal to the mechanics of fear of loss.

As a coping mechanism in my career in healthcare, I developed quite the black sense of humor. I never want to diminish the emotional experience that others have, but I find myself going into neutral around the heightened responses to loss. It comes off cold, but it’s really not. It is analytical, and self preserving. I grieve privately. Publicly, I take on the role of logistical planner around end of life discussions and funerals.

I find humor where I perhaps should not. Never will I forget my great grandmother’s funeral. During the viewing, in a very somber setting, my 85 year great-aunt screamed out “mama don’t leave me!!” and attempted to climb into the coffin with her mother while dragging her own oxygen cart. There are some things in life you can’t un-see, and you really shouldn’t find funny.

I have sometimes found myself in trouble with my humor. When my stepfather was cremated, he requested that part of his ashes to be scattered in the United States and some in England. His daughters also asked for some of his ashes to scatter at memorial bench. At one point my mother, or one of the girls were talking about losing their father. My mind immediately responded, “It’s not that we’ve lost him that bothers me. It’s the we don’t know which part of him is where.” I think I said it out loud. It was a bad thing.

The only time I ever cry at funerals is when people are memorializing. I am not crying for the person who has died. I am crying out of empathy for those who have lost a loved one. I am clear about this. I have a rather metaphysical perspective about death as a process. It comes from something my grandfather once told me about atoms and how they redistribute. I am not troubled by issues of heaven and hell. What troubles me is seeing people experiencing profound pain. I have taken courses on death and dying, and I teach about stages of loss and grief. The process is a part of my life, and has been since I nearly became a widow at age 34. I feel like I have had almost too much preparation. Too much loss. It has become a matter of course. So, my job is to help others.

I think I was about 25 when I had a dream that my grandfather had died. I awoke absolutely be bereft, and at 2 o’clock in the morning called him to make sure he was alright. It wasn’t the idea of his death that upset me. It was that he had died and I had not made sure that the last words he heard from me were, I love you. From that point on, I make sure to always say “I love you.” I want no regrets in that regard. In a perfect world, I would be able to resolve all personal issues and conflicts with everyone that I know before they die. I like that closure. However, I don’t think I will have that extraordinary luxury. I think perhaps for me, it is enough for me to know that they knew without question, that they were loved.