Lindsay Brant, RN, BSN, CCRN, EOLD, MFA, has been a critical care nurse in the Cardiothoracic ICU at UCLA Health for over a decade and is also a trained Integrative Therapist, Death Doula, and artist. Lindsay founded and chairs COMMUNITY, a nurse-led committee whose mission is to promote inclusivity, transparency and resilience in the CTICU and to ask the question, how can we show up for each other as we serve and ensure the dignity and autonomy of our patients?
Whether I am manipulating a material to attain a moving effect or harnessing love and wonder to inspire a patient to take the necessary steps to recover, nursing and art are about a way of seeing and being that promotes curiosity, connection, and change.
EW: Death is often considered taboo. Was there a defining moment in your life that ignited your passion to discuss and address end-of-life experiences openly?
LB: When I was little I had a bird named Hot Shot. At some point much later, I found out Hot Shot died six times before I was finally the one to find her at the bottom of the cage. The other birds were quietly replaced to avoid the conversation of death, loss and the impermanence of life. When I found the seventh Hot Shot, I wasn’t scared or devastated. I can still see her face, the kernel stuck in her throat and remember the feeling of holding her still body in my hands. I think I inherently knew life was not permanent. Life is what it is, until it isn’t, and even then, it should be held. The silence around Hot Shot’s deaths was the problem, not the loss. Life changes.
Surgeons, whose positivism we want and need when they are our only hope, often suffer from the Hot Shot problem. They want to fix. Early on in my work in the ICU I had a patient who had a wound that almost split her in two. The wound wasn’t healing, but the surgical team insisted on debriding it daily, an excruciating procedure, and, because of her unstable hemodynamic status, they wanted to use as little analgesic as possible. She had tolerated this, had put up a great fight, but eventually was ready to stop, was ready to die and was then just as adamant about her death as she was about her fight to live. The surgeons couldn’t hear this. So I stood in front of her ICU door and would not let them in, not until her voice was heard, not until a clear conversation was had about prognosis and a palliative plan of care. From that moment forward I was determined to be an advocate for patients’ right to stop treatment and for their right to die on their own terms.
So often in critical care medicine the dying process is denied and pushed aside, because we have so many tools to delay death which ironically extend death. I am determined to be a reminder that this process is sacred, that death should be respected, not ignored, that there is so much meaning and opportunity for transformation that is lost if death is not acknowledged.
EW: Given your unique background, how does your work intersect with the end-of-life and grief conversation — and please give us a preview of what you’re talking about on the End Well stage.
LB: I am an artist, a sculptor who works with illumination and transparency. In 2009, my mother had an accident and after three months of advocating for her through surgery, recovery and rehabilitation, I decided to also become a nurse. This change came as a surprise to many, and although I had to rewire my brain in order to adopt a new expertise, ultimately my interest was the same. How do you communicate in order to achieve a meaningful transformation? Whether I am manipulating a material to attain a moving effect or harnessing love and wonder to inspire a patient to take the necessary steps to recover, nursing and art are about a way of seeing and being that promotes curiosity, connection, and change.
I have now been a nurse in the Cardiothoracic Intensive Care Unit at UCLA for eleven years, and am fully versed in the extremes of what modern medicine can do to extend life. Absolutely miraculous are the recoveries I see and contribute to on a weekly basis. But when all of our Herculean medical and surgical measures don’t suffice to return a patient to wellness, when it is time to reorient toward end of life care is when communication tends to falter and the sterile medical environment becomes alienating and unceremonious. It is this failing, this lack of clear, warm words and heart-filled ritual around the death and dying of our patients that I am inspired to transform.
How best to be present with dying patients and their families has always been a natural interest and investigation for me. In 2015 I studied to become an integrative therapist to provide comfort and support to my patients through therapies like reiki, body scanning and essential oils. Then in 2017 I took Roshi Joan Halifax’s course Being with Dying that she taught with Cynda Rushton and Tony Back. This retreat grounded me further in the work to support and serve patients confronted by uncertainty and impermanence and at the same time offered me practices to maintain resilience and an open-hearted, open-minded approach to practice. Roshi Joan and all the brave and bright beings who gather around Upaya continue to be the most profound light illuminating my path. Through a practice of being present with patients and my colleagues along with the integration of alternative therapies, I became the go-to-nurse to support the dying process on my unit.
Lindsay Brant will speak at End Well 2024 on November 22, 2024. Join live or virtually!
Then a more challenging phase began. It was the day the brilliant poet, Mary Oliver, died, January 17th 2019, when I first heard the tapping, a red headed house finch pecking at my kitchen window. Day after day he kept tapping. Worried that he would hurt his beak, I researched that this could mean the bird had mistaken its reflection for competition, and so my partner and I covered the window with fabric. He kept tapping. What was he trying to say? What was he trying to ready us for?
A few days later, still with the tapping, my 12 year old dog Miss B stopped eating, she had hiked 5 miles in the Verdugos the week before, but when we took her to the vet, we discovered she had cancer all over her body. Within days she let us know that she was ready to die, not coming inside. I called an at home vet, gathered all her human and animal friends and her life ended in the garden surrounded by their love. That was the day the finch stopped tapping.
A little while later I had a dream with Miss B. We were in the Sierras on a familiar mountain trail. And she said, “ I am here and I am everywhere, always.” As she said this, I looked up and scanned the meadow to the horizon filled with strewn boulders and alpine lakes and she began to multiply, running, leaping, sleeping, all angles, all activities, she was strewn like the boulders, integrated, everywhere, always.
My older brother, Ryan died two months later.
My best friend Cory, the following year.
And then my brother, Harry the year after that.
By then COVID had ravaged the country. My unit took care of the sickest in Los Angeles County. COVID was definitely an inflection point where a critical mass of loss, distress and upheaval outweighed our ability to cope. We were exhausted and at times infinitely sad. COVID wreaked a rawness and heartbreak that was devastating but also profoundly opening in that our collective vulnerability could not be denied. COVID also demanded collaboration. There was no way to go it alone during that time, and we all benefited from the collective creativity and teamwork it required. It was this simultaneous vulnerability and connectivity that begged the question, how can we do this differently? How can we show up for patients and families, and, maybe even more importantly, how can we show up for each other to be better clinicians and more open hearted compassionate caregivers.
In the beginning of 2023 along with 34 amazing fellow souls interested in the dying process I took Alua Arthur’s wonderful Going with Grace course to formalize my role as a Death Doula and to learn more about death and dying outside the hospital. The course was another example of how a diverse group of people with a shared interest can create a transformative effect on each other. After my death doula training, and under the brilliant leadership of my unit director, Katrine Murray, I founded COMMUNITY, a twelve-member nurse driven committee with the initiative to change the way death and dying is handled in our hospital and, in the process, to nurture the wellbeing of our patients, families and staff.
The first concern of COMMUNITY is always how best to be present with, honor and support patients and their families. This requires an open, transparent discussion of values and what brings a patient and their family meaning and ultimately what health states seem intolerable to them. Nurses spend intimate time with patients and are able to best capture the evolving wishes of a patient. COMMUNITY then empowers nurses to advocate for patients’ GOALS of CARE to ensure their wishes are aligned with the medical and surgical plan. To transition a patient to end of life care, to navigate the denial, grief and sense of failure of the family and the team in order to protect the dignity of our patients sometimes takes great courage. We now have a team and algorithm to support nurses in this endeavor to both be present with grieving families and collaborate with our teams with transparency and equanimity.
The second concern of COMMUNITY is transforming the medical environment into a space of tenderness and warmth to hold the end of life process. COMMUNITY educates nurses about all the logistics they need to take care of during a death, so that we can better delegate and support each other through this process, placing the primary importance on the patient and family experience instead of the paperwork. The dying process asks for a ceremonial space, a ritual space, a creative space to initiate closure and promote healing. Guided by the wishes of the patient and family, COMMUNITY facilitates this transformation and encourages intimacy with the dying process. Our intention is to provide the compassionate and meaning-filled end of life care, so that the patient and family feel held in their grieving process.
COMMUNITY’s third concern is for the wellbeing, cohesion and resilience of our team. Constantly exposed to stressful and straining experiences, our team is at high risk for burnout and moral distress. COMMUNITY developed a series of open forums called SHOW UP and SHARE to hash out the complex ethical dynamics we encounter along with the uncanny level of wonder and connectivity we feel in serving our patients. As another opportunity for open and frank conversation SHOW UP and SHARE promotes courageous transparency and the ethic of compassion and cohesion.
EW: Cultures around the world have different practices and beliefs surrounding death. How has your cultural background influenced your perspective on the end of life and grief?
LB: If there was church I grew up in, it was green. It relished the slippery sensation of a tadpole sliding through your hand, the water striders’ effortless walk on water and life’s perpetual bloom out of death and decay. It sanctioned the visceral bodily bliss of running through the woods and sitting so silently high up in a tree where no one could find me apart from the bugs and birds. This always-dirty-at-the-end-of-a-play-day connectedness to nature gave me a grounding that no trauma, strife or sadness may take away. Nature inherently knows and teaches through the paradox of simultaneity: grief and love, tragedy and magic, stillness and mutability, individuality and indivisibility. Nature is always present, always changing, a forever continuum. Death is natural. Death extends beyond religion and culture in that death undeniably connects all of us. We are one, inextricably connected through this lived experience and dying process that inevitably leads to the beginning of something else.
EW: In your experience, what is the most significant societal norm or belief about death and dying that needs to be challenged or redefined?
LB: Failure, silence and shame.
Lindsay Brant will speak at End Well 2024 on November 22, 2024. Join live or virtually!