I stood knocking at the door of my hospice patient like I did every Monday for the past eight months. A musically talented man in his early 40s was always waiting for my weekly nursing visit, more so for the aspect of socialization. He was diagnosed with colon cancer two years prior and had a colostomy bag, leaving this once vibrant, social, even handsome man a shell of what he once was. He became introverted and allowed only one friend to check on him occasionally. He had no family and only one estranged child who lived in another country.

There was no answer at the door, but I knew that he slept hard at times and could be difficult to wake up. I walked around to his bedroom window, hollering his name and knocking, which I have done before. Only, this time was different. There was no answer at the door. Nor did I hear any movement inside.

I looked around for his car, and it was parked where it always was in his designated spot. I thought back to the last time I had contact with him, remembering I had tried to call him on Friday to see if he had any medicine that needed to be refilled before my Monday visit. He did not answer the phone, so I left a voicemail. I double-checked my messages, realizing I had never received a call back.

The discovery and the aftermath

After a few more minutes of knocking, calling and hollering his name, I decided to call the local police for a welfare check. When they arrived, they asked me several questions before proceeding to bust open the door. I walked in behind them, noticing how everything was exactly in its place. His laptop was open and sitting on the kitchen table. His guitar was propped up against the couch with the case open on the floor as if he had just finished playing. “Here he is!” hollered the officer. I eagerly ran to the officer, thinking he must have been sleeping so hard that he did not hear me knock. I had the words in my head of what I was going to say to him about how he scared me. Until I walked into the bathroom and there he was, lying on his stomach wedged between the commode and the bathtub. He was dead. “It appears he has been dead for several days,” one of the officers suggested.

My heart sank as I looked at him, lying there all alone, dressed for bed and his watch, his watch still on his wrist, ticking as if nothing had happened. Emergency Medical Services (EMS) arrived and assisted him onto his bed, where I pronounced him deceased and called the funeral home. After all the commotion, I was left standing there, alone, waiting for his body to be picked up. I called his friend and notified him of his passing. “Alright, just lock up when you leave,” was his best response.

The heavy burden of clinical guilt

As I stood there, looking around his room, the guilt started setting in. If I had just tried to call him back or gone by his house to check on him on Friday, would that have changed anything? Maybe if I had not been so exhausted from the demands of my job, I would not have been so eager to start my weekend, trying to forget the week’s hardships. Maybe if I had taken a moment, just one moment out of my exhausting schedule I could have been there for him and maybe he would not have died alone.

This is just one person, one case in the hundreds, maybe thousands of hospice patients I have cared for over the past 15 years. This one, by far, being the most difficult to process given the circumstances. And when do we, as clinicians, have the time or resources to grieve?

Acknowledging grief in hospice care

There is a hidden emotional impact that often goes unspoken for clinicians working in hospice and palliative care. Clinicians may continue moving through their duties with steady hands and calm voices yet carry sorrow that few people ever see. Over time, that sorrow can become part of the clinician’s inner life. Repeated exposure to death, suffering and family angst can shape clinicians into more compassionate, resilient, and empathetic caregivers, while also leaving them with a quiet emotional burden they must learn to carry.

There is not much focus, if any at all, on debriefing after a difficult death. Whether the dying process itself was difficult to manage or if it was an emotionally draining case where the clinician faces emotional fatigue, more focus needs to be geared toward supporting clinicians’ emotional well-being, providing time to process grief, and creating healthier ways to cope with loss.

Behind every badge is a person showing up with compassion, connecting with humanity and carrying grief even in the shortest of encounters. Over time, that quiet burden becomes part of their identity, shaping them into clinicians who understand that healing is not always about saving lives, but about honoring the lives lived. The challenge is not to stop feeling, but to learn how to carry those feelings while continuing to show up. And to keep showing up means allowing grief to continue.

Linda Ellington is a hospice nurse.