During the first year of my social work graduate program, I interned at a comprehensive care clinic at a New York City-area hospital. The primary population at the time was adults living with HIV and AIDS. The social work team was small- only four social workers on the team- and I shared a caseload with my field placement supervisor. The social workers would see clients at the clinic but also rotate to the inpatient floor of the hospital, so whenever it was my supervisor’s time to go to inpatient, I’d tag along.
One day, she asked for me to do a quick intake assessment for one of her clients who had been admitted on the inpatient floor. He was a middle-aged man with the initials “PM”, who was very pleasant and invited me to have a seat in one of the chairs in his room. One of the questions was confirming his AIDS status. He confirmed it, but quickly told me that no one else knew of his diagnosis, including his family.
I saw PM a few months later back in inpatient. This time, he looked completely different. He’d lost a lot of weight and his face was sunken. He was very weak, and couldn’t speak. In his room, I was met by his brother who seemed agitated because he wasn’t informed why his brother had been admitted. Before seeing PM, I looked at his clinic chart to discover that he’d been diagnosed with Epidemic (AIDS-associated)Â Kaposi sarcoma, an aggressive form of cancer. While asking questions from the intake assessment (after his brother stepped out of the room), PM answered with paper and pen. Before leaving, I asked PM if there’s anything he wanted me to tell my supervisor. He asked about the likelihood of him being discharged to go home.
A week later, I received a notification in the staff’s client appointment system that PM had died. I looked in his chart again to see an updated medical note from his clinic medical provider. The provider had recommended to PM’s brother and mother that PM should be discharged for hospice care. When asked why, the provider had to disclose PM’s AIDS status to his family.
Soon after PM’s death, my supervisor and I went back to inpatient, this time as witnesses for a young woman signing legal documentation to assign custody of her young sons to a relative. She died soon after. My supervisor asked if I wanted to debrief with her about PM’s and the young woman’s deaths, and I remember telling her that I was fine but would speak to her about it if I needed to.
I went from experiencing these deaths as a student to experiencing the deaths of several clients while working at my old agency after graduating. One client died by suicide, one was found dead in her apartment under suspicious circumstances but was later determined to be health related, one died via a drug overdose, and there are others who died but so much time as passed that I can’t remember their causes of death. On top of this, my staff would get routine emails informing us of clients who have died in other departments, along with the deaths of some staff members.
But the death that impacted me most was “LB”. He was middle-aged man whom I’d met around 2 years after joining my agency. When my supervisor introduced me to him in his office, LB was sitting across from my supervisor’s desk, crying as he wanted to sign up for services plus being spooked that he’d had 3 heart attacks in that month alone.
LB quickly became one of my favorite clients, where I’d do frequent home visits with him and I managed to get him a receptionist job at the agency location. The last time I saw LB was in April 2015 when he stopped by to see me for an update on a medical visit he’d just left. After that, all of my calls and letters either went unanswered or returned to sender. I managed to get in contact with LB’s mother that August, where she disclosed that LB died earlier in May from a heart attack. I told my supervisor and gave her his case closure documentation, and went about the rest of my day. When I got home, I sat on my bed and cried.
At the time, I thought I cried specifically for LB. In hindsight, I cried not only LB, but all the clients that died before him. I never fully gave myself the space to process each death (particularly the deaths that occurred when I was a student) and I think in some ways I’d become desensitized to hearing about the deaths as I transitioned from student to professional.
Dealing with the death of a client is challenging, and there are unique challenges when it happens during a student’s formative years in social work. How we process these events as students will likely dictate how we process them once we get into the profession. While my field placement supervisor checked in with my feelings with PM’s death and the young woman’s death, I declined as I felt that I didn’t need to process because I had only met with them infrequently. Plus, I hadn’t planned on being in case management as a career and thought that this was specific to this area of social work.
Looking back, I believed I took on the energy of the social workers and staff around me at the clinic: While it’s difficult, you have other clients to support. While you are human, here’s a level of stoicism that you take on to prevent yourself from looking weak in front of your staff and other clients, even when you’re supported by your supervisor. This became even more so when I had my own caseload. With family and friends, it’s customary to spend more time grieving. In your professional life, you have to keep moving. Even sitting with my peers in my social work foundations class, I found it difficult to share PM’s and the young woman’s deaths because most of my classmates were in social work settings where death wasn’t as common occurrence with their clients.
Also, the burnout I was experiencing at the time was a factor in how I processed LB’s death. I was contemplating leaving my agency to work for myself, and LB’s death was a contributing factor. In fact, a year or so before his death, he asked me, “How do you come to work and deal with all the sadness, deaths, and fires you have to put out?”
Each client’s death will have a different set of circumstances, and this 2016 article by Sharon Martin, LCSW, posted on The New Social Worker outlines some great advice on the interpersonal aspects to processing and grieving a client’s death. A client’s death may be unavoidable depending on the social work setting you find yourself in, but here are some additional advice:
- Identify your breathe supports. These can be your classmates or your co-workers.
- Work through your compassion fatigue.
- Find a way to honor your client’s memory, if appropriate. At my old agency, we would invite friends and family members of the client to share memories of the client with the staff that worked closely with the client.
- Don’t keep it bottled in. Eventually something will happen and it will trigger a memory.
Raise Your Voice: What advice would you give to a social work student experiencing the death of a client? How did you process a client’s death? Share below in the comments section.
