Idleness Before Idleness.

The gazette has kept one voice for a year of Fridays; today it stands aside for the first time. Patrick Riecke arrived in June the way the best things arrive here, by way of a reader passing a letter along, and wrote a kind word about an essay. In the correspondence that followed he said the most serious thing anyone has said back to this publication: that for ten years he led a team of hospital chaplains, and that he has stood, thousands of times, in the rooms where the idleness we spend our Fridays praising arrives in its final and involuntary form. I asked him to write what he had already half-written in those messages. He did, and it is the strongest piece of writing the gazette has ever been offered. It runs below in his own voice, under his own name, as the first guest essay in this publication's history.

A word of caution before you begin, offered as courtesy rather than apology: this essay is heavier than our usual weather. It concerns death and grief, plainly told, and it is best met when there is room for it; it will wait patiently for the hour that has. — Leo Umilio

"Hi, Patrick, we've got an RHC at the hospital."

The other chaplain spoke slowly, allowing me to wake up. It was 2:00 AM and this was my first call out for an RHC. My healthcare career was two weeks old.

Sleepily, I asked the questions they taught me during training.

"What's the time of death?"

"0147, just a few minutes ago," the night chaplain replied.

"Patient name?" I asked, pulling myself out of bed and toward the closet where my work clothes hung, waiting for someone to die.

"He's a John Doe. Work on getting an ID onsite."

My first callout was not going to be simple.

"He's in the emergency room. Don't forget to call the coroner." The veteran was helping the rookie.

"Ok, got it. Anything else I should know?" I asked. Sometimes this is the most important question a person can ask.

"Yeah, apparently the patient's car ended up in the river—with him inside. The police and firefighters fished him out. He was probably dead at the scene, but they brought him to the ER just in case."

Thirty minutes later, I was prepped, dressed, and standing in a tiny exam room with a young male—a dead young man.

There is no stillness, no idleness, quite like death.

The Daily Work of Death

In the subsequent ten years, I became the supervisor, then director of this department of death responders. Slowly, imperceptibly, I transitioned from the rookie to the veteran.

During my tenure, we responded to more than 15,000 patient deaths.

Let me type that sentence more slowly.

Real people in my department… we walked into rooms… 15,000 times… where a real person… had just died.

In some rooms, an alive mother was being prepped for surgery after learning that her pregnancy ended sooner than she had hoped.

In other rooms, clinicians removed a plastic tube from the throat of a patient whose death had been anticipated for hours or days.

Family members present, or not. Singing hymns or crying softly. Harmoniously supporting one another and the patient, or not.

In other rooms, a very elderly person had been hoping to die for some time. "I am not sure why I am still here." They weren't depressed, necessarily. They just never expected to be 94 years old. All their friends were dead, and maybe even a child—one of life's experiences that makes many people wish for the idleness of death.

"After I leave, would you please stay with him?" the man asked. "I don't want him to be alone."

"Of course," I said, in a different emergency exam room, years after my first patient death. His husband had been sick, but the end still felt abrupt. Neither man felt old enough to die or be abandoned by the death of their partner. First, it was just the three of us.

The still warm deceased man in the bed, his spouse, and me.

Then, there were just the two of us.

The idleness arose once again.

Every department in a hospital tracks certain metrics. Our metrics were "RHCs."

We used the acronym "RHC" for two reasons.

First, it's more sensitive than saying "a patient just died" in a hallway full of people hoping their dad or sister won't be dead today.

Second, in our state, only a physician can pronounce a patient "dead." But two nurses can verify that "Respirations Have Ceased."

So, the acronym RHC was born.

During the 2.5 years of the pandemic, our little team of bedside head nodders, witnesses of deaths peaceful and violent, early and late, attended and unattended, responded in person to 5,563 moments when respirations had ceased.

Two for me were the worst.

The first was my friend of 20 years who died during childbirth. Her name was Bre. Her baby survived and is magnificent. But I miss Bre.

The second was a little boy I met for the first time about 30 minutes after he died. He was two years old and healthy the day before we met. His floppy, sweet, cherub-like frame hung in his parents' arms. That shift forced the leader of the department (me) to visit the corporate-sponsored therapist later that week.

The Uncomfortable Idleness

When I first found the Idle Gazette (thank you, Kate Bowler), I read The Forgotten Bargain, and the argument that rest and idleness are fundamentally different.

An image came to my mind. An image that hospice nurses, chaplains, and other healthcare professionals know well.

A man of a certain age has just died. His hospital bed is in the slightly upright position that so many share. If there was a rush of hospital workers in his room, they are dissipating. Only one or two linger, turning off machines that no longer have a purpose in this room, typing a few notes, offering a word of comfort, and cleaning up the deceased.

His head tilts back slightly, the muscles in his neck turned off after many decades of use. His eyes are probably closed—either naturally or through the compassionate action of a healthcare worker. I hope he is not covered in blood. I hope that there are no other grisly details that will haunt his grandchildren, so unaccustomed to seeing any dead person, let alone their grandpa.

One feature, in the land of idle appreciation (appreciation of being idle), came immediately to mind when I first read the gazette.

This man has become so idle that his mouth hangs open. Not to speak. Nor to eat. To demonstrate that he will never speak or eat again.

The room has grown quiet. The final nurse has left. All the machines are off. The door and drape are pulled closed.

Family members or friends might be crying. Or planning. Or sobbing. Or laughing. Or telling stories. Or simply trying to get the hell out of there as quickly as possible.

But each time their voices ebb away, a stillness returns. Like a heavy stone has replaced the ceiling tiles.

In American culture, as The Forgotten Bargain argues, we don't "do" stillness. We tend to view idleness as a waste of time. That makes the moment of RHC very uncomfortable.

Most people, if given the opportunity, would prefer to die at home—not in a hospital. Most people, not given the opportunity, actually die in a healthcare facility of some kind.

Then their bodies are whisked away by a magician called the funeral home director—a professional whose work is less understood by the general public than a real magician's.

Money is exchanged.

The deceased—grandma, or brother, or friend, or lover—receives services to make them look "as alive as possible" for the viewing and funeral.

During the visitation, a line forms of people who must speak to the family.

Many horrible things are said, and most people are anxious to leave the parlor of idleness as quickly as possible.

"At least she's in a better place."

But her daughter wishes she was still here.

"I can't imagine how you're feeling."

Sure you can. But you don't want to.

"They look so good."

No, they don't. The most idle person in the room (the one in the casket) is wearing the most makeup.

And why are they wearing makeup? To make us feel better.

To feel less like this is really the end. That idleness, stillness, has settled in for a person we actually know. And will one day settle in for us, too.

The CEO's Delusion

"If I work like this for 5 more years, I can retire early and do whatever I want," my client, a CEO, says during our online coaching session.

After ceasing to lead the team responding to RHCs in 2023 and experiencing my own fantastic burnout, I now coach leaders struggling with their own burnout.

I speak across the United States on burnout prevention and recovery—finding ourselves in the midst of the frenetic lives that most of us lead.

"And, what do you want to do?" I ask the CEO.

"What?" He replies.

"What… do… you… want… to… do?" I ask slowly, hoping he will remember the five-year plan that will allow him, after working the number of hours that should fit into ten years, not five, to finally do what he wants to do.

"Uh… good question."

He does not know what he wants to do.

I flash back to my hospital work.

I remember an Indian American couple who worked hard like this CEO. They retired early. Then the man's wife was diagnosed with cancer.

I met her just after her RHC. Him, twenty minutes later after his panicked drive to the hospital.

His response was verbal, verbose, and vertical.

Pacing quickly up and down the hallway outside her room, he yelled at God. He blamed God.

"We just retired, after all these years of work, and you take her from me!?" I trailed the man whose wife had just become idle. The only thing he knew about me was my profession—chaplain.

I stayed quiet. God, life, death, idleness, do not require defense. The defense disrespects the defendant.

Eventually, he allowed a hug, and wept in my arms.

Lost in Our Own Maze

In the last three years, I have spoken on countless stages. My audiences are mostly healthcare workers. I explain the three characteristics of burnout (emotional exhaustion, cynicism, and a lost sense of purpose).

I cite US workplace studies that demonstrate more people are struggling and suffering than any other time in recent history. I tell them my story of burnout, landing in my own ER—not as a chaplain or director or chairperson of this-or-that committee—but as a patient whose physical heart had sounded an alarm.

The "not enough idleness" alarm.

Then I give them practical steps to turn down the burnout. To find themselves before they retire and die. To finally answer the question—What do I want to do?—with something greater than "stop working."

At the end of my keynotes, I encourage nurse leaders, physicians, medical social workers, professors, or whatever mission-driven, overworked, selfless population sits in that particular room, to do something uncanny.

After a group catharsis about the modern struggle of being in a service profession, diving deep into topics like depression, moral distress, and burnout, I take a hard left turn.

I encourage them to create a bucket list.

Why?

Because I don't want them to die without figuring out what they want to do.

I don't want to die without doing something I want to do.

What I am sorry to report is that less than 10% of attendees have a bucket list before our session together.

Furthermore, I get questions about this point.

"What if I don't know what I want?"

"I tried to start a bucket list, but can only think of a couple of things I want to do. Am I broken?"

"Isn't this a selfish activity? I feel guilty when I think about my own wants."

Once, an attendee argued with the very premise.

"If I can spend $4,000 to go to Italy, shouldn't I instead give it to the poor?"

All Americans want to go to Italy.

Idleness Before Idleness

Someday, though. Someday. Someday, I will be the man in the bed. My neck muscles will switch off. My eyes will be closed. My email and social media accounts unattended. My bank accounts closed. My schedule cleared permanently. My mouth gaping open.

I hope to, plan to, spend plenty of idle moments before then. Enjoying, not just enduring, my life.

It's practice. Practice for the moment when my own respirations cease. My jaw goes slack. And I am idle—whether I want to be or not.

Patrick Riecke led a hospital chaplaincy team that answered more than fifteen thousand patient deaths; he now writes, speaks, and coaches across the United States on burnout prevention and workforce wellbeing. Learn more about Patrick's work at patrickriecke.com.