A personal reflection by: Maria Panzera Rugg
The Promise That Started It All
I don’t think you ever truly choose hospice palliative care. For me, it has felt like something I’ve been becoming my whole life.
I still remember being seven years old, lying in a hospital bed after breaking my leg. The room was dark, the hallway quiet, and I felt completely alone. When I called out, I wasn’t met with comfort but correction. I remember the feeling more than the words—the sharpness of being unseen. In that moment, I made a quiet promise to myself: If I ever became a nurse, I would be different
I didn’t know then that this promise would shape the next 35 years of my life.
Choosing to Stay
Being a hospice palliative care nurse for me is about walking into rooms where there is grief, uncertainty, and sometimes silence—and choosing to stay. Not because I can fix what’s happening, but because I know presence and witness matters.
So much of this work lives in the in‑between spaces: the pause before a difficult question, the breath someone takes before telling the truth, the story a person needs to share one more time.
I’ve cared for people across the life span; saying goodbye to a new life in a neonatal intensive care unit to older adults closing long, complicated chapters. The circumstances shift, but the human need remains constant: to be seen, to be heard, to know they matter.
The Unseen Work of Caregiver Grief
Lately, I’ve been thinking more about the grief we carry as caregivers. Not the dramatic, singular losses that make headlines, but the quiet, cumulative ones that settle into the body over time.
The grief of walking with someone as their story changes. The grief of holding space for sorrow that has nowhere else to go. The grief of caring deeply, again and again, without always having a place to set it down.
This is, I feel, is the unseen work of palliative care—the emotional labour that rarely shows up in job descriptions but shapes us profoundly. Naming it matters. When we call it grief, we honour it. We make it something we can tend to, rather than something we silently endure.
Care as a Collective Practice
One of the greatest truths this work has taught me is that none of us can do it alone. The most meaningful care I’ve witnessed has always been collective—nurses, PSWs, physicians, social workers, spiritual care, volunteers, families, communities—each offering what they can, each holding a piece of the whole.
When it works well, it feels almost like a family, gathered around a person and each other, steadying themselves for whatever life and death bring.
This is why grief literacy matters. When teams and leaders recognize grief as part of the work, we reduce stigma, create space for honesty, and build practices that protect the workforce.
Small Rituals That Hold Us
Sustaining this work doesn’t require grand gestures. Often, it’s the smallest practices that keep us whole: a moment of silence at shift change, a huddle where someone can name what they’re carrying, a few minutes of reflection after a particularly hard event.
These are not extras. They are the scaffolding that allows us to keep showing up with compassion.
Passing It On
Now, as I spend more time teaching and mentoring, I think a lot about what we pass on. Not just knowledge, but a way of being—how we sit with people, how we listen, how we honour what matters most.
Presence is a practice. It can be taught. It can be protected.
Honouring Those Who Care
This May, as we honour Nursing Week, PSW Day, and National Hospice Palliative Care Week, I want to celebrate the people who work and live in these tender, difficult spaces—and also commit to caring for them.
This work has shaped me, humbled me, and reminded me again and again, that the most meaningful care is the care we give each other.
