I work on a very special floor of the hospital—one that not every hospital has. My floor specializes in Palliative care, which, in simplified and incomplete terms, is like hospice care. However, we also take normal medical patients on our floor—anything from the flu to GI bleeds to shingles, etc. Every night is unique and holds its own set of special challenges.
Of all the questions I get as a palliative care nurse, the most common is, by far, “How do you do this?” How do I take patient after patient that I know is going to die soon—and it very well may be on my shift.
Well, there are a lot of things that factor into my answer. Palliative care isn’t really something you’re prepared for in nursing school. All the lectures, every test question, all the NCLEX prep is aimed at “how do you save this patient.” Now I’m in a world where death isn’t the looming enemy to fight (unless we’re talking about my medical patients)—it’s the next step in my palliative patients’ journeys. One that I am to help them approach as gracefully and painlessly as possible. Frankly, there’s little way of knowing how you’ll handle palliative care (or if you can at all), until you’re there. And no matter how much you love it or how good you are at it, there will always be days where it shakes you—and that’s okay. Good, even (if you ask me).
There’s also the fact that, at the end of the day, that person is not my spouse or parent or sibling. I say this running the risk of sounding insensitive. I don’t mean to say that I don’t care about my patients—that I don’t build relationships or do my best to practice empathy—but it will always be different when it isn’t your family. By the time I meet these individuals, they usually aren’t really themselves anymore. They’re extremely confused or groggy or even unresponsive. I’m mostly building relationships with the families (and that can be where it gets hard).
All this to say, there are times…
There are times that the routine of it all gets stripped away, and you’re left standing face to face with the harsh reality of your own job. Many times, it happens when you least expect it—when you’re least prepared.
The other day, it’s when my pastor was describing the moment he found out his brother had passed away. He recounted the story of when he came to the hospital and the nurses told him to not enter the room quite yet—and why. I sat there listening to him, my throat closing up, thinking, that’s me.
I’ve made that early AM phone call.
I’ve run out of a room to greet a family who had just come to say its final goodbyes to a deceased loved one.
I’ve even stood there, helpless, as a man took what I knew would be one of his final breaths, while his daughter looked desperately at him, and then to me, and then back to her father. There were no words, no actions, to make that moment okay.
There are times when a patient who seemed to have days, even weeks left to live, passes quietly away, and you’re left there thinking, You weren’t supposed to die tonight. In those instances, I’ve seen a coworker, one who is specialized in palliative and hospice care, crumble after hanging up the phone with the patient’s devastated daughter. I watched as she hunched over at the nurses station and gave into her sobs.
There are times that you walk into a palliative patient’s room to find it’s a patient you had when he/she was still medical. At that time, you were doing all you could to get him/her better. You talked to him and joked with him. Now he’s lying there unresponsive, and you’re reminded that, at one time, every one of your palliative patients was vibrant as well.
There are times when death has suddenly touched the lives of people that you love. But you still suit up, go into work, and love on people who might not make it through the night. And as you titrate that morphine drip and check pulses and respirations, you can’t help but think, “Please don’t go tonight. I don’t want to face death again tonight. Just make it through the night.” Which may be a selfish thought—but it’s an honest one.
Finally, there are those times—those times that put all the others to shame. They’re the times when your compartmentalization skills chip away just the slightest, and you think to yourself that the day may come when you’re on the other side of the nurses’ station. You see your mother in that bed, or your father. You imagine a glimpse of your patient in his/her prime, and you’re reminded that he or she is just like you. Just like your family members. Just like anyone else. The pain and toil of life has marred his/her physical body, but in that bed lies years of memories. In that bed lies a once brand new mother, humming to her new baby. A father clapping proudly as his son walks across a stage. Reality comes crashing in, and it steals your breath on its way. There is the key—the danger and pain of true empathy. It’s scary and it hurts and it breaks you and grows you and changes you. I often fear that I don’t empathize with my patients enough, but the balance is difficult to find. I treat them with the same care that I would treat my family, but I can’t imagine my family member in that bed. Because I have imagined it—and I could barely breathe. Which is why I always tell these families, “it’s okay to not be okay.”
Because even though we see death on a weekly basis. Even though we can face it with a calm that many people cannot. Even though sometimes we take for granted what we do.
There are times.
Sometimes we’re not okay.
And that’s okay.
When families ask me how I do it, I don’t really know what to say, but I do tell them this: I see it as a privilege to do what I do. Palliative has changed the way I look at my world. My goal has always been (and still is) to work in Labor and Delivery—to watch life enter this world (though there are times in that setting as well, that the entrance will also be an exit). But I am so thankful for the honour of being with those leaving this world. It’s just as significant as birth. It can be ugly, yes, but, believe me, it can also be beautiful.
“A good name is better than precious ointment, and the day of death than the day of birth. It is better to go to the house of mourning than to go to the house of feasting, for this is the end of all mankind, and the living will lay it to heart.” Ecclesiastes 7:1-2