After practicing nearly 25 years as a registered nurse, there is one thing I have learned about healthcare, it’s unpredictable. Physically, patients who appear stable one minute, can crash the next. Emotionally, situations and conversations can take sudden and unexpected turns. Early in my career, I was caring for a home care patient who was terminally ill with a lung disease. As I was listening to his lungs on an overcast autumn day, he turned to me with a very solemn look. I took the stethoscope out of my ears, sat down in front of him, and asked him if he wanted to talk. He looked at me and asked, “Am I going to die soon?” I asked, “what makes you ask that?” He responded, “ we had to take out a lien on our home because of all of the medical bills and if I don’t die by spring my wife will lose the house.” I was dumbfounded and had absolutely no idea how to respond.
Since caring for that patient, I have been asked very difficult questions on countless occasions. Questions such as , “do you think I’m dying?”, “what would you do?” or “would you have the chemo if you were me?” are common. What I have learned from these experiences is, that in order to provide good care, one must learn to be be present, compassionate, and always prepared for the unexpected.
A recent story in the national news involved a physician talking to a hospitalized, terminally ill patient and his granddaughter, via computer. In that conversation, the doctor informed that the man that he would not likely return home. I do not know if this part of the conversation was ‘planned.’ Though this would be extremely difficult news for anyone to hear, the family stated that the patient was hard of hearing and needed to ask his granddaughter to repeat what the doctor had said. The man died in the hospital the next day.
When reviewing both the family’s perception of the encounter as well as the health care organization’s response, several facts became clear:
healthcare is unpredictable… and we, as healthcare professionals, need to be prepared to navigate any situation with compassion
perception is reality… and it is the only reality that matters when you or a loved one is terminally ill
a family member should not have to tell a loved one he/she is dying… not ever
Many years ago, I was caring for an elderly man with cancer. After I completed my assessment, I was speaking with his daughter, who was a nurse and a colleague. At one point in our conversation, she began to cry. I asked her to help me understand what the tears were about. In between sobs, she asked, “can’t I please just be the daughter?” I had wrongly been treating her as a nurse and a colleague, completely forgetting how emotionally connected she was to the patient. I learned in that moment that the patient’s family members’ feelings are just as important as the patient’s.
I cannot speak for the physician involved in the the recent media story, but I would imagine he might have done things differently if he had it to do over again. Stories such as this remind us that nothing, no matter how advanced the technology, can replace face to face human connection. This family deserved to have a professional healthcare provider truly ‘present’, sitting at the bedside, leaning in, providing silence when appropriate, clarification when needed, and dignity and compassion through it all.
In a world where it can feel as if technology often isolates and divides us, we must remind ourselves that true human connection is the key to bringing us together. There will come a time when each of us will need to face the end of our life, and it is at that time, when a cure is no longer available, that our spirits may find peace in the presence of compassion.