In nursing classes and clinical your patients are held in an objective light that can be a fascinating (or frustrating) amalgamation of medications, injuries, diseases, and circumstance.
The case studies we read and the end of day conference between nursing students were some of the most interesting days as a nursing student. The student with the most interesting client always held the room in their grip. As a palliative care and neurology nurse I saw a myriad of clients, no two were ever the same.
Complicated cases are intimidating and exciting for most nurses. We are smart enough to process through all of the objective and subjective data of several clients and yet we still have an innate sense, a need, to help those around us.
Is it any wonder that as one of the most varied careers, we suffer some of the highest rates of burnout and stress-related health problems?
We give give give of ourselves on the job and then try our best to leave it at the clinic or hospital when we clock out. As a palliative care nurse it is imperative that you leave those deaths behind you. Sure, some slip through your guard but without that level of separation we would fall into a deep depression.
But what happens when your work hops into your pocket and rides home with you?
My Papaw was a carpenter. He built furniture for a small company, then came home and worked in his shop carving ducks, hound dogs, bookshelves, and benches. He was also a singer and guitarist in a gospel group called The Planters. He looked just enough like Elvis to be handsome and loved to pick with us grand-kids. (He was the master of all things “punny”.) In the 90s he was diagnosed with Type 2 Diabetes and his health slowly declined from there. By 2007 he had suffered a few minor strokes and his diabetes had taken a toll on his body. My Mamaw struggled for years over how to properly care for the man she loved. They renewed their vows on their 50th wedding anniversary, unsure of how much longer they would be together. It was one of the sweetest celebrations I have ever attended.
In mid-2009 my Papaw’s health took a turn for the worse. Unexplained pain, frequent UTIs, probable prostate cancer, lacunar strokes, possible heart attacks… it all started piling up. In September, my Mamaw made what I am sure was one of the hardest decisions of her life: She placed him in Hospice care.
Few issues are so controversial in a family than when to let go of a loved one, and my family was no different. I had been in favor of palliative care all along. (How could I not be?) Palliative does not mean death, it means comfort and rest from what ails you. It is a welcome respite when you or your caregiver are too tired to go on.
I got the call that he had been moved from hospital to Hospice while I was on my way to work. In the wee hours of the morning I felt the panic in my chest and my hands shook non-stop. There was no way I could work my shift. The description of Papaw was classic end of life: speaking but not making sense and slipping in and out of consciousness. His breathing was ragged and loud, his hands and feet pale.
When I got to Hospice, I pushed it all from my mind, stuffed it way down deep where I wouldn’t be able to feel it. Now was not the time to fall apart.
So when I entered the room, I stood by the door and listened to the nurses give report. I made my own assessment of Papaw and the needs of the family in the room.
Then I waited. The Hospice nurse did her assessment and spoke to the family briefly before leaving to tend to her other patients. No sooner had she cleared the door than I was in action. I got someone to help me re-position him with pillows, raised the head of the bed to help fluids drain from the back of his mouth, and put an extra blanket on his feet. I talked to my Mamaw and Great-Aunts about what was happening and answered their questions. Honestly, most of the day is a blur. I don’t know how long I was there or who else I spoke to.
I was in work mode.
Too soon, he was gone. He woke only once more when I was present. I’m not sure if he recognized me or understood when I said hello. What I do know is that I did not cherish his last hours with my family. I did not engage with those around me as myself; I was Andrea, RN. I didn’t clock out until after the viewing and visitation.
The surviving members of his gospel group performed at his funeral, friends and family spoke on his behalf. I bawled through the entire service. My daughter, then three years old, held my hand and fretted over me. She had never seen her mommy cry.
When reality finally kicked in, hard, the emotions of the days previous were overwhelming, crashing down on me all at once. But what hurt the most was knowing that I had been stoic and unattached, like watching fish in an aquarium, throughout his end of life process.
Last week was the fifth anniversary of his death. When my work with end of life patients cropped up in my family, I did not handle it well. I disconnected and treated my sweet Papaw like a patient. He was comfortable and cared for, my family was given straight talk from someone with experience in death… and I emotionally avoided the entire situation. My nursing instincts kicked in and spared me from the heartbreak of losing someone I loved but only for a time.
We still miss him.
The loss of a loved one is a unique experience that should be free from judgment. Grief is personal. If you need to talk to someone, call 18004454808 to speak with a grief counselor.
If you would like to read more about death & dying from a nurse’s perspective check out “Sometimes We Are Firefighters”.