Death, Dying and Nursing

It's my first year as a nurse, and while there have been many challenges, one of the greatest has been helping patients who have just received a fatal diagnosis. We were taught about this in school: how to handle end of life issues, the 5 stages of grief, etc. With 8 years as a paramedic, I thought I was ready to deal with death, but what I forgot is that dying is very different from death.

I work on an observation unit of a hospital. Most of our patients come in for less than 24 hrs. They are either waiting for some test (which usually comes out negative), or they have just had surgery, and need a little time to recuperate before they go home. Sometimes, when there is no room elsewhere in the hospital, we keep patients that will be staying in the hospital for a long time until another bed becomes available. As a result, it is rare that my patients are VERY sick. Most of the time my patients are not expecting a bad diagnosis.

When a bad diagnosis does come, it is usually a surprise. I see these patients on the first or second day after their diagnosis, and I only see the denial stage. Even that stage presents with different varieties. I've seen patients ignore the diagnosis, and continue on as if they had been told nothing. They laugh and joke with the staff as if they don't have a care in the world. As a nurse, I wonder if I should let them have these last few moments of carefree joy (as false as it is) or if I should try to gently bring them back to reality. I've had patients who are completely saddened by the diagnosis to the point where it paralyzes them; they can do nothing. They make no decisions, do not want the doctors to do anything about their condition. It is as if ignoring the problem will make it go away.

As many different patients and diagnosis there are as many different forms of denial. Some are more difficult to deal with than others. One night I had a patient who hit her call bell constantly. She had a litany of requests: move me up in the bed 2 inches, add a little water to my apple juice, move the pillow under my knees a little to the left, etc. I must have walked to her room a dozen times per hour. It was truly getting on my nerves, and I was quickly losing patience. While trying to find my compassion, I realized that this woman had just lost control over everything that was important in her life. The doctors had given her no choices but surgery and little hope for survival. The only things she still had control over were where she was sitting in bed and the temperature of her drinks. Once I realized that, it was a little easier to find my compassion and meet that patient's needs. True to form in an observation unit, a bed came available in the hospital, and she was moved. Once again, my patient and I never got past denial, and from time to time, I've wondered how she's coping.

Sometimes nurses forget that we have another set of patients: the family. Helping them cope with a fatal diagnosis is another part of nursing. It is equally important, but often requires a different approach. Families don't always have the same reaction that the patient does. Saying goodbye to a loved one is a very difficult process.

I've wondered recently if how we deal with life affects how we deal with death. Recently my dad sent me a link to a very interesting video that addresses how we live our lives. It's crossed my mind several times recently to question how well I'd deal with a fatal diagnosis. I've wondered if the more content we our with our lives, if that makes us more capable of dealing with our own death.

I don't really have any answers to these questions. I just keep contemplating them as I care for my patients: those who are trying to live well and those who are trying to die well.