Acceptance

It wasn't until yesterday that I completely understood why so many people are amazed I enjoy being an oncology nurse. I have spent endless hours discussing the horrible news of being newly diagnosed with cancer and the torturous journey they will experience. I have sat down and listened as the doctors sadly gave the news there were not any more options to try for a cure.

I almost always know the results of a bad scan or the outcome that their cancer has returned or grown before the patient knows. During the time between that information and presenting it to the patient I am able to compose myself to enter the patient's room for a dreadful family meeting filled with anger, tears and lose of hope.

As an oncology nurse, my role allows me to prepare patients and family for what is called a dignified death. That is, supporting honoring one's wishes. During the time of being diagnosed and end-of-life, there is a length of time to adapt to the current plan of care. That is, informing patient and their family during health changes and possible death.

However...today was different. When I walked into her room she stared blankly at the wall. I knew this 34 year old woman for quite some time. She had failed many chemotherapy's and was on a new study protocol as a last resort. She was admitted into the hospital a week ago for what she thought was an infection. We quickly learned her lymphoma had spread dramatically in just a week. She had difficulties with breathing and was extremely fatigued. When I peered into the room my heart broke in two. Already knowing the grim news that she received just a few hours ago I took a deep breath and entered.

Instead of the of a big smile and gossip conversations we typically share when we are together, she didn't do anything. I didn't even get the acknowledgement of my existence. Not that I blame her, she was given, in her terms "a death sentence of days to weeks". Why did I feel an unmeasurable amount of awkwardness in this room? I have had the experience of talking with someone who knew they were going to die in the not so distant future and did not have this feeling before.

I sat on her bed and offered her my attention. I asked questions I was uncomfortable to ask and probably more for her to answer. Such as "how does that information make you feel? How is your family taking the news?" But there was still an underlying feeling that made me uneasy. But what was it?

There was a lot of silence shared between us. Not an awkward silence though. I think it gave her time to think and say things out loud to me. Perhaps hearing her own voice saying this made it more of a reality then a dream. A very bad dream I am sure she tried to wake herself from many times.

So here I sat. Making sure to give 100% of my attention, make eye contact and providing her with support. During that time she shared with me her deepest thoughts. At that time I was able to understand I could not provide this young woman with a dignified death as I had with so many people during my 4 years of being a nurse.

She was not ready to die. Her thought of leaving her husband who was having a hard time coping with her disease had resorted to drinking excessively. He was unable to take care of himself, never mind her and their kids. The amount of guilt she felt toward her three young children was unbearable for her express. How could she leave her children and husband together, alone. Even through out her sickness of 2 years, she still remained the primary care taker. Without her, there would be chaos. She has decided to go home in a few days. To be with her family, in her home and with her friends. The most comforting thing for her. But, she was afraid it was not the best thing for her children. She wondered if they would be scared to go into her bedroom, she was nervous they would be afraid of her. I assured her they would see more than a hospital bed but a person they trust and love.

Even though I think leaving her husband and children behind has left a giant hole in her heart, she had to start thinking about herself for once. She looked at me and asked "Does it hurt? I heard people suffer". I think she was starting to inquire information about death even though she had not fully come to terms with it. I looked her in the eyes and promised her I have never witnessed a painful or bad death. She looked relieved.

Even though I spent most of my night sorting through the guilt, chaos, her husbands inability to cope, afraid her young children would have little to no memory of her and her own issues of being afraid I still did not feel she was at ease.

I hope as time passes, she will recognize her need to be there for her family while she still walks this earth. It is the worst feeling as a nurse to not help provide this woman with a dignified death that I know we could offer her. But first, she needs to accept the fact she is dying and her time is very limited. I am afraid she die in anger.