Hardest Thing

This week I’ve had a patient who may be the first patient that I actually have cried over a patient and his situation.  I’ve had this patient for a couple of weeks.  He has a terminal form of cancer and has a bad prognosis.  In the last couple of weeks, I’ve helped the patient work through his diagnosis, progress through the stages of grief and became a reassuring listening ear.  Nursing school prepared me for all of these things…however nursing school did not prepare me for what I was/am feeling about the situation.  I wasn’t prepared that I would also experience the stages of grief…not as prominently as the patient and family but it is still there.

In the beginning I believed there was something that could be done to help this man.  I wasn’t sure what but I was sure that the doctors would be able to do something…after all modern medicine has a lot of miracles.

After the denial I began to become upset at the situation.  The patient was in the hospital, and had been for many weeks.  He had only seen his wife twice since then and his kids not at all.  His wife seemed to not want to deal with the problem and because of this she kept the kids away from the hospital and their father.  At first I was upset and couldn’t understand and then realized that this may be the wife’s way of dealing with the grief. 

I’m not sure I ever entered the bargaining stage, but I was able to witness my patient endure that stage.  He bargained with God for many days, before he moved on to the harder to handle “What if…” moments.  “What if…I had done this differently?  What if…I had been a better father/husband?  What if I had spent more time with the family”?  This was a tough stage for the patient because the more “what ifs…”  the more and more depressed he got.  It is hard to see your patient become depressed to the point of giving up and not seeing the point anymore…especially in this particular situation…because the hope of life isn’t there anymore.  It’s hard to know that there isn’t much you can say or do at this point to help.  It’s especially hard to know the patient is facing the hardest moment of his life…with no support and no one to be there with him. 

The patient finally agreed to sign a DNR and consider the option of hospice and the return home.  With this option he began to become less and less depressed.  He had something to look forward to…returning home to spend his last days with his family. 

As a nurse, I wanted to help him and make him less depressed but at the same time…I know that there’s not much that can be said or done.   Although I know this…it does not make it easier to face the feelings that are forced upon you…I don’t think there is any way to prepare yourself for that.