Nursing at end-of-life

Nurses are both blessed and cursed with witnessing life, death, and everything in between in our professional roles. We see pain and tragedy all too often… sometimes every day if you work in a busy Emergency Department or Intensive Care Unit. It can be very difficult to experience the feeling of helplessness when caring for a patient who is not going to “make it”. Our goal is to save lives. “Not today”, we tell ourselves as our patient crashes; we call for help and start resuscitation…sometimes it works, and sometimes it doesn’t. Highly skilled and experienced nurses are able to adapt to the stress of life-saving emergencies, but it is still a very difficult process; we focus on tasks and try not to think about the patient being so young. We try to block out the cries and looks of fear from family members as they pray for their loved one to survive. We get through them because we must; we have other patients who need us, and this is what we signed up for when we chose our profession… or it chose us.

We take the laughs when we can because humor really does help us get through those horrible shifts. We create “inside” jokes with our friends and colleagues to stay sane. I believe this is why nurses develop such strong bonds; we understand each other.

And then there comes a time in every nurse’s life when we are faced with the challenges of caring for a loved one as they near the end of their life. I am here now. Both of my parents have cancer; my mother has malignant pleural mesothelioma, and my father has stage IV bladder-lung-bone cancer. Fortunately, my mother has outlived her predicted life-expectancy of less than a year by an additional year, and has responded to chemotherapy, Alimta. My father, on the other hand, has not responded to chemo (IV or instillation directly into the bladder), cyber knife, radiation, or immunotherapy. We have had those difficult conversations with the oncologist, who is as kind and compassionate, as he is honest. As a family we have practiced patient-centered care by placing his preferences and needs at the center of his treatment plan; he is now in hospice and we are focusing on comfort and quality of life. To say that I am deeply grateful to their expertise and care is an understatement; they are truly amazing.  They manage pain with all the available tools in their “comfort care” toolbox; what they don’t have, they get. Quickly.

Talking openly about funeral arrangements, and what to expect as death becomes imminent, can be impossible to imagine when you are face-to-face with your dying parent. I suddenly forget that I am a nurse, and am back to being a daughter that can’t form a sentence without crying. You are torn between wanting (much) more time, and wanting the pain to end for your loved one. I am much better at holding things in and not saying what needs to be said, which has led to a mountain of regret in my lifetime… but that’s another post, for another time. Trying to manage my feelings and emotions about being a nurse, and caring for my father, who is nearing the end of his life, is what inspired me to start this blog. I hope that it can help me to find the words that I need to say in the end.