When I first began this role as a hospice nurse, it was so difficult for me to grasp the concept that my path with each patient has an end point. Please don’t misunderstand, it was understood that I was involved with each patient in order to help them pass as comfortable and as much on their own terms as possible. My issues came on behalf of the families. How was it at all fair that, after such an emotionally charged experience that I was just to walk away after? Death, life, loss, pain and fear – all just the tip of the iceberg in terms of the vast emotional rollercoaster that I was the ticket taker. “Hold on tight friends”, I often felt like saying, “keep your hearts and minds in check because this is going to be one hell of a ride.”
That ticket taker has a role – they prepare you for what is to come. They don’t try to minimize how scary and dangerous this ride might be. By educating and conveying the right information at just the right times, this person is able to help the rider understand that what’s about to come is a profound experience. That ride takes off, the rider goes off but always remains within the view of the ticket taker. While at the start and end point of the ride, they might look up and if the ride is about to take a huge dip, their stomach might drop or if a crazy twist is happening, a wave of fear might wash over, but, it happens all from the designated start point. In many ways, we nurses are reflections of those attendants.
While I grant you that the situations are vastly different, there are more than a few similarities between those roles. While a lot of my writing has to do with the patients and their experiences, this deals with families and loves ones specifically. I know what the emotional rollercoaster of losing a loved one might generally be like, I cannot always predict every small detail. Like a snowflake, each journey is vastly different and individual. The loss any person is a one of a kind experience. Even something like the loss of each parent differs wildly. Hospice nurses are there to help, to educate, to guide, to comfort and, this is the arguably the most profound, to teach the loved ones how to go on with out the lost one and in all honesty, without that nurse.
It does seem almost mind blowing to say that because of the profound emotional weight of this all. But, it is probably the kindest thing we can do for them. The loss of their loved ones is difficult enough, but, if we do not prepare them, then families will also mourn the loss of us. Throughout the whole process, we should be laying the groundwork for this. If we do not do it, the handicap will be profound – it is almost as if we are creating a void we cannot fill afterwards. We cannot set them up for this – it would be an injustice and be the complete opposite of what we are there for. Allow the on call nurse to take the visit if the family calls. Care for the family, but, give them the ability to free without you.
Having said that, it is really not that easy. I struggle with this SO MUCH. This piece is profoundly critical for us nurses, as well the family members. It is so hard for me to pull myself away from this hurting family. The feeling that I have abandoned them in those hard moments causes me such pangs of guilt. I mourn for the loss. I mourn the loss of seeing the families. It hurts. It weighs heavy on my heart. Feeling like I have bailed on them when they need a shoulder to cry on breaks me up inside.
But, my aha! moment in this came a few weeks ago when talking to my therapist. Yes, I talk w a therapist. Self care, friends, we have to do it. When lamenting this issue, she listened for a while and then carefully chose her next words. “Helen, do you feel like you are a good nurse? Do you feel like you do all you can do for your patients? What about the families? You prepare them both, right?” I answered saying that I do feel like I do whatever is in my power for all parties involved. “Well, then, since I also know how you are as a person and as a nurse, I can tell you that you are failing yourself with your thinking.” Stunned a bit, I listened to her explain. “You have prepared your families. You, from the first visit, have laid the groundwork for this separation. You educate, you advise and you help them gain the necessary emotional ground. By feeling like you are failing or cheating them, you are discounting all you have done. Trust in the work you have done. Trust in your abilities to prepare them. Trust, that as their nurse, your have given them all the tools to go on. You see, your thinking diminishes your hard work.” It is hard for me to be speechless, but I so was. Profound revelations have that effect on me.
So, I cannot say that I am perfectly content with all of this. But, there isn’t a hospice nurse I know that doesn’t try to do everything possible for patients and families. We have to start trusting that we have empowered them to go on. Am I now perfect with this and always feel great about this? Nope. Will I ever be? Can’t say I will be. But, truth is our jobs are hard enough without another thing to hold against ourselves. Think of them. Miss them. Hurt for them. But, trust in the fact that we have provided all the necessary tools for families to go on… with the memories of their loved ones and the recollections of the compassionate care we have provided for them.