Nancy wanted to know if she should let the children come see her father now that he had deteriorated so quickly. Both of them said they wanted to see him but she was worried that if they came it would leave them with a negative memory of a beloved grandfather. She thought they would expect him to be as interactive as he had been 2 days earlier. Was it better to let them remember him when he was not confused or should she let them see him even if he wasn’t himself? “What do I do?”
I thought of the playground and my son all those years ago. “What does your gut tell you?” She stared at me, maybe expecting a definitive response. As if there were one correct answer, and since I had taken care of other dying patients, I would have it. Instead I told her to trust herself and to trust her children. The fact that she was trying to figure out what was right was a good start. And she knew her kids better than anyone. “You can tell them what is happening, and ask what they want to do.” Even a 7- and 10-year-old can tell you what they are comfortable with. “What if they don’t want to come?” I reassured her, “That would be okay too.”
Our role as parents never seems to end. Nancy was worried about how to protect her 7- and 10-year-old, but another patient, Mary, was worried about her 57-year-old daughter. Mary had fought a long battle with lung cancer and continued treatment longer than she wanted to but not as long as her daughter wanted. Her oncologist had recommended hospice, but her daughter hoped she might get stronger and maybe have more chemo. Now Mary had reached a critical juncture. Her breathing was getting worse and there was a discussion of intubation. On one side of her bed stood her daughter and standing on the other side was the pulmonologist. After the doctor explained that her options were comfort care or a bronch and likely intubation, her daughter spoke up. “Mom, you have fought so bravely. Maybe we should do this. Maybe it will help.” But Mary shook her head at her daughter, and the pulmonologist and said, “Brave enough to fight. Brave enough to let go.”
Brave enough to let go. Letting go is a different kind of decision. It may feel like a passive one yet it requires equal consideration. It is more than a default. It involves looking at all the options, but it also involves a level of fearlessness. Although these three scenarios are different, they are similar too. The communication challenge in each case is to allow room to consider the less appealing option. Each has a larger canvas to consider: what comes after I make this decision? What are the possible consequences? What are the likely consequences? Our role as nurses is like mine was at the playground. To stand to the side, one hand offering support as we let our patients or family members climb. Brave enough to let go.
Ann Brady is the symptom management care coordinator at the Cancer Center, Huntington Hospital, Pasadena, California.