PDF of Challenges 0213

I stood by Jeannie’s hospital bed and thought to myself, “I have nothing to offer her.”

As a nurse, how do you feel when you think you have nothing to offer a patient? What do you do when you have no tasks, or things you can do to help your patient?

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Jeannie’s cries filled the room, not with their volume but with their weight. “I don’t know what to do,” she dropped her head into her hands, her shoulders shaking. “I keep waking up to the same nightmare.” She rocked back and forth, like a child soothing herself. 

Though 28 years old and the mother of two children, she was only on the brink of who she was supposed to be as an adult. How could someone this young be dying? 

I first met Jeannie after her pelvic exenteration surgery. She had completed chemo and radiation prior to surgery, but it was her post-op pain that was keeping her from being discharged. Our team was called in to help with her physical symptoms. Once we addressed her pain, we facilitated a family meeting. It was at that meeting, when, even with her pain high, she declared, “I am a warrior princess. I don’t believe in giving up.” Her mother and husband nodded in agreement and so did our team, allowing Jeannie to lead the way. The warrior princess was the Jeannie I was used to seeing. 

Our team worked with her through several more hospitalizations, helping with her physical symptoms. But with each hospitalization it became apparent that her emotional suffering was impacting her symptom profile. She wanted to be home with her children, yet each time she went home was followed by a quick readmit. She returned with a symptom out of control; often it was pain. But Jeannie crying was something I had not seen before.

As she wept into her hands I stared at her fingers, now so thin her wedding rings floated around them. Her anguish was palpable 
but I was uncertain as to how to comfort her. 
I was used to her warrior-princess persona. I 
had seen a tear roll down her cheek, but I had never seen her cry. Her pain could be 10 out of 10 yet even then she did not cry. When the doctor delivered more bad news, she did not cry; instead she tucked her chin down and straightened her shoulders, ready for the next battle. So her tears unnerved me. That was when I thought to myself, “I have nothing to offer her.” I shoved my hands deep into the pockets of my lab coat. I wanted to run from the bedside and keep running. That morning we had adjusted her PCA and I had stopped by to see how effective the change was. We spoke for a few minutes, a businesslike exchange that focused on her pain, when she started to cry. I have dealt with tears of anguish, with tears of frustration and rage. But embedded in her sobbing was raw exposure, primal. It exposed the depth of her despair. I would be lying if I didn’t say it frightened me. I wished I had skipped the physical check in and instead had called her nurse to find out how she was doing.

It wasn’t that I wanted to avoid Jeannie. I really liked her. We had a good connection, more than I often have with patients. I loved how upbeat she was, how she fought for the next treatment and insisted that she could beat cancer. I knew in all probability that she was wrong about beating her cancer, yet she converted me. Her optimism was believable. She had youth on her side, a verve for life fueled by the love of her children. And she had an unshakeable confidence in the power of positive thinking and prayer. But on this day it wasn’t her enthusiasm that was contagious; it was her suffering.