Last week, while shaving my legs, I listened to a Ted Talk by Leana Wen who is a medical doctor here in America. The video was about transparency between a doctor and their patient and how by doing this a true trustful relationship could begin to form.
She made valid points about patients having to hand over their most personal information, their lifestyle, their body to a person with a degree whom they know nothing about. Patient's don't know where their doctor's stand in the community, with their beliefs, or their conflicts of interest. It is like a one-sided conversation.
Leana Wen put forth this idea to a wave of hatred by physicians across the country. She got death threats and bomb threats and was asked to "move back to her country" despite living in the US since she was 8 years old.
I am not a doctor and the nursing model of care is much different than the physician's. Nurses are a bit more able to look at the bigger picture and take into consideration all of the peripheral reasons why a person might be sick or act the way they do. We are also more honest and upfront, because maybe, we have less to lose. We aren't going to get sued for our opinions like a provider might.
Yesterday I had a patient who had pretty severe cancer and was being seen at a prestigious cancer center that is nationally known. They told him he had lung and kidney cancer and he was young and was undergoing chemotherapy. When he came to us he had been coughing up blood which is never good. When all was said and done, his exam revealed a worsened cancer in the last month and cancer in places that our facility had seen in August that were never mentioned to them by their cancer center.
The patient's wife was furious and in tears, because there at 3 am they were both realizing the severity of the situation. She looked at me and asked my why won't any provider tell them the truth without sugar coating the outcome. I told her that I could not answer that question as I am not a doctor, but I looked her in the eye and explained slowly and carefully the true possible outcomes of her husband's disease process as it stood right then. She cried some more. He cried some more. I stood there and cried with them.
I understood first hand the power of cancer's grip to steal those that you love right from under you. It is so silent at first, so evil in the end. The wife thanked me for my honesty and my compassion. We were going to transfer him to a higher level of care and after I finished the paperwork I thought about Leana Wen and I too was angry for this family. Why don't doctors tell you how it is really going to be? Sometimes it is because they want you to move forward with their plan of care. Sometimes people don't want the truth. Sometimes I think they forget what it is like to be on the other end of the spectrum.
I went into work last night and was told that as my patient was being put into the ambulance for transfer, he died. His cancer swallowed him whole, so to speak, and he was gone. I knew the ending to his story, but some part of me had a glimmer of hope that maybe I was being a fatalist or being too severe. I know now that I was able to give them both a realistic picture as sad as it was.
A nurse's job is very hard. We have to learn so much about a patient in a short amount of time. We have to juggle 4-5 lives at a time while making everyone happy. We get to save lives and watch them slip away. Each one chipping a layer away silently. Each one embedding themselves in your collective personal graveyard. Try to remember as patients that we are limited to what the doctor says we can do for you, that though we may seemed rushed, or busy, we really do care about making you better. We wouldn't put ourselves through this daily torture if we weren't compassionate and loving at the core.
Today, I am looking for meaning in the face of untimely deaths, and I am not sure I find any good reasons. Love your life while you have it. Tell people how wonderful they are, don't forget to smile and laugh, and take all the hugs you can get.
Peace.
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