When the end is near

Most of us have dealt with end-of-life issues from our patients and families. Some of us have faced them within our own families. But how many of us have faced them individually? By this I mean actually coming to grips with our own impending mortality. I know that I have not, and I bet most all of you have not either.

Sure, I have thought about what it might feel like to be faced with those thoughts and decisions. But how accurate are my assumptions? What am I really going to be thinking about at that time in my life? I will never know until that time arrives. I may speculate and opine about what may be important to me, but that is all it really is right now...speculation.

My my grandfather is not doing well, and has been declining in health for some time now. I am certain he is not going to be here much longer, and I suspect he knows this as well. I can see him being more and more desperate to maintain as much control as he possibly can over his life. He is an extremely independent and stubborn man. Nobody can tell him what he needs to do, or what he shouldn't do...he knows far more than any of us. Or at least that what he wants us to believe. And I can't help but wonder who, exactly, is he trying to convince...us or himself?

When we are caring for someone who is facing their own mortality, we know there are a spectrum of emotions he or she is faced with. Elizabeth Kubler-Ross taught us that we typically transition through 5 stages of grieving: denial, anger, bargaining, depression, and acceptance. I can clearly see my grandfather in the first and second stages. And I think that, as a nurse, I want him to continue to express his emotions, and to work through the stages. Additionally, I recognize these stages exist, and anticipate that he may react this way. As his grandson, I want to tell him what a stubborn, irrational man he is being, and tell him to listen go his doctors and nurses. I know that wouldn't work, and would be extremely counterproductive. I know that he must make these transitions on his own, knowing that he has family at his side all the way. Some people will never say "sorry", "thank you", or "I love you." I believe my grandpa is one of them. But I know he doesn't have to say it to know that it exists.

I think that things happen in our lives very purposefully. Things seem to happen at either the "right" time or the very "wrong" one. It is really all a matter of perspective, and we all have heard that "hindsight is 20/20", illuding to the concept that the best perspective is perhaps the retrospective one. Maybe that is true. I believe that there are some, although not as many, that are known to us immediately as being very significant. It is how we react, it is the paths we choose at that crossroad, that can determine future events...and perhaps only hindsight will allow us to see them in more clarity. It's just that sometime we do not have the luxuries of time and retrospection at our disposal. It is at these times that what is "not" said may be more important than what "might have been."

I think that we, as nurses, are oftentimes faced with these situations. Sometimes we know that the most therapeutic thing you can do is listen. It may seem like we are doing nothing...and that would be absolutely correct. By doing "nothing", we allow our patients and their families to express their thoughts and feelings...sometimes for the first time. An open ear and a warm hand can provide more healing than we can ever know. We all know this to be true. It is what sets us apart as nurses. We should be proud to be in such an influential position in health care...even if we cannot see it at the moment.

Recognize every moment as being significant, for many times it is...just maybe not for you. Many times YOU are the turning point in someone else's life. I have said it before, and I am certain I will say it many more: you have an impact on many people, and you probably have no idea how important you are to this profession.

When my grandfather is in the hospital, alone at night, and he is being stubborn with the nursing staff, I can rest comfortably knowing they recognize his actions for what they are, even if he doesn't. I know that no matter what, he will be listened to, and be cared for indiscriminantly.

So, I say to each of you: the next time someone is angry with you, will not listen to your attempts to educate them on their disease, or just doesn't seem to want to accept the fact that "the end is near", please know that this person, this human being, is someone's mother, father, brother, or grandfather...and that they are resting comfortably at home knowing you are taking great care of their loved one, and that they are truly not alone.

Thank you for being there when no one else is. Thank you for the long, thankless hours you devote to others. Thank you for being a nurse. As this "Nurses Week" draws to a close, I want you to know that if no one else says it, I will: Thank You!!!!

Steve