Now that I'm fully entrenched in my NP clinicals, it's starting to sink in that my career as a registered nurse is coming to a close. I can still remember walking to the mailbox in my shitty apartment complex, and finding my acceptance letter into nursing school as if it were yesterday. It's crazy that this all started with an associate's degree.
I had a case this week that hit me hard. I'm usually pretty disturbed when there is a disruption in the natural order of things, but I've been a hospice and palliative care nurse for 6 years. Throughout those years, I've learned to compartmentalize an extraordinary amount of emotion. I have loved being a hospice nurse, and the relationships that I've forged along the way. There's this gray area in terms of clinical and personal that allows (in certain cases) for the formation of lasting friendships. I adore those families (some of whom will very likely read this blog...you know who you are). I've loved being able to walk people through this process, helping them navigate a situation that is impossible to spin into a positive. I respect all of my patients and families for sharing this intimate part of life with me, and I have never taken my job lightly. Hospice has never been just a job to me. Let me back that up even further, nursing has never been just a job to me.
That being said, I've had bad days....so many bad days. I've cried (usually in my car, which seems to be my safe space) a lot. I've had families that weren't handling grief well use me as the target of their angst. As a nurse, who is intimately familiar with grief, I understand that. As a human being, sometimes I would walk away from these exchanges severely wounded.
There's one case that comes to mind. During this time, I had an unusually high number of young cases on my caseload, which alone will wear down your emotional armor. In the midst of this, I had a family member who was not managing their grief well at all. Our first meeting involved them following me outside and screaming at me for a full 5 minutes over the fact that my name tag said "hospice" on it. Shaken, I made sure to let the team know to take off their name tags before entering this home.
As a hospice nurse, I never tell someone how I think they should be managing symptoms. I make recommendations. If someone is averse to pain medication, I try to offer alternative suggestions. Acupuncture...aromatherapy. I do my best to advocate for pain control, but ultimately it's not my decision to make. This family member was averse to pain management. I was conservative in my suggestions.
I had to call them one day to let them know that the physician would be coming in my place. I didn't want them to refuse the doctor's visit because I had already scheduled with them that day. Ideally we schedule joint visits, but this particular day i was wrapped up in a crisis situation and wasn't able to coordinate. This family member asked me, during this phone call if, "...you people just medicate your patients so that they die and you don't have to deal with them anymore." I remember this moment vividly. I remember where I was standing, the building I was in, the hateful tone as the words were spat out at me. It felt like an arrow, finding the weakest point in my emotional armor, and succeeding in a kill shot to my heart.
That night, I went home and couldn't find the wine bottle opener. I took a bottle of wine over to a neighbor's house so that they could help me open it, and I sat there recapping my day. I consumed the entire bottle that night, and then some. I woke up early in the morning with a skull-crushing hangover. Now, I've had cocktails with coworkers after a bad day, but this was veering into pathological territory. The next day that I was scheduled to work, I asked to be removed from the case. This was the first time I had asked to be removed from a case, and the only time I made that request because I felt abused. Ultimately, I had to save myself.
In thinking back on this experience, I wonder about this person. Did they ever realize how hurtful their words and actions were? Are they ok? Did they eventually make peace with the loss and their inability to control the outcome?
Nurses are often the target of dysfunctional grief. My story is not unique to me and me alone. I hope that someone reads this and thinks twice before verbally (or physically) abusing a nurse. We go home to our families, after witnessing trauma on a daily basis (and working long hours). We have to take that trauma, process it in a healthy way, and try to make ourselves whole. We suffer when our patients suffer.
