I cried in the chapel for the first time...

  1. 8

    I used to pride myself in my exceptional ability to maintain healthy level of emotional detachment, but a recent experience left me distressed and tearful. Thank you for reading and your support in helping this one socially awkward nurse to sort out her feelings and improve.

    In the past ten years of nursing, I never cried for a patient. It's not that I am cold or unfeeling. I do often get comments from patients how "nice" or "gentle" I am. While I do care greatly, I just don't get overcome with emotions at work. But a few nights ago, I ran away to our hospital chapel (during my break) and sat there, crying. I did not go there to pray -- I am not religious -- but I just needed some solitude.

    So what happened?

    The last couple weeks have been strangely emotional -- a dying patient, a frustrated patient, saddened family, etc. etc... the usual of course, just with more intensity.

    The last straw came from an unexpected patient. I had the patient often in the past -- I work in hem/onc/BMT unit where many patients stay for a long time. I knew his medical history well but not the person, as he is rather aloof, often irritable. And I am certainly not the type who's good at conversations. So it was very surprising when he suddenly seemed quite talkative one night and I ended up listening to him for almost half an hour. He talked about his religion, his little kids, his personal circumstances and how hard it was for him to deal with his diagnosis. He even talked about his feelings toward his own mortality... heavy stuff... I ended the shift feeling quite good, thinking I lent him a good listening ear.

    The next night, he had a visitor who stayed the night, and initially seemed in good mood. It all happened when I went in later to give his meds. Everything was just as usual. I rattled off the meds I was about to give, scanning the packets. Then, I heard a sniffle. I stopped and looked at him. He had his eyes covered, but the sniffle and quiet shaking was unmistakable. My mind went totally blank then, standing there frozen. I glanced at his companion, hoping she would intervene somehow. But she only stayed quiet, looking pensive.

    Oh how I wanted to be anywhere but there, standing next to the crying man, completely at a loss as to what to do or what to say!

    My hand reached out to touch his shoulder even before I figured out what to say, because anything was better than just standing there stupidly. A few seconds later I stammered, "Anything I can do?"

    Ugh, stupid! What could I possibly do?

    "Just need a minute?" A vigorous nod.

    "I'll leave your medicine on the table, okay?"

    I was about to sneak out, but he got up then, and took his meds. He asked for his pain med later and that was that.


    I have certainly witnessed more dramatic tragedies before. And I am still puzzled why this particular patient, whom I don't even know very well, should disturb me so. There was just something so disturbing about watching a man, with a big and imposing stature, but now helplessly lying in a bed, crying.

    It is possible I felt more connection to him because he opened up more in the previous night, but still, I don't think I cried because I felt bad for him. I feel many things, but I don't do "feeling bad" for my patients. I think I am frustrated and angry, extremely frustrated, because I really have no idea how to lessen their pain -- their emotional pain.

    Here's my problem. I am not good at socializing to begin with. I completely suck at "reading" people. While I can be "nice" in most situations, I have no idea how to react when people who are normally reserved suddenly show vulnerability. Do they want me to stay and console them? Do they want me to leave them alone? What should I say? Should I touch them or should I stay away?

    It has been exactly a year since working in oncology, and I have never been this frustrated with my inability. I've been studying furiously -- studying the books is about the only thing I can do confidently -- but my true problem is something that no book can teach me.

    So I ask your wisdom. What do you do, what do you say, in that awkward moment when your patient suddenly cries?
    Last edit by tnbutterfly on Sep 4, '13
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    Summer Days, sharanza930, canoehead, and 5 others like this.
  2. Visit  tokebi profile page

    About tokebi , MSN

    tokebi has '11' year(s) of experience and specializes in 'Hem/Onc/BMT'. From 'California'; Joined Mar '10; Posts: 418; Likes: 885.

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    21 Comments so far...

  3. Visit  kismetRN profile page
    1
    i don't have any advice..it's just that I do share same personality as what you have (not the type who's good at conversation)
    and that I can relate so much I have to read it twice More often though, when I am in an awkward situation with a patient I just find LISTENING
    and or a tap on a pt's shoulder works just fine.
    Been there,done that likes this.
  4. Visit  Been there,done that profile page
    5
    I thought you handled it very well. Maybe offer the chaplain's services next time.

    Nothing wrong with a good cry, wherever it may be. We are human and need to let our frustrations out.
    CountyRat, Baubo516, Altra, and 2 others like this.
  5. Visit  GrnTea profile page
    14
    Just imagine if it were you. Would you want someone to fumble around for words, say something that is well-meant but might completely miss the mark so then YOU have to accept their apology later, lay out some platitude in an attempt to be "supportive"?

    Or would you like that person to sit down next to you silently, pass the tissues, perhaps touch your arm, and just be there with you until you feel able to speak?

    I vote for number two. Silence is not always a bad thing, and it's easy to do.
    CountyRat, prmenrs, sspanje, and 11 others like this.
  6. Visit  Esme12 profile page
    11
    I think you handled it flawlessly....you expressed empathy and understanding....yet offered support in a non obtrusive way letting him know you were there and understood without empty words and hollow expressions.

    Sometimes we speak volumes in a single phrase....Welcome to nursing!

    There are times I think our own vulnerability/mortality, or that of those we love, dances across our heart and minds leaving us emotional and aware of our own mortality. We realize just how little control was actually have in our lives.....and that is overwhelming....humbling....frightening.

    ((HUGS)) great job!
    CountyRat, kismetRN, sspanje, and 8 others like this.
  7. Visit  valeriamariaflynn profile page
    1
    I have no doubt your patient knows you care. How many nurses take a half hour to listen to their patient? When this happens to me I hand tissues, hold their hand and say I am there for them, I am on their side, and to me support is shown more in actions than words. You've certainly shown that to him.
    Baubo516 likes this.
  8. Visit  tnbutterfly profile page
    3
    You handled the situation perfectly. Many of us find silence uncomfortable and we attempt to fill the silence with meaningless words. We stumble and blurt out the first thing that comes to our minds.

    In times like this, the best thing we can do is offer the gift of our silent presence and support. By being silent, we show the patient that we are accepting and comfortable with their emotion. A gentle touch conveys a lot. It lets the patient know that they can look to us as one with whom they can share their emotional pain.

    If a situation gets beyond what you can handle, it is quite appropriate to seek the assistance from those who have more experience/training in handling such issues.

    It does get easier, but don't let your feelings go away. Your tears are not a sign of weakness. Compassion is a vital quality to have for providing great nursing care.

    For more insight on nurses who cry, you might want to read When Nurses Cry.
    sharanza930, Baubo516, and Esme12 like this.
  9. Visit  Bortaz, RN profile page
    1
    I think you did just fine.
    canoehead likes this.
  10. Visit  VivaLasViejas profile page
    2
    You hit exactly the right note with this patient. And I think this situation got to you because seeing a proud, strong man cry tends to tug at our heartstrings. I know that's the quickest way for me to become a puddle---I melt whenever I witness a man's tears. And there's nothing wrong with that---it simply shows that we have feelings.
    Baubo516 and tokebi like this.
  11. Visit  tokebi profile page
    0
    It relieves me somewhat that my actions were not as stupid as I felt at the time. I really appreciate the encouragement and suggestions. I wish I were more socially intuitive... Even for little things that may seem like nothing to many of you, I have to consciously think about and calculate my actions. For example:

    Quote from GrnTea


    Or would you like that person to sit down next to you silently, pass the tissues, perhaps touch your arm, and just be there with you until you feel able to speak?

    I vote for number two. Silence is not always a bad thing, and it's easy to do.
    I totally agree silent support trumps over empty chatter. But, how can I know if the patient wants me to stay or get out? Someone might appreciate the nurse's presence but someone else might want privacy when he gets emotional like that. Would it be okay for me to ask, "Would you like me to stay with you, or leave you alone for a while?" Or, do you think such specific question would aggravate the patient?


    Quote from VivaLasViejas
    You hit exactly the right note with this patient. And I think this situation got to you because seeing a proud, strong man cry tends to tug at our heartstrings. I know that's the quickest way for me to become a puddle---I melt whenever I witness a man's tears. And there's nothing wrong with that---it simply shows that we have feelings.
    Yes, I agree! I realize we should not stereotype based on gender or looks, but I admit I had formed certain expectation due to his big, strong appearance that it completely caught me off-guard when he broke down.
  12. Visit  tokebi profile page
    2
    Quote from tnbutterfly

    For more insight on nurses who cry, you might want to read When Nurses Cry.
    Thank you for pointing me to the article. I have read it before, but re-reading it this time touched me very deeply, in light of my recent experience and self-reflections.
    Esme12 and tnbutterfly like this.
  13. Visit  duskyjewel profile page
    1
    I'm a hospice CNA, and I think you handled it fine. That's one of those times where we are utterly powerless to make any difference in anything at all. Watching someone go through the stages of grief is painful, humbling, and challenges even the most socially apt among us. Watching someone come to terms with their own mortality and start dealing with the fact that they REALLY ARE GOING TO DIE FROM THIS shakes us all to the core, no matter how often we see it. Because it's always the first time for the person going through it. And it's painful and horrible and so deeply personal.

    I have great social skills and I still struggle with how to correctly approach patients and families at such moments. Because what was right for the last one isn't right for this one. And won't be right for the next one.

    You were respectful but present. You were compassionate and available without being obtrusive. You did just fine.
    canoehead likes this.
  14. Visit  UrgentCareRN profile page
    5
    I just get down at eye-level, grab a Kleenex box, put my hand on their shoulder or arm and say, "I'm sorry you have to go through this. How can I help you?" And then simply respect whether they want to cry or be to themselves. I usually conclude by saying, "we are going to take good care of you today. Please let me know what I can do for you." As much as I try to be rock-solid with my emotions in my job, I do allow myself to be human and grieve with those who grieve, give comfort to those are wronged and bring hope to those in despair. Last week I triaged a man with 2/10 left chest discomfort for one week which he ignored because he's been under a lot of stress lately. I've found that when a patient verbalizes they've "been under a lot of stress lately" that they usually are waiting to break down and need someone to talk to. So I responded with my usual "things tough at work?" "No, my dad is dying and I'm just waiting for a call any day now from the hospice nurse." Then 30 sec later as I'm getting vitals, his cell phone rings. It's the hospice nurse. He hangs up and says " I gotta go. My dad is dying today and I need to drive 5 hrs to get there. " Talk about awkward. What do you say to someone who just discovered this is there last opportunity in life to see the person who brought them into this world. I handed him a Kleenex, took one for myself, said how sorry I was for him and then tactfully convinced him (out of serious concern for AMI) to give me 4 min to do an EKG. 5 min later he was on my monitor with a MD consulting cardiology. He went straight to the cath lab. And I wondered how the doc was going to break it to him. And he sat down at his eye level and said "I really want you to be with your dad today, but your heart is not getting enough oxygen right now and maybe this is your dads way of looking out for you " the man completed accepted his words and in between an 18 gauge, o2, nitro, ASA, more nitro and the AMR transport he opened up about his dads life and actually looked less stressed than when he arrived. Sometimes people just need to know you care. And even though we might feel awkward, they don't know we feel awkward. A few simple things and a few short phrases can help them so much. I used to feel uncomfortable because I felt like I needed to have an answer, a solution to everything. Now I realize most people don't want an answer. They just need someone to listen and acknowledge what they are going through. It's a great thing to be a nurse. I hope I never take it for granted.
    etymed, kismetRN, GrnTea, and 2 others like this.


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