overly pleasant demeanor after CA diagnosis?

[ashleyisawesome, BSN, RN]

Hi everyone! I am a brand new nurse, and I am working on a med/surg orthopedic/oncology floor. we have a lot more orthos than oncology pts, but were the only unit in the hospital that can give chemo, so we get a decent amount of CA pts.

last week was my first week of orientation and one of my pts was very recently diagnosed with breast CA, and had undergone a mastectomy and had both her ovaries removed that evening. i was expecting this woman to be depressed, crying, angry, something! i was fully prepared to do my best to console her... but she was super pleasant and energetic. every time i went in to check on her she said she didnt need anything. she had a smile on her face, and was making some jokes.

she also had no family with her. she had mentioned to me that she has a husband when i asked if there was anyone at home that could help her with her JP drains, but there was no sign of him for my whole shift.

i asked my preceptor if its common for people to be this happy when they are all alone after a major surgery and a recent cancer diagnosis, and she said shes seen it from time to time, and that it is a lot to take in and she may be in denial.

have any of you experienced this? it was just bizarre to me. not that i wish to see my patients crying and being depressed all night, but it just gave me an odd feeling, like right before people commit suicide and they act really happy. any thoughts or advice if i encounter this in the future?

[pfongk]

My uni lecturers would murder me if they could see me quoting wiki here but I'm wondering if your patient is in either the acceptance or denial stage of grief?

Kübler-Ross model - Wikipedia, the free encyclopedia

[westieluv]

It may have something to do with her spiritual values. If she has a very strong belief in everything that happens being God's will and that heaven is a beautiful place where she will be reunited with loved ones who have already passed, then she may truly be at peace with her diagnosis. I am a certified hospice and palliative nurse and I have seen this on more than one occasion.

[mariebailey, MSN, RN]

Denial-Anger-Bargaining-Depression-Acceptance All part of the grieving process, and they may not occur in that order.

[tokebi]

It could also be that people express grief, anger, etc, in very different ways. While she may be going through denial, it is also possible that cheerful exterior is her way of dealing with grief.

Or, maybe the grave diagnosis and treatment aren't as devastating to her as we presume. We just don't know.

As you build stronger relationship with this patient, she might reveal more intimate side of what she's going through. I am also brand new in oncology, and encountered a lot of casual politeness and smiles when I meet my patients initially. As the time goes on, patients (or their family) would confide in me, or I would catch glimpses of convoluted emotional turmoil.

[SoldierNurse22, BSN, RN]

I have also seen this before, and while it can be the grieving process, I've also seen cases where, like westieluv, the patient's spirituality or religious beliefs were the most noticeable quality of their mood, despite the progression of a very healthy grieving process through it all.

[umcRN, BSN, RN]

Interesting question. Can't people just have their own way of dealing with things? I was diagnosed with a brain tumor 10 months ago. Yes, I drove home in a bit of a daze but the diagnosis made complete sense to me with the symptoms I was having. I never really went through a shock stage and I've never cried over it. I don't see the point. I don't bother asking "why me?". I am a nurse in a pediatric cardiac ICU. Bad bad things happen to good, undeserving people all the time. I easily cry over the loss of patients, especially ones I was close with but have never felt the need to dwell over my own health issues. I had surgery, I had radiation, I get MRI's every three months fully aware that the type of tumor I have typically returns and has a 50% five year survival, I don't dwell on it. If I sat around moping and crying about it I would be missing out on this beautiful life I have. There is also the chance that it will never come back and then I'd just be missing out on life for nothing. I am not overly religious and sometimes I have a difficult time with faith when I see what happens at my job day in and day out but I still do believe in God and that he has a reason for the things that happen to us.

You may never know why this woman was so upbeat. Who knows, maybe when she was discharged she got home and cried for days but is the type of person to not want others to see that. Take the lead from your patients, as long as they know you are there for them no matter where they are in the process they will be able to trust you.

[loriangel14, RN]

A coworker of mine just went through a double mastectomy after her third bout with cancer. She is completely upbeat and is nothing but positive. I have also cared for patient's that just had surgery related to a CA diagnosis and they were the same way. Not everyone has to be the way we expect.

[iwillact]

I have been an RN for a year and a half. I was daignosed with breast cancer November 2. I have already decided to make the most of a bad situation, keep my sense of humor, live and love, and to fight like hell. Crying and feeling bad about losing my boobs and hair and about the side effects of chemo isnt going to help me recover. Im not in denial. I am going into this like a warrior not a victim. I am still me, Im a goof ball. I cry when Im alone and when my husband is holding me. Im scared of mets, Im scared of dying. I may or may not dry in front of my nurses. I dont know yet. Its easy to assume that because shes smiling that she is coping in an unhealthy way. You may not see the tears when the door closes.

[iwillact]

I just wanted to add I think its cool that you care enough to think about her reaction and care about what shes going through.