A Letter to my Hospice Patient

Meagan, BSN, RN

To the Patient I’ll Never Forget

When we first met, it was my third year of nursing. I was young and excited to start my new job in the clinic. You were in your 80's, and had been through a lot - Heart Disease, Chronic Kidney Disease, Dialysis, and now CHF. By the time we met, you had been coming to the clinic for several years. I heard nothing but wonderful sentiments about your kindness and resilience from my coworkers. I had only known you for 6 months before you surprised me – you wanted to transition to hospice.

I remember that day very clearly. We had been working very hard to keep your CHF under control, but we knew it wasn’t enough. You were more short of breath with minimal activity, had more swelling to your legs, and developed reoccurring ascites for which you required numerous abdominal paracentesis. You went to see the renal specialist and cardiologist – and hadn’t received good news – there was nothing else they could do.

You see, at that time, I had been a nurse for about three years and my experience came from a busy Telemetry unit. I had taken care of and helped to transition many hospice patients, but they hadn’t walked out of the hospital to go home. They were usually very ill, and after lengthy conversations with family and physicians, they were transitioned down to the inpatient hospice unit. As a nurse, my experience was actually caring for the hospice patient. What I didn’t have experience doing was initiating the hospice transition. You were my first. And, after you passed away, I realized I had learned some of the most valuable lessons in my nursing career.

I learned to slow down. When you work in the hospital, you’re always in “save” mode. You’re on high alert for the slightest change, because if you don’t catch it, it could spell disaster or even death for your patient. You’re ready at the slightest change to race down the hall and put to work those ACLS skills you worked so hard to learn. You’re ready to be the best patient advocate you can be to save their life. But I didn’t work on the unit any more. I worked in a clinic with a patient population consisting of the chronically ill. It dawned on me when you chose hospice that it was okay to slow down. I learned it was okay to use my clinical judgement as a nurse to initiate those difficult conversations with my patients and take a more holistic approach.

I learned that hospice does not mean “giving up.” When we talked about hospice and your thoughts on starting the process, you told me with such conviction that you were ready. You had been through “save” mode many times. You had been stuck countless times for IV’s or labs, had numerous abdominal paracentesis’, and had already been through dialysis. By this time, you didn’t want any more doctors office visits, trips to the hospital or any invasive procedures. I remember you telling me that you felt so blessed to have made it this far, and that resonated with me.

I learned what dignity truly means. By definition dignity is, “the state or quality of being worthy of honor or respect.” After you passed away, it was hard for me to see that empty chair every week. But, what I realized was that you had given yourself and your family a gift. There are times in our nursing careers when we see patients who can’t make these decisions for themselves. Sometimes they don’t have advanced directives in place, or they have family members that just can’t agree. I respected your family’s commitment to your wishes, as this is something I don’t think we get to experience often enough.

Although many years have passed, I will never forget the conversations we had, and the lessons I learned as a new nurse. I think about that day often and I thank you for helping to shape my nursing career.

Fellow Nurses, have you had similar experiences that changed your nursing practice?

What was your greatest take-away?

Dr Georgianna Donadio, PhD · Nov 30

Hello Meagan,

Thank you for this touching article. It is the humanity of nursing that makes it special, isn't it?

It was 1963 when I entered nursing and, while the profession has gone through many changes since then, what hasn't changed at the core is that we have the opportunity to learn what true caring is. The reason nurses are the most trusted and loved health care professionals is because of who we become as we serve and learn from our patients.

All the best to you in the years ahead.
Kind regards,
Georgianna

pmabraham, BSN, RN · Nov 30

As a fellow hospice nurse who also came from a cardiac unit, I can appreciate the learning curve from chasing abnormals to focusing on the quality of life for what the patient determines is quality. Thank you for a well-written article.

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A Letter to my Hospice Patient

Have you had an experience with a patient that changed your nursing practice?

To the Patient I’ll Never Forget

Fellow Nurses, have you had similar experiences that changed your nursing practice?

About Meagan, BSN, RN (New)

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