Candid Conversations With Families

gal220RN, BSN, RN

I can strip my clothes off at the drop of a hat, not that anyone is very excited to see me do it. Patients are outsiders in the circus ring of activity called healthcare, often clueless about what is wrong with them and what we are doing about it. We poke and prod them, sometimes without the courtesy of a 'Hello' or even announcing our names. Even more upsetting to patients and families is the often lackadaisical attitude of their caregivers as if what is happening to them is not important to us.

Let me first say most nurses recognize the importance of each patient care activity they participate in. Sometimes, we know this so deeply that the burden of caring for sick people becomes very heavy. We look for ways to decompress or compartmentalize our stress. Is it any wonder the number of nurses who are suffering as substance abusers? Like most frenetic professionals, we medicate our selves with food, alcohol, drugs, and any number of self-destructive habits. Nurses who can not find ways to relieve their stress are the burn-outs. They are the people who change career paths in the name of self-preservation. They are the casualties of an over-worked, underpaid and under- respected profession.

And then you find the survivors- the nursing "dinosaurs." They are the few rare individuals who have learned to live well while caring for others. They are typically tough, smart and have lots of common sense. They have seen trends, statistics, colleagues, and patients come to and go. They recall memories of patients who have long passed with clarity and feeling. But most important- they laugh.

Why is laughing important in an environment like a pediatric intensive care unit? There have been credible studies that have examined patients' positive response to humor. I surmise the result is the same with nurses. It is unfortunate that patients often perceive our laughter as a lack of caring or concern. I can understand their feelings but I hope I can shed some light on the other side of the story.

I remember recently standing our nurses' station talking nonsense with some peers. It was the first moment I had to catch my breath that day, well past the breakfast I did have a chance to eat. The unit was heavy with really sick kids and the strain was wearing on the staff. As we were discussing the facial characteristics of one of our attending physicians (akin to a weasel) who had just busted through complaining about something, a young man approached our desk. He was red-faced, despite the dark circles under his eyes. He looked tired and unshaven. I could see his hands clutched so tightly his fingers were blanched white. I knew his child had been in our unit for a few days and was getting sicker, despite our best efforts. In rounds, I heard mention of his prognosis and knew time was very short for his son.

Trembling with anger, he said with fury, "Don't you know there are sick people in here? You shouldn't be laughing. You are being too loud! My son is ..sick!" I knew what he was going to say, but could not. "My son is dying." That was the meaning. We all checked ourselves, profusely apologized for our loudness, as his child's nurse gently escorted him back to his room, trying to calm him. I was ashamed. I was embarrassed. How callous we had been! We were laughing and this man's son was dying. Surely these two things cannot co-exist in the same place.

After a lot of thought, I realized I was wrong about this. It was right we apologized to this man who was obviously stricken with grief, looking for some way to express his anger, his loss of control. I know parents of chronically ill and critically ill children appear angry with nursing staff as if we are the enemies. It took a long time to realize what this is about, and even longer to have the courage to talk with parents about it. When we lose control in one area of our lives, we will seek to express it somewhere else. The father in my story saw a situation where he could express anger safely- to a bunch of strangers acting unseemly outside his child's room. A father can't be angry with a child who is sick. He had no control over a disease that had no cure. His role in his child's life had been reduced from a provider to a bystander. There was literally nothing he could do, except hold a swollen hand and whisper soft reassurances of love. He could no longer say, "Everything is going to be alright." The father knew this was not true. It was not going to be alright. But were we wrong to be laughing?

A week later, the little boy died in the arms of his mother and father. I was there when his suffering ended and it was a blessing. Simultaneously in other rooms and floors, there were conversations happening, smiles erupting and laughter echoing through the hallways. Where else can the juxtaposition of laughter and death occur so closely? Does laughter equal ambivalence toward patients and their suffering? After lots of soul-searching I concluded that without laughter, there would be nothing left to fight for. Life would not be worth living. Laughter, gut-busting hilarity is the stuff that makes saving lives worthwhile. It has to be okay to laugh, otherwise, there would be no nursing dinosaurs left. It is the only way to survive and even thrive in the nursing profession.

Maybe it is time we have candid conversations with families about their perception of caring and the presence of laughter among grief and loss. I find parents and children are just waiting for an opportunity to talk openly about their anger, fears and their feelings of helplessness. Perhaps it is time as caregivers to ask ourselves how we feel about those same issues. Perhaps then can we hope to have a multitude of dinosaurs roaming amongst us once again? They would be a welcome addition to the human race, as far as I am concerned.

Candid Conversations With Families

About gal220RN, BSN, RN

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