Daughter vs. NURSE: Moral Courage

A loving story of a Mother, receiving TERMINAL CANCER diagnosis that places the Daughter/ Nurse in a heart-wrenching position. And the unusual way that decision was made, allowing for the enjoyment of LIFE, and a peaceful transition. Nurses Announcements Archive Article

Daughter vs. NURSE: Moral Courage

Reflection: Moral Courage

Moral courage is sometimes a shared experience. I have always had the realization that sometime in my Nursing career, I would be faced with the task of assisting my patient while they receive a terminal diagnosis. Allowing the patient time to process such information, and to make personal decisions based on their preferences and needs, is just a small part of nursing care.

But never in my wildest dreams, did I ever think, that it would be my very own MOTHER... sitting next to me,

And while I gently held her hand... Hearing the doctor say...


As you can well imagine, it was such terrible news to hear. And of course many questions surfaced. You know those "What If" questions...What if we did surgery. ... What if we did radiation? BUT all we heard back from the doctor was more negativity...


This diagnosis was not at all what we expected to hear. As the daughter of the patient in the room, I remained quiet, trying to simply process the news, allowing my Mother to ask questions that I knew she had. But then... the Pulmonologist began insisting that she return to the hospital and undergo a Bronchoscopy procedure. Momma looked at the Doctor and simply asked him...


The response from the Doctor was....

"WELL, I think you are being very SELFISH at this point"

As you can imagine I abruptly abandoned the Daughter role and "NURSE TAMMY, LVN" went into action. I quickly reminded the Doctor that this was not his decision to make. The patient has the right to be educated about her diagnosis and treatment options, and would require more time to come to reach a decision. I told him the he had No RIGHT telling any patient that they were being selfish!! He angrily stood up and left us alone in the room.

It seemed like we sat there together for an eternity..on the 12th floor of the office building, studying the Houston skyline.

The ride back home was so quiet. There was a lot of thinking and soul searching going on that day. The Pulmonologist's office called the very next day, with the arrangements that had already been made for the Bronchoscopy. (This doctor was persistent!!). Two long days went by, and then one day after class I sat down in Momma's room to visit. I could tell she had been really battling this decision. As her daughter, I just could not give her an answer...."permission to die".

BUT approaching this situation as a NURSE... I simply looked into her beautiful face and said...


She looked up at me, eyes wide opened, and shook her head NO...

I then simply smiled at her and said....


Such a tremendous release poured from her face at that point. She quickly began living the rest her life, spoiling her family with as much LOVE as she could.

She never regretted her decision.

As Nurse's... we are taught to become the patients advocate. We are there to offer teaching, protection, and to offer support... taking into consideration the wishes of the patient. We must find that inner moral courage and strength to be able to help our patients...and yes, even sometimes our very own MOTHER ... make the best choices and decisions regarding their personal care and spiritual well-being.

In Memory of my Mother,

Sandra J. Smith

01/04/1942 - 12/22/2010

Rehab Nursing; experience in LTC, SKILLED, LTAC, HOSPICE

13 Posts

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Your story is amazing! I hope you continue on with your nursing program and become the best nurse you possibly can be. I hope that I can have the same courage and persistance if I have to overcome any obstacles like yours! Your an inspiration! Thank you for such a great article.

Very well done - both the lovely story and the life choices. I work in cardiology, a field where we often focus on aggressive treatment. But some of the times I've felt best about myself as a nurse have been those times when I was able to help a patient deal with end-of-life issues or a terminal diagnosis. It's almost trite, but no less true, to say that we are a death-denying society. So often the patient, the doctor and the family all know that the end is approaching, but no one is able come out and acknowledge that fact, or what it means, or start to deal with the issues it raises. This is when the special point of view that the nurse brings can be so important.

Again, lovely writing.

Specializes in Labor/Delivery, Pediatrics, Peds ER.

So very sorry to learn you lost both your parents, and so close together. Kudos to you for your persistence in nursing as well as caring for your parents at the same time.

I can't quite imagine what possessed her doctor to tell your mother she was selfish for not wanting to undergo the bronchoscopy - it was he who was selfish in asking that of a patient he had just pronounced terminal with no options for treatment. Perhaps I'm wrong, but from what you said it sounds as though he was just trying to satisfy his professional curiosity about the type of cancer. Tough beans - not a good enough reason to put your mom through a procedure she obviously dreaded. I'm glad you put him in his place. Perhaps he will think twice before becoming so arrogant with a patient again.

Blessings to you in your future!


So many (((((((hugs))))))) this made me cry my eyes out. Bless you for being so strong.

Good for you for sticking up for your mom and for having such blessed time with your mom & your dad.

My own mom passed away on February 15th, 2011 after having received her diagnosis of terminal lung cancer on January 4th, 2011. My father passed away on June 5, 2009 from esophageal cancer. It is a tough road being a nurse and a daughter, but you handled it with such grace and courage. I wish you the best in your nursing career, you will be a wonderful nurse and will make your parents proud.

Specializes in LTC.


Your story is amazing! I can tell by reading that you are a wonderful nurse and daughter. Im so sorry for your loss of both of your parents so close. I'm glad that your mother enjoyed her last days here with you. Stay stong and keep May in your mind. Thank you for sharing your story.

Specializes in Home health was tops, 2nd was L&D.

Thank you for writing your story. I have a similar story and loses. My father received a kidney transplant at age 81 on 12/25/2009. It was a new program and they recruited him. I was against it even though I knew the 5 yrs of dialysis was a horrible treatment. He was the star patient at his dialysis center and doing well. Getting the kidney was a success, the DR's were so thrilled, then he started immunosupression drugs and got sick then sicker and sicker. I was in TN, they lived in FL. I went down to help set up home health and the actual house for his needs. I was the nurse but also the oldest daughter, the one who choose to come. He stabilized a bit then March 1st was admitted to ICU. They discovered his bone marrow was basically non-existent. His Transplant DR called multiple times every day. I had had the meetings with the team informing them He was not just "their KIdney" he was a father, a husband, a person. Finally towards end of March he asked my mother to give him the phone to talk to me. He begged for me to come get him and bring him home. So I quit my job, yes the oldest daughter choosing to care for her father and not her job. Call me irresponsible..my boss did, my sister did. When I got there the DR fought me with all his might until my father simply said he "had rights and would call a well known attorney!!" DR walked out in disgust but I got to bring him home the next morning. They said "on paper..your father ifs fine.. he will recover!" The man could not even sit in a cardiac chair he had to be tied in. I said "Stop looking at his labs..look at the patient!!" Once home he had 3 good days, then he was not so good.. Easter Sunday all 3 of his grandchildren called and he spoke to them by name and had significant conversation which each, one from TN one from FL, one from Hawaii. he could not carry on conversation with me or my mom and we were right in his room! This was his gift to them. He died 4/6/10, not as comfortable as we had hoped but at home and in peace none the less. His transplant DR called after one week to see how my father was and when I said he died, the man was beside himself. Just kept saying but the kidney was doing so well. And I told him yes the kidney was still working when he died! The sister came Easter night and left 4 hrs after he died. My mother who had inoperable lung cancer for 3 yrs fell apart. Within days she decided she had no purpose in life. She worked all thru his death even though she was 78 , she loved her job and we all thought it would sustain her. We were all very wrong. By mid May our daily conversations were so worrisome I just called boss at new job and said I had to go see.. I took my 6 yo grand daughter and hoped in the car. She could barely answer the door. She was a shell of the woman who raised me...I convinced her to visit TN just to see, even thought she had sworn never she agreed. I got her to eat and spend a week with me then she asked to go back to FL. My son took off to drive her back and returned in same day to TN. Then the next day she called and asked to come to live with me in TN. She said she wanted to buy us a house as I had a duplex. So I went house searching and emailed her hundreds of photos. She chose the one she liked best and made an offer. It was accepted. She told them at work she was leaving ( yes she kept working until 1st week of July.) The sister had decided she did not want anything to do with her mother as the sister was still mourning her father and had a right to do so in any manner she saw fit. My mother did not have a right to mourn the loss of her husband of 59 yrs! She told her this one week after his death and refused to talk to her ever again. She had no right to move or to sell home in FL and spend any of HER money on home in TN or on anything else. I had also been told to "get over it" when I spoke of sadness..told you are a NUrse..you know how to deal with this!

My mother moved her 7/21/10.. she loved it but became more fragile and more prone to falls. She asked me to quit my new job..so I did. Again me the irresponsible child. She would not agree to walker/cane even though she had them. She did not want to look "sick" She was feisty and in control.. the same as she had been my entire life. DR told her she was terminal.. she said they told me that 3 yrs ago and "I told them it was not convenient for my schedule" Hospice came.. she got irritated with them as well for warning her of chances of broken hips etc. She said" I am doing things my way" and she did..Being the nurse/daughter was overwhelming...knowing she would fall every day, knowing she was dying. 11/26/10 she fell and broke her hip.. she argued with the Xray results and nurses.. she had "not fallen hard" and therefore impossible to have broken her hip... Wanted surgery, but once it was explained about anesthesia, ventilator , rehab post-op and the current condition of her lungs.. she decided no....she said"Never will go to rehab. I will live here and die here." I even contacted the sister,, who said "Put her in Nursing home" in an email. She could not even phone. I replied with 'She does not want that" Got no reply. My mother requested we both trade our cars on a minivan so we could get her out of the house.. I agreed, the dealer came to house to do the deal. She got to go out 7 times and really was thrilled about it. Then Thanksgiving day, she went into coma....I did all the things a good daughter and nurse would do.. That evening my neighbors brought me a dinner plate, I went to eat it in the sunroom which was her room since breaking hip. All of a sudden she spoke up and said" Don't I get to eat?". I was like well yes of course and she ate all on my plate then said she had eaten earlier? I inquired.. she said Dad had brought her a plate. I asked it he stayed here,, she said no but he will be back soon. Sat morning she awoke.. very cheerful asked for pain medicine, and then told me to go cook breakfast.. the minute I left the room she took her last breath. 11/27/10.

Hospice came.. did their thing.. then I was alone. I called the sister who did not return my call for 4 days. When I told her.. she said well what about the estate??? She said" do not think you will get that house regardless of what she changed and how it is.. The estate will stand as it did the day Dad died!"

Now the attorneys will fight it out. And me.. I can not be a nurse. Not now..maybe not ever! I do not even know how to move on between the estate issues, all her things in the house that I am not allowed to move. Guess she was right I am the irresponsible one. In 23 yrs as RN I had 3 patients actually die with me..my husband in 1992, my father and my mother. I come to this site, I am able to post and offer good advice and answer questions for others but I can not go out and actually do nursing. I have had interviews and turned them down.. I have another on Thursday.. I only agreed as the ED seemed so nice and interested. I fell bad..I will probably waste her time. I can not even talk to Hospice counselor as attorney feels she may be called to testify if sister pushes the incompetant card. Also no med ins as I did quit my job.

My mother was my best friend for my whole life and I am 54 years old. I was the nurse, the fixer, the go to person when times were tough. My sister owns million dollar horse farm, has 6 figure job, she was never there for any one in the family ever. Her friends are her life and it has always been that way. But I am the irresponsible one!

I do not know what to do next. I was enrolled in RN to MSN program and had to drop once when Dad was dying then quit when Mom was needy. I have no interest in doing that now. DR says I am mourning completely normal. Is there such a thing?

Of course quitting 2 jobs in one year does not leave one with alot of options where I live.. regardless of the reason.. One NM told me while she respected my choice,,it was just that.. my choice and she thought I owed it to my employer to be there. If a nurse can not care for a terminal parent or spouse.. I think that something is wrong with the world.

To whomever reads this, please forgive the wordiness. I was a great nurse and most of the time I loved it. But now I do not even tell people I am a nurse. I do not tell them anything. It has been 3 months and I make it thru one day at a time. I do not feel it is my fault they died but the loneliness is horrible.

Specializes in Care Coordination, MDS, med-surg, Peds.

you have been through an incredibly difficult time, and you have survived. Now, you have to go on. I would suggest some counselor, even if not the Hospice one. Are you religious? Perhaps a priest or minister could help, but I think you may need professional assistance in dealing with all this. I would lthink it would be normal to be in mourning and even to be depressed after your experiences.

You are undoubtedly tough and a survivor. If traditional nursing seems difficult now, there are other aspects of nursing that you might consider such as LTC, Dr offices/urgent care centers, telephone triage, school nursing, or have you thought of teaching?

Sending you my best wishes and support!!!!

Specializes in Mental Health and Pediatrics.

Your story is an emotional one. I encourage you to continue on your journey to complete your program at school and follow your goals with working in palliative care. I too have lost both my parents and remember the struggle of sitting there while being both the daughter and a nurse. I will never forget the day that I got accepted to nursing school- I called my mother from work to tell her.. I was so excited! She picked up the phone.. but she couldn't talk.. something was wrong.. very wrong! Mom.. what is wrong? garble...I hung up and called my dad to go check on her. By the time he got there she was ok and I went after work to see her. She seemed ok but we make an appt with her MD for the next morning anyway. Too late.. that was a mini stroke. The next morning full blown stroke. I blamed myself for not getting her to the hospital.. somehow I should have known that is what it was or something. But I wasn't even a nurse yet. I couldn't have. But I do remember as I sat there in the hospital and various doctors with her over the next few days realizing something very powerful.. I am the grown up now. I have to take care of mom now, she can't take care of me anymore! THAT is a very scary thing! She survived the stroke and went on to be very well taken care of on a nursing home for 7 years. I wanted to quit my job and not go to nursing school so I could take care of her at home. She would have none of it! She wanted me to follow my dreams. It was hard to go to school and take care of my kids and feel like I couldn't leave her there. So hard I can't explain it. My dad couldn't go in there for more than 10 minutes to see her..but he went every day. I had to drive an hour and a half there, plus work go to school and had toddlers at home. But I made it, and I made her proud. Two years ago my dad's drinking finally caught up with him and found him on the floor.

There were times when I didn't want staff to know I was a nurse becuase they would treat me differently and expect that I knew what all the tests and results meant automatically or that I should perform the care for my dad while I was there. That was very uncomfortable for my father and for me if he needed to be changed, as he was such a proud man and he felt he had lost his dignity when he got to the point in his life that he could no longer take care of those needs himself.. but he did not want his daughter to have to do it for him either. I had to do this all alone, because my brother and mom had already passed away. It killed me to see the strongest man I ever knew wasting away in that hospital room. The one thing he never wanted was to have to go into a nursing home.. I just had to whisper in his ear to that it was ok to let go..Funny that at the same time that summer 2008 that artist release the song You can let go now daddy..word for word what I was going through!

So thanks for sharing your story and allowing me to share mine! Stay strong and good luck with your program! :nurse:

Specializes in Home health was tops, 2nd was L&D.

Wow, you are really strong and an inspiration. I realize you are at the beginning of your journey and I feel I am closer to the end of mine, so different choices were made based on different expectations. Congratulations of sticking with it and becoming a great nurse and you bet both your parents are very proud and watching you every day.

Your children have a lot to look up to.

Specializes in OR, public health, dialysis, geriatrics.

Wonderful statement of what it truly means to be not only a nurse, but a loving child.