Do you ever feel like you can't deal emotionally?

[Jo Dirt]

I had a second interview with a hospice agency. I know you need to be comfortable with death and dying because it is a part of this job, but do you ever have times when you deal with it so much it starts to affect you negatively?

They tell me hospice is pretty much just like home health, and that you have home health patients who never transfer to hospice who die at home, too. A lot of times a hospice patient may choose to go to the hospital for one reason or another and if they decide it is close to the end the hospital will usually keep them. I envision lots of crying and grief, or is it really like that?

I'm very interested in death and dying and even took a course on the subject. But reality is different than reading about it.

[Valerie Salva, BSN, RN]

With adults pts, I never had a problem dealing.

When my hospice started taking children, then I started having a problem.

[Em1995]

I've never felt like I couldn't deal with my job emotionally.I will admit that , at times, I have felt emotionally drained. I do feel and feel deeply, but I also have a well-developed personal spirituality. I know it helps me, personally, to have a belief that death is not an "end". To me, it is a transition to a dimension that we, as humans, cannot understand.

I think my toughest time was taking care of a 17 year old last summer.My heart hurt for she and her parents.They were very private people and would not allow anyone else on the team into their home.So, it was lonely for me, to say the least. Two weeks before she died, her dad and I sat outside under a tree and he looked at me with piercing eyes and told me it "was barbaric to let her stay alive this way". He wanted me to increase her med dose despite the fact that she was extremely comfortable.She was on a PCA of morphine, but tolerated very high doses. (I had managed to get her intractable nausea and vomiting under control through her teenage friend's plants, had tried all the conventional meds and diet, but good old home grown works better than anything...this stopped her n and V, enabled her to eat, and even ENJOY eating!)

I fully understood why her dad was pleading with me to end it. His beautiful child was cachectic and no longer the healthy, vibrant girl before this cancer destroyed her body. We were able to relate and bond after more visits and he was able to realize that his daughter was very comfortable and would go when she was able to let go. She still had work to do and he was able to realize that.

The day she died, I was on-call and he asked that I come right away. She was very close to death. I sat at her bedside with her parents as she slowly and peacefully let go. I know you might think I'm crazy, but I know I saw her spirit leave her body. I cried with her parents, helped them clean her body, and left as I knew they wanted time with her before the funeral folks came.

As I drove home, still with a lump in my throat that June day,it was incredibly dark. It was only 3 pm, but the approaching storm made it look like night time. Amidst the crack of thunder and a downpour, all of a sudden, the sun burst through the black clouds and a magnificant rainbow appeared that took my breath away. Amidst my tears, I somehow knew that this bright light was my patient's way of telling me she had arrived.

I did take a couple days off after her death. This was difficult because there was no one else on the team who was involved and who could de-brief with me...and the fact that this was a child made it more difficult.

I write a lot and find this is my elixer for venting. I also do watercolors and find that creating is such a soothing way to work through(or, I should say, WITH) my feelings.

I feel so blessed to be in this profession. My patients and families are truly a gift.

[leslie :-D]

i'm w/em.

i always 'deal' but many times, am emotionally spent.

since we started peds, it's been much, much worse for me.

i take more days off, and have yet to find ways of coping consistently.

even when the kiddos are at peace, i still struggle.

a lot of it depends on how well pt and family are coping, too.

the harder it is for them, the harder it is for the nurse.

i don't know how home hospice is.

but working in inpatient, these pts are physically unstable as well as dealing w/their terminality.

it's a tough job, but very fulfilling.

leslie

[donsterRN, ASN, BSN]

My patients and families are truly a gift.

So are you.

The family of whom you wrote was blessed that you were there for their daughter. Your writing of that event was beautiful and very moving. Thank you for sharing it.

Hugs.

[AtlantaRN, RN]

death and dying is the easy part for me. What I have trouble with is the family dynamics at times. I have a patient now, with copd. he lost his wife 9 months ago, he had cared for her in a debilitated state for 15+ yrs. He is just so angry! As he is now on 02, I asked the med director to prescribe wellbutrin and nicoderm (that wasn't on the perdiem, but the cost was so great that the administrator said It was fine for us to pay). He came to the office today and dropped them off, said he didn't need them. He told the secretary that he should just "off himself" so at least he would be with his wife.

I told him and left copies on the second day visit, that 2 of his meds wouldn't be covered, and I left a copy of the wal mart $4 prescription program (thing is, the first time you do the $4 thing--the person to whom they are prescribed has to get them). He was going on and on about how i "lied" to him, that hospice would cover "all" the meds. I reinforced the conversation about wal mart,he then said "damn, i have insurance, I get them for free". Then he said i was trying to kill him because he was "gonna have a heart attack because i've been without my meds for 4 days" ((a gal that cohabitates with him called me yesterday, and we went over the wal mart meds and how his 2 meds aren't covered)).

I know he is experiencing profound grief, and he is isolated--hence coming up to the office. He comes up to the office once a week and wants to see the nurse that cared for his wife. He's asked for her cell phone number and her home number, and he only wants her to be his nurse. It's like he is stalking her. This nurse has said she is uncomfortable with his unnatural attachment to her. He had been attached to a girl that lived there through the time his wife was ill, but then her boyfriend got out of jail and she moved and didn't tell the patient where she moved to--he is obsessed about finding her and sending her a valentines day card.

Sometimes it is just so emotionally draining. I want to do right by the patient, and I want to be a good example, and I know we are to care for our patients unconditionally, but with him latching on to female staff--I'm concerned for my own safety at this point.

I'm sure he is a good person that is just not coping with the loss, but How to get him on the right track.......

Anywhoo, yes, I too at times can't deal emotionally--I just talk to my coworkers and get some perspective.

linda