The Gift I Didn't Want to Give

A patient's wife become angry with a new hospice nurse, and what she learns from the encounter. Nurses Announcements Archive Article

The Gift I Didn't Want to Give

If Carrie Lawson had tried to invoke a feeling of serenity by the way she'd designed her home, she'd succeeded. The walls were a painted light green, and the curtains a complimentary olive. The furniture looked plush and comfortable. The lighting and soft music added to the overall charm of the room.

But Carrie had never planned for the latest addition to the room: a stark, steel-railed hospital bed. On that bed was her husband, Jeffrey. On the day I met him, Jeffrey put that room to its ultimate test: congested, jaundiced and moaning incoherently; Jeffrey was a stark contrast to the room's serenity.

Jeffrey was one of my first hospice patients. I'd spent the previous two weeks working with a nurse who had 30 years' hospice experience. I'd tried to absorb all the knowledge she'd given. I thought I was ready for the "Jeffreys" I'd have to care for.

My introduction and opening explanations to Carrie fell flat. Her responses to me were quiet and clipped. I felt her hostility before I'd had a chance to warrant it. My questions drew eye rolls before she gave me brief, clipped answers. Her eyes kept drifting to Jeffrey; then they'd stare off into the distance. All my training hadn't prepared me for stiff, rejecting posture and her unwelcoming ears.

As the visit ended, I asked if she had any questions. She asked why one of his symptoms seemed to be increasing so quickly. Relieved that she seemed to want clinical knowledge, I gave her a brief review of Jeffrey's disease and its anticipated course of progress. My words were met with silence.

But, then, her anger came. "I want a different nurse," she spat. "You act like he's a page in a textbook and like you're looking at a scorecard for his future."

Her words hit me hard. I'd wanted so much to be a comfort to her. My heart filled with remorse and fear: what if this was how I'd be greeted by all my future patients?

But I swallowed my pride and finished the visit as quickly as possible - and later, asked my supervisor to send a different nurse for Jeffrey.

That was hard, because what if the supervisor wrote me off as a bad risk for this job?

She didn't.

Instead, she reminded me one of the ways people try to regain control is by expressing anger. She pointed to my account of Carrie's flattened responses to my questions. She asked me to imagine how it might feel to Carrie - who had, obviously, worked so hard to instill a sense of serenity into her life. She asked me how that person might feel; to have to cope with uncertainty and chaos, in the form of her husband's illness and impending death. She asked me to try to understand that Carrie might be very angry at this intrusion into the serenity she'd planned, for her life.

I began to understand: since Carrie would likely find it difficult to be angry at her husband, she had to find a target for that anger. She had found one: me.

"In a way, you gave Carrie a gift," my supervisor told me. "You gave her someone to be angry with."

Seeing the sense of this didn't make it easy to accept Carrie's angry rejection - but it did make sense. In time, I would meet many other "Carrie's" - and those words have always stayed with me. I remind myself that sometimes, one of the gifts I can give someone is the gift of someone to be angry with. It's not a gift I want to give, but it may be the one that someone most needs.

Donna Powers is a hospice nurse from Euclid, Oh. She enjoys writing short stories and poetry.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

What a wonderful story and a great lesson to learn. I'm sure you give many "gifts" to your patients.

Thanks for sharing!!

Specializes in ORTHO, PCU, ED.

It's good for us to step back and put ourselves in their shoes for a moment too. Oftentimes it helps me cope with their actions and behavior. Good article.

Anger almost always comes from fear. Good thing to remember.

Nicely written piece.

Specializes in Tele, ICU, Staff Development.

Really enjoyed your article and insight, thank you for sharing

Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.

Excellent article. It felt as if I was there, I felt the tension in the room. This is the first article I have enjoyed. Looking forward to more articles.

Specializes in None yet..

Thank you for the profound teaching you shared. It takes enormous strength for most of us, I think, to get over ourselves when confronted with anger and to focus on the clients' needs that are beneath. You are an inspiration for this important healing function. Thank you!

I appreciated reading your piece. As a hospice nurse, I've been in that same position. That's a very good way to think about it.

Thank you.

Specializes in Infusion Nursing, Home Health Infusion.

Even though the family member,Carrie in this story was distressed and tying to get a need met they are still going about it in the wrong way! This can potentiality escalate the situation if you do not have a nurse or nurses that know how to effectively deal with this type of very common situation in nursing. In addition the family and patient actually potentiate the feeling of helplessness and that leads to the nurse wanting to disconnect.

These skills are not always easy to learn. I too had to learn not to get defensive and bight my tongue many many times and also to stop and think before I say ANYTHING! I am unwilling, however, to allow myself to be a target for that type of anger. I do however, understand it from both sides and have been in many situations where I am the patient or a loved one of the patient and know how powerful those feeling are! It does not excuse the behavior though and the harm that it creates! In this situation I would have acknowledged her upset and how difficult this must be for her to see her loved one suffer and specifically asked her how I could help to begin with and then tried to connect on a more personal level.

I can step back emotionally and not take it personally and try to redirect the conversation back to getting the needs of the family and patients met realizing they often feel hopeless,fearful and sad! If those interventions do not work and yes I have had that happen as well I need to get more people involved such as security, the MD and other support services. I have noticed over the last several years that I have had an increased need to do just that. I blame this on the shift to patient satisfaction and applying the customer service model to healthcare. This has fed the beast and he has become a monster!

Specializes in public health, women's health, reproductive health.

Thank you for sharing this.

I felt from the post that she did not deescalate the situation in that manner mostly because she was new and therefore didn't fully understand the situation and could not think on her feet that way yet. An important point to make though as that sort of talking down of angry clients and relatives is an essential aspect of our jobs. I'd bet that once she understood where that anger was coming from she was able to handle the situation much in the at you describe in the future.