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  1. Irvine, Cyndy BSN, RN

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I VISITED Regina when I was a home healthcare nurse. She was 60 years old, had no children, and lived alone in low-income housing. Having been hospitalized twice in 1 month for worsening heart failure, she was being assessed on a weekly basis.

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I was forewarned by coworkers that she was a difficult patient. "She's very negative," "She'll bring you down," and "She goes on and on, there'll never be a convenient time to leave," they told me. "Don't sit down," one nurse advised, "or you'll never get out of there." I thought I could care for her successfully, despite their warnings; I'd dealt with some challenging patients in the past.


Regina was the last patient visit of my day. I found her small apartment clean and comfortable, but lacking in the family photos and colorful children's artwork I often saw in other patients' homes. Petite and gray-haired, she sat in a big overstuffed chair.


Regina was polite and cooperative and appeared well nourished. My assessment indicated adherence to her medication and dietary regimens and I found no signs or symptoms of worsening heart failure. "This wasn't so bad," I thought as I prepared to leave. That's when Regina pointed to the couch and asked me to stay a bit longer. I sat down and braced myself for a litany of complaints.


"Not meant to be here"

She talked for over an hour. "I'm not meant to be here in this world; it's all been some mistake," she told me. Her parents never wanted any children. They were in their forties when she was born, and they weren't happy about that. She ran away from home as a teenager, living in motels, boarding houses, and various shelters. She was married once for just 3 weeks, until her husband left her. She'd drifted through myriad jobs as a hotel maid, waitress, line-worker in a bean cannery, and ticket-taker for a carnival company. Most recently, she'd been cooking at a truck stop until the owner died and the business closed down.


"I'm ready to close down too," she sighed. "I'm not about to take a knife to myself, but I'm just ready to give up my place in line to someone else who wants it.


"I'm not like most folks," she added; "I like rainy days best because I'm more comfortable then. What do you think of that?" she asked, eyeing me intently. "You think that's okay?"


"Well, yes," I replied, not knowing how else to answer. I couldn't make up reasons for why Regina should feel happy with her life. I knew she'd perceive the slightest dishonesty from me and I'd lose any trust I'd established.


"Well thank you!" she said. "The nurses, the doctors, all kinds of people, say that's not really normal, that I'm depressed and need some counseling or medication. I don't want any of that."


As our conversation ended, she seemed content with my response-so why wasn't I? Perhaps I felt I'd betrayed my profession by agreeing with her. As nurses we're educated to be supportive; did this include supporting her in her gloomy outlook on life, which could have negative health implications?


A listening ear and an open mind

A few days after our conversation, I learned that Regina had died; a neighbor had discovered her unresponsive when she didn't answer her door at breakfast time. "What a tragedy," a coworker said to me. "She still had a lot of years left to live."


"Yes," I answered quietly, "it's a tragedy." But not because she'd died, I thought, but because she was ever born. I realized that I'd assumed Regina's line of thinking.


Regina's life wasn't as tragic as some. And she didn't ask for sympathy; all she sought was a listening ear and validation of her outlook on life. I hope I provided that for her, although it seemed like such a small contribution at the time. Regina reminded me that life just isn't rosy for everyone; not everyone finds happiness.


As nurses we can't always make our patients happy; that's impossible. However, we can meet them where they are, and listen quietly, with our restless hands folded and our eager minds quiet.


As I glance out of a nearby window, I see that it's rainy outside. It's a Regina kind of day. Most people would wish for a little sunshine but I think she'd feel pretty comfortable. And yes, Regina, I think that's okay.