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  1. Ufema, Joy RN, MS

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Silver angels and chocolate smiles



When my father died last Christmas, we had a small funeral in the midst of the hectic holiday. I felt cheated in my mourning and would like to have a special remembrance service, even though several months have passed. Do you have any ideas for making it memorable?-L.E., TEX.

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It must have been difficult for you to endure those days that are expected to be festive and joyous. Think of this memorial service as an investment in your grief work. As for making it special, consider turning to your own family for ideas. I'd like to share this story.


A dear friend's mother died a few days before her daughter's graduation from college. Not wanting to detract from her daughter's accomplishment, she postponed the funeral. Later, when the family gathered to discuss funeral arrangements, the proud graduate remembered her grandma's fondness for angels and chocolate. "She used to slip me a pack of M&M's when we hugged good-bye," she said.


That gave my friend an idea for remembrances of her mother to distribute at the funeral service. When mourners filed out of the church a few days later, many wore a small silver angel pin and chocolate smiles.


Go ahead, get involved



I've been an RN for only a year. Nurses with more experience have told me that they've learned not to get emotionally involved with terminally ill patients. What are your thoughts?-J.W., ONTARIO


We kid ourselves if we pretend we won't be touched by a patient's death, but I believe the rewards of opening our hearts to our patients outweigh the pain. I recall a woman admitted to the ICU in respiratory failure from advanced lung cancer. Endotracheally intubated, requiring mechanical ventilation, and sedated, Mary Louise looked much older than her 47 years. I spoke with her daughter about her condition.


"Did you know she was so ill?" I gently asked.


"Yes, but Mom never complained. She's had a rough life. My dad was abusive and an alcoholic but Mom stuck it out for us kids."


During subsequent visits, I witnessed Mary Louise's quiet determination and grit. Miraculously, she improved enough for extubation and transfer to a medical unit. By then, I felt I knew her well enough to make a request.


I explained that I was preparing to give a talk at a nursing conference. "I'll be teaching nurses about how to take care of seriously ill patients," I said. "I wondered if you'd allow me to take your picture to use in my program."


She lay quietly, her dark hair splayed over the pillows. Then, smiling sweetly, she answered, "Sure, anything you need." After signing the release form, Mary Louise looked directly into the camera. She exuded quiet dignity.


I leaned over her frail body. "Thank you so much. I promise to tell your story with truth and honor."


She took my hand, pulling me to sit on the bed.


"Joy, I know I don't have long to live. Thank you for helping me feel special."


I nodded, patted her hand, and left. Alone in my office, I allowed my feelings to flow from my head to my heart. Suddenly, I felt the need to express them. I bounded up the stairs, two at a time.


"Mary Louise, I want to tell you that you have the sweetest spirit I've ever known."


She smiled broadly.


"And that it matters to me that you are dying. I'm going to miss you."


When I walked out of her room, I was different than when I entered. And I wouldn't have it any other way.


Grim prognosis



My patient has late-stage pancreatic cancer. During a rather quick visit, her oncologist supposedly discussed her poor prognosis with her. He also wrote on the progress note that her prognosis was "grim." So I was caught off-guard when she told me the physician said she could live for another year. I stammered something like "Oh, that's good." What should I have said?-M.C., VT.


I'm convinced that this one's not on you, the nurse. The responsibility for this miscommunication lies squarely with the physician. You mention the visit was brief. If he was bringing this patient such bad news, I hope he would have remained to comfort her.


The right thing for you to do is to excuse yourself and contact the physician. Tell him what your patient "heard" and ask if that's the information he intended to communicate. If not, offer to accompany him for an immediate follow-up visit. If he refuses, notify your nurse manager.


Your patient is running out of precious time to finish important things in her life. This miscommunication delays these opportunities while she still has strength to complete them. Your patient's fortunate to have you as an advocate.


After she learns the truth about her prognosis, just sit with her. Trust your kind heart. It's what made you take action in the first place.