Statistics say 10 out of 10 people are going to die. The odds are not in our favor.
That’s what I thought about yesterday as I overheard a very elderly woman yelling at a doctor. “FIX HIM! And STOP TRYING TO KILL HIM!” She could barely stand without her walker. Her husband could hardly breathe.
And I thought about my friend, Ryan.
You see, Ryan called me late the night before last. It’s been 6 months since his Grandma passed away, and he misses her. He knows I blog, and write, and love to communicate stories that people can relate to about life in general, but especially about the day-to-day life as a nurse. “Rita! Please, write a blog about palliative care! We’ve got to tell people about the importance of difficult conversations!” he insisted.
Now, I know Ryan. He has a great big heart. He precepted me 8 years ago in the Medical ICU. So, I saw first-hand his genuine care for our patients – The eye contact immediately upon entering the room, the hand-holding, the gentle touch, but most of all, I remember Ryan telling the truth.
That’s a hard thing to do, you know. Tell the truth. Tell your patient and their family member that things aren’t looking very good. Answering those difficult questions dropped in the lap of every ICU nurse, “What would YOU do if it was YOUR loved one?” You see because often-times, they are asking for the truth, but they don’t really want it. And when you do tell the truth, you are often hated for it.
But Ryan wasn’t teaching me how to be loved by my patient. He was teaching me how to do the right thing – how to tell the truth.
I struggled with how to begin this blog, but knew once I had time, and sat and began writing, the words would come. Palliative care is an area of nursing near and dear to my heart, as well. So when I heard that little old lady yell at that young doctor still wet behind the ears, knees shaking, knowing he probably felt obligated to make sure that little 91-year-old man not only NEVER heard any bad news, but also would NEVER die……. Well, I knew just where to start.
Ryan shared with me that he knows how blessed he was to have had 3 of his grandparents still living as he approached 40. He felt that because he was a nurse, and because he was not 12 years old, he would be emotionally prepared when the day came for any of them to pass. But that was not the case.
The call came late one evening. The healthiest of his grandparents had fallen the night prior. Ryan shared that two of his aunts had done nothing less than a phenomenol job of caring for her, and making sure that she never wound up in a nursing home – A wish that his Grandma had made very, very clear. And they honored that wish. When Ryan’s aunts were unable to get her up, they called EMS, and she was taken to a nearby hospital, and further flown to a larger hospital with the capability and expertise to care for her diagnosis – A stroke – and a big one!
Ryan headed to the hospital and was first to arrive. It would take several hours for his other family members to make the trip. He remembers feeling alone. The next 48 hours would be spent vigilantly at Grandma’s side, experiencing a roller coaster ride of emotions that Ryan was accustomed to his patients’ family members experiencing, but found himself unprepared for. In between his own breakdowns, he would comfort his parents, his sister, his aunts and uncles, while periodically having to go into “RN mode” to explain to each one of them what was going on – What this medication was, why that procedure was being done, what the doctor meant when he said this or that. Much of the delivery of bad news fell into the lap of Ryan as he traveled to and from the airport to get family members flying in from out of state.
But Ryan also remembers sitting bedside alone with his grandmother, and finding himself humming some of the tunes that his Grandma had often sang to comfort him and his twin sister, Angela. When the tears came as he hummed Dolly Parton’s “Coat of Many Colors,” the respiratory therapist stopped everything she was doing to comfort him. “I’m her grandson, and I thought I was prepared for this because I’m in my late 30’s now,” Ryan told her. Her tears caught Ryan off-guard. “You know,” she said, “when we admitted her, the nurse said that her patient was surely someone’s Nana. She was talking about you.” Ryan found her empathy and her taking the time from her job to share that with him so kind.
“She was a remarkable woman. When I was young and hurt or frightened, she would pull me close and sing a song while patting my back to the rhythm of the music. Somehow she always made things right. She never let us leave her home hungry or without pulling us close and holding us for a moment. No one in our family ever had to question how much we were loved,” Ryan shared.
Each time he was gone for a little bit, the nurse always reassured him that while he was away, she was comfortable, she was clean, she was cared for, she was not in pain, she was not alone, and she looked like a “sleeping beauty.” Ryan related that he felt as if the nurse could sense he was trying to simultaneously grieve the imminent loss of his grandmother, while also trying to be the nurse who could explain all of what was happening to his family members. She stepped in on several occasions to help.
When the difficult conversations took place, Ryan asked the questions no one wanted to hear the answers to. One of his passions, as likely the most tenderhearted bedside nurse I’ve yet to know, is making sure that the risks and benefits of procedures are fully explained and understood before obtaining an informed consent. So Ryan made sure when these discussions took place regarding his grandmother, that all of the appropriate questions were asked and possible scenarios discussed. And he was sure to ask for the BAD news, as well as the good news. “We OWE our patients that,” he says.
And the news was not good. Grandma had a very large bleed in her head.
That’s when Ryan’s Grandpa said, “Let her go.” Everyone was in agreement. His grandparents had HAD those conversations. They understood that “for better or for worse, until death do us part,” was a reality that would someday take place. They’d talked about it. They didn’t want to suffer when their time came, and be kept alive on machines, and they certainly didn’t want to be shocked and compressed and bloated up with fluids and chemicals.
No – Grandson at the bedside, stroking Grandma’s hand, humming “Coat of Many Colors,” and sharing with a respiratory therapist a few tears – Those would have been Ryan’s Grandma’s wishes. He and his sister knew very well the comfort only Grandma could bring with those tunes, and her touch that could fix anything. She’d loved them well over the years. This was their turn to love her one last time.
So 6 months later, and an 11 p.m. phone call, Ryan tearfully shared with me that he feels he did nothing extraordinary. Grandma would have wanted them to care for each other in the family, and that’s just what they did during those days they were bedside with her, and that’s just what they’ve continued to do since then. Ryan is proud of his family for being able to do that.
Ryan wants healthcare workers to know that consents matter, as do the thorough explanations of the risks and benefits that should precede them. When illnesses and injuries are life changing, those very life changes should be discussed, honestly. But most of all – Tell the truth. Your patients and their family members deserve and should get the truth, even if they don’t like you or respect you anymore because of it.
Ryan wants the entire healthcare team to know that each member matters – the Pastoral Care representative, the respiratory therapist, the stock person who quietly makes sure necessary supplies are readily available in the room, the nurse, the nurse aid/tech, the physician, the phlebotomist, the CT scan technician, the transporters, the housekeeper who keeps the room clean, and the food service worker. Ryan was comforted by all of them. We are called healthcare “team” for a reason, and Ryan appreciates them all.
In the course of Ryan’s career, he has not only worked as a staff nurse in the ICU, ER and Cardiac Catheterization/Electrophysiology Lab, but is also a licensed paramedic. “I have spent my entire adult life caring for people,” Ryan says, “but you are never too old or too experienced to learn something new.”
The Palliative Care team Nurse Practitioner gave Ryan a new perspective during this experience. Each of them were encouraged to spend a moment alone with Grandma, to tell her they loved her, and that they would miss her. He recalls her asking each of his family members what his grandma would say if she could be asked what the worse part of these days were. She also asked what they felt she would say the silver lining was. The answer was unanimous among Ryan’s family. Grandma would say she would only be thinking of them, and wanted them to be sure to care for one another. You see, that’s what Ryan’s grandma did. She always cared for everyone before herself. She never wanted to be a burden, and she never wanted to land in a nursing home. She wanted to die in the peace and comfort of knowing she was surrounded by those she loved, and who loved her.
And she did.
Several things stood out to Ryan and his family throughout this experience, and as a registered nurse myself, I think each of them are worth mentioning. Every person who walked into Grandma June’s room washed their hands. They all introduced themselves. Most importantly, no one treated her like a patient who had a stroke. She was treated like a wife, a mother and a Grandma. All of the staff understood how precious she was to each of her loved ones and did a phenomenal job of assuring that she was comfortable and that she passed with 2 of her girls at her side. It was exactly as it should have been.
Ryan also, most importantly wants patients and family members to know that these conversations MUST TAKE PLACE. We MUST discuss our wishes with those we love and trust, and we MUST NOT WAIT. Life catches us off guard all too often, and there are some things we cannot be emotionally prepared for. These conversations are not pleasant, but they are far less painful when they are had before a catastrophic, life-threatening event takes place. None of us are promised tomorrow, and all of us are going to die someday. So please, HAVE THESE CONVERSATIONS!
To my friend Ryan, I feel so honored that you asked me to write this, and incredibly lucky to call you my friend. I’m not sure I’ll ever hum a church hymn again without thinking of your grandmother – the incredibly sweet woman I truly wish I would have met. Some day, I hope to BE a grandma, and I already know that I’m going to hum tunes to my grandchildren as I rock them, just like your Grandma June did for you and Angela.
Ryan, you continue to be my “preceptor” in so many ways…. Thanks for sharing a small piece of your Grandma’s heart with me. And thanks especially, for sharing YOUR heart with me. I love you.
Oh, one last thing, Ryan. I think the song lyrics you shared with me were spot on! “And when we’re gone, long gone, the only thing that will have mattered is the love that we shared, and the way that we cared, when we’re gone, long gone.”