Terminally ill patients can at times provide a challenge to nurses, more-so because of the physical disability caused by disease progression. However, it was in the last four days of a particular patient’s life that psychological aspects began to challenge my nursing skills in a way that I had never before experienced.
I looked after this patient every day for three of the last four days of his life. This patient had been known to me for several months, however their behavioural changes in those last few days challenged me immensely.
The patient had become withdrawn, verbally aggressive and refused all cares and treatment. It was hard watching a usually determined and communicative person shut themselves off from the world.
I would quietly approach the patient each morning, ask them what they would like done and offer them meals, hygiene, etc. The verbal aggression would begin and grow in intensity, to the point where I would speak back in a firm manner, asking the patient not to talk to me like that. I would explain that my colleagues and I were here to make his time peaceful and comfortable and that we were only trying to help him.
The second day I looked after him started in a similar manner with me offering the usual patient care. Again he refused, but then asked me to help him end it all.
This was not the first time someone had asked me to help them end their lives, but it is the first time that I answered in the only way I felt that may have helped the patient.
I said to him that I couldn’t do what he wanted and that if he wanted to argue with someone over when he was going to die, then he should argue with God.
He stated that he had made his peace with God. So I replied that that was good, but that God still had the final say. Throughout the day the patient remained frustrated and angry, and eventually asked me to get the doctors, so that they could help him pass.
The third day of caring for this patient is one that will stay with me forever.
The patient was given a small hand held bell to use instead of the bed buzzer, and during the morning the bell rang. I walked into his room thinking it strange that he had rung the bell, as he had been acting very withdrawn.
When I approached his bed, he took hold of my hand and said, “I know Ive been a pest.”
That took me totally by surprise as I had never given any indication to this patient that caring for him was troublesome to me. I began to say, “I know…” but something made me stop. Holding the patient’s hand, I said, “You know what? I don’t know or understand how angry and frustrated you are. I don’t know what it’s like to go through what you are going through.”
He then picked up my hand, kissed the back of it and said, “I’m sorry.”
All I said in reply was that “It’s ok. You have made your peace with us and with God now.”
The patient passed away the next day. I hope my words to him gave him some comfort as he passed.
So, next time a terminally ill patient yells, and is aggressive or demanding, remind yourself to take a step back and look at the bigger picture. They may never get to see their children grow old, or see another sunrise, or walk on the beach again. What they will lose, we take for granted.
Sandra Dash began her nursing career in 1993 in NSW working in Trauma, Orthopaedics and ICU. She then spent the next nine years working in the Northern Territory, NSW and Victoria with the military. During this time Sandra found her beginning in Nursing Education teaching at both University and TAFE levels and earning a Master's of Health Science (Nursing Education). In 2010 She moved to Queensland and began the most rewarding career in Palliative Care, through which she has not only cared for people at a distressing time in their life but has also been able to continue her passion for education.