What not to say

I’m never going to say it again.

Ever.

I thought I was being a good nurse by reassuring my patient. I never once considered that I was making a terrible mistake. My patients trust me to be an expert, a professional and generally infallible. But in this moment, I violated that trust.

I had an excellent relationship with my patient and her daughter. Let’s call the patient Mary and the daughter Ann (not their real names). I visited them in their home after Mary was discharged from the hospital after a serious health problem. Mary was significantly weaker then she was previous to the stroke and was having trouble adjusting. Ann had her own physical and emotional problems and was adjusting to having her mother live with her and the constant help she needed. They were both worried and scared that they were not going to be able to manage.

I spent a lot of time with Mary and Ann during my first visit and I did what I do best. I reassured, smiled, chit chatted, educated and made sure that the visit was not only clinical but truly a positive experience for the patient and the family.

I feel that my job is to gain the trust of the patient and provide them with a comforting moment. One that would change their life a little bit and possibly even prevent an immediate re-hospitalization, which so often occurs. I hope to help the patient make some small change in their health which will hopefully take them in a new direction. I do firmly believe that I am making a difference in their lives. This is the belief that makes me happy and excited every day to do my job.

“There is something wrong with my mother”.

I went to see this patient for a follow up visit and Ann met me at the door and told me this. I was not worried, because the daughter definitely seemed like an over reactor. I went to look at Mary and she seemed weaker. I asked her several questions and she told me that she had a low grade fever and general achiness.

Of course Mary was “between” doctors…she couldn’t get to her regular doctor because she couldn’t leave the house safely. They had called a doctor that makes home visits but were told they need a referral. I called the visiting doctor’s office and they were closed for lunch. I called one of the doctors on her cell phone and she said she would take care of the referral. I explained the symptoms to her and she said she would not be able to see the patient until she was in the system, hopefully tomorrow. I called my office and spoke to manager and she said she would also call the visiting doctor’s office.

Ugh. I hate this part of the job. I hate feeling helpless, like the system is working against me.

I sat down with the patient and I put my hand on her shoulder and tried to calm her down. She was afraid she was dying.  I told her that her symptoms are significant, but were not going to kill her. I told her she may have an infection, that she is sick, but “regular people sick”. I actually said that. I was trying to convince her that yes, she felt like crap, but no, she wasn’t going to die. I held her hand and smiled.

“You’re going to be ok”, I said.

We chatted a little bit more, talked about her family, talked about my family, then I left.

When our physical therapist went to see her the next morning, she was unresponsive and EMS was called. She was diagnosed with a serious infection, treated and discharged several days later, weak and scared from the experience. My manager told me that Mary was requesting that I not return to the case. Ann said I was so busy showing them pictures of my new baby and I should have done a better job of taking care of the patient.

At first I was hurt, but then I just felt bad. I felt terrible even though there was nothing more I could have done. I couldn’t send the patient to the hospital for increased weakness and a low grade fever.

But there was something I could have said. There was something I SHOULD have said.

“I don’t know what’s wrong”.

It seems so small.  I thought I was doing the right thing, I was sure I was being a good nurse. But I was so wrong. I took it really hard. Not because I never make mistakes, but because I truly felt that I had failed my patient. My only consolation was that I knew would take this experience and try and learn from it.

Lessons I learned:

  1. I need to stop talking about myself and my family. The patient wants to focus on themselves.
  2. When a family member says there is something wrong, I need to listen.
  3. I will never again tell a patient “you’re going to be ok”. It discounts their feelings and it’s disrespectful of their situation.
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