The Toughest Talk

The first time, in 1986, a nurse at Temple University Hospital, Philadelphia, looked me square in the eye and scolded, "That's just not right!" I had just told her that my dying father, in the end stages of long-undiagnosed stomach cancer, was not to be told he was terminal.

I was following my mother's wishes, though uneasy with the deception. I wanted to say goodbye to Dad with honesty. But Mother bore the burden of care, and she didn't want to "remove all hope" from the man she had loved for more than 50 years.

Nurses back then knew better. They said we couldn't fool him; he'd know at the end; he'd be angry. In time, as predicted: We couldn't. He did. He was.

And Then Again

The second time I encountered a need for a tough talk, it was me in the hospital bed.

It was the mid-90s, I was a young mother, and I had cancer. I remembered how my mother had danced around my father, and I couldn't help but wonder if she was doing the same with me.

Was she in cahoots with the rest of my family, filtering information to keep me feeling hopeful? Why was everyone unnaturally and nervously cheerful when they came to see me? Didn't they know I was battling for my life?

I asked doctors what my chances of survival were; they would smile paternally and say it was hard to pinpoint. I believe, in retrospect, they were trying to be vague yet optimistic. To me, vague was simply a curse.

There I was in my Abington Memorial Hospital bed in Abington, PA, with chemo pumping unthinkable toxins into me while draining all feeling of well-being out of me. Bald. Weak. Sick at heart. Yet there wasn't a nurse who entered my room who escaped my grill: What are my chances? How long do I have? Will I live to raise my son?

Thank God for those oncology nurses. They didn't answer the questions definitively - after all, no one of a human composition really could. But they engaged in discourse, prolonged what-if discussions, offering understanding of the angst a mother feels at the idea of losing the chance to see her only child grow up. Sometimes talks were accompanied by back rubs, and always by a sense of compassion.

Turns out the doctors were right after all. I had cause for optimism. My fight is long behind me. I was a lucky one. But the memory of those tough talks will never dim.

Tough Question on Tough Talks

From that perspective, I recently posed questions to healthcare professionals who deal with death and dying on an everyday basis at Samaritan Hospice, Mount Holly, NJ.

How do nurses faced with the task of discussing a patient's terminal illness best handle the conversation? What can they say to help a patient face his mortality? Is there a way to minimize the emotional pain for the recipient? And why does this sometimes fall to nurses instead of physicians?

"Physicians sometimes think they are telling patients the whole story," said Jeannette Poole, BA, RN, CHPN, nurse liaison for Samaritan Hospice. "They may have told a patient they 'can't do more aggressive kinds of care.'"

While that phrase may be shorthand for a healthcare provider, it may not resonate with a patient.

"People are sometimes so raw, so new to this information, they just don't understand the meaning totally," said Poole. "They have been in such an aggressive mode of fighting their disease. trying to get well, stay the same, or just not deteriorate. So when this information is presented, it's a new vocabulary. And of course, there can be a sense of denial as well."