Thursday, July 22, 2010

Sometimes Compassion is the Best Prescription I Can Write

Sometimes I think people overshare in their blogs or Facebook/Twitter posts. This may be verging on that, but a conversation yesterday and several recent events have led this topic to weigh heavily on my mind today. It is quite possible for something profound to the writer to come as across cheesy to the reader, but I hope I do it justice.

Yesterday, I was having a conversation with a Nurse Practitioner student about patients at end of life. When you decide to be a critical care nurse, you are focused on high-energy, fast-paced management of critically ill patients. The meds, the machines, the critical thinking required to get people better. What you don't necessarily realize is that we also encounter instances (not infrequent) where we have exhausted available therapies, or the patient is ready to give up the fight. Sometimes the best thing we can do is to make someone comfortable and provide support to their family.

As we were having this conversation, I pulled out the obituary of a patient who had touched me profoundly at the end of his life. I couldn't have told you exactly when he died, but it turns out it was around this time of year. He was 80, had suffered a massive heart attack at 40, and was told he wouldn't live past 60. Months after a huge 80th birthday celebration, he suffered a heart attack. He was stable at first, but then it became apparent that things weren't going well. After days of trying the available therapies, his family made the decision to let him go peacefully. He had been in and out of consciousness, and was confused when awake. Of course his family and his healthcare team didn't take the decision lightly. Even when you know you are out of options, it is hard to throw in the towel. Sometimes we have to be the ones to tell patients/their families that it is ok to let go.

On the day he passed away, I was in the room with the patient and his son. He had not been alert, but he suddenly grabbed my hand and pulled the oxygen mask away from his face. "I'm not scared," he said "They told me I wouldn't live past 60. I lived to 80. I watched my children and my grandchildren grow up. I'm not scared." Of course I was bawling. What a gift he gave us- he let us know that our decision was the right one, and that he wasn't in pain and wasn't scared. He gave his son peace of mind, and let us know that he was ready. It was a moment that will always stick with me.

Not everyone has time to prepare for such a sad event, but when people are aware that their time is close, they seem to achieve peace and acceptance. People also seem to have amazing control at the end- some wait for that last family member to arrive, defying the odds so one more person can say goodbye. Others wait until everyone has stepped out for a meal or a breath of fresh air, not wanting to burden them. As a Nurse Practitioner, sometimes I feel like I intrude on a very intimate moment, but I would also like to think there are times when I have brought someone just a sliver of comfort.

While we are good at the fast-paced, high intensity atmosphere of critical care, we don't always know what to say to patients and families at the end of life. You worry about saying the wrong thing, and sometimes "I'm sorry" seems so insufficient. Sometimes we tell our patients that it is ok to go. Sometimes it is a hand on a shoulder, tissues for a grieving family member, tears shed by the staff. Sometimes the medications and machines aren't the right thing anymore. Sometimes the best prescription we can write is for compassion.


  1. I spent the evening with a patient at the hospital, acutally around the time you posted this special story. I was on rounds on the joint replacement unit and bumped into a sweet spouse of a recovering back surgery patient. She was looking for someone at the nursing station and I approached her to assist as no one was present. She said "my husband is having flounder and it looked good, we wanted to have dinner together but when I went to the cafeteria there was different food available, I tried room service but they wouldn't send the fish." I smiled and explained to her the different offerings for patients and visitors. I told her to give me fifteen minutes.

    I went down to the kitchen and had a plate fixed for her - flounder. I brought up the tray just as the patient was finishing his. She was so happy to have that piece of fish. They asked me to stay for supper. Strangely enough I did. So here we were each of them with a bedside table and their tray of flounder, me talking about the future design considerations of the unit (such a nerd).

    We spent an hour and a half together talking about the area, growing up in MoCo, the care received, being recovering back surgery veterans, etc. They told me I was the highlight of their experience at MGH and it was so perfectly timed and needed and invigorating, I can't tell you. I told her we used to round as non-clinical directors. I told her that I missed the bedside as a clinician from my past career. I told her that at the end of the day it was all about having dinner or checking to be sure we were doing the right thing and that we were evolving and creating a larger culture of quality care in a comfortable environment. I told her we were working on the built environment and the way people interact and become compassionate caregivers and available to all of their needs.

    It was such a nice exchange, they spoke of their 53 year marriage as they held hands and we chatted away. The icing on the cake - they asked me back for lunch before discharge tomorrow and just as I went to leave the room, a dietary clerk was on her way in with a piece of flounder for the wife. It turns out she had called all along and asked for the kitchen to make an exception. Needless to say she ate that tray too! I guess the compassion prescription, as you describe it, was written at 6:26 pm according to your blog. We all filled it Kiersten just about that time.

    Thanks for being you K.


  2. Todd- Sometimes it is about pulling up a chair and doing something so out of your job description. It is so freaking rewarding. Thank you for being so invested in MGH, and for being invigorated by such "minor" details. I'm glad others are that way!

  3. Last night aitting with my Aunt I was telling her about things I remembered doing with her when I was a child. I started to cry and she brightened her eyes and stared into mine with a look that told me " I love you and it's all ok". It was the most amazing look that I will remember always-a connection that will never be lost. Just to be able to sit with her was more joyful than anything