“The doctor says I’m dying”: tough conversations about death

One of my most vivid placement memories was my first conversation with a patient about dying. One afternoon I went to check on Joan (name changed), a lady in a side room on an elderly ward. I was helping her to have a drink when she looked up and said: “the doctor says I’m dying.”

I froze. My stomach turned and my mind started racing, taken aback by a statement I felt totally unprepared to respond to. I had grown fond of Joan and to see her so distressed was upsetting. I felt a sense of panic, worried that I might say the wrong thing.

I knew from the handover that morning that Joan was receiving end of life care and from what the other nurses had said, she was deteriorating and it was unlikely that she would get any better.

Taking a deep breath, I thought back to our communication lectures which covered how to deal with difficult questions. I drew up a chair next to Joan and holding her hand, I asked some straightforward questions like ‘when did you discover that?’ and ‘how does that make you feel?’, trying my best to mask my own anxiety and appear relaxed.

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While I think I started off ok, all of a sudden I panicked; I didn’t know what to say next.  Almost without thinking, I said: “Don’t worry Joan, we’re all doing everything we can to get you better and back to your normal self.”

I immediately felt awful and her face said it all; she knew I was covering. I said it out of a desire to help Joan stay hopeful, optimistic, but in reality it sounded trite, like I was brushing her off and trying to avoid a deeper conversation. I think that it made her feel worse.

Kicking myself, I spoke to my mentor who reassured me that she too struggled with questions like those and some research when I got home that night revealed that I wasn’t alone – apparently it’s common for healthcare professionals to avoid or block difficult questions, particularly about death or dying. I suppose we like to focus on how we can ‘fix’ things and don’t want our patients to lose hope.

Looking back, I wish I’d spent more time with Joan, even just to sit quietly by her side. She may have had more questions that she wanted to ask and as a student nurse, I may not have known the answers but I could have found out on her behalf.

Honesty and courage are such important parts of nursing, especially at the end of someone’s life. Sometimes the best thing we can do is to be there; to listen, answer questions and ease fears – or just to hold someone’s hand and let them know that they are not alone.

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