For many future hospice patients, there is a time when life is about to change. And someone needs to say something . . .
A doctor leans forward in her chair. For no reason—other than doing one more thing to avoid speaking—she shifts several thin manila files across her desk. She has done this with only a glance at the files because she was making herself keep eye contact with her patient. The patient hasn’t moved. He sits motionless and upright just like the prior three visits. This gentleman is old enough to be her grandfather. Wearing a wrinkled sports jacket and food-stained tie, he’s overdressed like her Pops would be. Dress nice for the doctor’s office, that’s what her grandfather always advised.
Her patient is a nice man. Always polite. Always with a list of questions. Now, as his oncologist, she knows his most recent test results. What should she say about the final worst thing that will happen in his life when she manages to open her mouth?
Later, the seventy-something man in the wrinkled jacket and stained tie faces his wife. She didn’t go with him to the doctor’s office because she was “under the weather.” As they sit on the couch—the one she’s been negotiating to dump for three years because their cats have shredded the sides—he loosens his tie. They sit angled toward each other, his knee touching her knee. She still wears her house robe and sips the tea he made for her after returning home. It’s chamomile, of course, the same kind of tea she drank on their first date over fifty years ago.
She is his oxygen; his yesterday, today, and tomorrow. They have been through the death of a child and have watched two other children graduate from college and start families. What should be the first thing he says to her that will begin the last thing they will do together?
On the next day, a hospice nurse approaches the door. A blue nylon satchel hangs over his shoulder, the color the same as his scrubs and one with enough room for a computer and lunch (which he’ll eat in the car between patients). He checks the Google directions again on his smart phone to confirm this is the correct house. There is a man inside. He is seventy-something, a new patient with a wife and two adult kids. One is flying in from Seattle tonight, according to the nurse’s notes.
The nurse has never been here before. What should he say to this family? Though he’s been a hospice nurse for almost a decade, every first visit feels . . . new. Each family is the same, and yet is so different. What can he do to truly help them?
* * *
There is always a first time to tell, or learn about, a “life-limiting” illness. The heart is too damaged for surgery and has become a ticking time bomb. A stage-four cancer, undetected weeks before, ravages the body. The chronic obstructive pulmonary disease (COPD), once manageable at the beginning of the year, compromises the lungs by mid-summer.
How will a doctor tell this news to a patient?
How will the patient respond?
What will that patient explain to his loved ones?
Is there anything reassuring for a hospice nurse to say?
Silence seduces us. Humans hoard secrets. Full disclosure can feel like an anvil on our hearts. We put off saying anything until tomorrow, which is always conveniently the next day. How easy it is to mutter white lies (but for good reasons). Why not whisper half-truths or partial information? We want someone else—anyone else—to break the “bad news” and all we’ll have to do is frown in sympathy or beat a hasty retreat.
But can silence be a blessing, a prelude to the first words? Once I helped start a BeFriender Ministry program at a church. (It’s similar to the likely better-known Stephen Ministries). Laypersons were trained to visit the lonely, isolated, and grieving. These volunteers were encouraged to “empty their cup” before each visit, to leave their own issues behind as they briefly entered into another’s life. While easier said than done, the effort was essential. When serving another, truly try to be present with them. A moment of silence can be the best thing before all the awkward and truthful and necessary words leave our mouths.
I hope doctors don’t casually share terrible news; I hope every physician pauses and strives to use the most honest words.
I hope loved ones that don’t know what to say begin to speak anyway; there are no “perfect” ways to share the unexpected and unwanted.
When one of my hospice colleagues enters a home for the first time (or tenth time), let it be with wondering what’s the best and most supportive thing to say.
First words matter. And then the next, and the next . . .
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)by