I recently returned from a week-long vacation overseas.
My return to work was a jolt back to reality.
I began the week in OB/GYN, working two long days full of pregnant women, ultrasounds, and everything women’s health. I’ve been spending the latter part of the workweek in family practice, broadening my patient population to include every age and gender.
I’ll start by sharing a specific patient circumstance that happened. I was on-call with a family practice doctor when we received a notification from the lab reporting a critical value: a white blood cell count of more than 100,000 (over 10 times the normal level) and a platelet count of 27 (a dangerously low level). The patient had come into the office for a sore throat and flu-like symptoms, and now the doctor was presented with the task of telling the patient that he needed to be hospitalized immediately. The doctor turned to me and asked, “How do you tell a patient with a sore throat that he might have a serious illness, possibly acute leukemia?” I, of course, had no idea if this was a rhetorical question and didn’t answer (mostly because I had no answer).
I sat for a minute and tried to imagine myself in this patient’s shoes: coming into the doctor with a simple sore throat and then being told that my lab results were an admission ticket to the hospital. Not only would my day be altered dramatically, but this could be the start of a life-altering journey if indeed acute leukemia was the eventual perpetrator. A monumental shift in my personal story. As I imagined the patient’s experience, I couldn’t help but enter into his suffering just a bit. My heart went out to this man.
But he is just one person, and my job as a nurse brings me into contact with tens and hundreds of patients who each have a unique story.
Every patient has past experiences that have brought them to my point of interaction with them, and they will continue to have a story after I take their blood pressure, run an EKG, or administer a medication. This concept of individual patient narrative was part of my nursing school’s fundamental beliefs: every patient is a “person.” Being a “person” involves having a story that is valuable, individual, and multidimensional. In the case of the man with possible acute leukemia, I am brought into his life at a pivotal moment, but I am just seeing him at one point in his life. Part of the difficulty as a nurse is to see the patient in front of you as a whole being, with more to his story than a diagnosis.
One of my favorite books from college, “Medicine as Ministry” by Margaret E. Mohrmann, has a chapter discussing how nurses can positively impact their patients by paying attention to their suffering and listening to their story: “Paying attention to those who suffer – hearing their pain, seeing their damaged selves as damaged selves and not just vehicles for interesting diagnoses – means more than anything, listening to the stories they have to tell us” (Mohrmann, 65). By simply acknowledging the suffering of a patient in a genuine way, a nurse can honor a patient’s personhood. She or he can affirm that the patient has emotional and spiritual aspects to their being. Truly sharing the human experience – the pain and hurt – through listening makes the raw reality a bit more bearable.
For many people, the doctor’s office is where the symptoms get a name. It’s not just a persistent cough: it’s pertussis. It’s not just urinary frequency and excessive thirst: it’s diabetes. It’s not just a sore throat and the flu: it’s acute leukemia. Diagnoses may bring clarification, but they also bring fear, anxiety, and despair. A patient may be able to clearly articulate his or her story with the new-found cancer diagnosis language, but it does nothing to ease the emotional journey that is to come.
Mohrmann argues that since every patient has a personal narrative, it is beneficial and empowering for them to be regarded as the “hero” of their story (70). Just as a hero in a great Greek epic conquers great tasks and perseveres through strife, a patient undergoes challenges that require similar determination and hard work. Living through disease and its ramifications is no mean feat. I would say that Mohrmann is on to something, and the patients that I’ve seen certainly are heroes by those standards.
To Sum Up
A patient is a person. Every person has a story that involves suffering. Nurses have an optimal opportunity to empower a suffering person by listening to his or her story and acknowledging the multifaceted needs of the individual. Nurses can help patients see themselves as heroes.
But it’s so hard. I work in an office that sees patients every 15 minutes. There are tasks to do, people to call, results to review, orders to send. And now I want to add in another component to my job: listen to a patient’s story? Hear their fears and anxieties? Take the time to simply be present in their suffering, when words seem to fail? Or in other cases, honestly and directly relay the realities that their health is declining to a seriously dangerous point?
Yes. I think that it is worth the extra time: to make a person feel heard, cared for, loved. I may just have to leave a few minutes later at the end of the day, but yes, it is worth it.
I’d like to end with one of my favorite quotes from C.S. Lewis’ The Weight of Glory. It has always served as a reminder to me as a nurse to treat each of my patients as a person: