presence

nursing is usually just a series of tasks.  pass the meds, walk people, do some dressing changes, call the doctor to clarify orders, whatever.  we run from patient to patient usually desperately behind and looking to spend as little time as possible in each place so we can catch back up.  the whole idea of patient care, the actual caring about and spending time with people often gets lost in the shuffle.  it's just the way things usually go.

last week i found myself in a unique situation.  we were shuffling all of our patients from one unit to another because of construction.  my job was to wait for my patients on the new unit and to settle them as they arrived.  because of the hugeness of picking up and moving a whole unit in several hours, we were blissfully staffed with the never before (and never again, i'm sure) ratio that essentially left all of us with only 1 or 2 patients to move.  my first "patient" to arrive was actually just her husband pushing a wheelchair of her belongings, as she was in the OR.  the patient had advanced cancer and was getting a washout for an infection from a previous procedure.  as i started to put her things away, the surgeon came to the room to let her husband know her surgery was over.  i was on my hands and knees wiping up the entire bottle of the saline i'd just dropped on the floor when i heard him tell the husband that there was a tear in the bowel.  this was followed by a very matter of fact "if she gets a fistula, i think it's time to pursue palliative care.  if it were my wife i'd start thinking about how long you want to fight this thing".  and then the surgeon left, and it was just me and my patient's husband whom i had met less than 5 minutes before.  

what do you say in a moment like that?  i've been there?  i'm sorry?  i'll do whatever i can to make this even the tiniest bit easier for you?  all of the above?  are there really any words that can blunt the pain of that kind of conversation?  

no, there aren't. 

in nursing school we aren't taught how to be helpful when someone's world is falling apart, probably because that's not something that can be learned.  so i offered the husband what i had, what i NEVER have but for some reason on this day in this situation, i did.  my time.  no other patients to worry about, no other tasks to run to, no ringing phone to interrupt the moment.  

i sat with him.  i gave him the comforting words that came to mind, and when those sounded like not enough to my ears i was just there.  it didn't change things, or make the truth any less difficult, but it was something.

i think that it's easy to lose sight of the fact that just being present when people are hurting is helpful.  sitting with someone whose heart is breaking is sad and sometimes uncomfortable, and for me brought up memories that i'd rather not remember.  but it was what the moment called for, and because of that i was happy to be there.  

this is the thing that i so easily forget: taking care of people means actually caring.  it's so easy for me to view the day as a giant checklist of meds and tasks that i put a line through when i finally finish.  i power through 10 or 12 hours with a death-grip on 'my plan for the day', trying to be productive and efficient.  but sometimes the day just calls for sitting in a chair and shedding a few tears for someone else's pain; for offering up my presence when i have nothing else to give.