It can be challenging for bedside nurses to put aside our personal opinions, values and beliefs to allow the desires, beliefs and cultures of our patients to be the priority. I recently had the opportunity to put this into practice with a young patient, in particular, with her mother. I'll refer to her mother as "Lisa".
My patient was young, sick and we healthcare professionals recognized she was not going to recover from her illness. Her mom felt differently; as she shared with me that she "believes in miracles and would not give up hope". I stood by my patient's bed and listened to our Attending physician cautiously try to help Lisa and her two daughters understand the gravity of this patient's circumstances. Nothing we were doing was stopping the progression of her illness.
The doctor knelt next to Lisa, who was sitting, holding her daughter's hand while hearing the doctor cautiously try to convey that it was time to consider changing our focus from keeping her daughter alive, to helping her have a dignified, comfortable transition to the next life. Lisa never looked at the doctor while she was kneeling at eye level and the only thing Lisa said was, "I can't talk about this". The doctor tried to clarify whether Lisa was concerned about talking about this in the room with her daughter or not able to talk about it anywhere. Lisa did not answer. I sensed that something was amiss, so I stepped in and suggested that the family think and talk about what the doctor said and then let me, her nurse, know what they wanted to do. Lisa's refusal to talk with the doctor reminded me of my clinical rotation with the Navajo people during nursing school. Their culture does not recognize death in the same way other cultures do. I desperately wanted to do something to help them understand, while still respecting their culture.
An advantage of being a nurse is there are always reasons to be in the room with the patient and family, the key is learning to be present and available for families during these critical moments. I did just that. I hung some medications, did another assessment on the patient, all while Lisa and her two other daughters were silently sitting, with their heads lowered in what could have been meditation or prayer. When they talked with each other, they did so in Navajo, and I continued puttering in the room.
After a few minutes, I tidied up the room and while doing so I asked if there was anything I could do for them as their nurse. Lisa kept looking at her daughter and shook her head, no. I took that quiet opportunity and asked if they would be interested in having any clergy visit. Lisa responded that she didn't know anybody in the Salt Lake area. I took advantage of this small opening and told them we had resources and would be able to contact a Native American clergy if they were interested. It was a weekend, so it may take a few hours, but I was willing to ask for them. Lisa looked at me in surprise and I knew I had made a connection with her. I said nothing more and went out to page the hospital chaplain for help. Sure enough, within the hour, we told Lisa that a Native American shaman would be at the hospital within two hours. I thought I saw a bit of relief in her face.
My patient's blood pressure suddenly dropped and I increased some medications, trying to keep her vital organs perfused. I knew I was fighting a losing battle, but it needed to be done, for now. Lisa was next to me and asked if I would talk with her brother on the phone. This was a very unusual request because it seemed she was doing all she could to avoid addressing what was happening with her daughter. I told her I would be happy to talk with her brother, but didn't know what she wanted me to say. She said to just tell him what is happening. She called him and handed me the phone. I proceeded to tell him how sick his niece was and that Lisa couldn't talk with him. He asked what he was supposed to do and all I could say was how sick she was and that if she wasn't on the breathing machine or the blood pressure medications, she would pass away. He asked if he could talk with Lisa and, thankfully, she complied. Whew... I was able to provide a transition for them to have a critical communication. When Lisa finished talking with him, she shared that he was leaving to drive up to Salt Lake to help during this difficult time. It would be a seven hour drive, at least. At least that was something we could look forward, although they would arrive after my shift ended, which meant I would need to do my best to keep her alive until then.
The shaman arrived and Lisa asked me to explain her daughters situation. I shared how sick she was, that her liver was not working and everything we tried to do was not helping. She was on the ventilator and would not survive having it removed. He listened intently and told me to continue taking care of Lisa's daughter while he blessed her. He asked to let him know if he was in my way, which I agreed to do.
It was a busy time for me; I needed to hang two antibiotics and replace her pain medicine and chart another full assessment. I focused on being a nurse of a critically ill patient, but was well aware of the blessing happening in the room. The shaman chanted and waved a large eagle feather all around my patient, pausing to touch her at times. He waved the feather around the medication pumps and took time to bless Lisa and then Lisa asked him to bless me, her nurse. He walked to me and asked me to hold out my hands and proceeds to bless me. The feeling in the room was full of peace, calmness and hope. I forced my mind to be quiet and take in what was happening. It was just me, my patient, Lisa and the shaman in the room. I was grateful to be included in Lisa's moment with her daughter and thanked both her and the shaman when I left the room.
The remainder of my shift went quickly and I noticed that Lisa remained in the room, holding her daughter's hand as she rested her head on the side of the bed. These few hours would end up being the last she had with her daughter, as Lisa decided to withdraw care when her brothers arrived a few hours into the night shift. My patient passed very quickly and I heard the family was very thankful for the blessing she received.
My 45 minute drive home was full of pensive thoughts and gratitude for my decision to become a nurse years ago. Experiences like this keep me grounded and thankful for the important things in my life. Every day is a genuine gift and we get to choose what to fill each moment with; let's choose wisely.
