On Euphemisms and Learning to Be PresentNovember 28, 2011
By Alicia Marie Hinton, who is a BSN student at the College of New Rochelle School of Nursing in New Rochelle, NY. This is her first post for this blog.
My senior year preceptorship was an assignment on a palliative and acute care unit at a busy medical center. When I received the assignment, I prayed that no patient of mine would die during my time on the unit. Every nursing student is afraid of their first patient death. Simulation and course work prepare students in various ways for this experience, but nothing can really prepare you for the emotions you’ll feel. Some students experience a patient death during an undergraduate nursing program, but for others it may not happen until their first year or two working as an RN. I hoped to never endure it, but knew it was inevitable.
During report, working alongside my preceptor, I listened anxiously to the status of the various patients. Since my first day on the unit, I’d practiced my therapeutic techniques and researched different cultural needs pertaining to the death of a patient. I felt culturally competent and well informed about what a nurse should do when a patient dies, but I couldn’t shake my fear. What would I say to the family? Would they value my presence?
Finally, during morning rounds on my third day on the unit, I was told that a certain Mr. P wasn’t doing too well and might “expire” that day. Our focus would be to provide comfort for him and his family.
How did they know he was to “expire”? Was that the politically correct term for dying? I was familiar with “passed away,” “deceased,” or “gone to a better place.” But the word “expire” didn’t feel right. I’d cared for Mr. P since his admission and interacted daily with his family, and news of his impending death hit me hard, increasing my anxiety about how I’d respond when it happened. While I was anxious about my own feelings about the patient’s death, I was preoccupied with my ability to comfort that family.
It wasn’t until later during the shift that the call bell went off in Mr. P’s room and the unit clerk responded. I heard the unit clerk say, “I am so sorry.” As my preceptor approached me, there wasn’t anyone there to cue the slow motion or play the soft music that many medical TV shows would have us imagine. She calmly told me that Mr. P had expired. The word echoed in my head. It made death seem mechanical and artificial. When she asked me to go speak with the family, I assumed a stoic expression to hide my ambivalence and told her that I was ready. I searched for the right words to use, but nothing I’d rehearsed came back to me.
As I entered the patient’s room, I was overwhelmed with emotions and I had to force myself to keep walking. When I looked up and met a relative’s eyes, she clasped my hand, hugged me close, and said, “Thank you so much for caring for him. You all provided such excellent care and comfort, and we’re truly thankful.” Then she turned to my preceptor and said, “Don’t worry, she’s going to be a wonderful nurse.”
At that moment all my fears dissipated. I knew I was a nurse. As family members expressed grief and shared memories of Mr. P, I comforted them and, most importantly, simply offered my presence. The death of a patient will never be an “expiration” to me, and I can imagine that it might never get easier for me to deal with. But I now know that the desire to be present and console the family will be enough to silence my fears about what I will say or do.