A friend and I sat at a wine bar. Over a glass of Pinot Noir, the topic of blogging came up. I told her I was writing a post about the need to teach oncology teams how to talk to late-stage cancer patients about death. She said, "Oh, you can't talk about that all in one conversation. You have to talk about things like that in short, repeated conversations. It's too much for someone to take in all at once."
My friend is a diabetic educator, a pharmaceutical rep, and she is better prepared to discuss life-changing illness with her clients than most oncology nurses are to talk to theirs. Talking about the life-threatening aspects of diabetes is in her job description. Therefore, she's been educated on how to do it.
Unlike educators and pharmaceutical reps, oncology nurses are hired for what we do to patients, not for talking to them. Although documenting patient education is part of our job description, it doesn't carry the same weight of importance as administering chemotherapy. Assuring that oncology nurses and oncologists are competent in discussing dying with patients is not a priority for hospitals.
I started an IV on a patient, and drew a lab from it at the same time. As you see from the photo, things got a little messy. When I removed the pillowcase from under the patient's arm, we were both surprised to see the stain was a perfectly shaped heart of blood. We took it to be a good omen, and I photographed it.
Is there any wonder that we rely on our own initiative to learn how to talk about dying with our patients?
What if oncology nurses and oncologists were taught and supported in the necessary skills to bring the process of dying the same respect given to the process of giving birth?
Envision the oncology community: patients, physicians, nurses, social service workers, and spiritual care, working together, creating the same level of compassion and purpose for dying that parents, midwives, nurses, and obstetricians have created for childbirth.
If education about childbirth empowers mothers in labor, might not education about what to expect at death empower patients with a sense of control, lessening their fear and pain? What would patients plan, given small conversations of education, in an adequate amount of time? Would patients create personal soundtrack CDs of music? Choose poetry for loved ones to read? Decorate their rooms with art to view as their vision dims? Lie in beds wide enough so loved ones can hold them?
As it stands, we burden hospice nurses with guiding patients and families, who do not know what to expect, through the entire dying process. When there is not enough time, patients go without the necessary knowledge to find personal meaning in this eventual and unavoidable passage.