Last weekend a physician and I were rounding on the oncology unit. This physician is great because he loves to jump in to divide and conquer the work.
We both returned to our dictation room at the same time to start taking about a patient and a difficult situation. He described what he encountered, and as he spoke I had a feeling of déjà vu. I looked at him, puzzled, and asked, “Wait a minute, did we accidentally see the same patient?”
We had actually seen two different patients. Both women, with a fairly recent lung cancer diagnosis and both at the beginning of their treatment, were hospitalized due to complications from treatment (worsening shortness of breath and dehydration).
Outside of the similar diagnosis, what else was so similar? Well, they were both belligerent to the staff, which included us. In addition, both believed they were going to be cured, even though they knew they were in advanced stage (stage IV). They verbalized that they may just stop treatment altogether, convinced that the staff was not doing everything possible.
My patient went as far to say that I "ruined her world" by telling her the results of her recent CT scan the day before. She had not wanted me to leave until I told her what it showed, even though I informed her the scan was to see why she was short of breath and not a response to treatment -- she'd had a couple of prior scans already.
The patient was livid with me repeating these scans, even though they were not for response determination. I could tell by the patronizing way she was speaking to me, I was not liked by her one bit. Her friend and husband sat idly by not saying a word.
Both patients did have a history of depression and were under the care of a psychiatrist. Fortunately, they did not share a hospital room together.
They made us both feel "crazy" and as if we'd harmed them in some way. We decided that this may be denial and consulted our behavioral oncologists to come visit each patient.
A cancer diagnosis often does make people feel out of control and powerless. Possibly this is magnified in those with a mental illness or emotional disturbances. In addition, denial is linked to poor long-term adjustment to the illness. Denial can also compromise a patient’s ability to anticipate and prepare for unknown stressors.1 This was denial in its truest and most severe form.
I was so traumatized by my patient’s comments and behavior toward me that it stuck with me for a few days. She was doing her best to pick a fight with me, but I kept calm, cool, and collected, although I did feel verbally abused by this patient.
There was no reasoning or rationalizing with her. And her husband and friend did not make any attempt to defuse the situation. Maybe they were already well aware of her behavior. This was only my second time with her, and the day prior you would have thought I was her best friend. It was puzzling and disheartening.
Has anything like this ever happened to you? If so, how did you handle the situation? Any tips on how to deflect such behavior in the future?
- Gobel, B.H., Triest-Robertson, S. and Vogel, W.H. (2009). Advanced Oncology Nursing Certification Review and Resource Manual. Pages 653-654. Oncology Publishing Division of the Oncology Nursing Society, Pittsburgh, PA.