It was an innocent, polite question. My patient’s wife asked how my weekend away was. She only knew I had taken a long weekend because we had to juggle their visits around last week. Otherwise, she wouldn’t have known my plans. It’s nursing 101. Don’t talk about yourself. Instead, focus on the pt and his life and concerns.  
I was taken off guard because Maureen and I often grouse together about the summer heat. It has been a record breaking one for heat and draught. We New Englanders are not used to steady temps over 90 and weeks without rain. We are used to complaining about the weather and it has been exceptionally uncomfortable and Maureen tells me that has never liked heat. This year she is also facing the loss of her husband of 41 years so I imagine the extreme temperatures are extra annoying.  
So when she asked me how my weekend in Northern Vt was, I answered ” cool, comfortable and nice and quiet.” The correct response would have been ” nice. Thank you.” And that should have been that. That is all they cared about at this stage of life. Edgar certainly didn’t care. He was dying of cancer. Maureen was being polite and I should have registered that. She had a list of questions that were important for her as she continued to care for Edgar. Questions that were of greater importance at this moment than how my days off were.
“He’s gotten very sleepy'” Maureen explained. “Are we giving him too much medicine?”
I explained that it is often hard to tell if the sleepiness is due to the side effects of some of his medications or part of his end of life process. I suspected the latter. She understood that. It’s a tight line between keeping patients comfortable and somewhat alert. I try to ask patients and their families if comfort or alertness is more important while the patient is still engaged with the world. It’s not a great choice but some do have preferences. Some patients say that they would like to put up with a little more discomfort if it means staying present with their loved ones longer. Others want to be deliberately sedated because they are scared of the experience or bored when they can’t do the things they enjoyed. If a patient is already disengaged when I meet her, I watch closely for signs of discomfort and let that be my guide. I teach families to watch for any signs of fretfullness like a furrowed brow or restlessness. Families and caregivers become very good at this and know the patient well so are able to spot symptoms quickly.
 The couple is very friendly and I like Maureen. These are the types of patients who are easy to slip into familiarity with. Hospice nursing is so very personal and we enter families lives at such an intimate time that the boundaries can get fuzzy. I want my patients and their families to feel secure in the knowledge that they are cared for. The art of the deal is learning to balance the genuine caring and connection that we feel for our patients and families while keeping our professional skills at the front of our practice.  

Sent from my iPad