I recall caring for a male patient, Mr. D, who was just diagnosed with terminal cancer. He shared that his diagnosis didn't seem to bother his wife, basing his comments on the fact that when his wife came in the room, she "acts like everything is fine." I witnessed something entirely different as I left the room. Right outside the door stood Mrs. D drying her tears. She said she had to "pull things together" before she went into the room because if her husband saw her crying, he would know how sick he was. My response to Mrs. D was, "Oh, no, I think that if your husband sees your tears, he will know how much you care."
In the April-June 2011 column, "What Are the Gaps in Spiritual Care?" I mentioned I had heard renowned nurse author Dr. Patricia Benner speak (Sweat, 2011). She identified a practice-education gap in dealing with suffering. Students are seeing much suffering in the clinical setting, but it is not connected with classroom teaching. It seems there is a reluctance to talk about suffering in education, in practice, and personally, as noted in the above case.
Staying aloof as the wife was trying to do is not the answer to suffering, yet it is often our response or action when we are uncertain of what to say or do. Aloofness is not a new response. Look at the example of the disciples when Jesus was suffering-they fell asleep, left him alone, and even denied knowing him. Reasons for aloofness include fear, uncertainty, feeling unprepared, or trying to protect ourselves from getting involved.
Mr. D was expressing that he felt alone in his suffering. This was due in part because he and his wife were not openly communicating. Additionally, Mrs. D wasn't yet willing to accept the suffering or the seriousness of her husband's diagnosis. This left Mr. D, and probably Mrs. D as well, feeling isolated. According to Nouwen in his classic book "The Wounded Healer," isolation is among the worst of human sufferings (Nouwen, 1979, p. 65).
In general, more openness needed to take place. Mr. D needed to be able to honestly face his feelings and fears with his wife, Mrs. D needed to be honest with her husband, and as their nurse I needed to assist them in the process. Verbalizing fear can be a start to removing isolation. Verbalizing reasons why we stay aloof must be addressed, by nurses and with patients and families. Nouwen offers a basic principle: none of us can help anyone without becoming involved, without entering with our whole person into the painful situation, and without taking a risk of becoming hurt, wounded, or even destroyed in the process (Nouwen, p. 77).
What are ways we can help alleviate isolation? In this case, the couple needed someone to facilitate communication. By helping Mr. D feel more connected with his wife some of his fears and feelings of isolation could be alleviated. I could have offered my presence (Smith, 2007) as well as more time. Instead, I merely offered a few words and was off to the next patient. Bringing the couple together in the room and helping them talk may have opened a door for communication and deeper sharing of feelings, perhaps even for shedding tears.
Showing care and compassion helps alleviate isolation. Compassion is an awareness of another's suffering coupled with a desire to relieve it. Having someone present-and someone who cares, eases isolation. As a nurse, this is not necessarily easy to accomplish. Reflecting on personal isolation and suffering can help us come alongside and open our hearts to what the patient is experiencing. With a deeper connection, the patient may be able to find meaning in his or her circumstances and find hope in what had seemed like a hopeless situation. We can help those who feel isolated by being present and showing tender care.