Constant compassion is taught in our nursing schools as a way of approaching our patients; however, it goes deeper than mere kindness. It is based on the idea that we cannot fully understand the pain that our patients experience, so we always need to demonstrate care and concern. What we can find, if we listen, are a multitude of fears and anxieties that often go unspoken.
It was 2 years ago during my first medical-surgical experience when I encountered my new patient Barbara, a postoperative abdominal surgery patient, with her husband, Carl, at bedside. After introducing myself as the registered nurse, Carl warned me that I was going to have my hands full with Barbara.
"If you can bring me some decent food, the day will go a lot smoother," Barbara joked. I told her, "I'll see what I can find." When I returned with a chocolate pudding cup and a carton of apple juice, I was met with a disgusted response from Barbara. "Umm, no thanks!" she exclaimed, "Carl, can you see if there's a decent grilled cheese sandwich around the block?"
In her slouched sitting position, I offered to help reposition Barbara to put less strain on her back. Demonstrating the numerous possibilities on the fancy electronic bed, I attempted to show her how I could make her more comfortable. My attempt failed as Barbara winced in pain at the slightest movement of the bed. She cried out, "Stop! Stop! Just leave me here, I'm fine!" I left the patient as she wished and told her to ring the call bell if she needed anything.
When I insisted on offering the room chair that was occupied by Barbara's purse to her visiting sister, my gesture was met with resistance from my patient, "No, leave my purse there. My sister is okay, she can stand. I'm the one that needs to sit and rest." I apologized for the gesture, left her purse in the chair, and asked if there was anything I could do for the family. It had only been a few hours into my shift, but it seemed as if I could do little to help Barbara. Yet this was the exact scenario laid out for me in nursing school: "Always show constant compassion to your patients because you do not know what they are going through."
Later that morning, the surgical team was performing their patient rounds. The resident physician was pleased with Barbara's progress. Based on Barbara's urinary output, among other things, the physician determined she was well suited to have her urinary catheter removed but added the caveat that if she did not produce a specified amount of urine within a few hours, another catheter would have to be inserted.
The visitors excused themselves to go find lunch, leaving just the 2 of us in the room. For some added reinforcement and knowing that it was going to be an uncomfortable procedure for Barbara, I decided to enlist the assistance of another nurse to aid in catheter removal to ensure that the procedure went smoothly. After a quick removal, the other nurse and I transferred Barbara over to the bedside commode, placed the call bell within her reach, and instructed her to contact us when she was done. Before we could exit the room, the patient, gesturing to me, said, "Wait, I want him to stay!" I locked eyes with my fellow wide-eyed nurse as she shrugged her shoulders, and I responded, "Okay."
With no questions asked, I nodded in agreement and closed the curtain behind me. As I walked over to the patient, she grabbed my hand and started sobbing. "I shouldn't be here, I should've just let whatever's inside me just kill me," she cried through gritted teeth. "And my husband ... who's going to take care of him. He is going to be so lost with me in the hospital. He doesn't know how to cook, and he can't do anything for himself without me there."
Stunned silence.
I realized suddenly that it was at this moment that my patient finally felt comfortable talking about her feelings: While she was on a portable toilet; beside her nurse; behind a curtain in a shared room; and attempting to urinate. For reasons unbeknownst to me, I had been granted access to this private space and become witness to a sudden honesty that may have never been revealed. There were no more jokes with her husband about the terrible hospital food. The sarcasm in her voice from the morning had vanished, replaced with mournful sobbing. The only thing I knew for certain was that she wanted me to stay, so I did, squatting next to her bedside toilet. I reassured her but gave no false promises. I told her that she had a great team caring for her, and that I would sit with her for as long as it took.
The room was quiet and a little warm. This was not exactly the type of transformative experience I learned about in school. My legs started to go numb in my squatted position and hand slick with the sweat from Barbara's grip. Time passed, probably 20 minutes. Barbara took in a deep breath for a momentary pause from sobbing until ... she passed gas. We both looked at each other and smiled. We made progress.
To me, this has become an all too familiar scene, watching patients unexpectedly breakdown within the confines of their hospital room. As they sit in their beds in preparation for or after a procedure, with a chair to one side and table tray to the other, with little to no comforts of home, they expose their vulnerabilities to me, and I listen. In school we were taught the responsibilities of administering lifesaving medication; in real life, as a bedside nurse, we learn about the responsibility of watching a patient cry.
In this time of uncertainty during the pandemic crisis in our country, what is certain is that these skills are even more important as nurses remain at the bedside with critically ill and dying patients who do not have family present. Our job is to not to make false promises, but to let our patients know that there is someone by their side to provide them comfort. One of the greatest gifts we can provide is the comfort of a shoulder to cry on or, in moments of silence, a hand to hold.
compassion; medical-surgical; patient care