It was not a full moon that day, but it felt like one. Everyday working as a hospice nurse case manager was different from the last. I was used to being rerouted multiple times a day to accommodate my patients’ needs, but there seemed to be more setbacks that usual that day. It was 4:30 pm on a Friday afternoon when I arrived at my last patient visit of the week. I was greeted by a lovely family caring for their amazing matriarch, Joy, who had been diagnosed with metastatic ovarian cancer only six months before.
Joy lived at home with her husband, Jim. She had three daughters, Alice, Julia, and Marcy. Alice recently moved in to help out with Joy’s care. Julia and Marcy lived nearby and also participated in caring for their mother. Despite her swift decline, Joy had reached a point of acceptance with her short prognosis. Jim and Alice, although devastated by Joy’s diagnosis, were respectful of her wishes to focus on comfort rather than curative care.
Julia and Marcy, on the other hand, were struggling to understand why Joy was forgoing further treatment so soon after being diagnosed. While Jim and Alice had faith that God had a plan for Joy, Julia and Marcy believed that God’s plan was for Joy to survive this horrible disease. Joy asked for my help explaining her condition to her family, so they can all understand her end-of-life wishes. After reviewing all of her clinical paperwork, I was able to gain a better understanding of the extent of her metastasis. The ovarian cancer had invaded Joy’s peritoneum. It had spread to her lymph nodes, breast tissue, lungs, liver, spine, and brain. She was too weak to undergo chemotherapy, and the metastasis was too widespread for surgical intervention. As I gathered the words to explain these devastating findings to Joy’s family, a painful memory entered my mind.
“Don’t be a coward. Say it!” I yelled at my mother’s poor oncologist, who fought tirelessly to try and save her. My anger was not with him. It was with my mom’s cancer. I could not even imagine living without her. It did not feel real. I needed to hear him say the words. As I sat there with Joy’s family, I remembered the bravery of my mother’s oncologist, who said the words that her other health care providers could not bring themselves to say. I recentered myself back into the conversation with Joy’s family and repeated the same terrifying words that my mother’s oncologist was brave enough to say to me on the worst day of my life.
“We’ve done everything we can, but we are out of options. I’m so sorry. Your mom is going to die.” I said to Joy’s family with empathy but careful not to mince my words.
The room was silent for a few moments after I said the words. I explained the findings on the notes from Joy’s oncologist, from the extent of the metastasis to the lack of further treatment options. A few more moments went by, but it felt like an eternity of silence. Julia, who was consumed by anger in the beginning of my visit, looked into my eyes, with tears falling from hers. I was expecting her to scream at me, and I would not have blamed her at all. I understood.
“Thank you,” she whispered genuinely.
Joy passed away two months later. Jim, Alice, Julia, and Marcy worked harmoniously to make Joy’s final days comfortable and peaceful. I had delivered the same devastating news hundreds of times during my career as a hospice nurse. For some reason, this family helped me look at this difficult task in a new light. Perhaps it was Joy’s spirit that reminded me so much of my mom, or maybe it was the connection between Julia’s anger and my own. My mother passed away three years before I met Joy and her family, but my experience with them made me realized that my mother’s oncologist took an incredible burden off of my shoulders the day he told me she was going to die. He gave me the comfort of knowing I did everything in my power to save her and her death was not my fault. When I am struggling to deliver difficult news to the family of one of my hospice patients, I think of Joy and my mother, and I think of my mom’s brave oncologist, who helped give me permission to let go.
Joy lived at home with her husband, Jim. She had three daughters, Alice, Julia, and Marcy. Alice recently moved in to help out with Joy’s care. Julia and Marcy lived nearby and also participated in caring for their mother. Despite her swift decline, Joy had reached a point of acceptance with her short prognosis. Jim and Alice, although devastated by Joy’s diagnosis, were respectful of her wishes to focus on comfort rather than curative care.
Julia and Marcy, on the other hand, were struggling to understand why Joy was forgoing further treatment so soon after being diagnosed. While Jim and Alice had faith that God had a plan for Joy, Julia and Marcy believed that God’s plan was for Joy to survive this horrible disease. Joy asked for my help explaining her condition to her family, so they can all understand her end-of-life wishes. After reviewing all of her clinical paperwork, I was able to gain a better understanding of the extent of her metastasis. The ovarian cancer had invaded Joy’s peritoneum. It had spread to her lymph nodes, breast tissue, lungs, liver, spine, and brain. She was too weak to undergo chemotherapy, and the metastasis was too widespread for surgical intervention. As I gathered the words to explain these devastating findings to Joy’s family, a painful memory entered my mind.
“Don’t be a coward. Say it!” I yelled at my mother’s poor oncologist, who fought tirelessly to try and save her. My anger was not with him. It was with my mom’s cancer. I could not even imagine living without her. It did not feel real. I needed to hear him say the words. As I sat there with Joy’s family, I remembered the bravery of my mother’s oncologist, who said the words that her other health care providers could not bring themselves to say. I recentered myself back into the conversation with Joy’s family and repeated the same terrifying words that my mother’s oncologist was brave enough to say to me on the worst day of my life.
“We’ve done everything we can, but we are out of options. I’m so sorry. Your mom is going to die.” I said to Joy’s family with empathy but careful not to mince my words.
The room was silent for a few moments after I said the words. I explained the findings on the notes from Joy’s oncologist, from the extent of the metastasis to the lack of further treatment options. A few more moments went by, but it felt like an eternity of silence. Julia, who was consumed by anger in the beginning of my visit, looked into my eyes, with tears falling from hers. I was expecting her to scream at me, and I would not have blamed her at all. I understood.
“Thank you,” she whispered genuinely.
Joy passed away two months later. Jim, Alice, Julia, and Marcy worked harmoniously to make Joy’s final days comfortable and peaceful. I had delivered the same devastating news hundreds of times during my career as a hospice nurse. For some reason, this family helped me look at this difficult task in a new light. Perhaps it was Joy’s spirit that reminded me so much of my mom, or maybe it was the connection between Julia’s anger and my own. My mother passed away three years before I met Joy and her family, but my experience with them made me realized that my mother’s oncologist took an incredible burden off of my shoulders the day he told me she was going to die. He gave me the comfort of knowing I did everything in my power to save her and her death was not my fault. When I am struggling to deliver difficult news to the family of one of my hospice patients, I think of Joy and my mother, and I think of my mom’s brave oncologist, who helped give me permission to let go.
