Hospice Care in the Eyes of a Young Migrant Nurse

“Isn’t it terrifying for a young nurse like you to take care of a patient waiting for death to happen?” Gary asked. The sky outside the unit was dark on that cold winter night. His lampshade created shadows as I walked into his room.  His shortness of breathing progressed and I had the morphine elixir in my hand. That question was one of the most difficult that I ever had and even up to this date, it still strikes a chord in my heart.

Trained in the Philippines, I completed a Competency Assessment Programme for Overseas Registered Nurses prior to my practice as a registered nurse here in New Zealand. Bringing along with me my acute nursing experience back home prior to my move here, palliative care in a western world was a relatively foreign context. As our education is patterned and based in the United States curriculum and with our use of western books, the concept is introduced in nursing school but we have no clinical exposure as palliative care treatment is very uncommon back home. For most of us, it is out of the cultural sphere and the thought of palliative care alone inevitably brought shivers down my spine.

When my clinical placement was announced for the bridging course, I was lucky enough to have a choice. Our course coordinator asked me to choose between a geriatric facility and a hospice care unit for my clinical placement. Despite initial hesitations, I chose the latter. On the personal level, I had that self-imposed obligation to face that fear, to know about myself better. A new experience can be a great learning curve. In my mind, this can be a golden opportunity for me to learn about palliative care and more importantly, more about my job.

Here in New Zealand, most of the palliative care patients are referred from rest homes, public and private hospitals. Generally, they are not for resuscitation. An actual experience being exposed in palliative care was new for me to grasp and personally, my mind was not that wide open enough to entertain the concept in a broader sense. There is a big cultural variation on how we view death and dying. In the Philippines, it is common for most patients and family members to expect the health care team to initiate all the possible life-saving measures to prolong life despite agony and near-death. Most of them, if not, are for resuscitation and since palliative care is uncommon, it is also oftentimes, grossly antagonized. If the very morbid patients don’t die in the hospital, patients or family members prefer for the patient to be sent home before they die, where family members can take care of them and die in their care.  In a Western context, quality life and pain-free transition to the next journey takes precedence and palliative care is a widely-accepted specialty.

That experience gave me an idea how Westerners view death and dying, in comparison to how some Asian countries view it. At first, it was a big crisis on my part as it was preloaded in my thinking that health care is all about promoting life. With my experience, with all the great support that I received from the whole team, I eventually realized that promoting life is quite different from promoting quality of life. My latest experience prior to my placement was in emergency care and the pace is whole lot different as patients in emergency stay in the department for a shorter duration. In most cases, we see people in the emergency getting well. In the hospice, you can see how patients slowly die and your role is very important to aid them to have a graceful transition, with comfort, respect and dignity.

Gary was a diplomatic middle-aged gentleman with cardiac tumour with visceral thorax metastasis. He was in the unit for 2 weeks for palliative care. A night before he died he talked with me about so many things, asked me about my home country and I asked him questions just the same. When he asked that question about my job, my mouth was suddenly controlled with the pounding beating of my heart. Myriad of thoughts flashed into my mind.  I went speechless for few seconds. I told him it wasn't hard for me take care of people dying as I have embraced the idea of caring people. It was life-changing as it has taught me to understand more about life. Deep within me, I was emotionally shattered at the thought of seeing people go. Few hours later, his shortness of breathing progressed more than what it was and he was in painful agony. I sensed that for Gary, the end is near.

My preceptor rang the family who were two hours away and I helped her in preparing cocktails of morphine and midazolam for Gary. He went to slumber and I saw him being freed from the struggle that I saw in his eyes. At that time, I was emotionally struggling and it was a little traumatic for me to testify. His phone beeped many times. With permission from the immediate kin, my preceptor asked me if I could open the messages of goodbyes and read them to Gary. I went on to the patient’s side and read them loud enough for the patient to hear while she held his hand and while being in control of the drugs. I felt like shaking and was overwhelmed with sudden gush of emotions deep inside but I forced to compose myself and be calm as much as I possibly could. All I wanted was to cry while I read those messages of goodbyes from his family members and friends. It was heart-hammering, yet life-changing. It was an experience fully loaded with cathartic emotions, introspection and interpersonal adjustments. On the brighter side, my understanding in palliative care broadened into a greater perspective.

Admittedly, it wasn't an easy process but I was wholly grateful. When I reported on duty the next day, the patient was no longer in his room. I was sure he had a peaceful transition from life. It made me realize even more that it is not all about exploring the technicalities of nursing but significantly, the interpersonal aspect as well, as both of them are equally important. As what nursing theorist Hildegard Peplau stressed in her Theory of Interpersonal Relations, the nurse-patient relationship is a “significant, therapeutic interpersonal process” and the importance of nurses’ ability to understand their own behaviour so they can help others identify perceived difficulties is paramount in nursing care.

True indeed, for me it was a great learning curve. The experience didn’t teach me about death. It taught me more about life. It also made me to think deeper on why I become a nurse.

The name used in the article is not the patient’s real name.

This is the original  article of the same sort published in Kai Tiaki Nursing Journal, New Zealand, May 2014.