Sadness

Tuesdays and Fridays are pediatrics day in the Chemo Treatment Room.

Ever since I was a lowly student nurse, I worried about how I would deal with the emotional aspects of my interactions with patients. I had considerable anxiety about it, prior to my first clinical practicum, to the point where I spoke up and asked a panel of nurses in to talk to our First Year class how they dealt with the pain and anxiety and worry of their patients.

But when I got to the clinical areas, I discovered that most of the time it was a non-issue. Generally speaking, many nurses are not daily confronted by the heart-wrenching. It is an asepct of care we often do not have time for, and, as a novice nurse, I have to say that I tend to spend much of my time and energy on completing the tasks required of me by my job description and the other members of my team. Patients are, at times, a health history and a condition and a series of tasks I need to complete. A bit of self-analysis made me realize that while this is partly a defense-mechanism, a necessity of self-preservation, it also defined my work and my job. For the purposes of getting a job done, there is often little time for emotional involvement, and that aspect of care is often glossed over out of necessity, for the sake of my own mental health, my professional development, and the need to get the job done.

When I changed jobs recently, that same old anxiety resurfaced. Cancer nursing is an area where you see the same patients over and over; where you get to know people and where a nurse has time to sit and listen to an illness narrative. It is now my job to find out how someone is coping with their chemo, because if there are problems, I need to do what is necessary to help them be fixed. It is a daunting prospect, to be faced with both the nursing tasks and needs of the patients, but also their general well-being, their emotional health, too. Certainly this should have always been a part of my practice, regardless of the clinical area, but somehow it seems all the more integral to the care cancer patients because it is so central to their recovery. And it is harder to minimize when the nurse is developing a long-standing relationship with a patient, and not just changing their dressing and sending them home.

I did fine, though, the first day I was on the floor. I discovered that to give good nursing care, I need to have a bit of emotional distance, because if I got caught up in each individual story, I would quickly become too emotionally crippled to work. Each diagnosis seems an insurmountable tragedy to the patient. Each day of survival is a triumph, and each relapse is a heartbreak. But cancer patients daily surmount the insurmountable and bear the unbearably sad reality of their bodies' rebellions. I have already, in two days, learned from these patients that we cope with what we get and take everything one event, one day at a time. What the patients want is not someone who feels sorry for them. They need someone who can answer questions and relieve pain and nausea and anxiety with their professional knowledge. Good lessons for the first week of work, right?

So I did fine, that is, until my first peds day. I was relieved to hear I would not be working with kids, because I truly believe it would be beyond my personal capability to watch a blameless, trusting kid go through what they do. So I did fine, but what I didn't count on was being able to hear them. When I heard the first cry, the first kid yelling "Mommy! Mommy! It hurts! OOOOOOWWWWWWWWWW! Stoooooppppp!!" was very nearly more than I could bear. My stomach flipped and twisted and stayed clenched even when the voice was soothed. Tears came to my eyes and I tried furiously to keep the at bay. My hands shook and it took all of my concentration just to complete the simple task I was engaged in.

T called at lunchtime to say that he and Jack were at home because my poor little boy wasn't feeling well. That almost did me in. Typical mommy worry about a typical preschooler's typical cold would have allowed me to get through the day, but with a chorus of kids screaming, literally, in pain and fear, I took the opportunity to escape and left early to take care of Jack.

I am not ready to pack in the job because of it, but I am really going to have to find ways to cope with peds day, and I think if I do pack it in early, it will be because I do not have what it takes to watch kids suffer and be scared, even if I know it is the only way they will be able to live to see next Christmas. I will never again see another ageless bald chemo kid without my stomach doing that flip and my eyes watering.

That night, I looked at my kid and thought of those kids, probably still scared from what had happened to them and what was yet to come, and I thought of those parents, not sure if a sniffle was the first sign of the relapse that would mean for sure this time that they would outlive their own child. That night, my usual leave-work-at-work visualization techniques did not work. I wanted alcohol.

So I have concluded that I need to find a happy medium between task-focused professional detatchment and a high level of emotional involvement. That is the key to becoming a good nurse, and sticking with this job. I think I may need professional help on this one.