Can Nurses Care Too Much?

When we talk about compassion in medicine, most of the focus is on doctors. But what about nurses? I asked Theresa Brown, a nurse and writer, to share her experiences caring for — and caring about — her patients.

Theresa Brown (Photo credit: Arthur Kosowsky)

By Theresa Brown

In medical oncology our patients stay in the hospital often for weeks or even months. They leave and come back, again and again, with this or that complication, or because they need more chemo, or because they’ve relapsed. We get to know them, their families, even their friends. And because we know them so well, in such an intense and intimate setting, we end up caring about them. 

Recently I was assigned to a patient I had gotten to know well, a guy in his fifties who’d lived and worked in the same small town in rural Pennsylvania for years. I had been his nurse off and on since his initial diagnosis the previous spring, and had cared for him more recently after an autologous stem cell transplant. But now he was deteriorating. His abdomen was bloated, due to a problem with his liver, and he also had a huge blood clot in the vein where his permanent IV line was placed. For two days he had been saying, “I feel terrible,” a non-specific complaint that is scary and ominous. 

“If he dies I don’t know what I’m going to do,” I confided to the dayshift nurse. She looked at me, then looked down at her papers and nodded.

This is what it means to be a nurse in oncology, a no-win situation where compassion routinely gets hijacked by grief. On TV or in the movies, dying patients are usually tended to by physicians. But if you die in a hospital, the person caring for you in your last days, hours, and minutes will be a nurse. The doctors care, too, of course, and check in and write orders, but we’re the ones who are always there. We watch over the patients as they struggle against their disease, and we’re there, too, if they decline, beginning their slow embrace with death.

When I did my initial assessment of the patient that afternoon, something just seemed off. I asked him to follow my finger with his eyes and to push up and down against my hands while I pushed back. These are basic tests of neurological function and his grip was good, but his ability to push down was almost nonexistent. I asked him again to follow my finger. 

“He’s not doing it, is he?” asked his wife. “No, he’s not,” I said. She had remained calm and kind throughout his many hospitalizations, but I could hear the worry in her voice.

I called the doctor. She was leaving the hospital for the day when she got my page, but she came back and examined the patient. His ammonia levels were rising due to his failing liver, something that can cause “mental status changes.” He was getting large doses of heparin, a blood thinner, because of his clot. Could the heparin have caused a bleed inside his head? The doctor’s exam, like mine, showed some deterioration in neurological function. She ordered a CT of the patient’s head and she prescribed a treatment to bring down his ammonia levels.

The next time I went into his room, I bent over him to give him a shot. When I finished he grabbed my hands. His grip was strong, and for those few seconds at least, he was completely lucid. “So am I gonna live or am I gonna die?” he asked me.

“I don’t know,” I told him, turning away to put the used syringe in the sharps container. My voice seemed small and tinny. “I wish I could look in a crystal ball and find out, but I can’t,” I said, forcing myself to turn back around and look at him.

Why did this patient matter so much to me? This was the patient who thought I looked like a “Phyllis” more than a Theresa, so “Phyllis” became a joke between him, his wife, and me. One of the first days he was in my care, when he still looked healthy and felt pretty robust, he told me a hilarious story, supposedly true, but unprintable in a family newspaper, about infidelity, obesity, and why it’s good to have a cellphone handy if you’re trysting in the backseat of a car. The first time he spiked a temperature I called the intern in a panic. “He’s got a fever!” I said, as if it was the first fever in the history of the world. Later I apologized to her, but she understood.

Now, though, he was struggling. I had several days off following that shift and I called work on my third day at home to ask about him. “C.M.O.,” our secretary told me, and I swore into the phone. C.M.O. means “comfort measures only”: they were withdrawing care. He had a cerebral bleed; he’d “seized” the night before and was now in the Neuro I.C.U. Without even thinking about it I decided to go to the hospital where I knew his family would be gathered.

The lounge to the N.I.C.U. was filled with his family members, all sad, some crying. I saw his wife, who hugged me. She asked me if I wanted to see him, but I said no, since he wouldn’t have known me. Instead, we talked about the two of them, about trying to pick up her life, about making sure that he wasn’t suffering. When I left she said the same thing she had said to me the last night her husband was my patient: “I love you.” He died later that day.

It hurts even now. A nurse on my floor said, “You girls get too attached,” and she’s right, of course.




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