Tie Up Loose Ends for the Patient's Sake

The healthcare system expects a lot of nurses and rates of turnover, burnout, and compassion fatigue are evidence that many of us feel that much more is taken out of us than ever comes back.

Compassion is a complex quality and means different things to different people, however, empathy is an element of compassion that we cannot afford to lose for the sake of our patients.

Nurses don’t have to be Mother Teresa, saints, or martyrs, but sometimes when it comes to empathy, we are the cleanup crew.

A friend of mine is undergoing an autologous stem cell transplant for a blood cancer. While he was on oral chemotherapy, he stayed as physically active as he could tolerate. He’s been active all his life, and is an endurance athlete. Since his hematologist recommended the transplant as his best chance to achieve remission, he’s been “training” for his transplant. He’s done extra endurance workouts and is probably one of the fittest people ever to undergo this procedure.

He made plans for everything in his life over the next several months. A four month leave of absence from work was arranged, he’s planned for people to stay with him while he recovers in a hotel near the hospital for six weeks, his wife has rearranged her routine with their home in a rural area and the animals they have.

During the workup before the transplant, they discovered a heart murmur. Nearly 60 years old, he has never been aware, never experienced symptoms, and no doctor ever mentioned it, even during a recent hospitalization. Before he goes through intensive chemotherapy, the hematologist rightly wants to rule out any conditions that might contraindicate the process.

Upon discovery of the murmur, my friend was sent to a cardiologist. The cardiologist had reservations about giving chemotherapy, and said he needed to discuss it with the hematologist. This was on a Thursday.

The surprise, along with the combination of fear and disappointment hit him hard. He wasn’t going to get an answer yet. His hematologist said, “I need to think about this.” And that was it.

On Friday, my friend tried calling the office to talk to the nurse practitioner, or someone at the hematologist’s office, to ask about it, but no one was there. He needed more information, and no one was around to talk to him. He wanted to know what the hematologist was thinking, the risks and benefits, and what would happen if the entire transplant was called off and he was back to square one.

He called me, worried, mostly that the hematologist’s response meant the transplant wasn’t going to happen. It was the weekend, and he was left in limbo, not knowing what to do, feeling emotionally paralyzed.

I told him to reach out again in all possible ways, by phone call, voice mail, email, or any other way of reaching the hematologist’s staff to see if someone could call him to alleviate his anxiety.

I also told him, don’t take it as a “No”. I told him to take the doctor’s response as, “It’s Friday, I don’t want to deal with it right now, it’s not an emergency, I’ll look into it on Monday.” I explained to him that things often go like that in healthcare.

While patients are usually understanding about weekend delays for minor issues, this was not minor to my friend. After the long psychological and practical buildup to this point in the process, they left him hanging, over the weekend, living with the anxiety and not knowing if all his plans were upended. His anticipation of recovery and remission and getting back to his life had all been put on hold. His fear that if the transplant was no longer an option, and he had to rely on a less effective means of controlling the cancer, it could mean a difference between life and death, and almost certainly his quality of life.

If someone could have talked to him and explained what was going on, it would have allowed him peace of mind instead of swirling anxiety over the weekend. We must remember to clean up loose ends, we cannot leave patients hanging like that.

As it turned out, on Monday he got a phone call from the nurse practitioner, who apologized. And the oncologist did decide the benefits were greater than the risks, so they went forward with the transplant.

A little empathy would have gone a long way in this situation. I’m glad that as a friend I was able lower his anxiety.

We need to remember as healthcare professionals, that just because our shift ends, it doesn’t mean the patient’s shift ends. While it is not realistic to expect us to be on 24/7 if we’re not on call, we still need to do an empathy check before we leave the patient, tie up loose ends, polish the edges, and take out the trash.