ICU and Oncology

I worked a lot of years in a lot of settings, but never encountered this scenario.  It took my breath away.  Honestly, I don't know what I'd say.  Maybe that is the best way to approach this...you can't know what you would do until you are actually there.  You can make an educated guess, but you can't KNOW.  It's okay to be that vulnerable with your patients.  It's okay to say, "I don't have any idea what you must be going through or what I would do in your shoes."  You don't have to have an answer for every situation.  Being honest is better than making something up.

I saw a friend who was an oncology nurse for years.  When I told her your scenario, she just smiled.  One of those knowing smiles; one of those "You ain't heard nothing yet" smiles.  So I'd say gird yourself for even more challenging moments if you have more oncology days ahead of you.  One of the stories she relayed:

One morning she walked into a patient's room and asked, "How are you doing?"  The patient bluntly responded, "I'm dying.  How the ... do you think I'm doing?"  My friend said after that incident she learned to rephrase her questions.  She began asking, "What kind of a night did you have?"

For your scenario, she recommends this response:  "We don't have to do therapy today.  If you'd like to talk, I'll listen."  

My addition would be, then you do just that.  You don't try to fix it; this situation isn't fixable.  You just listen  - give them a safe place to vent and process their emotions and thoughts outloud, if they want to.

You also want to make sure the appropriate resources have been called in, particularly social work.  My sister is a social worker and worked hospice for years; I'm going to ask her to take a look at this and respond if she has time.