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Raising the Bar in Rehab

ICU and Oncology

Published July 16, 2009 8:56 AM by
So, this sassy therapist (me) has been getting into the hang of acute-care.  I enjoy the challenges of fitting in a therapy session with a patient's busy schedule, I like the population I have been working with lately- mostly general medical, some low back surgeries and a few strokes.   However, I walked into work last week and was given the schedule for the ICU and Oncology floors. 

I was mentally preparing myself for my day; trying to remember all of the lines and monitors of the ICU, and reviewing the charts of my patients. 

I totally wasn't ready for my first patient of the day.  I walked into her room, which was completely dark.  She was awake on the bed, in obvious distress.  She said to me, "I can't do therapy today, because I have to pick a day to die."  This patient had been told by her care team that she wasn't going to get better.  Her medical treatments were ineffective and there wasn't much time left.  I had no idea what to do or say, and I felt like a completely insignificant speck.   I sat on her bed and did my best to console her, but I still left helpless when I walked out of the room.  In reality, I really was helpless, and this was just part of the circle. 

It's situations like that which remind me of how lucky I am, how futile my petty problems seem.  Later I asked my step-mom for some advice, who told me the best thing you can do is reply to the patient, "Do you want to talk about it?  What can I do to help?" 

My question for you is the same- What would you do in a situation like that? 


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 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.  

Janey Goude July 21, 2009 12:30 AM

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