When things DON’T get better

 I remember telling my mother, who had Multiple Sclerosis,  over and over again “it’ll be okay”.  She never argued the point with me, but it was definitely NOT okay.  As a matter of fact, she suffered with physical pain more days than not.

Mr. Smith found out that the pain he was experiencing in his back and legs for the last few months was caused by cancer that had already metastasized to the bones.  When we entered his hospital room that evening to do our change of shift report, he was emotionally distraught, the nurse grabbed his hand and said in a very confident voice, “it’ll be alright Mr. Smith”.

One report states that in 2005, 133 million Americans were living with at least one chronic condition, It goes on to say that this number is expected to grow by 2020 to 157 million (Bodenheimer, Chen & Bennett, 2009).

So, what do we say when things just aren’t going to get better?  The most comfortable thing to say for most of us is a quick “It will be okay”.  But is that really what’s best for the patient, or just what’s best for us?

Actually what happens to these patients more times than not, is they get put into one of three nice neat little boxes: the “frequent flyer” box, or perhaps the “drug seeking” box or a super easy box  the “hypochondriac” box.

Of course these labels are both false and extremely hurtful to the patients, but they take some of the self-imposed responsibility off of ourselves.  It’s ironic that a profession known to be compassionate and trustworthy would be so cold and dishonest with our patients whom we serve.

I do not believe that any nurse or medical professional truly chooses healthcare for a paycheck, but rather because we have made a conscious decision to put the needs of others above our own…we do this everyday that we see patients.  So, what can we do to reach out in compassion to this increasing patient population?

Listen to the patients needs.  People who suffer from chronic pain will typically speak of their pain in different ways than an acute pain sufferer.  They have learned to adapt coping skills that will down play the “look” of pain.  These patients may have family or friends at the bedside and be laughing and behaving like “all is well”, but verbalize to the nurse a pain level of 6, 7, or higher.  IF these patients say that they have pain…THEY HAVE PAIN. Listen to them properly, use your listening skills to decode what they’re hiding or minimizing.

Observe the signs of pain.  It’s not enough to just ask our patients to rate their pain on a scale of one to ten, we need to go farther and actually look for the signs that the patient may not tell us about.  We already know to look for facial grimacing, moaning and teeth grinding, but what about those that are irritated, moody, and angry?  They may very well be attempting to deal with their pain the only way they can.  Chronic pain sufferers will struggle with depression, decreased activity, poor concentration and many entertain suicidal thoughts or language.

Make sure they know they have Value.  While we may agree that every person has value, when we use platitudes with these patients we tend to devalue them and their feelings.  Things like “you just need things to get this off your mind”, or “you walked yesterday, you can do it today”.  An especially difficult one is, “you just need to work harder or try harder”.  Pep talks are great for the gym, but don’t translate well at the bedside.  Rather, allow the patient to tell their story and just listen.

Evaluate your own patients.  How do you feel about the patients who can’t be “fixed”, the ones who will be on the call light every four hours on the hour for their pain medications, the ones who verbally lash out at you when you forget to bring the medicine because you were so busy?  It’s frustrating to try and please these patients sometimes, and nobody enjoys being yelled at or berated because we didn’t do something in a timely manner.  Keep in mind that they are trying very hard to be “normal”, but they are going through a lot.  Chronic pain is just one of those things in life that’s hard to understand unless you’ve gone through it.  It tends to wreak havoc on the body and the mind, not to mention that it’s physically and emotionally exhausting.  All we can do is be patient and allow the patients to deal with their pain in the best way that they can.  We cannot fix them.

When we Listen, Observe, Value and Evaluate we show love to our patients who are suffering.  This does not come naturally to most of us, but our patients are worth our little bit of discomfort as we attempt to find the right words to say.

 Bodenheimer, T., Chen, E. & Bennett, H. (2009, February). Confronting the growing burden of chronic disease: Can the u.s. health care workforce do the job?.Health Issues33(2), Retrieved from http://content.healthaffairs.org/content/28/1/64.full