Holiday Blues

I found this great site that gives very concrete tips for holiday blues through the Hospice Blog. I kept thinking enthusiastically, "Yeah, yeah, yeah, this is great. I should really link to it from my site." But I procrastinated and procrastinated. But now it's hit me - the holiday blues are setting in and I'll procrastinate no more.

Whenever I have stuff going on in my personal life that gets me down, my job is so much harder. I've gone months without asking myself, "Do I have the emotional strength to do this job?" But once again, the question lerks in the corners of my mind. I know that this is just because the holidays are getting me down in general, but it feels bad, nonetheless.

At work last night, I had two patients that were particularly emotionally intensive. One of them was good ol' Mrs. Roman. Her daughter has finally agreed to make Mrs. Roman a DNR/DNI (Do Not Resuscitate / Do Not Intubate). (I will write more on code statuses and what they mean at at later date). So the plan is for Mrs. Roman to go home once home hospice services can be arranged. Mrs. Roman was her normal, difficult self. She hollared at me, "Son of a bitch!" She swung her arms out at me, trying to punch me. But she also said (after giving her a third massage of the night), "I love you very much." And you know what? I love this crazy, spunky old woman, too. I have often thought that I'd like to do hospice work. But hospice work seems so much harder. In palliative care, I only see patients when they are hospitalized. This is usually short-term - either to manage severe symptoms so that they can go back home for home hospice or at the very end to assist them in a peaceful death. Hospice works with the same people for the last six months of their life. That's a lot more time for getting emotionally attached. I've only known Mrs. Roman for a few weeks and already, the sorrow is so much greater, knowing she is going to go home to die. Or is it also these damn holiday blues amplifying how I feel?

I also had another palliative care patient who was very aggitated. I've mentioned a few times that a common symptom during end of life is to pick at tubes and clothes. Mrs. Lee was doing this a lot last night. I had a very hard time getting her to settle down. Like the man in the first story about tubes, Mrs. Lee has a urinary catheter in place. She kept trying to pull it out. However, Mrs. Lee has a history of urinary retention. So even if I took it out, she would likely need to have it put back in once her bladder became distended (and she is still having quite a bit of urine output). She is also on a lot of oxygen and kept taking her oxygen mask off. We tried to talk the sons into allowing us to decrease her oxygen for her comfort, but they refused. They believe that she gets more aggitated without oxygen, but they also are afraid she'll die more quickly without it and they want to take her home to die. That is an understandable and admirable, though I'm not sure how realistic, plan. I tried doing some education with the family. Education usually helps with anxiety and the eldest son's anxiety level was through the roof. They refused chaplain services, though I think they were in more need for those services than most. I felt so helpless. And it's true. We are all helpless in this situation. I can't keep their mother from dying. And nothing short of that seems to help the eldest son. The youngest son, fortunately, was more open to talking about the four tasks of living and dying and the four things that matter most. We stood at the foot of Mrs. Lee's bed as her youngest son shared stories with me about his mother's life. We whispered to avoid waking Mrs. Lee. But she awoke and became even more aggitated. I suggested we move closer to the bed. According to Elizabeth Kubler-Ross, people who are dying get very distressed when they hear people whispering about them. They want you to talk in front of them, openly and honestly, about what is happening. Mrs. Lee calmed down immediately when we moved to her bedside and used a normal tone of voice. In fact, she appeared to have fallen right back to sleep.

This family's needs, especially the needs of the eldest son, were so great. I felt troubled to have left my shift feeling like I hadn't been able to bring them any solace or peace. Again, is it me or the Holiday Blues that make this so painful?

I hope you are all enjoying the holidays, whichever winter holiday you celebrate. And may you all be free from the Holiday Blues! :)