Honesty. It’s supposed to be something engrained in us from childhood, something natural and expected. When it comes to you and your loved one’s health, honesty is all you really want. Yet all too often in healthcare, patients and families aren’t getting the honesty they deserve.
Just recently, I’ve had the pleasure of two experiences at my work in the emergency department where my honesty proved to make all the difference.
My patient one night was 92 years of age, hooked up to an uncomfortable BiPap, suffering from her second major illness in the past 6 months. She was being hospitalized yet again for severe pneumonia. She had two IVs, telemetry cords, and incessant beeping in her cramped ED room. Her family sat by her side for hours awaiting an inpatient bed.
One of the many times I found myself in her room, she took off her BiPap and shook her head at me. She told me she didn’t want to wear it anymore, she wanted to get up on her own, she wanted to go home, she wanted it all to stop. Her family consoled her, telling her it would all be okay and this was for the best. I repositioned her BiPap, looked her in the eyes, and said, “I know. It’s awful. It’s uncomfortable. I’m not going to lie to you, it’s going to keep feeling like this. But it’s keeping you from having that tube down your throat again and getting sicker. It’s going to suck, but you can do this.” After I said it, I immediately became aware that her family was still in the room and might not appreciate my bluntness. Then one of her daughters spoke. She said, “Thank you. So much. Thank you for being honest with her, that never happens. No one just tells us the truth.” I looked from her to the patient, who was no longer messing with her face mask. She still looked uncomfortable, but she was no longer fighting it.
Through the rest of the evening, several of her children and grandchildren took the time to speak with me privately about their concerns. We discussed things like hospice and end of life care, things that they were always too afraid to bring up to healthcare providers. They were afraid of being judged or of looking stupid. I educated them to the best of my ability, but more importantly, I let them know it’s okay to ask these questions, and it’s okay to want their loved one to be comfortable. I gave them permission to express all the things they had been holding in for so long.
On the other end of the age spectrum, I cared for a 24 year old man with an accidental injury. He was scared and uncertain of what would happen, as he had never been in the hospital before. His anxiety was palpable, and his mother tried to comfort him from the bedside but wasn’t successful. Telling him it was going to be fine and to relax didn’t seem to be helping, although her intentions were good.
After I finished my triage process and got him set up, I started to explain what would happen. At this point in time, it was uncertain if he would need surgery to fix his injury. He asked me if I had seen an injury like this and how it is typically treated. He asked if in my opinion he’d need to have surgery. He asked what the medications were for and what his options were. He asked if he should take the medicine, if he really needed it. He asked me what to do now.
I’ve seen countless nurses shake their heads and defer questions to the doctors. Looking at this scared and trembling guy, I couldn’t brush him off. I sat down, pretended I didn’t have any other patients, and I told him I hadn’t seen an injury this severe in a long time. I told him I couldn’t be sure about the surgery and I didn’t want to lie to him. I said it was a possibility, and I explained why. Then I decided to take it one step further, as I could see how upset the possibility of surgery was making him. I said, “I know you’re scared, but you’re going to be okay and I’ll tell you why.” I explained that his injury was close to an artery, but luckily the artery wasn’t severed. I told him if it had, he probably wouldn’t be sitting up talking to me, that his bleeding would be uncontrollable, and we would have a much more serious problem. Once again, feeling nervous about coming off too insensitive, I waited for his response. I then noticed he stopped shaking. He let out a quiet laugh and said, “That’s all I needed. I just needed someone to tell me I wasn’t going to die and this was okay. It sounds stupid but, I guess I just wanted to hear someone say it.” I smiled and said, “no you’re not going to die. You’re going to be fine. You’re going to get all fixed up and get out of here.” We shared a smile, I gave him the medications I suggested he should take, and asked if there was anything else I could do for him.
Honesty doesn’t have to be complicated. It doesn’t have to take a long time or be an emotional speech. It doesn’t mean being abrasive and harsh. Sometimes just saying those simple words out loud can bring some your patients some peace, and perhaps more importantly, trust.