silence

my advice? keep a dustpan in your bag - some days it's all about cleaning up messes, many of which you didn't make yourself.

the worst is this one:
MD: i know you're seeing Mr.S later - just wanted you to know that we had 'the talk' this morning and we're going to be getting hospice set up for him.

RN to Mr.S: so, i know you had a big talk with the doctor this morning - how are you feeling about stopping treatment?

Mr.S: wait...what? what do you mean?

RN, groaning and reaching for dustpan...

turns out MD used words like transition and hospice and comfortable and change in focus and supportive care but forgot to used words like die, or dying, or death, or not treating the cancer anymore or end of life. it's easier than you might think to fall victim to unending euphemisms and fail to get your point across. it's especially easy to do so if you've done most of the talking. in this case, if the MD had asked the right questions, or any questions, she would have known that her message hadn't gotten through.

when it's done well, it's a beautiful thing. when MD has the time and patience and skill, and emotional intellect to treat 'the talk' as an exchange and a time to gather information from the patient rather than viewing it as a speech he's giving, that's when the cornerstone of end of life care can be carefully placed so that it can be built upon. and it's all about what they say and what they don't say and how their body speaks and whether or not they can manage silence.

like the MD i saw who spoke and explained and suggested and connected and advised, and then fell silent. the last words leaving his lips like a stone dropped down a well - the silence of falling. the silence needs to be listened to and honored. this is where the hearing happens and the processing begins. out of this particularly long pin-drop silence came the most important fact of the day:
i'm not ready
we all needed to know this in order to take care of this patient, and we wouldn't have without the silence. that's not to say that it's all easy from there - and it's beautiful and awful all at once.

the pained expressions and broken hearts and furrowed brows and weary family members and quart of shed tears will shift something in the soul, and haunt the car ride home and lead to the inevitable 'why do i do this/this is exactly why i do this ' conflict that is my signature, and will most importantly, make me physically incapable of being patient with the person who asks if i could be 'snack mom' at tonight's soccer game. RN: wait...what?