OncRN is a wonderful blog written by an anonymous author sharing stories and insights in her line of work that many times speak to palliative themes. S/he says it best in her blog description,
my life gets intermittantly (sic) rocked by the wonders/horrors of being an oncology nurse. i just need to talk it all through sometimes.
A recent post is about how to say good-bye to our patients, particularly the words we use. Words are a great teaching point for anyone new to hospice and palliative medicine as it is a great demonstration of how a very difficult or awkward situation can become meaningful, poignant, funny, inspiring with the right choice of words.
Here the blogger writes:
this line of work is littered with or decorated by (depending on your state of mind) many, many good-byes
this variety is uniquely emotional and complicated because our language and/or culture is sorely lacking in words appropriate for such a send off.
i’m sorry? godspeed? farewell? stay in touch? – nothing quite works.
anything, though, to avoid the ubiquitous ‘take care’.
I will admit to using “take care,” quite a lot lately, but I am trying to say good bye more often. Not necessarily always in the moment that could win me an Emmy or Oscar, but really as a natural, unforced, kind close to an encounter. I have even resorted to saying it a lot (to myself) with lots of different intonations to see how it sounds. GOOD-bye, good-BYE, Goodbye, Good-bye, Goodbye now, etc. Of course then I feel like a flight attendant, but it is good to hear the different ways it can be spoken.
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Obviously any closing statement that references the future is often inappropriate, but sometimes it can reflect the situation quite accurately. For patients I am very certain to see soon, I feel comfortable saying, “I’ll see you tomorrow/next week.” When I am less certain I may change it to something I know to be factual, “I’ll be rounding a little later tomorrow,” barring my unforeseen death of course.
When it gets towards the end of the day and I am making afternoon rounds, I quickly learned that a simple “have a good night” likely sounded hollow to people that saw nothing good about any part of their day or night. So I have changed my customary closing to a variation of “have a quiet night,” or “have a peaceful night.” Even though I may say it many times in a day, I actually feel a little more calm and peaceful when I say it.
Of course some goodbyes are meant to be more than just a close to a discussion and for those I make them as personal and heartfelt as I can allow myself. Sometimes they come with smiles, sometimes with tears, many times with both, but those can’t be scripted.
Christian Sinclair is a palliative care physician who blogs at Pallimed.
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