1. Haas, Sharon G. RN, BSN

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As a senior nursing student nearing graduation, I was both relieved and proud when I completed the rigorous 4-year baccalaureate nursing program of a small Midwestern college. It was especially sweet for me; 30 years ago, I had completed 2 years of a 3-year hospital program and then suspended my schooling to get married. Like many of my classmates, I had waited until my children were raised before returning to school. Although I always intended to get my RN, the new program required me to repeat all of the classes and clinical experiences, and so I was as surprised as anyone when I announced that I was going to return to school to complete my degree.


It was a long and difficult 4 years, but I had survived. When I arrived for my shift at the Hospice in-patient unit one particular morning, I was feeling comfortable, confident, and eager to receive my assignment for the day.


Patients came to this unit for one of three reasons: for symptom control, to stabilize a medication regimen, or because they were expected to die. I was assigned to take care of Mildred,* an 81-year-old woman who had end-stage breast cancer with metastasis to her lung and spine.


"She's a tough one," I was warned. "She'll run you ragged with her whining and demanding," my preceptor confirmed. I said a silent prayer as I made my way to room 19 to meet this whiny, cranky, demanding creature.


Mildred was propped up in her bed, pillows all mashed and askew and bedcovers nearly on the floor. This diminutive, frail-looking woman didn't look at all like the person I was warned about.


"What do you have to do to get something to eat around this place?" she whined as I walked to her bedside. Her voice was not unlike the sound of fingernails screeching along the blackboard. Putting on my bravest smile, I apologized for the delay and suggested that she wash her face and hands and I would straighten her bed before I went for her breakfast. Her grandchildren were arriving that afternoon from Chicago, and she was looking forward to their visit. We would do her bath and make her bed up with fresh sheets after breakfast.


In this unit, which accommodated only 10 patients, a small kitchen on the premises prepared each patient's meals according to individual preferences, nutritional needs, and swallowing ability; therefore, a greater variety of food was available. Although Mildred claimed she was hungry, she was not interested in anything I offered. After much discussion, she agreed to Cream of Wheat cooked cereal, applesauce with the chill taken off, and some weak tea as her breakfast. Mildred was beginning to like me and seemed to approve of my caring for her. She smiled up at me as I helped her wash for breakfast and made comments that she liked the way I applied lotion and patted her skin dry.


As a student, it is always important to receive validation, no matter what form it may take, to reassure us that we have chosen the right profession, that we really do belong here, and that we are good at our jobs. Many of my nurse friends had told me that they secretly longed for such comments and felt used and unappreciated when they didn't hear them. Knowing this, I was positively glowing when Mildred smiled up at me and said, "You're such a good nurse" and that I had "such a gentle touch."


As I left to fetch Mildred's breakfast, I felt certain I was in the right place. I was ready to sign up to be a hospice nurse right then and there. Moments later, I returned to Mildred's room with a small tray laden with her choices for breakfast. As I placed the tray on her overbed table and began to set it up, Mildred stared up at me with a quizzical expression, then a frown, as she asked, "Have I seen you before?"


I don't think my confidence returned for several days. Of course, I continued to give Mildred the very best care possible, and I was with her the day she died. Her comments ranged from very complimentary to very critical; it's just the way Mildred was, right to the end, when she didn't recognize anyone.


As nursing students, we expected to learn a huge array of medical/nursing-related information, nursing theories, and numerous hands-on skills. We expected to face all kinds of patients and learned how to remain gracious and professional through it all. My experience with Mildred taught me something I had not expected to learn, especially not from a dying patient: the essence of humility, a lack of false pride.


It's a lesson I have carried with me every day since then. Even now, I often hear Mildred's voice in the back of my mind, asking, "Have I seen you before?"


Contributed by


Sharon G. Haas, RN, BSN


*Name has been changed. [Context Link]