Reflections from a Nurses Diary

Reflections from a Nurses Diary

– Dr Kripa Angeline A and Dr Kingsle Kishore Coumar, Puducherry

Our team of palliative care nurses cared for a 34-year-old female patient diagnosed with adenocarcinoma of the stomach in 2023. Her journey was particularly complex, given her history as an Operation Theater assistant and her numerous medical challenges: she had undergone eight cycles of FLOT chemotherapy and had a history of diabetes, hypertension, asthma, tuberculosis, and a Krukenberg tumor. Her case highlighted the need for palliative care in catering to the physical and emotional needs of patients, along with underscoring the profound importance of multidisciplinary collaboration in addressing her needs.

Pain, Fear, and the Struggle for Hope

When the patient was first referred to our pain and palliative care team, she was suffering from severe back pain and a host of other distressing symptoms: vomiting, loss of appetite, weight loss, and clear signs of disease progression. As we began assessing her, it became evident that her physical pain was compounded by deep emotional suffering. Having been strong throughout her treatment journey, she now faced the psychological weight of her diagnosis, along with the financial burden her illness placed on her family.

During our initial conversations, she expressed her fears and uncertainties. “Will I ever feel normal again?” she asked, a question we hear too often. Navigating this conversation required balancing honesty with maintaining hope, a delicate but essential challenge in palliative care. Together, we reassured her that while her version of “normal” might shift, we were committed towards improving her quality of life, and offer the best support we could to alleviate her suffering.

Symptom Management and the Challenges We Faced

Our team initiated a symptom management plan, by adjusting her anti-sickness medications and introducing Pantoprazole to control nausea. For her throbbing back pain, we prescribed morphine and diclofenac, which provided some relief. Yet, as with any intervention, we had to carefully monitor for new side effects, and adjust her care plan as her condition evolved.

As time passed, her physical condition deteriorated. Despite undergoing a subtotal gastrectomy, D2 lymphadenectomy, and Gastrojejunostomy, her cancer metastasized, and the oncology team recommended stopping further chemotherapy due to her hyperbilirubinemia and the risk of neutropenia. This marked a significant turning point in her care. It became clear that the focus had shifted from curative treatment to ensuring her comfort, dignity, and quality of life.

Family Involvement: A Source of Strength and Challenge

Her family, especially her husband and son, were central figures in her care. The emotional closeness they shared with her was apparent, yet the financial toll of her illness placed additional stress on them. Her husband had to take time off work, leading to significant financial strain, and their son had to stay with another family for support. The reality that they might not have a home to return to after discharge weighed heavily on all of them.

As nurses, we took on the difficult task of discussing the medical realities and end-of-life options with the family. It is never easy to inform a family that their loved one is nearing the end of life, but through clear and compassionate communication, we helped them prepare for what lay ahead. Her husband expressed gratitude for the honesty we provided, saying, “At least we know how to prepare” a sentiment that reflected the value of open dialogue during such an emotionally charged time.

Faith, Hope, and Preparing for End-of-Life

Though it took different forms, hope remained a central theme, throughout her care. As nurses, we constantly find ourselves balancing the role of delivering difficult news while also trying to nurture hope, whether it’s hope for a pain-free moment or hope for time spent with loved ones. The patient was deeply spiritual and often asked us about our perspectives on faith and hope in the context of palliative care. We spoke about finding meaning in the days she had left and focused on making those days as meaningful and comfortable as possible.

During one of our visits, we were able to secure special permission for her to go home for Diwali (the festival of lights in India). Surrounded by family and friends, she was able to experience one last celebration, full of love and joy. Our team continued to visit her home, manage her pain and provide support. This experience gave her a sense of normalcy amidst the chaos of illness; and for her, that was priceless.

During one home visit, she asked, “Do you think there’s something after all this pain?”. The question encapsulated her search for meaning beyond the physical suffering. Our response was grounded in the enduring legacy of love and faith, reminding her that even in her pain, she was leaving behind a legacy of strength and love for her family.

The Importance of Multidisciplinary Teams in Palliative Care

This patient’s care was made possible through the collaboration of our multidisciplinary team, which included oncologists, anaesthetists, surgeons, physiotherapists, and nurses. Each of us brought in different expertise, but together, we worked towards the common goal of providing holistic care. The doctors managed her evolving symptoms and made difficult decisions regarding treatment, while we, the nurses were beside her every day, to provide not only clinical care but also the emotional and psychological support, which she very much needed.

Our Physiotherapists assisted her when her mobility declined, and our extended team ensured she had all the necessary resources for a comfortable home environment. As palliative care nurses, we played multiple roles—from clinical assessments to guiding the family through advanced care planning. Our empathy and emotional support were just as vital as the medical interventions, for palliative care is as much about human connection as it is about managing symptoms.

Reflections on End-of-Life Care and the Role of the Family

The patient’s family, particularly her husband and mother, became caregivers at home, taking on daily responsibilities such as cooking, cleaning, and providing physical care. As we watched her son sitting by her side, holding her hand and sharing stories from his school day, we were reminded of the importance of normalcy in such moments. It once again proved that palliative care extended far beyond the hospital—and went into homes and hearts and required the complete engagement of both healthcare professionals and the patient’s family.

Lessons Learned from Multidisciplinary Palliative Care

Caring for this patient reaffirmed that palliative care is about more than medical management; it is about communication, compassion, and the human connection. Through our collective efforts, we helped prepare both the patient and her family for end-of-life, all while balancing honesty with hope. The lessons of resilience, faith, and love, that she taught us will stay with us and remind us that palliative care is not merely a profession—it is a calling.