Share this article on:

Am I Going to Be Okay?

Allen, Danielle RN

AJN The American Journal of Nursing: March 2015 - Volume 115 - Issue 3 - p 72
doi: 10.1097/01.NAJ.0000461813.57473.14
Reflections

Keeping the trust of patients at critical moments.

Keeping the trust of patients at critical moments.

Danielle Allen is a nurse at Stanford Health Care, Stanford, CA. Contact author: danielle.christine.allen@gmail.com. Reflections is coordinated by Madeleine Mysko, MA, RN: mmysko@comcast.net.

Figure. I

Figure. I

Am I going to be okay?” Ami gasps. Her breath hitches, her chest rising and falling in spasms. One of my hands holds a mask to her face; the other hand holds hers. Pain has made her strong—my fingers are almost as white as her pale face, radiant with fear.

She's in danger—but I don't think she will die. The doctor is on her way and I think we can save Ami. But although nurses and physicians pride themselves on fixing people, Ami's life is about to change once again, and her future is uncertain.

Ami stares at me, her brown eyes like river pebbles as tears wash over them. I know she is waiting for my answer—so is her husband, standing behind me, watching as I crouch at her bedside.

My instinct is to tell them yes, everything is going to be okay. I don't want Ami to panic, and keeping her calm will help the outcome. But I also don't want to lie. During the last week, I've built a relationship of trust with Ami through patience and compassion, but most importantly, through honesty.

Ami has been in and out of hospitals her whole life. A genetic disease has committed her to frequent-flier status, and she has spent years of her young adult life struggling to breathe, eat, and live like a normal person. The accumulated pain and fear from her hospital stays seems to have manifested as severe anxiety and a desperate need for control.

Lying to Ami now would reinforce her feelings of mistrust for nurses and physicians, but I want to do it anyway. I want to tell her it will be okay, because I want it to be true. And I think she wants me to say it. She trusts me—if I promise it will be okay, she'll believe me. Then maybe she'll feel that this whole emergency will soon be over.

My mind returns to a time I'll never forget, when I heard a nurse tell a patient it would be okay. It was during a code. Blood sprayed with every heartbeat. While one nurse applied pressure, the primary nurse suctioned blood and kept repeating, “It's okay, you'll be okay,” long after he'd lost consciousness.

I'm sure she didn't intend for the last thing he'd ever hear to be a lie. Probably, she was saying the only thing she thought might help. And who knows, she might not have even been talking to him, but to herself. “It's okay, you'll be okay” is many nurses’ mantra in moments of stress—when a confused patient turns violent, when a frustrated staff member yells, when you've made a mistake.

Still, that moment sits like a rock on my heart. Should you tell a patient it will be okay, when you know it won't? Some patients find the phrase comforting, even when they know the prognosis is bleak. Others may lose trust. As a health care provider, it can be difficult to guess how these common words of comfort will be received. And if you don't say it will be okay, what do you say? I want my patients to trust me, but I also want them to feel safe and reassured. Where's the line?

I look into Ami's wide eyes, dilated with panic. She's desperate for me to answer her question.

I open my mouth to lie, but different words come out. “I don't know exactly what will happen, but I'll stay with you.”

Ami closes her eyes and lays her head back on the pillow. Tendrils of wet hair cling to her gown. I don't know if her hair is wet from tears, or from when I helped her wash her hair in the sink this morning. That feels like a long time ago now.

Every word is a struggle for Ami, but she forces them out. “The last time I asked a nurse if I'd be okay, she said yes. But I wasn't.” Ami turns to me. “Thank you for not lying to me.”

Her grip loosens on my hand, so I squeeze it gently.

“Can we breathe together?” I ask.

Ami nods. We did this earlier today when she struggled to catch her breath. In slowly through the nose, visualizing the lungs inflating like a balloon. Out slowly through the mouth, like blowing through a straw.

“In,” I say, and our lungs open together. “Out,” I say, and we both release.

In, out. In, out. In, out.

Ami's breath is slower, almost comfortable for the first time since the emergency started. Still, it will probably not be okay.

But I do the only thing I can, the one thing I could promise.

I stay with her.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.