In Mindcast

Maria McMillan – The importance of valuing your presence for others

Maria McMillan is a Psychiatric Nurse and a Psychoanalytic Psychotherapist. Maria talks about the importance, if you are working with those who are very ill or dying, of being there even when you can’t prevent the illness from taking its course. This material relates to a piece of work she carried out recently on behalf of the Tavistock and Portman NHS Foundation Trust.

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Recently I was with a group of nursing colleagues and we were discussing their particular experiences of nursing at the height of the COVID pandemic. One nurse in particular, spoke with despair about feeling utterly stripped and bereft of any sense of being an effective nurse, he had seen so many patients die, he had felt so helpless that wondered whether he actually justified the title of being called a nurse.

I could see that my colleagues were nodding in some sort of recognition of what he was saying and the quality of his despair. So I asked him to say a little bit more, and he started to describe a particular patient he had been a key nurse for, and this patient unusually had been on the ward for over three months. In that length of time he had really got to know this woman, he had got to understand her he thought, he had provided her with comfort along with his colleagues, she had become quite a known patient on the ward because of the time she had spent there. He had known what had made her comfortable, what she liked to eat, what she didn’t like to eat, what made her irritable, what made her slightly more hopeful, he cajoled her, he tried to revive the life in her and accordingly on many occasions she did appear to be close to recovery, but then, as is often the case with a patient suffering COVID, there would be a very sudden unexpected and catastrophic decline in the state of health. But because she had recovered many of these dips in her health there was a consensus in the ward that she would probably make it. And then one day he turns up for an early shift and he is told the awful news that she had died very suddenly in the night. “What a waste of time!” he exclaimed, it was a shocking thing to say but it was authentic, and I knew that his colleagues understood exactly what he meant. We acknowledged that very painful and angry state of mind, when one’s efforts, one’s real hard dedication seems to have been worth nothing and that’s what nursing COVID patients often leaves the nurse with. It is a particularly cruel aspect of this type of nursing and this type of illness.

But I thought that it might be helpful to think what else was behind that anger and that sense of futility and we started to think about a sort of intimacy that does play a part in nursing patients who are not going to respond to a care plan or to a medication but who are inevitable there to die. It is a cruel travesty, in terms of nursing, to feel that there is nothing actively, there is no process, there is no procedure that is going to make a significant impact and you are left being a human being, ok with skills, with experience, but ultimately you are one human being with another person, with another human being who is dying. And we thought about the exceptional experience of doing that on behalf of society, being there with the patient at the most extreme point in their life and then inevitable death, and we thought about why it is so difficult in the quietness and in the space of being able to reflect, why is it felt so difficult to appreciate that might actually be a terribly important aspect of nursing. To really be with the patient, with their agony, with their despair, with their hope, with their irritability, that the being with all of those different things that one patient can bring, all those confusing and complicated things that the patient brings with them, that being with is implicit in the nursing role, and perhaps it is difficult for us as nurses to acknowledge it because it doesn’t get measured, it is not included in the care plan, it is not something that we easily can describe, but it is there in what we do and in being with the patient who has exhausted all of the doctors initiatives and skill and experience, it is down to the nurse to be with that patient and to do something that no one else is able to do, to watch, to feel, to be with and to witness.

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