The Balancing Act of Caring for the Dying


by Barbara Karnes, R.N.

Dear Barbara,

I work at a hospital as an X-ray tech. I take routine chest
X-rays in the ICU every morning. Many elderly patients would be better dead.  All I do is to add unnecessary pain every day.

It’s hard to take care of extremely ill people, to see how their quality of life has deteriorated, to witness all the suffering, and to not have a voice in that care. I agree that there are a lot of people in our health care system who are suffering, and I often question why treatment is continuing, why comfort care is not being offered and given.

However, you and I, as employees in health care, are not there to give medical advice or tell the patient and their family what they should be doing or how they would be better off with comfort care. Our job is to support everyone in the decisions they have made about their medical care. Those decisions and plans of care are for the patient and their families to decide based on the input from their physician.

BUT it is the responsibility of the physician to advise the family of a realistic prognosis and discuss anticipated outcomes. Hospitals (and most of health care) are about fixing people, treatments, and cure. What the odds are of accomplishing a “cure”, or of the treatments being successful in returning a person to normal life activities, are often overrated, not said, or not even considered. Our healthcare system is about addressing diseases that people have. I would like to see it more about people that have diseases. If healthcare was more people oriented I think suffering would be looked at differently.

It can be difficult when our job involves actions that are contrary to our personal beliefs, when we see what we believe is needless suffering and indignity and are powerless to change it. For healthcare professionals it is often a balancing act to care for patients and then deal with the sense of futility that is triggered when they are doing their job. When or if that conflict becomes unbearable then it is time to look into another line of work. I know that is harsh sounding but what other choice is there?

Yes, we can carefully ask questions to our supervisors about procedures and the care given. We can use gentleness and compassion in performing procedures and treatment, but the bottom line is the work we are in involves pain and suffering. The work we are in is controlled by others.

I created a film and a booklet for professional caregivers who deal with end of life called Care for the Caregiver.  You may want to watch the link on the website to see if this film might also give you ideas for self care. While the film is about taking care of yourself when working in the end of life arena, a lot of the information within it is applicable to many career choices. Like flight attendants who tell us in our safety briefings on an airplane — “put our oxygen masks on first so that you can help others”, I strongly believe we must take care of ourselves as health care professionals before we can help others. If we don’t, we won’t be able to continue in this line of work.


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