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Good morning, Mrs Heltzel.
Morning. You can put your things in the kitchen.
NARRATOR: Caring for individuals at end of life, especially in-home,
allows healthcare providers to become close with patients.
Over the course of time, patients might see you as a
supportive person to talk to. This connection may prompt
patients to describe or acknowledge their past
traumatic events. For some, this might be the first time
they ever shared their story with another person.
Well, if you have medication you no longer use, or are
expired, I can help you dispose of those through
a drug take back program, or I can help you do that
here at home.
At home.
Great. Let me clean up and we’ll walk through those steps.
Had no idea I could throw away medications at home.
Yeah, almost all medicines can be thrown into your
household trash. You just have to mix them with
something undesirable, like coffee grounds, cat litter.
How far along are you?
Um... twenty weeks.
Boy or girl.
We want it to be a surprise. Do you have any kids?
No, my first husband wanted to, but I was always...
nervous about it.
He had six with his second wife.
Six? Think I’ll stop at two.
Can’t blame you.
I... may have been exposed to Agent Orange-
that’s why I was nervous.
Soldiers would come in with their fatigues coated in it.
I can’t tell you how many of those uniforms we cut away.
I had a friend, a nurse I worked with, she had a baby
with a birth defect. I don’t know if that had anything to do
with it or not, but I wasn’t gonna take that chance.
There’s so much I wish I could’ve left there...
but you can’t.
People often think of combat veterans as the only ones
having traumatic experiences, but it can happen to nurses too.
Is there anything about your military experience you’d
like to tell me about?
You couldn’t wear makeup because it was so hot.
little bit of lipstick maybe, that was it.
The soldiers- all they wanted was comfort.
Someone to remind them of their mother, sister, or girlfriend.
One morning, before my shift, I couldn’t get rid of the...
stench of... death... from the night before.
I didn’t know if it was just in my head, or if it was really
there, but I couldn’t go in like that.
I had a bottle of perfume from R&R. I put some on and
went to work.
That night was a revolving door. They just kept coming in.
We had to triage, decide first priority. We wrote vital
signs on their chest with a magic marker.
And all the time they would just lay there watching you.
Watching your face... just watching.... watching to see
what your reaction to their wound would be.
This one soldier had been out on patrol and stepped on a mine.
He knew he stepped on it, so he warned everyone around him.
They all scattered- found cover. As soon as he saw they were safe
he jumped. Somehow, he was still alive and conscious when
we got him, but the back of his legs all the way to his waist
were... really bad. The chopper medic kept pouring fluids into
him- we did the same. But just as fast as we put it in,
it came pouring out.
The thing that haunts me, though, is in the midst of all
this chaos and blood and yelling, that young man looked
me straight right the eyes and said...
“Ma’am, you sure smell nice.”
Those were his last words... he died soon after.
I always kept a bottle with me after that.
I’d put some on as soon as I heard a chopper coming in.
What a beautiful way to remember him.
NARRATOR: Healthcare providers can support patients by actively
listening without judgements, expectations, or distractions.
Respond genuinely, and refrain from offering platitudes,
advice or statements that may inadvertently invalidate or
minimize a patient’s experience. Providers may acknowledge or
thank the individual by saying: “Thank you for trusting me with
this memory.” Or, “Thank you for sharing your experience
with me.” Follow-up by asking: “In what ways can I continue to
help you?” Or, “I want to make sure you experience the healing
that you feel you need. In addition to the care you’re
receiving now, you can also speak with a mental health
professional if you’d like?” It’s important to recognize
one’s own limits, especially for providers without advanced
mental health training. Depending on your role, it is
not the responsibility of a provider to become
a patient’s therapist.
Talking about your experiences can be difficult, and also
meaningful, and sometimes these memories can resurface when we
least expect it. Is that what it’s been like for you?
It’s like a little black box where it’s all been stuffed
deep inside- always there.
And I think if I were to open that box, I wouldn't last
two minutes. So, I keep it shut. Lid closed. But every now
and then bits and pieces come out. It’s difficult, but I think
I'm okay with it.
That’s an important step, Mrs Heltzel, and I’m happy to talk
with you about it again. But, if you’d like to speak with a
mental health provider in addition, or instead of me,
I can help you with that too.
I’d rather talk to you.
Okay. And along with talking about your experiences, I’d also
like to hear about your current coping strategies for dealing
with these stressful memories when they come up.
You wanna do that now?
We can start that, yes. Or, we can continue our discussion
about disposing of medicine. It’s your choice.
The medicine.
Perfect. I think we left off at cat litter.
I think so.
Well, you can mix medicine with something undesirable,
like cat litter [fades out]
NARRATOR: Providing psychotherapy for persons with PTSD takes time
and special training. For this reason, creating a list of
trained therapists for patient referral will be helpful.
The deep, personal nature of end of life care can foster
trusting relationships between patients, families, and
providers. If a patient discloses details of a
traumatic event, remember: Listening with empathy is a
powerful gift any person can offer.