How to say goodbye to patients

OncRN is a wonderful blog written by an anonymous author sharing stories and insights in her line of work that many times speak to palliative themes.  S/he says it best in her blog description,

my life gets intermittantly (sic) rocked by the wonders/horrors of being an oncology nurse. i just need to talk it all through sometimes.

A recent post is about how to say good-bye to our patients, particularly the words we use.  Words are a great teaching point for anyone new to hospice and palliative medicine as it is a great demonstration of how a very difficult or awkward situation can become meaningful, poignant, funny, inspiring with the right choice of words.

Here the blogger writes:

this line of work is littered with or decorated by (depending on your state of mind) many, many good-byes
this variety is uniquely emotional and complicated because our language and/or culture is sorely lacking in words appropriate for such a send off.
i’m sorry? godspeed? farewell? stay in touch? – nothing quite works.
anything, though, to avoid the ubiquitous ‘take care’.

I will admit to using “take care,” quite a lot lately, but I am trying to say good bye more often.  Not necessarily always in the moment that could win me an Emmy or Oscar, but really as a natural, unforced, kind close to an encounter.  I have even resorted to saying it a lot (to myself) with lots of different intonations to see how it sounds. GOOD-bye, good-BYE, Goodbye, Good-bye, Goodbye now, etc. Of course then I feel like a flight attendant, but it is good to hear the different ways it can be spoken.

Obviously any closing statement that references the future is often inappropriate, but sometimes it can reflect the situation quite accurately.  For patients I am very certain to see soon, I feel comfortable saying, “I’ll see you tomorrow/next week.” When I am less certain I may change it to something I know to be factual, “I’ll be rounding a little later tomorrow,” barring my unforeseen death of course.

When it gets towards the end of the day and I am making afternoon rounds, I quickly learned that a simple “have a good night” likely sounded hollow to people that saw nothing good about any part of their day or night.  So I have changed my customary closing to a variation of “have a quiet night,” or “have a peaceful night.”  Even though I may say it many times in a day, I actually feel a little more calm and peaceful when I say it.

Of course some goodbyes are meant to be more than just a close to a discussion and for those I make them as personal and heartfelt as I can allow myself.  Sometimes they come with smiles, sometimes with tears, many times with both, but those can’t be scripted.

Christian Sinclair is a palliative care physician who blogs at Pallimed.

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