I was working as a psychiatric liaison clinical nurse specialist in a department of medicine when I was called to see Anne.  Her attending physician had requested that I talk to Ann because “she was not dealing appropriately with her diagnosis of pancreatic cancer.”  As I listened to his discussion of Anne’s history, I kept thinking to myself, “How does one deal ‘appropriately’ with being told you have cancer, especially pancreatic cancer.”  The reason I was perplexed by this situation was that pancreatic cancer is known to be deadly and has a year to two years of survival after being diagnosed.  From Anne’s history, she had been having symptoms for at least a year.

As I entered Anne’s room, I noticed a thin, frail woman whose eyes spoke of merriment and life.  I told her that her doctor had wanted me to talk to her because she had been diagnosed with cancer and he was concerned how she was dealing with the diagnosis.  She looked at me and said, “Not well. I mean, is it normal to be thinking about your funeral and how you want things done?”  I shook my head and continued to look at her because I did not think that she was finished saying what she wanted to say to me.  “You know, I’ve done a lot of reading about the pancreas.  I’ve gone to medical school libraries to check out books and read journal articles about the different pancreatic disorders.  You see, I’ve had these pancreatic symptoms for a year and a half.  The doctors haven’t been able to find anything definitive until today.  This was my third CAT scan and the cancer finally showed up on this scan.  So, you see, I know that I don’t have much time to live.”  As I sat listening to her talk, I kept thinking to myself that this lady knows herself and knows what she wants to do.  Now, whether the doctors or her family will allow her to do what she wants in another story.  And, I also knew that she was correct about not having long to live.

As I nodded my head in agreement, Anne continued to say, “How do you tell your husband that you love that you are dying?  How do I tell my two daughters that I won’t be here much longer?  Am I insane to be thinking about my funeral?  You know, they (her husband and daughters) won’t know where to begin.”  I looked at Anne and saw how much concern she had for her family and said, “No, it’s not insane to be thinking about your funeral.  Remember, though, you have been reading about the pancreas and its disorders for a long time.  You have been worried that you had pancreatic cancer all this time and now have found out.  However, your husband and daughters haven’t had the same amount of time to deal with this.  It will be a shock to them.  Let’s progress slower with them.”

We discussed how she would talk to her husband and daughters that evening and that she would just talk about her diagnosis and that she did not have long to live.  I returned the next day to find her in better spirits, but still worried about her family.  Anne said, “They don’t want to believe that I don’t have much time.  They keep telling me that everything will be O.K.  I guess they feel they have to do that for me.”  We talked about giving her family time to deal with her diagnosis of cancer and when would be a good time to talk to her husband about funeral arrangements.  She decided that while her family was dealing with her diagnosis, she would write down directions for her funeral and what she wanted done.  During the week that she was in the hospital, we talked daily about her and her family’s progress.  On Friday when she left the hospital, she decided to tell her husband about her funeral arrangements.   I found out that Anne died six weeks later.  I’m glad that she was able to have the time with her family and plan her funeral for them.  It was her last gift to her loved ones.

Jane Bryant (Neese), RN, MS, CS 
Baltimore, MD

– excerpted from Touched By a Nurse©