The Art of Saying Nothing

because sometimes there's nothing you can say

I started off with a (very short) career in sales before I went to nursing school. This was before Air BnB was a thing — the place I worked for had a business model based around renting out people’s unused vacation homes in Cabo San Lucas. There were twenty of us in the office, and we all worked for one rich guy who had several homes himself.

It was an interesting experience — I doubt they’re still around now — and it taught me a lot about how to be circumspect.

You see, I’d never been to Cabo personally.

We had a DOS program, where you’d put in how many rooms people needed, and dates, and we could go off of available inventory, figuring things out — and there were photos I could look at, and that I could send to the clients, online.

But I didn’t really know anything.

I just sounded real good on the phone.

I learned very early on that people who’re about to go on vacation — and often times spend A Ton of Money on Vacation — are very anxious, especially when they’ve never been to their destinations, etc. And I was their tour guide in a way. I could make recommendations for nearby restaurants (I’m sure our owner got a kick back), I knew which beaches were safe to swim at, and which were not, etc etc etc. We rented homes to some very famous people, and in one memorable escapade had Someone Famous break a glass coffee table because they were drunk off their ass in one of these houses that we had to replace.

My job was to sell these rentals, yes…but also to not oversell them. It did my boss nor me (since I got paid commission) any favors, to hype things that couldn’t happen, or make promises that I couldn’t execute on.

Because there’s nothing worse than disappointment, right?

And I think about that training experience now, a lot, as a covid nurse.

Family calls.

They want to know if their loved one is better.

I always, always, always ask when they were last updated. Usually it’s been within 24 hrs, and often times I can say ‘nothing’s changed’ (if that’s true).

Then they want me to read them the vitals off the monitor, or the ventilator, and major lab values (if their loved one’s been in the hospital awhile, we’ve been explaining things along the way.)

You just always have to be so careful about not hyping anything up, ever, and you have to contextualize everything, all the time.

Sure they may be on a little less oxygen today, percentagewise, but, you know, going from 80% to 75% isn’t all that great a change, seeing as you’re not extubatable till you’re down to 40% or less.

Or their PEEP might be better, but, that could be because we’ve got them on their stomach, and seeing as you can’t live on your stomach, that’s not real helpful.

Sometimes I feel like a cruel nanny — like the family member is a toddler, and all they want to do is to run out an open door. They can see hope through the doorframe, and all they’ve got to do is get past me to get out into it.

But I can’t let them do that. It’s not fair to them, expectation-wise, and it’s not therapeutic for the patient — if you’re basing Big Decisions off of how they’re doing, if our palliative care team is having Goals of Care talks with you — I can’t even let you see a glimmer of a pipe dream.

Any hope I offer has to come utterly tethered to reality.

So family members will fish, as I box, and try to lower expectations, and somedays (most days) the best thing I can offer is ‘They’re not getting better — but they’re also not getting worse.’ Or, ‘We’re giving them a chance to heal. We just have to see if they can take it.’

Which I know hurts on the other end of the line. Especially with covid, man, because it can be such a yo-yo — people really can be doing better, and then their lungs punk out, and it’s such a two steps forward, three steps back disease.

I don’t like having these sorts of conversations (basically, any time you need to tell a family member ‘these injuries are incompatible with life’ it’s a huuuugeee bummer) and I know that it makes me seem like a dick, and some people get really frustrated by them — but it’s really the only ethical way for me to present the scenario.

I would so much rather a patient prove me wrong by going on to do unexpectedly better than surmised, than have a family member sobbing because a death came out of left field.

I can take the occasional (and occasionally snide) “They sure proved you wrong, didn’t they?” so much better than the, “But everything was going fine, you said so!”

It’s a rough time to be in a profession where you can’t give people exactly what they want.

If covid has made anything clear to us, it is that in the wider world, the general American population expects The Customer To Be Always Right, even when the topics are as important as the utility of masks, and the timing of restaurant reopenings. And now that everyone’s become an armchair epidemiologist….

But I can’t give people that at work, you know? I can’t fix lungs. I can’t make things ‘right’. I can only report honestly on what I’m seeing, and what experience has led me to predict the path will be.

So I’ve gotten very good at saying nothing at all (nothing positive, at least) when giving information, not to protect myself, but to protect the family’s expectations.

I can’t oversell the condo. The view’s bleak, there’s sharks in the water, and there’s not enough air.

— Cassie