You First. Then Your Patient. Then Everything Else Follows.
I have a friend named Karen — a nurse practitioner at a local oncology center. She works with patients post stem-cell transplant. We are in a service group together, and have a regularly scheduled call on Fridays on what we are working on in this group.
Karen’s Call
Karen told me about a patient call she had coming up the following week. She was anxious about to tell him that there were no viable treatment options available for a side effect he was experiencing post-transplant.
We talked about her anxiety. What was it really about?
She said she was worried about his reaction — that he'd be upset, which is hard for her to sit with. She felt bad she didn't have more to offer him, and worried about what that might mean for their working relationship going forward.
We talked through whether there was anything she could do to change the fact that there simply weren't any viable options right now. She was clear: no, there wasn't anything she could do about that.
My Suggestion
My first suggestion was simple: take care of herself, first.
This is a tough one! Including the anxiety that can go with it — the pull to pour all your energy into preparing for a hard call, bracing for a negative response. Anything that looks like being gentle with yourself can feel like shortchanging your patient. I've felt that same pull myself in moments of stress many times.
But the opposite is true.
We talked about a simple breathing technique — inhaling into the abdomen, with the exhale twice as long as the inhale, done four to six times. It's a pattern that naturally calms the nervous system. Since prayer is part of Karen's spiritual life, we also talked about a prayer practice she'd found grounding before.
This wasn't just about helping her feel calm. A regulated Karen is a resourced Karen — full access to her clinical judgment, her years of experience, her wisdom. And something more: space. The sense of urgency, the feeling that something has to be fixed right now, softens. What's left is room to truly be present with her patient — room to notice things she might otherwise miss.
She felt more prepared going into the call.
What Happened Next
A week later, Karen told me the call had gone well. She delivered the hard message, answered his questions, and stayed present with him the whole time.
Partway through, the conversation took an unexpected turn — he shared some details about his job. Karen realized she'd never once asked him about his work in all the years she'd cared for him.
They talked about it for a while. Near the end of the call, he told her:
"Karen, I am so glad you were the one to tell me this today."
She felt good about the interaction — grateful she'd shown up prepared and grounded.
Why It Mattered
I told Karen she'd given her patient exemplary care. She was centered. She had room to ask about his work, to really see him, not just his diagnosis. His words told her exactly that: he felt seen.
We spoke about this experience recently, as I was preparing to write this post. She said that ever since that call — at least eighteen months ago now — her relationship with that patient has stayed genuinely strong. I have no doubt her presence that day played a real part in that.
Looking back, the only thing I'd add is something called bookending — reaching out to a nurse colleague or trusted friend, by phone or text, before and after a hard interaction for support. Even a text or a voicemail can help you feel some support before, and discharge some of the stress and emotions you're carrying afterwards. If you need a real conversation afterward, you can set that up with someone else you trust.
Post Script
I sent Karen a draft of this blog to get her feedback. She loved it and said she really liked how I circled back to the 18 month update. For her, that was the most meaningful outcome of her continued work with him and trust building with him.
A Note on Authorship & AI
The ideas, stories, experiences, and primary content in this article are written by the author. AI tools may occasionally be used for minor editing, such as grammar, clarity, or organization. AI is not used to generate the author’s stories, experiences, or original perspective. All final content is reviewed, revised as needed, and approved by the author before publication.