When No One Says the Hardest Words

My brief time in psychiatric nursing has its stories, but hospice—well, hospice stories are something else entirely.

Driving home today, replaying the day in my mind, I found myself drifting back to one of the wildest situations I’ve ever been pulled into. The first patient, the first family—a case that began from the leadership side of my role, but very quickly evolved into me stepping in as the case manager. What I saw at first was a moment calling for compassion, a moment where a family needed someone to show up fully, gently, and without judgment.

But in that space of compassion, I realize now I may have overlooked the other side of the story—the part that was brewing beneath the surface, the part that denial was quietly feeding, the part that would later erupt in ways no one saw coming.

One of those stories… that one still breaks my heart. Not because of the chaos. Not because of the anger. Not even because of the irrational behavior that spilled out when emotions ran hotter than anyone could contain.

The heartbreak came from something much simpler—something far more devastating.

Because the devastation of that situation wasn’t rooted in the chaos that unfolded. It wasn’t the anger or the fear or the volatility. The true heartbreak was in recognizing that this was one of those moments where we, as a system, as clinicians, as humans, need to do better.

While the truth was what that family desperately needed, the pull to care—to comfort, to soften, to support—was so strong. And when that instinct collided with the level of concern and urgency beneath it all, the gap between what was said and what needed to be said grew wider and wider.

This wasn’t just a family in crisis.
This was a family navigating the unspoken.
This was a moment where silence did the most damage.

And that’s what still stays with me.

Because all of that silence, all of that unspoken reality, became the perfect breeding ground for a moment I will never forget. A moment where one overwhelmed, terrified, grief-stricken family member stormed into the room—angry, shaking, convinced we were somehow giving up on their mother.

A weapon was produced, not waved around wildly, but displayed with purpose. Not to harm, but to prove a point.
A point born from denial.
A point rooted in fear.
A point sharpened by the fact that no one had spoken the truth out loud.

In that moment, there was a tense discussion—one that teetered between emotion and danger—about ceasing hospice care entirely. About “taking her somewhere else.” About “fixing this.” About how “she just needs more time.”

And there I stood, trying to hold the room together, trying to hold myself together, balancing on the thinnest line between strength and weakness. My compassion, my instinct to soothe, my desire to de-escalate—they were my strengths. But in moments like that, they also felt like my greatest weaknesses. The place where my heart wanted to take over, even when the situation demanded a firmness I was still learning how to wield.

It was the fact that no one had said the words.

Your mom is dying.

Words you’d assume would be the norm in hospice. Words you’d think someone—anyone—would have spoken long before we were standing in a room full of fear and confusion.

But the truth is, they’re not normal.
Not for families.
Not for the medical system.
And, sometimes—maybe more often than we want to admit—not even for us. The ones who dedicate our lives to this work. The ones who sit at kitchen tables and bedside vigils. The ones who walk into these stories every day.

Those five words can feel heavier than any diagnosis, any order set, any medication adjustment. They catch in the throat. They rattle something deep. They force reality into a space where denial has been doing everything it can to survive.

I wish I could say this was the only story, but this, unfortunately, was just the first. Each one deserves its own moment—its own truth. But this first one… the pain isn’t in the incident itself. It’s in what wasn’t spoken. What should have been said. What could have prepared a family for the seismic shift that was already happening right in front of them.

And that’s what stays with me.
Every day.
Not the drama.
Not the volatility.

The silence.
The silence where honesty should have lived.

Grief comes in all shapes, and it rarely looks the way we expect it to. Looking back now, I can appreciate the compassion I showed in that moment—the depth of care I felt, the instinct to protect a family drowning in anticipatory grief. But grief doesn’t follow rules, and it doesn’t stay neatly contained. When emotions run high and denial is fighting for its last breath, compassion alone can’t hold the room. And when those emotions collide with something as unpredictable as a weapon—when bullets and heartbreak exist in the same space—things can shift in an instant and go drastically in the opposite direction.