Terminally ill patients can, at times, provide a challenge to nurses, more so because of physical disability caused by disease progression. However, it was in the last four days of a particular patient's life that psychological aspects began to challenge my nursing skills in a way that I had never experienced before.

I looked after this patient every day for three of the last four days of his life. This patient had been known to me for several months, however, their behavioural changes in those last few days challenged me immensely.

The patient had become withdrawn, verbally aggressive and refused all care and treatment. It was hard watching a usually determined and communicative person shut themselves off from the world.

I would quietly approach the patient each morning, ask them what they would like done and offer them meals, hygiene, etc. The verbal aggression would begin and grow in intensity, to the point where I would speak back in a firm manner, asking the patient not to talk to me like that. I would explain that my colleagues and I were here to make his time peaceful and comfortable and that we were only trying to help him.

The second day started in a similar manner, with me offering the usual patient care. Again he refused, but then asked me to help him end it all.

This was not the first time someone had asked me to help them end their lives, but it is the first time that I answered in the only way I felt that may have helped the patient.

I said to him that I couldn’t do what he wanted and that if he wanted to argue with someone over when he was going to die, then he should argue with God.

He stated that he had made his peace with God. So I replied saying that was good, but God still had the final say. Throughout the day the patient remained frustrated and angry, and eventually asked me to get the doctors so that they could help him pass.

The third day of caring for this patient is one that will stay with me forever.

The patient was given a small handheld bell to use instead of the bed buzzer, and during the morning the bell rang. I walked into his room thinking it was strange that he had rung the bell, as he had been acting very withdrawn.

When I approached his bed, he took hold of my hand and said, 'I know I've been a pest.'

That took me totally by surprise, as I had never given any indication to this patient that caring for him was troublesome to me. I began to say, 'I know-' but something made me stop. Holding the patient's hand, I said, 'You know what? I don’t know or understand how angry and frustrated you are. I don’t know what it's like to go through what you are going through.'

He then picked up my hand, kissed the back of it and said, 'I'm sorry.'

All I said in reply was, 'It's ok. You have made your peace with us and with God now.'

The patient passed away the next day. I hope my words gave him some comfort as he passed.

So, next time a terminally ill patient yells, is aggressive or demanding, remind yourself to take a step back and look at the bigger picture. They may never get to see their children grow old, or see another sunrise, or walk on the beach again. What they will lose, we take for granted.