I lied...a story of how I outright LIED to patient's family.

[JDougRN]

I got the call on the EMS radio around 5 am. This is the usual time we get calls from EMS responding to nursing homes- The nurses are rounding on their patients to give am meds, and they find their residents dead or in distress. An 87 yo female, febrile, and in severe respiratory distress coming in. Pt is a DNR, but family is very involved, is aware, and will meet them in the ER.

I'm alerted that family is in the waiting room before the patient even gets there. I go out and introduce myself, tell them I will be her nurse, and that I will bring them back as soon as I get her settled in the room.

EMS arrives, and carefully transfers their frail burden onto one of my stretchers. You can see the relief on their faces, that they got her here and are able to hand her off before she dies on their watch. I'm now the proud owner of one very ill person. Temp 102+, Respiratory rate 14 and irregular. HR 50's, sat 84% on NRB, I don't need my Littmann to hear the rhonchi- Other hx is advanced dementia, DM, CHF. Has been in the nursing home for about 6 months- her husband had taken care of her at home as long as he could, but it finally got too much for him to manage, as he was also dealing with his own health problems at the age of 92.

I got her settled, and the Doc comes in- I give him the pertinent info- Not a whole lot we can do at this point other than make her comfortable and treat the infection. Chances are poor that she will make it, and we both know it. Doc moves on to deal with people he can help, leaving me in control of this mess.

I bring her visitors in, including her only daughter in her 60's, and several close friends of the family. I get them settled in and TRY explain to them what is going on. They don't get how bad off she is- I try to explain it to them in soft terms- They share with me who she is- a wife, a mother, a friend.I learn her husband is frail and elderly. I strongly suggest that if he is able, that he come. The daughter tells me she is going to leave to go get Dad. I explain that mom could go at any moment, each gasp she takes could be her last. I don't want them to have to deal with the idea that she died without ANY of her family around. But I REALLY wanted her husband there. The daughter calls her husband, who is dispatched to go get him dressed and here.

In this age of technology, we can keep up with a lot of things. I'm updated that son in law is at dad's house, he's getting him dressed, getting him loaded in the car with the wheelchair. I'm watching my patient brady down, 50's, 40's 30's....The monitor is alarming, and my pt.'s daughter sees it. Husband lands in the parking lot, and the son in law is getting him loaded in his wheelchair.

Then she died, no resps, asystole on the monitor. The daughter asks me- "Is she gone?"

"Not yet" I told her her- I gave her some silly answer- the monitor isn't picking up anything because she is so sick. I mute the alarms, turning the monitor away so she can't see the flat line.. I send 2 of my male coworkers to go out and GRAB the husband, RUN him in.

He arrives, looking a bit baffled at the whirlwind of men running out to snatch him out of his van and deliver him to trauma room 3.

I kneel down and introduce myself. I told him. "I'm sorry, but your girl is dying." He looks at me without comprehension. I took his hand, and joined it with his dead wife's. I told him "Your wife is dying right now- tell her you are here, tell her you love her- these are the last things you will be able to tell her....Tell her it's OK to go-"

He grasped her hand and brought it to his temple. "I love you baby....it's OK to go, I'm here."

I waited a minute and placed my stethoscope to her chest, made a big deal pronouncing her time of death as just then.

I lied- she died without her husband.... but that is something they will never know, but I will live with forever. I know I helped the living, but damn, holding this stuff inside hurts. I tried to explain it to my husband when I got home. He didn't get it. This is something I carry inside.

I know my fellow nurses will understand. Thanks for letting me vent and get this out.

[nocnursewm]

That is an example of what my DON used to call "creative reality" or at least an offshoot of it. In this case you were caring for more than the patient, giving the family what they needed for closure. In short, what a good nurse is supposed to do.

[learner1108]

My 96 yo DNR father died at 5am in morning in hospital from pneumonia. Nurse told me that he was sleeping when she came in, so she gave his roommate meds and when she went to check my father, he had died. I was grateful to her because I believe he died peacefully. You did a wonderful thing for the children and husband.

[Christy1019, ASN, RN]

You absolutly did the right thing. I remember when I worked in a Dr.'s office, an elderly man and his wife walked in he was ill. I did an EKG and knew immdediatly the man was dying even though he was still very alert and oriented. (His only complaint was server dizziness) While waiting for him to be transported to the ER I stayed with him and his wife and teased him the entire time about differnt things. I had him and his wife laughing knowing the entire time he was dying. I debated about being honest but just kept up the banter with the couple. He did die on the way to the hospital. I went through a phase, should I have done this, should I have been more honest so they could say their good byes? Several months later the wife had an appointment when I placed her in the room she hugged me and said, " I want to thank you so much, my husband's last moments were spent laughing because of you. This meant a lot to both of us." I know I did the right thing even though at times I question myself still. YOU DID THE RIGHT THING BE PROUD!!!!

Totally off subject, but what did his ekg show??

[CoraNary]

I don't think of what you did as a lie, no, you didn't tell the truth, but you allowed the family what they needed without doing any harm. How terrible it would have been for the family to have heard she was gone just before the husband arrived, the daughter would have probably beat herself up for not calling her husband to bring her dad just a little sooner. And the husband wouldn't have gotten to say his goodbye. ... you did a beautiful thing and allowed them to have their closure. ..

[Mark R. Thompson]

"Let it go","Let it Go"..........

[NurseAngie]

I am very moved by your story and deeply respect you for your compassion. Thank you for sharing.

[KnitWitch, ASN, RN]

I have absolutely told this "lie" before and I wouldn't hesitate to tell it again if the situation warranted it. There's a time for cold, hard truth and there's a time to hold hands and support the family -- who, could we not forget, are also your responsibility by extension? So when there's nothing else to do for my patient, I need to do everything I can to support their family. And if that means providing the framework to encourage and support their peace of mind, I'm going to do it.

I mean. Look, I've had families who have spent 5 hours in and out of a room talking to and holding the corpse of a beloved family member. I'm not going to tell them that their way of expressing grief and seeking closure is wrong. I'm not. I'm going to give them whatever they need (within reason) to feel like they got their due.

So to the posters who are taking issue with "lying" to family, you sound pretty heartless to me, and not at all concerned with including the family in the care of the patient.

And to the one poster who was concerned about the status of her license for "lying" to the family... You would have to do a LOT worse than that for the state BON to take notice of you. Trust me. A dead body can't complain, and a family who feels like they got closure and compassion from their loved one's care team ... they are NOT the ones going to complain.

[once-a-nurse]

I read this post in the most timely manner! For the last year I was the caregiver for a sweet man who was in the last stages of MS... he'd been bedridden for years and deteriorated quickly after his last hospitalization for UT sepsis and pneumonia. His lovely wife stayed home almost all of the time but on the few occasions when she absolutely had to leave the house, I was so scared he'd die while she was gone! I would have absolutely lied to her so she could have had that moment to say goodbye. What you did was an act of mercy and nothing more!

[fantomrose]

You gave this family something that only you could have given them. You passed on to them a peace that passes understanding and you should be proud of the way you handled this. You truly have been able to prove what nursing is with the compassion that most who aren't nurses can not truly understand.

[NotReady4PrimeTime, RN]

Losing someone we love is a wrenching and traumatic experience, no matter how prepared we are for their death. When a health care professional does something innocuous intended to lessen that pain, as JDoug did, the event is transformed into something to be treasured.

Several years ago I was assigned the care of an infant who had been classified as a DNR hours earlier. The baby had a very complex cardiac anomaly and had undergone several surgeries in his short life. He was pacemaker dependent, on a ventilator and high-dose epinephrine at the time his status was changed. The epi was weaned almost to off when I took over. He had been bleeding from under his chest dressing all day and the blue pads under him were constantly wet. The first two times I changed the pads he tolerated it well. But the third time, his blood pressure began to sag. An RT and I moved him into his mother's arms and I settled in to watch for the spiral to continue. Just before midnight there was a code in the OR that our staff was requested to assist with so our physician and the code nurse went. Over the next hour I noticed several changes on the monitor. His BP was still very soft, his sats were starting to fall, the ETCO2 monitor was not giving a realistic number. Then I could see that his pacemaker wasn't capturing any more. I turned off the alarms for everything and made note of the time. In our hospital a physician is the only one to pronounce, and she was still in the OR... A few minutes later, when I was sure the baby had died, his dad looked up at me and said, "He's in pain. Just look at how his little chest is jerking. I know he's in pain." Nurses are not permitted to adjust or turn off pacemakers so it was still firing at the set rate. I could see the distress in his dad's eyes, so I did the only thing I could. I gave the baby a dose of fentanyl. I also asked the charge nurse to page our physician so she could come back to the unit long enough to pronounce. The baby's parents were very calm when she told them he had died, and they stayed with him long enough for me to disconnect him from his lines and the monitor. I remember every detail of that night. In a similar situation, I would do it again.

People probably won't remember what you say or what you do but they will remember how you made them feel. It's never wrong to offer peace and comfort. Never.

[everoo]

The fact is...We weren't in this situation. Every situation is different. Nurses must curtail they're practice for each individual situation. If you look at, say, 10 deaths...and the nurse delivers the news to each family in the same delicate manner, each family will handle the news differently. So for the troll, he's obviously in the very SMALL minority of those who may think this was wrong.

[GinaJohn]

Nurse Doug, You demonstrated the upmost care and compassion every nurse should strive for.

I worked briefly in a SNF, my patient passed away, I had to call the daughter. With tears in my eyes I met the daughter in the hall. She proceeded to yell at me for not calling her BEFORE her mother died! She went on to call me a "Stupid B****" I realize she was devastated (as I had recently lost my mother to cancer @ 61 & was angry at myself for falling asleep by her side).

I had to "Suck it Up" that night. I often think of how everything transpired and that I wish I could have called her in time.

You were able to give that family a few last moments & I am sure the family will always be grateful! Thank God for nurses like you, the one's who's hearts are full of compassion!