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by rn-jane

I have been a rn for almost 9 years, i have always worked cardiac and seen alot of codes and my share of dying patients. I know all people respond to death differently and i try not to judge people but last night experienced something so bizarre.
We had a patient that was infarcting since saturday, she refused intubation and made herself a dnr but will allow chemical code. Our cardiologist told her she needed a heart cath to determine the damage, totally refused everything. Family from everywhere came, even as far from tennesee was there yesterday, they were aware of her decision and how the doctors felt.
At one time i swear there were 20 people in the room and more filling up the waiting room. They left about 5pm and i told them one or two may stay with the patient if she liked them to, they left saying to call if she needed them. About 830pm patient was having hallucinations, confusion, o2 sat at 95% on 2liters. I told respiratory to give her a treatment that was due. She was crying for her family to come. I called her son, asked them to come in to stay perhaps for a few hours. They were reluctant, and said the son would come to stay for a hour or so...They lived 5 minutes away, he never showed.
At 1005 patient went into vent tachcardia and after all means to resucitate patient allowed per protocol patient went into v-fib and asystole. One of the nurses called the family and told them of a perhaps lethal arrythmia happening to the patient, they said fix the arrythmia and call them in the morning. When the family was made aware by the cardiologist she was gone, they all came in and was screaming, throwing thmselves on the bed< where the body was, floor ect. I have never seen such a dramatic performance. My supervisor also said in her 40 years of nursing she never witnessed anything like it. They were also screaming and crying in the parking lot, security notified us.
I cried all the way home, i know as a nurse we did everything we could legally allowed to us. Why do i feel so bad?

[DZcarrie]

i think it was my mom (who is a nurse) who told me she read in a sociology book that in some cultures the louder the screaming/fuss you make after a loved one passes...it is supposed to signify exactly how much you loved them and are grieving. could this be what happened? the family may not have been upset with your care...it was just their way of showing how much they loved this woman.

i hope this helps!

[SharonH, RN]

If one of my parents, children etc. died I think I would have the exact same reaction. I think it's the one time you're allowed to act out. Grief is so personal, I don't see how someone's reaction could be "overdramatic".

I think you felt bad because you witnessed such raw emotion at the loss. Losing a patient, no matter what the circumstance, never gets easy.

[ValerieB]

I think some people just can't accept that people do die and it's part of life. Some people in families are dramatic as you describe because maybe there's some guilt over things that have happened between them over the years. Some people will put their family members through the mill to keep them alive despite their advanced age. I've never seen family act as you describe, but have seen the drama in lots of different situations. One never knows what the dynamics of these families are and they think that the hospital should "fix" everything. Sometimes we just have to roll our eyes and move on to our next patient.

[sirI]

Originally Posted by rn-jane

I have been a rn for almost 9 years, i have always worked cardiac and seen alot of codes and my share of dying patients. I know all people respond to death differently and i try not to judge people but last night experienced something so bizarre.
We had a patient that was infarcting since saturday, she refused intubation and made herself a dnr but will allow chemical code. Our cardiologist told her she needed a heart cath to determine the damage, totally refused everything. Family from everywhere came, even as far from tennesee was there yesterday, they were aware of her decision and how the doctors felt.
At one time i swear there were 20 people in the room and more filling up the waiting room. They left about 5pm and i told them one or two may stay with the patient if she liked them to, they left saying to call if she needed them. About 830pm patient was having hallucinations, confusion, o2 sat at 95% on 2liters. I told respiratory to give her a treatment that was due. She was crying for her family to come. I called her son, asked them to come in to stay perhaps for a few hours. They were reluctant, and said the son would come to stay for a hour or so...They lived 5 minutes away, he never showed.
At 1005 patient went into vent tachcardia and after all means to resucitate patient allowed per protocol patient went into v-fib and asystole. One of the nurses called the family and told them of a perhaps lethal arrythmia happening to the patient, they said fix the arrythmia and call them in the morning. When the family was made aware by the cardiologist she was gone, they all came in and was screaming, throwing thmselves on the bed< where the body was, floor ect. I have never seen such a dramatic performance. My supervisor also said in her 40 years of nursing she never witnessed anything like it. They were also screaming and crying in the parking lot, security notified us.
I cried all the way home, i know as a nurse we did everything we could legally allowed to us. Why do i feel so bad?

Some cultures are that way. People show grief through screams, tearing clothes and pulling out hair. As previously said, the louder, the more respect shown and grief-stricken cries released.

Some people like to perform during this time, also.

Why do you feel the way you do? You are human and you have a heart. You mourned in your private way, alone and now, sharing your grief with us. Silent participation we are.

[ageless]

The worst was a time when a family was standing around a 90 year old A&Ox3 man lying in the bed while they decided code status. When one member of the family brought up DNR another grabbed a pillow and held it about a foot over her father's face and screamed "NO, No, we can't or we should just smother him now!!!

It had the whole floor upset!! they fought over his bed for hours!

[earle58]

i agree w/sharon- i don't think 'overdramatic' exactly defines the situation. i find it safe to say that i think we all understand what you're saying- the kind of scenario you might see in a movie. but grief is so intensively personal and subjective; their seemingly avoiding her was probably their inability to deal with the seriousness of the situation. and as every person is unique, so are family processes. the gutteral rawness of the emotions displayed would have affected me too. it's not a reflection of the care given but the family's current inability to deal in the here and now and could be related to sev'l etiologies.
it could have been a cultural response as another poster mentioned or it could be dysfunctional grief. i'm a hospice nurse and have witnessed a few times, what you describe. it is very unsettling but does happen more often than people know.....

leslie

[mercyteapot]

A co-worker of mine lost her 17 year daughter about 4 years ago, and behaved that way at the funeral. I thought to myself that she was never going to be okay again, but actually, I think it was cathartic. She emerged from the cloud of depression and despair much sooner than my friend, who lost her 4 year old son to ALL, though. That friend's funeral behavior was much more sedate. I can't imagine the grief of losing a child, so I'm not judging either reaction, just expressing an observation.

[Princess74]

Originally Posted by SharonH, RN

If one of my parents, children etc. died I think I would have the exact same reaction. I think it's the one time you're allowed to act out. Grief is so personal, I don't see how someone's reaction could be "overdramatic".

I agree 100%

[RN4NICU]

Perhaps what was so bothersome to the OP (it was to me when I read it) was that the family apparently couldn't be bothered while the patient was still alive - AEB: staff calls to let family know pt was asking for them and they didn't come in, even though they said they would; they were notified of a very serious dysrhythmia and they pretty much blew it off (fix it and call them in the morning?!); THEN when the patient passes, THEN they come in, THEN they show their concern ---- rather than show the patient how much they cared for her when she was still alive and crying for them to be with her. Perhaps their actions were a reflection of their feeling guilty for not coming in when the patient was asking for them?

OP - You did all you could for your patient. She is at peace now.