When a patient is dying, am I expecting too much?

Nurses General Nursing

Published

I had a family the other day that I really just felt bad about. The patient was only 50 and had cancer of the lungs. Two dgters and a few young grandchildren. You can just tell these people really didn't have much. However, the patient was dying, soon. As I got on shift she was still alert and terrified so I asked her if she wanted me to call the Chaplin for her. She nodded her head, eyes as big as saucers. After he left I went to check on her and one of the dgters was in the room. I asked her, where is your sister? She said, she had to go home to get her husband and children. (I knew they lived well over 45 minutes away.) I said, does she want to be here when you mom dies? She looked shocked that I said that...Yes, she said. Should I call her back? Well, yes, right away. An hour later I went to check on the patient and her dgter was leaving, again. I calmly walked over, checked her pulse (none) she had that shallow, ineffective breathing and her heart was bounding. I looked at the dgter that remained and said, did your sister go out for a cigarette? No, she said, mom is sleeping so she went home. I looked her straight in the eye and said, go get her, now. She said, well, you don't understand, her husband got paid today and they need to get the check. Ok, I do understand, really I do. But your mom is dying as we speak. She looked shocked. Ran out of the room and got her sister in the parking lot. They said to me, now what? Umm, you say good-bye. I pulled up chairs to let them sit beside her and stayed in the room in case they needed support in the end. She died with her dgters holding her hands 5 minutes later.

So I guess, the problem I have is this...Both daughters were told by me that mom was dying soon. Both girls knew early in the day that death was soon. No plans were made by them to get the spouse to the bank by a friend or another family member. No arrangements were made for a sitter for the youngest child (a baby that is not yet 1) So, he was in the room when grandma died. No funeral arrangements were made. WTH! When you have a Hospice nurse telling you, your mom is going to die, soon. FREAKIN LISTEN! Am I asking too much?

(OH YEAH! As a side note, when your told you have Stage 4 lung cancer with extensive mets and a cancer center tells you nothing more can be done. HERE IS A THOUGHT! Make some arrangements. Tell your family what kind of service you want. How about put a downpayment on something. THAT way, when you die at 7:30 at night your kids aren't staring at the nurse saying "We don't know what to do. We don't have a funeral home picked out and Oh yeah, NO money to pay for it.) FYI, I found out you can be cremated for 850.00.

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Look at it from their end; they were overwhelmed. Remember that "teaching" or "listening" takes a back seat when you're emotionally compromised.

Shay, I have a feeling that there may have been a class difference here, just a thought, and that can be difficult for me in some circumstances. It's just hard to comprehend the moment-to-moment, paycheck-to-paycheck way some people think, and the way babies are treated like backpacks. "Here, can ya hold this a sec? I'm going for a smoke."

As to denial, I am watching my father get sicker and weaker with Parkinson's and my rational, strong mother finally begin to accept that whe will not get well. We kids have been telling her for two years that Dad needs to see a doctor for an evaluation. She only began to accept it last summer, when he cracked up the car before he got out of the garage and, when my husband and I bought it from him, thought we were swindling him.

You got these adult children through this, and while they may never realize what you did for them, you gave them a great gift - freedom from guilt over not being there at her time of death.

I actually find the entire tone of your post quite disturbing. As a hospice nurse, you should be there to help the family through the process as well as the patient, not to criticize them for acting in a different manner than what you expect. Your post comes across as judgemental and demeaning towards the patient and family. I agree with the other posters here who have talked about the different ways people handle death and dying. These people need your understanding and support, not judgement. If you cannot understand that, then perhaps you should not be working in hospice.

My goodness. Even hospice nurses/saints have off days, folks. If we can't vent here, then where?

my goodness, cut shay a break, will ya???

anyone who knows shay and her hx of posting, knows that she is a FINE hospice nurse.

hospice is a specialty that has incredibly high turnover.

nurses can get burnt out in 2 weeks of this work, no exaggeration.

another difference is, shay works inpatient.

continuous care of the dying pt and their families, can literally suck the life out of you.

we are talking about ongoing physical, emotional, spiritual suffering.

acuity is much higher in inpatient.

i don't know if shay is burnt out or not, but i will tell you, this is not a typical post of hers.

she has demonstrated over and over again, her proficiency and sensitivity in dealing w/her pts/families.

(((shay))).....pm me if you want.

even after dealing w/the same family for wks at a time, i have learned to relay info as if they're hearing it for the first time.

when it comes to grief, the dysfunctional type seems to be the norm.

they just didn't hear you...even if you thought they were listening.

it's like they're in shock and nothing can penetrate that shell they're wearing.

but you know this.

that's why i'm a bit confused about this post?

take care of yourself, honey.:icon_hug:

no one else will.

leslie

These people need your understanding and support, not judgement. If you cannot understand that, then perhaps you should not be working in hospice.

Uncalled for.. How about some support for a fellow nurse? They also need your support and understanding, not your judgement..

Shay.....I GET it. Really. I'm not a hospice nurse per se, but see excactly that in LTC setting. (we get old and young pts)

When they tell me they want to be there when they die and I tell them it is now or just a few minutes and they need to run to the store to get a coke or smokes....yeah...It does grrr you. You are doing everything you can to support the patient and family at that time, but they aren't participating...frustrating.

Yes, I've been around for my share of family members deaths including my fathers...nope...it doesn't happened as planned either.

Specializes in ICU, Telemetry.

I've had people like the daughters....adamant that they want to be there when grandma passes, but swanning out to get sodas, go home and get the cellphone charger (still remember that one), yet telling me, "I've got to be here when she passes." Not telling us where they're going, we're trying to find them when their loved one goes agonal. And one yelled at me because she'd gone to Walmart, with me telling her that her dad wouldn't be there when she did, and she came back to find a dead dad. It's denial, it's immaturity sometimes (the world revolves around ME, so mom will wait till I get back), and sometimes it's just people holding on to a normal behavior because that's all they can do. They can't fix mom or dad, but they can go get their check, because that's what they do on Fridays, or go teach Sunday School because they always do. But just because you can understand it doesn't make you feel less like slamming your head into the wall.

You had a tough, frustrating day, but you did the best you could. :icon_hug:

Specializes in Hospice, Palliative Care, Gero, dementia.

Here's another way to look at the behavior too -- maybe, despite saying they wanted to be there, there was a level of deep ambivalence about it?

Maybe there was denial, but maybe, just maybe it was also about a conflict between "the right thing for me to do as a loving daughter is to be present when mom passes, but I am scared to death at the prospect."

Let me explain why this thought came to me. I am working on a research study of the experience of family caregivers of ALF residents at end of life. Besides interviews, I am also spending time with the family CG and the dying relative. I have a participant whose mother has recently experienced a fairly rapid decline. I was sitting w/the daughter at her mom's bedside when she says to me "I don't know if I want to be here or not..." she couldn't even say the word "when she dies.

Even though I am a hospice nurse, I was not there as HER hospice nurse. I was this fairly neutral individual, who was interested in her experience and perceptions. Would she have shared the same comment with me if I was there as a nurse? Maybe, maybe not.

So, maybe it was the "I'm in crisis and my brain is not registering what you are saying." Maybe it was "I'm in denial (gods I hate that word!) and maybe if I'm not here mom won't die." Maybe it was "I'm really scared to be here when she dies." Maybe it was something that none of us have thought of.

We hospice nurses are, in general, a lot better at leaving any control issues we have at the door, and following our patients' and families' leads...but as someone else said, even the best, most compassionate and experienced of us have our times of frustration with our patients/families.

I hope coming here and venting helped. I hope if you are needing more to care for yourself at this time you have the resources available to you to assist you.

blessings, miriam

Specializes in Corrections, Cardiac, Hospice.

For all those who showed me kindness and compassion, thank you. This particular case was very frustrating to me, but I can assure you they never knew it. Not for one flamin second. I spent an hour after her death on the phone with funeral homes, trying to find some way for them to afford a service.

Also, I DO know what it is like to live paycheck to paycheck. I left home at 17 and with the help of my husband put myself through college, many times working two jobs. Believe me, I have had 40 cents left to get me to the next week. I would never judge. I cannot believe a couple of the responses I have gotten. You say I am nasty? Go back and look at your own posts. Shame on you.

No, I am not ashamed of my feelings, but I do feel bad for those of you who feel the need to bash me when I come here to vent. I know what kind of nurse I am. This very evening I had a family member bring me flowers because I took such good care of her and her father last week. So I certainly don't need to rethink my career choice. The hostility and character assasination I have received from a couple of you really hurt. But, fortunately, I can choose to push that aside and concentrate on the posts that encourage me to rethink my position. Perhaps I was a bit hard on these two girls HERE. But when I was sitting beside them as their mom took her last breath, I was holding them and supporting them. Just like I do ALL my families. I give out hugs like some people give out chewing gum. Those of you who were so hard on me, can you say the same?

I believe there are many ways to disagree, without being disagreeable. Until some of you learn that, I will just use my option to ignore your posts. And YES, NOW I am angry.

Specializes in Psychiatric Nursing.

Wow! What an awful day I am so sorry you had to go through that. Sounds like you were an incredible advocate for both the patient and the family. Watching someone you love pass away is a really awful thing to have to go through and from my experience sometimes their can be some serious conflicting feelings that can occur, on the one hand you want to be there for you loved one and know you really should be there but also a small part of you the would love to run like hell. Possibly the daughters were in some denial over the seriousness of their mother's condition. I am sure for you it had to be heart wrenching needing to be so blunt with those women about what was about to take place but you are an amazing person for doing so. Our hearts go out to you. :heartbeat:redbeathe:heartbeat

Specializes in ER.

Shay,

I have nothing to add to all the supportive posts, I can't explain what happened, but I DO want to be counted as one of the people that thinks you did a fine job.

Just as those daughters didn't get what you were explaining to them, the negative posters don't get what kind of nurse you have been for years, and how you are allowed to have a bad shift once in a while. Even nurses are human. You gave that family the best you had and that's all anyone could ask. I hope some of the speculating about why they might not have processed anything that night gives you a bit of peace about how things went. I don't think there was anything going on that night that you had the power to change.

One of my patients told me last night her mother always said "be a duck, and try to smell purple," in times of stress. So let it all roll off your back, and take a deep breath while you think about something totally unrelated, and get on with it. Well the first thing that came to my mind was a cranky duck that had just been doused with purple paint quacking and flapping his wings, spraying paint everywhere- a nice mental image if someone's yelling at you!

Hope any of this helps- be a duck shay.

+ Add a Comment