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

Nurses General Nursing

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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.

I have worked oncology/hospice in the past and yes, I do think you were expecting too much. Families just don't see the things that we see and they don't understand the signs of death like we do. That being said, I am sorry for the loss of your patient and thank you for doing the work that you do. Hospice was tough for me - seeing the patient healthy one day and dead in a month was mentally exhausting (for me). It makes me very grateful that there are nurses like you that can support the patient and family in these very hard times in their lives. :heartbeat

Shay, if I came down hard on you, hon, I apologize. My point was that you were expecting far too much and you were being incredibly judgmental with both the patient and her family, and I still believe you were treating them unfairly. That said, I also mentioned that, of the two portraits that you presented of yourself in your original post, you may be an effective and compassionate hospice nurse who needs to step back. Everyone gets overwhelmed. When did you last take time off for just yourself?

Specializes in Med/Surg, Home Health.

I am not a hospice nurse, but I took care of MANY terminal/dying patients on the med/surg floor I used to work on. I know how frustrating/depressing/emotional the entire situation can be. Ive had families like those too and it is also frustrating. Hugs to you, and dont stop posting here. We all need a place to vent.

A friendly reminder...we are here to support each other. I hope that we all can find the knowledge to understand that our words on here do not reflect our actions in the real world. But we do need to be able to vent our frustrations somewhere... and its better to do so here than with our patients. Cut her alittle slack please. If this is the response you give everyone who vents, no one will feel comfortable letting out our feelings on here.

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.

You are right, I don't know Shay, or her history. This is the only post I have read from her, and I do plan on looking for some of her previous posts to get to know her better. My response was to this post only, and my response was very strong. But when I read this post, I thought about how I would feel if someone were to talk about my family in this manner. Everyone deals with loss in a different way, but in this particular post, it seemed to me that the OP was very disdainful of both the patient and her family. I did not mean to offend.

How much time do you save writing dgter instead of "daughter"?

It took me a few tries reading your post to figure out what the heck you were talking about. Just saying.

So, you see a tornado coming and try to warn your blind friend. You see it coming, so you tell the blind woman to start building her emergency shelter. She says okay, then goes out for coffee with her friends. The tornado edges closer, and closer, so you remind her again that there is a tornado coming... She goes out again for some errands. You tell her to get into the emergency shelter, she agrees to, but goes off and does something else. You're starting to get frustrated because she's just not listening to your caring advice. Bam! Tornado hits, and her house is completely destroyed. She looks at you and asks what the heck she does now!

Yeah, of course you'd be frustrated. The fact of a death being involved isn't going to change your human reaction to becoming frustrated or confused that someone isn't trusting what you're saying.

Specializes in neurotrauma ICU.
How much time do you save writing dgter instead of "daughter"?

It took me a few tries reading your post to figure out what the heck you were talking about. Just saying.

really??????????????

Specializes in Acute Care Cardiac, Education, Prof Practice.

I have a comments, and that is all.

1. Everyone deals differently, and some don't deal at all. My father refused at the age of almost 50 to see his Alzheimer ridden mother one last time before she died. I, at a confused age of 20, did go. We both have our peace.

2. People should live their lives putting more energy into communicating their love for each other, than worrying about how they will cram it all in at the end. I love my family and friends, and they will know it now, in the end and beyond.

3. It takes a hell of a lot of acceptance, and passing through many stages of the grief process in order to plan for your own funeral arrangements.

Tait

Specializes in Medical.

I once received a dying patient from theatre (they opened her and everything had infarcted). She was sick when I left the room to greet the family, who were wlaking up the corridor, and dead when I opened the door to let them in. I was amazed that they couldn't tell she was dead. I let them sit with her, then came back a few minutes later, waited in the room a moment, and when the DIL said "It won't be much longer, will it?" paused a moment and said "I think she's just gone."

My point is that lay people often have no idea - the son and daughter-in-law were in their forties but clearly hadn't been around death much and couldn't see it. So I;m not surprised that the daughters didn't get that when you said she was dying you meant "she's dying now, any minute, so if you want to be with her don't go away."

That said, I'm really sorry you had this frustrating experience. I've read other posts of yours and have no doubt that your frustration wasn't visible to the family, that your care of them and the patient was thorough and compassionate, and I can relate to your reaction.

i don't think people are in the right mindset when they're in such emotional distress such as one goes through when their close loved one in actively dying. compound this with living paycheck to paycheck and more than likely and uneducated background, you get something like what you just discribed. because YOU know better doesn't mean THEY know better.

Specializes in CCU/MICU.

Shay,

Your post was clearly a vent post. DO NOT feel bad for venting. Isn't that why we're here? You sound frustrated because you care! You just wanted this family to experience this death the way that they had said they wanted and you did your best to provide that for them. Sounds like between your expectations and their grieving/lack of understanding, that just didn't sink in this time.

I think it is fairly reasonable to expect people to have been SOMEWHAT prepared (not yelling... just using caps for emphasis!), because that is the "responsible" thing to do. However, that being said, there are ALWAYS going to be some people that are going to let you down... that is one sure thing in life. Next time it doesn't seem like someone is "getting" it, just remind your self that this is one of THOSE situations and have a sit-down with that family and give them some gentle, extra-education... sometimes you just have to be gentle, but FRANK. And there is nothing wrong with that. You can only do what you can do....

I was running a code up on the oncology floor one time (actually first-code that I really ran as a CCU nurse off of my unit). It was a lady who had cancer, but was not at the "end." She was in Vtach, so we were doing CPR and getting ready to shock and I look over and her husband is taking pictures in the corner with his camera. I am thinking, well... I don't thinking that my mind could muster a thought. I was amused, appalled, confused... whatever. However, he was polite and calm and quiet, so I didn't care what he did. Got her back and sent her to the unit. I decided that maybe he should have been upset or something... I mean he watched his wife "die" and be brutally resuscitated! Where was the emotion??? He definitely must have some "disturbed grieving processes" going on. (Is that a real nrsg dx?) After talking to him, I decided that he'd actually just been prepared for something like this...She'd been sick for awhile... I think he'd been kind of documenting her illness, albeit, a rather morbid scrapbook, I'm guessing. When I reported off on this lady, I told the other nurses that the husband was just a little bit "eccentric." People will just be people, what are ya gonna do? :)

Take care, Shay

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