Medical staff rude to my brother;complicated;advice please

[burberrylover]

This past week was a difficult one for my brother. After caring for a lady with cerebral palsy for 14 years(She lived in), she died. It started on the 21st when he brought her into the ER due to stomach pain. After doing a scan, it was determined that she had terminal cancer and had to have surgery to assess/remove the tumors.

Before the surgery, two surgeons sat down with my brother(who had POA). One doctor was fine, explained the procedure and was very compassionate. The conversation with the other doctor and my brother went like this:

Brother: I want everything to be done for her.

Doctor: You have to think about her quality of life (He was referring to the fact that she had CP and that if she survived the surgery, her life would not be that great anyway)

My brother took offense to this as he felt that her CP should not matter and that the best care should be offered.

The same doctor also raised his voice to my brother when my brother requested that CPR be done if needed, telling my brother that her ribs would most likely be broken and "did he really want that to be done to her?"

Anyway, she made it through the emergency surgery. The doctors and nurses began to pressure my brother, telling him to call hospice as she was terminal. This was on the 22nd, a Sunday, He said that he would call but that he wanted to see an oncologist about her prognosis first. He knew that she was terminal but just wanted these questions answered. He also wanted her to have pain relief but not so much that she could not communicate.

On Monday the 23rd, the breathing tube was removed( her liviing will stated that she did not want life support). By this time, one nurse in particular was acting in a very odd way. Two examples a) A doctor noticed that the lady's oxygen had been removed and the nurse told the doctor that my brother requested that it be removed. He did not. and b) When they transferred the lady to another room, the nurse grabbed the wheelchair away from my brother and said, "I will push the wheelchair and you can be the candleholder". Now, I am not a nurse yet and maybe that is nurse-ese for something, but that comment just sounds off.

By Wednesday the 25th, she was still hanging on. My brother had still not seen the oncologist. Doesn't this seem weird? She has all of these major tumors but an oncologist could not swing by? So my brother stays with her and comforts her. He has still not called hospice. At 4pm, the social worker from the ICU floor rudely hands my brother a piece of paper with the name and number of a local funeral home on it, shakes her head and says in a snotty tone,"I am leaving. Call this number if you have issues. It's too bad you could not have called hospice" . My brother's friend died about four hours later.

I feel that the the first doctor, the nurse and the social worker acted inappropriately. Can I please get some insight from all of you? Were these people acting normal in their world?

[shoegalRN, RN]

I am not debating. I am pointing out there is another side and I think that irritates you.

I'm not the one irritated. I've stated my opinion several times in this thread, from everyone's prospective, and it seems to me if someone don't agree with YOUR stance, you are the one who becomes irritated.

Come back once you get through nursing school, pass your boards, and actually work as a nurse and THEN tell me what you think.

[shoegalRN, RN]

lol, ya think?

No, I'm not irritated. I just voiced my opinion like everyone else on this thread. I've already agreed to disagree with the OP. She is the one who wants to go back and forth.

[burberrylover]

Come back once you get through nursing school, pass your boards, and actually work as a nurse and THEN tell me what you think.

Again, is yelling at a patient's family member appropriate? Is thrusting a piece of paper with a funeral parlor's name on it ok?

[shoegalRN, RN]

Come back once you get through nursing school, pass your boards, and actually work as a nurse and THEN tell me what you think.

Again, is yelling at a patient's family member appropriate? Is thrusting a piece of paper with a funeral parlor's name on it ok?

Go back on page ONE and read my original post. I've already apologized for the treatment you SAID your brother recieved. When attempting to give another point of view that is NOT in agreement with you is where YOU become irritated.

From what I can tell, just about everyone on this thread has apologized for the way the situation went down, but also tried to educate you as to WHY it may have went down that way, which seems to me is NOT what you want to hear.

I'm not gonna keep apologizing for something that I was NOT there to witness for MYSELF.

[TheCommuter, BSN, RN]

Good morning, everyone. . .

Let's please continue to discuss the sensitive issues at hand and provide some insight without going too far off the original topic or sounding too inflammatory. In other words, address the topics without attacking each other.

Thank you all!

[Altra, BSN, RN]

As for the "raise Holy Hell" bit ...

I'd come back from the other side and inflict Hell on someone who cared for me for over a decade, but neglected to come up with my expressed, written wishes regarding end of life treatment until after I'd been subjected to pointless, painful interventions that I was powerless to stop.

As a nurse caring for that patient, whether in the ER, OR, PACU, or ICU, my response would have been the same: given the patient's condition & prognosis, why are we doing this? I would find it very regrettable and distasteful to participate in. And then, if the patient's long-time caregiver suddenly provided a document initiated by the patient that would have made it unlikely that those pointless, painful interventions would have been performed ... I would be cold too. Professional, but cold.

Why? Because I'm a stone cold *****? No. Because I am compassionate. Because I do everything I can to alleviate suffering, or see that it is avoided.

Everyone has to pick their battles in life. As I see it, your brother has to grieve and cope with the loss of someone about whom he cared deeply. If he sees the perceived rudeness as the most important thing for him to deal with right now, then ... I guess that's what he'll do.

[emnicams]

Before I ever thought about going into nursing, my family allowed my grandfather to suffer for five weeks in ICU before we ever made him a DNR. Severe COPD'er, post AAA repair, on the vent, on dialysis because his kidneys shut down post surgery, so swollen with fluids his entire bed had to be padded due to his skin weeping. It took emergency surgery to remove his large intestine, in which the surgery had to be stopped d/t low BP and he was sent back to ICU with his abdomen left open for us to make him a DNR... he died that night.

It sounds to me like your brother is grieving and needs someone to blame.. needs to focus his anger somewhere. My family went through that a little too. The nurses would make little snide comments, but now I understand where their frustration was coming from. The doctors actually continued giving us false hope, which I find more appalling than any remark the nurses ever made.

It's been almost six years and I still wish EVERY DAY we had just let him go peacefully.

I hope your brother finds peace.

[Lovely_RN, MSN]

Our society desperately needs to be educated about death and dying and we also need to be educated about learning how to select a POA.

The person you’re closest to isn't necessarily the best choice. You have to pick someone who is knowledgeable about death and dying, the "medical establishment" and who is emotionally strong enough to follow your wishes...this is not the person you like best in most situations.

My DH is NOT my HCP (Health Care Proxy) and I told him flat out that if something happens to me that I want my mom (a nurse) to make the decisions. I have written instructions and we have actually discussed and both agreed on what we want to happen. She is willing to do it for me and I am willing to do it for her. I have also involved my siblings and they know that when the time comes that I am the one who will make the decisions for our parents.

Was it an easy conversation to have? Nope...my sibs and DH think I am extremely morbid to want to talk about death and dying so much. It's not that I love death it's just that I’ve seen too many terminally ill people suffer for longer than they should have for no good reason because their families are ignorant about the dying process and have unrealistic expectations about what medicine can do.

OP have you ever had to cause someone pain? Have you ever had to ignore cries of pain? Have you ever seen suffering first hand and not been in a position to do anything about it?

I have and when it’s the fault of people who (whether it’s because of their ignorance or selfishness is irrelevant) refuse to accept the advice of professionals who actually know better…shutting up and pasting a smile on ones face is damn near impossible when the reason you became a nurse is to alleviate suffering not be an agent of it.

I'm not saying it's the family's fault for expecting miracles when all they know of healthcare is what they see on T.V. You know the fictional shows that depict miraculous cures, full code victims making complete recoveries in less than 24 hours, and people waking from TBI with no s/s of brain damage or the extensive rehab process etc etc.

Technology has advanced greatly in the last few decades but unfortunately the ability to use this technology judiciously has not advanced at an equivalent pace.

I wonder how long we can go on as a society with all of this technology that can extend the dying process (and suffering) of patients without making the public understand that death is an inevitable part of life?

[Altra, BSN, RN]

As for the "thrusting" of the name of a local funeral home ... I'll paint a picture for you.

It's easy for a nonmedical person to misinterpret many of the more subtle communications that go on between nurses/other HCPs and patients/families/caregivers. When I walk into a patient's room and say hello, how are you, what brings you here today & shake hands ... the patient/family/caregiver are likely to think I'm simply being friendly. And I am - but in that moment I've also assessed mental status, affect, respirations, skin color & temperature, muscle tone, and the patient's understanding of their condition.

In the same vein - I believe it is likely that your brother did not "hear", because of his stress level, repeated suggestions to begin to think about arrangements for the patient. No HCP or social worker would have denied his shock, anger, and grief over the situation - but is simply reality that some unpleasant details of death must be dealt with quickly. Sometimes, regrettably, as a HCP, the time to guide patients/families/caregivers gently through a situation simply runs out and direct action, now, is required.

[morte, LPN, LVN]

three of the last four comments, even after commutor posted her request to keep on topic, have not.....what is it that is driving all of you to answer questions that are not asked??????

[ShayRN]

I can honestly say in all my years of nursing I have never once heard a nurse say "that patient needs to die because s/he is handicapped." What I have heard them say is "S/he needs to go to God, they have suffered too much." I truely hope your brother is doing better after losing his friend. I sincerely hope that when he has some distance from the situation he can go back and look at the events with a cooler head. Maybe then things will seem different. The candleholder comment to me was not that significant. I see that as a nurse trying to include him in the transfer. Kind of like, "I drive, you navigate." The funeral home being thrust into his face? Yeah, I can see that happening. I really can and can't excuse it. I have had people admitted to my inpatient hospice facility without funeral homes picked out and while I don't understand it and find it frustrating, you as a family member would never know my feelings. A doctor yelling at someone? Shocking, just shocking. I can't imagine that ever happening. Ok, well, yeah I can and just understand you can wait from here until Kingdom comes and you won't get an apology for that one.

However, I would like to add just one more thing about the pain management...Too many times I have seen family members demand pain medication be stopped because they want to talk to their loved ones, when in fact it isn't the pain medication making the person unresponsive. It is the disease progression and the dying process. It just breaks my heart when family members refuse medication on their loved ones while the patient sceams bloody murder with turns or any type of hands on care. I want to scream from the mountain tops, MORPHINE DOESN'T KILL, CANCER KILLS! Yes, ofcourse you can overdose someone on Morphine and kill them, but so will overdoses of Digoxin, Coumadin and even Aspirin will make you bleed out when you take too much. When given by those of us specifically trained in pain management (ie Hospice nurses) you can have quality pain control and a dignified death.

[litchi]

I don't think people are trying to say that your brother was lying about what the hospital staff said. I think most are suggesting that that due to his own personal distress, it's possible that he misinterpreted their meanings and tone. It's something that happens all the time in situations like he was in. It's easy to take offense to non-offensive things and only hear what you want to hear when you're given such devastating news.

If in fact, they were as callous as he says they were..then yes, their behavior was inappropriate. The thing is, no one here knows if they were or not and neither do you. We can only give you our opinion and interpretation, which is based off of previous encounters in similar situations. Many have said from personal experience that, even though they were nothing but compassionate when delivering bad news to the friends and families, they were seen as rude and uncaring as well. Maybe that's what happened with your brother, maybe not. Most seem to think it is, but we'll never know.

At any rate, my advice is focus on helping your brother through his grief. Don't dwell on this subject because it will only make things worse.. It accomplishes nothing anyway. Being mad at the hospital staff isn't going to take his grief away and it's not doing anything positive for you either. It seems as though this has become a point of contention, but remember the reason for your original post--concern for your brother.

You seem like a great sister and it's obvious you have a lot of love for your brother. I doubt he needs you to fight for him in this situation though. Just listening to him and supporting him should be enough.