A tough decision.

My 43 yr old patient was still under my care in the PACU. He was recovering from a lumbar laminectomy. He'd suffered pain for years and now had surgical pain from the procedure. I treated him with dilaudid and got his pain under control. He told me that his mother was also in the hospital but a different one, across town. He'd been with her but left for his scheduled surgery. We didn't have a room assignment so I called the waiting room to check for family. His sister and brother were there and his sister said she wanted to talk to me before she saw him.

I asked another nurse to keep an eye on my pt and went to the waiting room. The attendant directed me to a couple sitting near the television. As I approached them they seemed tense and I saw their eyes were red and puffy. I introduced my self, "Hi, I'm George, your brother's nurse, and he's doing fine." The woman replied, "Oh good, I knew he would be. Thank you. I....just.....need to ask you something. You see, mom's been sick. We've been caring for her, especially my brother. And.....she died, while he was in surgery, he doesn't know."

Wow, it's funny how nursing likes to throw you curve balls now and then. I needed more information for this one. I expressed condolences and then let her continue. "So we don't want to tell him right now but I don't know when we should. What do you think?"

Okay, two choices. One, we don't tell the patient. His siblings will go in to see him and talk about him and try to pretend that mom is okay. If he asks about her they may feel compelled to lie. Then, sometime down the road he'll find out she died and when she died and that they were not honest with him. I don't like that option.

So I asked her a question. "If you were in recovery, when would you want people to let you know your mom had died? Your brother has been through major surgery and I understand wanting to protect him but he'll find out sometime. Right now, he is stable and I think he needs you guys to be with him when he finds out about his mother. He'll be okay. I'll break the news and then you two and he can help each other. We'll get through this.

We went into the PACU and I led them to their sibling. I gave them report on my patient, that the surgery had gone well, we were controlling his pain and his vital signs were stable. We are waiting for a room and from a surgical standpoint, it's time to work on healing. Then I said I had something else to tell him. "I'm very sorry but I've just heard that your mother has died. I have your brother and sister here. You three need to talk and help each other. You are stable and I'm going to pull the curtain to give you guys privacy and all the time you need. If you like, I'll call a chaplain. If you need me, I'll be at the desk here." They declined the chaplain. Then I pulled the curtain and stepped out.

They spoke quietly, they cried, they hugged. After 20 minutes we got a room assignment so I returned to my patient's side and told all three that we had a room and I going to catch up my charting and call report. They thanked me and continued their conversation about who had been called and who still needed to be called. The prior tension was gone and I saw a strength from the three siblings united.