Concerned about new widow... she is VERY angry

ZASHAGALKA, RN · Sep 9, 2006

Her husband died after a very short battle with cancer. The oncologist told them due to his liver function that chemo would kill him, but he did do radiation. However, the cancer spread and within 3 months he died. They were just about to retire and travel. Now, the wife is very angry, making threats against the oncologist, stating he didn't give them the option to do chemo and it was their right to choose. She has called the oncologist and written him letters. She talked to our bereavement counselor once, then told him he should look at a different line of work. She refuses to see a therapist.
Is it appropriate to call her grown sons and voice my concerns without giving out all of the info? I am really concerned about her and also just found out her youngest son was just diagnosed with cancer. And her mother is dying. I don't think she can take anymore.
What to do????
I am taking care of her mother and I also took care of her husband during his last weeks, so I have met the sons.

Personally, I wouldn't.

There ARE stages of grief and anger is one of them. It seems she is stuck at that point, and while you might be correct that she needs some help to get past that, I don't think it's wise for YOU to intervene.

Here's my concern: she's looking to 'blame' someone for her husband's death. You pointed out TWO healthcare professionals that she has displaced her anger towards. You risk becoming the third.

And you risk it with the very real possibility of doing something that can be exploited to actually penalize you: violating HIPAA. Worse, because your concerns are in regards to someone whose relationship towards you in these matters ended with the death of YOUR pt, you risk a very murky view of obligations.

If you are extending yourself beyond your formal professional relationships to meet such obligations, can't it be reasonably argued that you are extending your professional obligations to encompass such needs? Wouldn't that make you professionally responsible for the failure of such needs to be met?

Professional Liability requires four components: have an obligation, fail to meet that obligation, harm results, the harm is directly related to the failure.

As far as HIPAA, notifying her sons can be a direct violation of professional liability, meeting enough of those requirements that any inquiry into your behaviour could cause professional sanctions.

More importantly is the first requirement. If you extend such professional obligations, you CREATE the pathway that leads to such liabilities.

There are no easy answers. But, from a PROFESSIONAL standpoint, this is beyond your ability to easily address WITHOUT extending that relationship past professional boundaries. The healthcare system IS trying to address it, hence the grief counselor. And you yourself have pointed out how well that worked.

Personal morals and ethics are not always the same as professional ones. This is why we try to define our professional boundaries. Those professional boundaries protect us, in more ways than one.

I just don't think I'd cross those boundaries in this case, at all. If she is not accepting the help that IS being professional offered, she will likely NOT accept the help that comes from outside effort on your part, and she might well hold it against you for even trying. That IS the problem - that is where she is stuck.

I would address it with her during your interactions w/ the care of her mom and I would make sure she knows what resources are available to her. And, IF her sons show during the care of mom, and IF you can talk to them, I would make sure THEY know about such resourses.

Other then that, I'd try to marshall the resources available to her while she is there for her mom. But, I do so WITHOUT solely taking on such obligations. That's why we have a multi-disciplinary team.

~faith,

Timothy.

leslie :-D · Sep 10, 2006

hi nosew,

i agree with timothy re: professional boundaries.

but even beyond the legal implications, this woman is not going to hear you or anyone else re: futility of treatment.

her anger is protective in nature, as it is masking the raw, gutteral pain of her reality.

it is also fueling her in a desperate search for someone to blame.

from my experiences, this anger is short-lived.

it could go on for months but it probably won't.

it will be more important to have these resources available for her when she finally breaks down.

the licsw should have access to crisis counsellors, given the degree of trauma present in her life.

any respectable and experienced atty will not agree to represent her.

they should understand grief in all of its' presentations.

i would also give the sons, a therapists' name and number, for when the time and opportunity presents itself.

but as it stands, the grief/anger this poor soul is experiencing is eventually going to spiral downward into inconsolable grief.

and that is when she will need all the resources and support available to her.

i will pray to God tonight, for her well-being and healing.

leslie

doodlemom · Sep 10, 2006

I agree with the last 2 replies. She is not going to hear anything and calling her children is stepping over professional boundaries - not to mention HIPAA. It's too much of a risk.

EmptytheBoat · Sep 10, 2006

By all means, call the son(s) and let them know your concerns

for their mother, she needs all the support she can get at this

time. Rally any other troops you can, church, pastor i.e..

You need not get into specifics, just your concern for the

grieving. This is bereavement, which is part of Hospice, and

does not have to be done by a Licensed Social Worker or

certified Bereavement counselor. Best wishes and God Bless

you for your compassion.

Donamy · Sep 12, 2006

Love on her, know that she is angry and hurt and love on her some more. Give her time to breakdown and realize what has and will happen. Stay with the family. You seem to be a strong assett at this point. Hospice means family. I have never taken care of a family(and we ALL have our dysfunctional capabilities) that I have not in some way become family. Just love on her and listen!!!

nosonew, BSN, RN · Sep 13, 2006

Actually, I was a bit more concerned about what she might do to the oncologist than to herself.

However, UPDATE... spoke with her at length today. She sounds better and she and I do get along very well. She told me our bereavement counselor "sucked" and if he would "quit beating around the bush and just state it like it is they MAY have gotten somewhere". She is open to suggestions and she and I are going to get together next week for lunch to talk about her feelings.

We need to talk about her mother (on hospice also) as she has some medical issues and daughter is POA. So... I think we are on the right track right now.. and I am going to keep in close contact as I can.

I am NOT going to contact the sons at this time. At least not without her permission, which I plan to ask her next week for.

She did actually tell me on the phone today that she is still "angry as hell" but doesn't feel like killing anyone anymore as that won't bring her husband back. (whew). I think her anger stage is moving forward...and onward we go.

Thanks for the advice ladies!

CHATSDALE · Sep 13, 2006

talk with the woman but hold off for now about dumping on the sons with this they have so much on their plate right now they really don't need more right now esp the sick one

living with someone most of your life, then you lose them w/o the necessary time for acceptance piling that on top of the sickness of son and mother she probably just retired and she has no job, no husband, on the verge of losing mother and son and facing her own mortality

step back and be there if she needs you

btw that some of those grief counselors don't know anything except what is in the book they really don't know what dealing with real people