Ever experience a patient's family member grieving in an odd way?

[shhhh]

My patient came in with a devastating injury and he has a very poor prognosis. The trauma docs I work with made this prognosis very clear to his family, and all of them seem to grasp the situation well except for his wife. After the trauma attending spoke with the family, he brought the wife and her friend back. He and I were at the bedside trying our hardest to be supportive, but we grew more and more uncomfortable watching the wife with the patient. While this was going on, her friend was looking at ME with this mortified expression on her face.

While acting pretty histrionically, she began kissing his hands, then she kissed his face and neck repeatedly. Then a couple minutes later, she pulled the blanket off of him and unsnapped his gown and started stroking and kissing his bare chest. The doc kept looking at me with this "What the heck do we do?" look on his face, and I'm sure I was giving him the same expression. At first, I thought that if she wasn't really doing any harm to him, then she should be able to do what she needs to do to help her grieve, because her husband will most certainly die from this. Then a couple minutes later, I thought that how she was exposing his chest and touching him like that in front of her friend wasn't giving him much dignity (the trauma surgeon and I were talking after and we both thought that a lot of what we saw bordered on sexual...bleuughh), so I decided enough was enough. Before I got my courage to say something about her behavior, I had to leave the room to take a phone call. Then the doc left the room to return a page. When I came back, she was basically straddling him in the bed. I said, "I need to collect labs. Do you want to go get coffee downstairs while I get them?" They left, but came back a couple hours later. I made it clear that she can't expose him (he had a low temp, so I put on a Bair Hugger) and that touching him so much interferred with the EKG. She didn't really listen to me and I returned to the room to find her laying next to him in the bed with her legs draped over his, stroking his chest. I told her she couldn't be in the bed with him and she got out, reluctantly, but as soon as I left and then came back, she crawled back in the bed with him. I needed to retape his ET tube with RT, so I asked her to leave again. I ended up putting the bed high in the air and put all the bed rails up so she couldn't climb up into the bed when she returned. She never did return to the room by the time my shift was over, but I reported all this to the on-coming nurse, who's a very seasoned nurse and she was a little shocked by what I told her I witnessed.

Part of feels like I'm being way too judgemental about this, but I've been a nurse for almost 8 years and have dealt with a lot of end of life cases, and this was by far the most bizarre reaction I've ever seen. Would you agree that this reaction is pretty off the wall, or do you think I'm being a bit too prudish? Do any of YOU have a comparable story (or more odd story) to share?

[SneakySnake]

As a nurse I understand your discomfort but as a wife I can (maybe) understand her actions. I know that physical and sexual contact is comforting for both my husband and myself. I would give her privacy with her husband as much as possible and make sure that she was not inadvertently harming/endangering him with her actions. If the pt is safe let her hug, kiss, caress, and lie down with him....this is her husband and she is most likely loosing him and she is having to deal with this loss and showing her emotions in a very public place. I can't even imagine what I would do if I were in her situation...I imagine she is in much psychological turmoil also and that kind of stress can cause some pretty bizarre reactions....is there someone she can talk with? As much as possible while maintaining safety allow her to be with her husband and provide privacy for them both.

I have never been with a husband/wife when their beloved passed but I have been with mothers who have lost their children. Yes, it can be uncomfortable watching them stroke caress hold that lifeless body for hours on end but I don't think that wanting that physical contact and trying to maintain it is out of line.

I have also been with mothers who do not want that contact after the child has died....A quick touch on the child's hand and they are ready to let go. I really think it just depends on the person and the situation.

[mcleanl]

YUCK, YUCK and triple YUCK!!!!! I am on the telephone (on hold) but I have soooo much to say about this!

[DLS_PMHNP, MSN, RN, NP]

ok, so I'm a hospice nurse and may be a little biased..

Would it have been so bad to let her lay in bed with him after you were done with your procedures, ET tube, etc? He was surely going to die. Would it have been ok to have her holding him when he took his last breath?

[Anisettes, BSN, RN]

While I can empathize with you being uncomfortable with her level of physicality - I, myself have never been one for public displays of affection, though I could certainly tear my husband up in private - my personal opinion is barring her actually interfering with his monitoring or acting in a way that would hasten his passing, I'd probably have left the room and given them privacy.

You don't know what passed between them in life, what her background or his is. How they communicated privately, what unfinished things might have been left in limbo between them. You know nothing other than your patient was terminal and his wife's behavior made you uncomfortable.

And that's okay, you're required to have an open mind but not so open that your brain falls out. But at the same time, human grief is very complicated and no two people will act out the same way. She may be someone unable to verbalize what's happening and react physically like she did. We don't know what trauma's she may have had in her background.

Women who have been sexually abused often act out in ways that would seem to deny suffering - after all, who feels sorry for a prostitute or a promiscuous woman? Most people dismiss them out of hand without know what may have set them on that path.

I'm NOT saying this is what's going on with your patient's wife - but what we see on the surface does not always illuminate what's really going on. You see her acting in a way that makes you and others very uncomfortable, but this may be the only way she is able to cope at this sudden trauma and impending loss.

Again, if she's not affecting his outcome or interfering with his care, I would give them as much privacy as I could and I certainly would not insist she leave his bed if it did not harm him for her to be there.

Love doesn't come to everyone readily or frequently or easily and she may never love or be loved again (or she may feel this way) and she is losing the one person she may cherish above all others.

Me? I'd cut her a lot of slack and be grateful it's not my loved one in the bed. Just because you're not like or acting like everyone else, doesn't mean your feelings and actions aren't just as valid. Empathy trumps judgement for me as often as I can allow it and I'm not required to decide what's appropriate or not, I'm only required to keep my patient free from harm - and if her actions don't cause him harm, I'd leave her be. If it were me, I'd rather go out of this life with the hands of someone who loved me on my skin over being left untouched at all.

[CT Pixie, BSN, RN]

While working in LTC I had two residents who were married but were in seperate rooms..long story. Anyway, the husband was actively dying and several times I found my little lady down the hall and lying in bed with her husband..many times she was just stroking his face or chest..sometimes she was nuzzling in his neck..other times she had been sitting upright and had his head against her chest stroking his hair..broke my heart.

Some of the other nurses were absolutely FREAKED out about this..why was she stroking him?! Why was she kissing him??! People! They had been married 80 years..yes..80..they were married at 16..I saw nothing wrong with her actions..but others found it odd. He did die peacefully wrapped in her arms, her face nuzzeled into his neck..in my opinion the most perfect way he should have gone..being held by the woman who had loved him for oh so many years.

God forbid, something traumatic happened to my husband..I'm pretty sure I'd want to be lying by his side..stoking his face, chest like I always do..I don't think I'd go as far as straddling him..but I might fling a leg across him..the way we always snuggle. I totally believe he'd want that..and if it were me in that bed..I'd want him there next to me too.

[Amanda.RN]

Though I understand that the situation may have been uncomfortable, as a nurse with hospice experience and understanding that many people need intimate physical contact with their mate, I can understand what she was doing and why she was doing it. If her husband was certainly going to die, she was trying to get as much contact as possible with her loved one prior to his death. No one knows what they would do and how they would react in a situation like that until it arises. I have to say, I may have reacted similarly, especially curling up next to him in bed. I've always love "snuggling", as she likely did, so she was probably just trying to soak-up every last moment she had with him alive. Many people do not want to have physical contact with a deceased person, even if that person was their spouse/lover/best friend, etc. Everyone grieves differently. As long as she wasn't causing harm, interfering with his comfort or causing pain, I would have provided privacy and allowed her to continue laying with him. If at any time you feel that a family member is not coping well with the death or impending death of a loved one, your facility likely will have a chaplain who can come and meet with the family to provide support (even if the family isn't religious, the chaplain would still be able to provide comforting words). Many facilities also offer support services who can do things like taking hand-impressions in clay and providing other memorabilia for the family. If you have the opportunity to take a continuing education course on death and/or end-of-life care, I would recommend it. It may provide you with more insight on the situation.

Best Regards,

Amanda

[DLS_PMHNP, MSN, RN, NP]

YUCK, YUCK and triple YUCK!!!!! I am on the telephone (on hold) but I have soooo much to say about this!

Really?

I'm glad she was able to be with him.

I've seen this before in hospice. many many times.

everyone grieves differently. just because it differs from our values, it doesn't make it 'yuck'

[mcleanl]

I totally disagree with most of what has been posted above. An ICU setting is NO place for spouses to be lying in bed and caressing a patients chest. There is no mention in the post about the patients code status.....it only mentions a poor prognosis.

I don't think that anything sexual (and my take on the story is two people witnessing the event took it as sexual) should be performed on a non-consenting adult.....husband or not. And before I get flamed....I am not talking about holding a hand or kissing a hand or arm....I am talking about blantant sexual behaviour. Yes, caressing your husbands chest.......is way out of line for a critical care patient. This patient is intubated and likely sedated....with NO say in how his wife is exposing his body. If the roles were reversed would it be okay for a husband to expose his wife....NO WAY.

I think it is very strange and very appropriate to let her know what the appropriate conduct is.....this can be done is a very careful and considerate way.

[EowynRN]

I have little experience with death and dying, but this seems within the realm of normal to me. If my husband were dying, I would want to give him as much physical contact as possible. I might not go to that level, but I would definitely try to cuddle, caress, and let him know that he's not alone. Also, I have no idea how I would act if it came on suddenly from an injury. I think as nurses it's our job to evaluate how we feel about the situation, and understand that others might react in a different way. If her behaviors did not actually injur him, I don't understand why you would go to such lenghts (raising the bed-isn't that a safety issue in itself?) to keep her away. You should probably reexamine how you feel about death/dying and the coping process, and think of ways that you can support a family member in their coping process instead of hindering it.

[NurseLoveJoy88, ASN, RN]

I totally disagree with most of what has been posted above. An ICU setting is NO place for spouses to be lying in bed and caressing a patients chest. There is no mention in the post about the patients code status.....it only mentions a poor prognosis.

I don't think that anything sexual (and my take on the story is two people witnessing the event took it as sexual) should be performed on a non-consenting adult.....husband or not. And before I get flamed....I am not talking about holding a hand or kissing a hand or arm....I am talking about blantant sexual behaviour. Yes, caressing your husbands chest.......is way out of line for a critical care patient. This patient is intubated and likely sedated....with NO say in how his wife is exposing his body. If the roles were reversed would it be okay for a husband to expose his wife....NO WAY.

I think it is very strange and very appropriate to let her know what the appropriate conduct is.....this can be done is a very careful and considerate way.

No flamming from me. I can respect your point of view as well. I think the wife's actions are normal and healthy. I just wished her and the patient was given the privacy they deserved and had a right too. :redbeathe

[blueyesue]

If I am dying and my husband crawls in the hospital bed with me, please don't stop him. Let him hold me one last time.