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?

[mustlovepoodles, 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.

This story brought tears to my eyes. I think it's beautiful that this lady could give her husband so much comfort in his final days. But it's also sad because she will have no one to give her similar comfort when it's her turn. IMO, when someone has reached the end of their life, their prognosis is poor and they are injured or ill beyond repair, we *should* be encouraging families to touch and caress their loved ones. I'm a peds nurse, so I dont' have much experience with adult death, but I have witnessed many deaths in the NICU and PICU. I lost count of how many times I have found a mother or father or both wrapped up in the bed or chair with their dying children. I wouldn't have dreamed of moving them, unless I could see that their actions were having a demonstrably negative impact on the patient. Dying is dying. Would it really matter if they died a day or so early? I'd rather see someone die in the arms of their lover than die untouched on clean cold sheets.

[SneakySnake]

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.

Not flaming but I just want to say my husband has every right and is welcome to fondle my boobies or expose my body to himself:yeah: Ensure safety and provide privacy and get the wife someone to talk with about what she is going through

I think that as nurses we deal with life, death, and other horrific, tragic unimaginable situations on a regular basis and sometimes (I know it is the case with me) it is hard to switch from "nurse mode" to "human mode" and see situations from family (lay persons) perspective.

[Whispera, MSN, RN]

It seems you're saying the poor prognosis meant the patient was going to die??? If that's the case, I would have done what I needed to do to complete my tasks, shown the wife's friend the waiting room, and left the wife and her husband alone, drawing the curtains around them and alerting everyone to try to maintain their privacy. There was no indication there was a history of abuse, right?

If the husband was near death, he could probably still hear his wife and feel her touch. It was important for them to be close, in whatever way they chose, to say goodbye. Since he wasn't capable of choosing, who would know better than her, what he would want?

When my husband's father was near death, my husband and his brother went to get their mother who was paralyzed on one side of the body. They lifted her into her their father's hospital bed (at her request), helped her cuddle with him, closed the curtains, and left them alone (and bawled their eyes out). Everyone thought it was a totally appropriate thing to do. Yes, Mom wasn't straddling Dad, but if she had, well, if that was their way of living...oh well!

I understand being shocked, truly I do. I think sometimes, though, we have to swallow our shock and do what our clients (including patients' significant others) feel is needed...

[CT Pixie, BSN, RN]

This story brought tears to my eyes. I think it's beautiful that this lady could give her husband so much comfort in his final days. But it's also sad because she will have no one to give her similar comfort when it's her turn.

She took a turn for the worse a couple of days after husbands passing. Her daughter was lying in bed with her when she passed..she had all the comfort and love anyone could hope for at their last hours and minutes. This was a very close, tight-knit, loving family. I knew it wouldn't be long after his passing that she would meet him in Heaven.

(Rest easy Mr & Mrs B)

[Mrs. SnowStormRN, RN]

I agree with most of the posters here. Everyone grieves differently and privacy would've been the best option here. Always remember your normal may be weird to someone else, and their normal may be weird to you. I had a Jewish professor who said she had an African American man die, his wife came in and she was screaming and hugging him and crying loudly and hysterically. She said she had never seen anything like that (She figured it was a cultural difference). LoL! I laughed because I had seen that plenty of times. Ive seen people not cry at all. If I lost my husband I would probably want to cuddle with him, stroke his chest one last time, I may be screaming hysterically. IDK, I may not even want to face him due to denial, I dont want to know what I will do for a very long time. Just know we are all different and we deal with death differently. Good Luck to you!!!

[leslie :-D]

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 do agree with you on one point- that i too, require consent from both spouses re sexual behavior.

i've known of a few marriages (in hospice) where they couldn't be farther apart.

that their facade was only that, a facade.

one hospice husband told me (confidentially) that he was looking forward to dying..."to get away from that %#@&%!! %!$!!"

so unless i personally know that the marriage is close and intimate, i get consents from both.

and fwiw, i do NOT think that exposing a man's chest, is comparable to a woman's chest exposed.

laying in bed holding spouse (yes, even in icu!) is a lovely and loving way to say good-bye.

damn the vent, it's quite manageable.

i'd love to know that you lightened up a bit, when the your elderly woman lays dying, as her elderly husband, (now a broken man) helplessly watches at bedside, that you'd give them their privacy to say their good-byes...even if he wants to hold her.

finally, as for the straddling...

when i've observed that, i immediately ran to the straddler and told her "this" is NOT making him comfortable and you need to get off of him now."

again, i did this because not only do i believe it would be uncomfortable, i didn't have patient's consent.

good thread.:)

leslie

[Sparrowhawk]

I can see why she'd wanna do it..but I"m not sure I agree with it being in public like that...but I agree with the person who said do your thing, have the friend leave and leave them in peace...tho rubbin' his bare chest is a bit odd..but hey everyone is different an dit's not ours to judge.

[mcleanl]

It seems you're saying the poor prognosis meant the patient was going to die??? If that's the case, I would have done what I needed to do to complete my tasks, shown the wife's friend the waiting room, and left the wife and her husband alone, drawing the curtains around them and alerting everyone to try to maintain their privacy. There was no indication there was a history of abuse, right?

If the husband was near death, he could probably still hear his wife and feel her touch. It was important for them to be close, in whatever way they chose, to say goodbye. Since he wasn't capable of choosing, who would know better than her, what he would want?

When my husband's father was near death, my husband and his brother went to get their mother who was paralyzed on one side of the body. They lifted her into her their father's hospital bed (at her request), helped her cuddle with him, closed the curtains, and left them alone (and bawled their eyes out). Everyone thought it was a totally appropriate thing to do. Yes, Mom wasn't straddling Dad, but if she had, well, if that was their way of living...oh well!

Poor prognosis in the ICU is common...regardless of code status. So it is entirely possible that this patient is a full code or code status has not been decided so that means CONSTANT care by the RN. There are monitors, lines, ETT, NGT,A lines, Swan Ganz, possible DHT......there could be ICP monitors or camino bolts......chest tubes....etc, etc, etc. The OP did not say he was comfort care.....

ICU care can be vastly different than hospice care. The nurse may be titrating drips constantly, giving fluid boluses, giving blood products. These patients are often very busy. I don't know what the circumstances of this patient are......but for the most part (I work in a STICU)..the patients are very ooey and gooey.......even when they aren't trauma related. I understand that things may be different in hospice care or a nursing home. I have worked in the ICU for a very long time and I unless my patient is a DNR/comfort measure there is often very little time to give any kind of privacy.

Most family members come into the ICU with a healthy bit of intimidation....they are afraid of the vent/cardiac monitor, lines, drips wires....and to some extent this serves them well....as they are less likely to harm the patient. Reading the hospice long term situations seem very different to me.....

[kakamegamama]

Nope, wouldn't have straddled.....however......

I would have loved to have been able to lie beside my husband as he died. Instead, I was doing CPR. I AM thankful that the ER doc/nurse allowed me and my youngest daughter to stay by his gurney after they pronounced him for as long as we wanted. I won't forget the last time I touched his face, ever....

[GilaRRT]

Not sure how I'd act if my wife died but after my experiences in other countries where fathers were forceable torn away from their dying children and family members because men can't be around all those women caregivers, I am probably going to be much more tolerant of behaviour that I would have considered strange in the past. This makes little difference if we are talking about hospice care at home or end of life in an ICU.

[Batman25]

Just to echo so many others in this thread pls let the woman hold her husband. The man is dying. Let her enjoy the end of his life as much as she can. Let her be in peace and find some closure. She needs that.

[tokmom, BSN, RN]

I had a pt that was end stage and her husband took off flying in his private plane. The one holding her hand when she passed away was me. I never thought much of his disappearance. Maybe he felt closer to her and God up in that big blue sky. We left a message with the hanger people to have him call us when he landed. He never came to the hospital. The one child was in a wedding and I guess was told by the dad.

Everyone is different in grieving process.