I have been a rn for almost 9 years, i have always worked cardiac and seen alot of codes and my share of dying patients. I know all people respond to death differently and i try not to judge people but last night experienced something so bizarre.
We had a patient that was infarcting since saturday, she refused intubation and made herself a dnr but will allow chemical code. Our cardiologist told her she needed a heart cath to determine the damage, totally refused everything. Family from everywhere came, even as far from tennesee was there yesterday, they were aware of her decision and how the doctors felt.
At one time i swear there were 20 people in the room and more filling up the waiting room. They left about 5pm and i told them one or two may stay with the patient if she liked them to, they left saying to call if she needed them. About 830pm patient was having hallucinations, confusion, o2 sat at 95% on 2liters. I told respiratory to give her a treatment that was due. She was crying for her family to come. I called her son, asked them to come in to stay perhaps for a few hours. They were reluctant, and said the son would come to stay for a hour or so...They lived 5 minutes away, he never showed.
At 1005 patient went into vent tachcardia and after all means to resucitate patient allowed per protocol patient went into v-fib and asystole. One of the nurses called the family and told them of a perhaps lethal arrythmia happening to the patient, they said fix the arrythmia and call them in the morning. When the family was made aware by the cardiologist she was gone, they all came in and was screaming, throwing thmselves on the bed
I cried all the way home, i know as a nurse we did everything we could legally allowed to us. Why do i feel so bad?
Everyone deals with grief differently. I'm not sure nor do I even want to think about how I will react when I lose a parent or heaven forbid if I have to bury one of my children.
My grandmother who is a very prim and proper southern lady literally lost it when her father died several years ago. She said she could hear someone screaming and after a couple of minutes realized it was her. She did get a hold of herself then.
As for the family not coming when called, well....I've learned from dealing with my husbands family and my father's family that some people are real good at denial. If they don't see it or acknowledge it then they don't have to deal with it and maybe it'll go away. It being anything from money problems, family problems, sickness and even death. I've learned to be patient with them but I've also learned to be politely and gently blunt. So far it's worked ok....but I only do this with them because they are family and I can.
You are upset because even though you know you did everything you possibly could someone died. It's a natural thing but when we get to the point where it doesn't affect us we're in trouble. It's called compassion and that's what makes you a good nurse.
Coming from a mixed cultural background I can understand their grief. Personally, I do not think anyone can "overreact" to such event. If a loved one died I think I'd act the same way or worst. It is such a personal thing and you cannot practice for it....it just happens and you live the moment and do whatever it takes to get it off your chest.
I know people who throw a party and celebrate at the funeral (their culture) and everyone sees it normal. While we know in some other families this would be ludicris. :)
Sharon and others - Thanks for being the voice of reason in this sad thread.
Since when are people suppossed to grieve in a certain way? Or deal with impending death in a way that meets the standards of ANYONE else....culturally or not.
OP, being witness to the raw emotions and the display of those emotions of people who are in the throes of shock, sadness, and perhaps anger in seeing someone they love dearly, dead, is overwhelming to even the most seasoned of nurses. I think your reaction ("crying all the way home") was completely normal as you were touched deeply by the unfolding process with this family's way of handling the situation to the best of their ability...which I believe is what they were doing.
Sometimes it's not perfect. Perfect in the way one individual might think perfect should be. Our job is to accept and support WHATEVER way people deal with situations like this and allow them to do what they need to do by giving them the space and the time they need to do it and offering information and our comfort to the extent that they will accept. Sometimes it's a simple, "I'm sorry, I will be right here if you need anything," and then check on them frequently. This is a way to handle people in the depths of greif no matter if you're in the role of nurse, friend, relative, or acquaintance.
If anything is learned, we learn something about ourselves and our expectations and the way in which we personally deal with the death of a loved one. We find out that not all people are the same and no one way of greiving exists.
This thread saddens me. I think that some may learn by visiting grieving websites on the net. It seems there is much to learn here.
I can see where the OP is coming from....what would seem like an overreaction or a "show" given the attitudes and actions of the family.
However, I'm sure in their minds they really didn't think their mom would die, and when she did pass, it threw them for a loop.
At the same time, the whole "TV" soundings of the scenerio makes me wonder if this lady had money, and they were just waiting for her to die. Then when it happened, they put on their show to convince everyone of their grief.
(I doubt that b/c she seemed to be loved with so many people there earlier.)
Some people just want to remember their loved ones awake, looking at them, etc....not in trouble, being worked on, dead with tubes all over them, etc.
I work in LTC, and we had a family one time where the resident had a DNR, and when she passed away they came in and raised Cain about us NOT doing anything to save her. We had another lady who pitched a fit b/c she ALWAYS called her mother when her mother was eating, and we did our best to ALWAYS get her mother to the phone to talk to her anyway, then said that it was our fault that she didn't get to talk to her mother before her mother died when her mother laid in bed for two days dying and she didn't show up at all.
Quite frankly, its a way of disassociation. They don't want to be responsable, because being responsable means that they didn't care enough, or they didn't try enough, or whatever. Its easier to blame someone else for all our problems, and that's just what they do.
Specializes in LTC, assisted living, med-surg, psych.
I can't really add much of anything to what's already been posted here, except this: There really is no 'right' or 'wrong' way to mourn. Every culture, every family, every person has their own way of dealing with the loss of a loved one, and even that can vary depending on the situation.
For instance, I remember feeling like I was going to go insane when our second child died 7 hours after birth, 21 years ago; however I kept things bottled up tightly inside and worked desperately to maintain a calm front, because that's the way things were handled in my family of origin. Years later, though, the death of my beloved 15-year-old cat sent me into a fit of hysterics like I'd probably never had even when I was very little: I literally screamed, howled, and kicked the floor like a four-year-old throwing a tantrum!
When I look back now, I think that I was just letting out all of the pent-up emotions I'd been holding onto through the losses of my daughter, father, and mother, because by that time, I finally felt safe enough to express those emotions. My husband understood, and I knew no one was going to judge me or tell me not to cry. As a result, I think I deal much better with grief now........when a loss of some sort occurs, I allow myself to experience it fully, and I really do believe it shortens the process over the long term.
This is also why, as a nurse who has probably witnessed every possible emotional reaction to the shock of a loved one's death, I don't make judgments about peoples' responses, no matter how melodramatic they may appear to be on the surface. We really do not know with any certainty what is in another person's heart; who are we to decide whether a particular reaction is appropriate??
I am sorry for you. It is no surprise to me that you feel so bad. This family put on the display of care and meaning yet, when it really mattered, REALLY mattered they showed the true depth of thier concern.
This is very sad. The patient and family knew she was dieing, she only asked for their companionship as she died and they snubbed her!!
Crocodile tears? For display.
I agree that meaningful deeds are done versus just for display.
Sorry for this patient that the family could only put on the front of care.
I also understand that yes, some cultures have passing customs that involve much display yet, this poster was talking about the sadness of a patient who had to die without the comfort of her family, which she saught and the declined, (yet, lived five minutes away?)
Gen
I'm with Gennaver on this one. They might not even be guilty at all about not being there when the pt. passed. It's just for show. Probably angling for a lawsuit? Hope you documented that they were contacted and that they refused to see pt. while alive.
There are cultural differences and we have to accept them. In my family a show like that would be unacceptable and the other family members would feel as if they had been disgraced and yes we do have a hard time accepting things over the long run. Sometimes I see people putting on performances for the benefit of relatives. I can see them watching other family memebers out of the corner of their eyes to see how the behavior is being recieved. What can I say, it all goes with being a nurse. I know families that are exactly the opposite of mine and failure to make a display would be considered disgraceful. As for the refusal to come in when called, it is my opinion that some people feel so deeply that they appear to be neglectful or rejecting of family member.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
I agree with the other posters who wondered whether the family really knew what was going on. After re-reading the OP, this is the feeling I get. If I didn't know any medical terminology, and someone had called to tell me about a 'lethal arrythmia', I might have misunderstood it to be a temporary thing.
It sounds like the family didn't really care at all. Those who prosest too much, are usually trying to hide the truth. Their loud and dramatic grief may have just been a show to everyone else that "See, we really do care, listen to how much pain we are in". But, that's just my internet psychologist's opinion.
Perhaps what was so bothersome to the OP (it was to me when I read it) was that the family apparently couldn't be bothered while the patient was still alive - AEB: staff calls to let family know pt was asking for them and they didn't come in, even though they said they would; they were notified of a very serious dysrhythmia and they pretty much blew it off (fix it and call them in the morning?!); THEN when the patient passes, THEN they come in, THEN they show their concern ---- rather than show the patient how much they cared for her when she was still alive and crying for them to be with her. Perhaps their actions were a reflection of their feeling guilty for not coming in when the patient was asking for them?
OP - You did all you could for your patient. She is at peace now.
I think there is something to that. I have found that distant family members (other than direct relation - parent, sibling) will display the most screaming etc.. I think some of it is because they had such a limited amount of contact with them while they were alive and never were as directly involved in the illness cycle. Faamily that suffered with them have a perspective and realization of their death, they are not as "shocked" and I think are able to handle it differently. I once took care of a child who suffered and died from a brain tumor. When his death was imminent, hordes of family showed up at the bedside and the mom said to the nurses (not in a mean or resentful way). She said how much appreciated everyone coming to see him but where were they when he was alive and when she needed help caring for him. He needed them more then than he does now. I have a lot more respect for the greif of the family who was there than for the screaming fits of the family who was barely there.
It was probably a mixture of show and grief. My mom freaked out at her dads funeral and started screaming, crying, and just basically fell apart. I hate to admit it but the three or four days that my grandfather was in ICU at the University of kentucky Hospital we never went to see him. My mom is obese and has some trouble walking, I told her that we would drive up to the main entrance, I would steal a wheelchair if I had to and push her to the ICU but she just decided that he would be ok and didn't go. He was 83 years old and involved in a MVA, the local er treated him as best they could and told my aunt and uncle that he would need orthopedic surgery and to pick which hospital they wanted him to go to in Lexington. While in hospital he started going down hill, they took him to the ICU and he had a stroke, within twelve hours he suffered a massive MI and was gone, I wish in hindsight that we had gone to see him, guilt can be a big factor in how we grieve. Hind sight is 20/20 and sometimes it really bites you in the butt. The good lord gives us obstacles.
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riern
65 Posts
Everyone deals with grief differently. I'm not sure nor do I even want to think about how I will react when I lose a parent or heaven forbid if I have to bury one of my children.
My grandmother who is a very prim and proper southern lady literally lost it when her father died several years ago. She said she could hear someone screaming and after a couple of minutes realized it was her. She did get a hold of herself then.
As for the family not coming when called, well....I've learned from dealing with my husbands family and my father's family that some people are real good at denial. If they don't see it or acknowledge it then they don't have to deal with it and maybe it'll go away. It being anything from money problems, family problems, sickness and even death. I've learned to be patient with them but I've also learned to be politely and gently blunt. So far it's worked ok....but I only do this with them because they are family and I can.
You are upset because even though you know you did everything you possibly could someone died. It's a natural thing but when we get to the point where it doesn't affect us we're in trouble. It's called compassion and that's what makes you a good nurse.