Ever had a family overdramatic with dying patient?

Nurses General Nursing

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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?

Specializes in Telemetry, ICU, Resource Pool, Dialysis.
... but to become annoyed and disgruntled over the 'dramatics' of a mourning family is beyond my comprehension. their reaction was gutteral and knee-jerk. do the posters think they were attn-seeking? should we start hanging signs on our units that excess noise will be prohibited (so in the event you lose a loved one, keep the noise down)? should we inject them with ativan 3 mg?

leslie

Exactly. Grief is, to me, the ultimate emotion. I don't think it should ever be "modified" by bystanders - except to do what we can to unobtrusively contain it. Nobody should ever be made to feel worse than they already do (if that's even possible) by people insinuating that their emotions are a little too strong. Or that, God forbid, they may be bothering others for a short period of time. I hate seeing things like "display-putter-oner" and "flamboyant" used to describe grief.

I'm sure there are people who may be putting on a display for other family members. But who am I to know which ones they are. And these type of people are rare.

Just as an example of insensitivity by hospital staff: We had a 30y/o woman come into the ED code blue. Her husband was with her. She was coded for over an hour before she died. One of the nurses present made the comment in the room "Why does this crap always happen during shift change? Now I'm behind." The husband was standing just outside the room and heard it. Obviously he was angry. He took out his wallet and showed her pictures of their 2 young kids, and said "I'm sure they're sorry that their mom caused you such inconvience this morning" Even people who are incapable of feeling empathy for others can learn to behave sensitively and respectfully. I'm not even sure that that nurse felt bad - she seemed more upset that the husband had become angry with her. How we treat people during this time becomes a permanant part of their memory associated with the death of that loved one. It becomes part of the entire experience.

Leslie - I'm so glad that there are people like you in this profession.

Perhaps "pro-death" is a bit strong. I think you got the idea though. Maybe "pro-last wish" or something of that nature is more suitable. I was just reading all the arguments and so forth thinking that I might could add a slightly different twist on the topic.

I have witnessed family members throwing themselves on the floor, collapsing in the pt's room or the middle of the unit and so on. My concern with that is that we have lost one member of that family and we need to keep the others safe - grieving or not.

I am ever aware that grieving and the sometimes total shock of losing a loved one - especially unexpected (even expected deaths bring a variety of reactions) - may cause brief moments of what would otherwise be classified as insane behavior in the survivors.

I just try to keep them safe - to avoid syncopal episodes and causing themselves injury - or other such reactions in the particularly thesbianistic family. Some of the variances - as pointed out by many - are cultural in origin.

Whatever the case may be, it's an isolated incident that is likely not to occur on a daily basis so chalk it up to experience and move on.

~~PC~~

We got him out there, placed him under the large tree that he had selected from the ICU room, watched the birds, went through several O2 tanks, visited with his family, looked at family pictures, ate ice cream (that his son went to get at a local Baskin-Robbins which was closed but they opened the doors just for this occasion) and prayed. I stayed with him the entire time and was on phone contact with the unit, RT, etc so that he could have his needs met.

After nearly two hours in the blazing heat (Central Texas), he decided that he was ready and asked me to turn off the IV's. In less than 30 minutes, he took his last breath with his family all there praying over him. A remarkable event after they sat and told me repeatedly that they just don't understand why he wanted everything to end that way. I had lengthy discussions with them after which they thanked me endlessly for making their loved one's last wishes happen.

What a beautiful, wonderful death. Bless you for making it possible.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

"overdramatic" is in the eye of the beholder. I turned into a 5 year old crying child when i got the call that Grandma died. I know i won't handle Dad's passing that well.

tencat -

Thanks. It was well worth the uphill battle I had with administration to make it happen. I hope someone does the same for me someday (not anytime soon though!).

I actually had a number of fellow nurses (and people from other depts) come up to me in the few weeks after that saying that they were glad that I was the nurse....saying that if they'd have had the pt, it wouldn't have been that way. I'd like to think that anyone would make it happen but I had the luxury of only having that pt that day and I can be a bit on the assertive side when I put my mind to it. Plenty of people (ahem - our caring administration) said no but I wasn't willing to make his last wish only a dream.

You only have one chance to get it right. Those last few hours will be forever in the memory of his family.

Thanks again for the kind words....PC

Specializes in Med/Surg, Geriatrics.
Wow, jansailsea, the more I read your posts the more i just think... "wow"! I have not read your profile, I guess you are a nurse, but for the life of me, I just am not feeling any compassion from you towards humanity at all....

Let me explain,

First of all, what about the rights of the dying patient and their family? Sometimes just "closing the door" isn't gonna help. Especially during codes, etc. Your display of concern for the other pt.'s, at first, seems understandable...to a point. I think perhaps you may not realize the different grief processes others may go through.

I can tell you, if I lost my child, or husband, God forbid, I wouldn't give a damn who in the entire state heard me. That wouldn't even cross my mind. Perhaps if you realize the extent of the pain and emotion a person may be sufferring, you would "get it". And certainly, if I were the nurse, I wouldn't really care, either. I would be more concerned trying to get the looki-lous out of the way and allow the family some privacy! Does it really matter who hears what?

Do you really think being in the ER or the ICU is perceived to be a picnic, a day at the lake, for other pt's? Sure there is a lot of suffering and sorrow in our line of work. We as nurses have to somehow become accustomed to that and learn how to deal w/it....it seems you deal w/grief at an almost angry level...irritation, more concerned for others than the one who is truly at that moment undergoing perhaps the worst pain/grief in their lives? Yeah, it scares others, that is really not to be helped. Pain and death do exist in the world, I'm not getting the concept of the "other person's rights" and "boundaries"....

Just like in L&D, there are gals moaning, screaming and yelling all the time....and guess what, the other laboring moms (as well as visitors) hear 'em. Does it scare them? Yeah, most of the time; we nurses offer reassurance and assistance. Am I gonna tell my gal who is writhing in pain to "pipe down, so you don't scare the others...", uh, no, not gonna happen.

Working in our line, seeing what we do, we witness the rawest of emotions....giving birth and dying....the two are closely related, one the pain brings joy (usually), the other sadness, grief.

I have seen the kinds of nurses who, over time, have become bitter, stoic "walls", incapable of experienceing any emotion, b/c of their inability to deal w/the pain. I will never be that nurse, the day that comes, I'm outta nursing. To this day, when one of my moms loses a baby or we lose a little one in NICU, I sit w/them and cry w/them....as do most of us.

Dealing w/grief is never easy, but to be so harsh about it, so judgemental, really....geez, I hope you work in a clinic or do phone triage or something....

Peace to you, jansailsea, I'm sorry to sound critical.

Thank you, thank you, thank you!

Specializes in Rodeo Nursing (Neuro).
Perhaps "pro-death" is a bit strong. I think you got the idea though. Maybe "pro-last wish" or something of that nature is more suitable. I was just reading all the arguments and so forth thinking that I might could add a slightly different twist on the topic.

I have witnessed family members throwing themselves on the floor, collapsing in the pt's room or the middle of the unit and so on. My concern with that is that we have lost one member of that family and we need to keep the others safe - grieving or not.

I am ever aware that grieving and the sometimes total shock of losing a loved one - especially unexpected (even expected deaths bring a variety of reactions) - may cause brief moments of what would otherwise be classified as insane behavior in the survivors.

I just try to keep them safe - to avoid syncopal episodes and causing themselves injury - or other such reactions in the particularly thesbianistic family. Some of the variances - as pointed out by many - are cultural in origin.

Whatever the case may be, it's an isolated incident that is likely not to occur on a daily basis so chalk it up to experience and move on.

~~PC~~

Don't think I'll be buying any "I'm pro-death" bumperstickers anytime soon, but I like your philosophy. I have to do a death and dying CEU sometime in the near future (state law), and I'm going to be interested to see what it says about survivors.

Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Don't think I'll be buying any "I'm pro-death" bumperstickers anytime soon, but I like your philosophy. I have to do a death and dying CEU sometime in the near future (state law), and I'm going to be interested to see what it says about survivors.

How 'bout "Pro patient-centered death experience"?? :p

PCloudy - I want to add my admiration of all you did for your patient. We put so much into making the birth experience memorable and comfortable for all involved - with all the new birthing centers, water births, etc... But death is the other end of the same spectrum. The transition in is glorified, but the transition out often gets sterilized and swept under the rug. Keep up the good work!!

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?

I hate to be the only negative response here, but I see it as the family was trying not to look like a bunch of jerks by making a scene after they went home and not coming back. If I had a DNR and was bad off and my family didn't won't to spend the last of my good minutes with me, why should they want to spend time with me when i am dead and gone. I think you were had. It is normal to grieve and such, but you showed more sympathy by crying on your way home form work than they did by making a scene when everyone could see it. I suggest you look up the real meaning of piousness. You are a good nurse!

Specializes in orthopaedics/Medical/Oncology/Haematolog.
I hate to be the only negative response here, but I see it as the family was trying not to look like a bunch of jerks by making a scene after they went home and not coming back. If I had a DNR and was bad off and my family didn't won't to spend the last of my good minutes with me, why should they want to spend time with me when i am dead and gone. I think you were had. It is normal to grieve and such, but you showed more sympathy by crying on your way home form work than they did by making a scene when everyone could see it. I suggest you look up the real meaning of piousness. You are a good nurse!

I don't believe anyone in the midst of an overwhelming feeling, whether it is grief and sadness, joy or laughter or madness is having an over-reaction. Who judges whether a reaction is "over the top". Are there overreaction police out there somewhere? We are nurses, we are with the dying all the time, who are we to say that everyone should be with their loved ones as they die? For some people that is a very frightening concept.

I think it is all up to the culturally competent nurse to realize that no matter what her own views on a situation, or the reasons she perceives for the families behaviors, beliefs, and actions, how a family deals with that loss is no ones business but their own. That family alone owns their reactions, any feelings, whether they are grief, guilt, or nonchalance is for THEM to have, and not us to comment on. Any feelings we as professionals have on the matter are what WE own. No one can make us feel shock, horror, amusement or disgust at someone else's personal reactions, we OWN how we react. We think what we like, and whether we are right or wrong, it's really none of our concern. Personally, I could give a toss how someone else perceives my personal choice of the grieving process. Let them grieve. I don't know how other countries do it, but in New Zealand there are cultural safety papers in our nursing degrees. I think they are marvelous for creating understanding of the different concepts different cultures portray. The New Zealand Native culture grieves for 3 to 5 days after the death of a loved one. All the extended family comes together for the full term. They all sleep in a large lodge with the departed family member right there in the same room in an open coffin. There is wailing yes, and there are stories of the loved ones past, and stories of the loved ones ancestors past, let's not fantasize here, yes, sometimes there are arguments and disagreements and longtime grievances are aired. There is laughter and sharing of food and drink and everyone sleeps together in a big lodge. I believe these ceremonies go a long way to clearing a lot of the grieving process and bringing the family together to support each other. In essence, what is sometimes really mind-boggling to some is perfectly natural to others. We are in the business of healing, sometimes, we can't heal the sick. Let's not forget to worry about the healing of those that are left behind. And at the risk of making my parting comment a negative one, I'm sure that family wasn't thinking of how badly their behavior would make you feel. And I'm sure if they could read this, they would be suitably mollified and next time they will leave their shock and grieving and yes maybe...just maybe a little guilt, until they were at home or somewhere similarly conveniently hidden from polite society.

I believe that when we are dealing with death and dying that where are manny issue that are happening at the same time. The griving process at manny levels with manny family members. The culture plays a very big role in what you are seeing. There are also manny issue that have not been work out thru out life and now cannot be work out due to death. As a nurse it is our role to remined all people that time is critical and to work out as much as you can while people are alive.Dont forget about religon and what people believe. For most death is another step and set the stage for the passing of all. Reminding familys that there is a better place without suffering can be a good thing. God bless your work Joe DeMarco :)

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?

Specializes in Med Surg, Hospice, Home Health.

I heard of a situation at my hospital where the patient was a full code, there were 20+ people in the room, and when the code team arrived, they had to drag people out of the room who had fallen down screaming and crying and carrying on...he didn't make it needless to say.

atlantarn

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