I had an 89 yr old patient curse out the doctor today.

[my.toys]

Because he told her she had about 4 more months to live.

Seriously, why do people think they are going to be immortal?

If I was told tommorrow that I was dying, I would try to make the best of the time I have, not curse the person telling me about my condition.

I really don't understand why death is treated as an anomoly, especially by people who are at an advanced age.

[Emergency RN]

I had an 89 yr old patient curse out the doctor today.

Because he told her she had about 4 more months to live. Seriously, why do people think they are going to be immortal? If I was told tommorrow that I was dying, I would try to make the best of the time I have, not curse the person telling me about my condition. I really don't understand why death is treated as an anomoly, especially by people who are at an advanced age.

Pardon me, but are you even a nurse? Why ask such an obvious question from the Five Stages of Dying? I mean, this is pretty basic psych nursing 101; clearly the reason for her reaction is the Anger phase from Elisabeth Kübler-Ross' classic description of how people accept impending death.

Amazon.com: On Death and Dying (9780684839387): Elisabeth Kubler-Ross: Books

The patient is just lashing out at the doctor because he was simply the one that brought the bad news.

[cecilsgirl]

Death is one of those things we never know how we will really react because we have not been there yet, I think too, I would not fight it at that age, but you know, survival instincts set in I think, just like I never want to get where someone else has to clean me up, but again, if the process happens slow,- and then one day there you are- in need of having someone clean you up......... who knows?? just a thought.

[RNperdiem, RN]

Poor doctor, they put up with their share of abuse too.

[suanna]

If you review Kubler-Ross stages of grief (death and dying) denial and anger are neck and neck for initial reaction. It is a difficult process to deal with by the staff, the patient and thier family. I find the patients reaction fairly common and as part of our mandate as patient care advocates we are supposed to help the patient process and express those emotions. It isn't a warm friendly chat with a friend, but it is part of our job. I'm sure the doctor is aware of this. I don't care if I'm 110 years old, I'm still going to be shocked when someone tells me I'm knocking on the pearly gates.

[TigerGalLE, BSN, RN]

Hospice medical care for dying patients : The New Yorker

Great article on death and dying from an MDs point of view.

[CoffeeRTC, BSN, RN]

I have elderly patients curse at doctors alot. Quite a few times they've deserved it too. LOL

[Altra, BSN, RN]

OK, how about we cut the OP some slack.

It would be presumptious of me to speak for the OP, but I will say that in my experience, I am daily astounded by what I see as the growing problem of our cultural ignorance of the inevitable circle of life.

We increasingly live in a world disconnected from the "natural" physicality of this planet where there are daily and seasonal rhythms and cycles of birth, growth, activity, rest, decline and inevitably death of all living things. Many people are mobile enough throughout their lifetimes that their contact and experience with the elderly is limited, and they therefore have limited or even no experience with watching others, and themselves, pass through the various stages of life and play different generational roles.

As a culture, we increasingly only define ourselves in terms of the ever-present NOW.

What a shock it is, to many, that we will not continue to exist in this "now" forever.

And that is what drives countless through futile, invasive and undignified interventions -- the lack of acceptance that the physical body is not perfect, certainly not forever, and that we are limited by our physical bodies.

It is psychologically unhealthy, IMO, to deny our own physicality.

[ICU_RN_BSN]

Come on everyone...What are the first two stages of dying???? Denial...Anger...Are you that surprised at her?

[Moogie]

I am not judging the patient but as a new RN I am still kind of stunned by how many patients seem to feel like death is something that can be delayed inevitably.

A 94 year old patient was asking if he could get a lung transplant last week, a patient who was comatose and completely unresponsive but who had scads of family members, had an NG tube placed because no one wanted to let MeeMaw go and Hospice was refused because "that's for people who are dying." *sigh* Did I mention she moaned in pain whenever anyone touched her, because the family took pain relief off the table, because they were worried she wouldn't recognize them anymore?

I wish we could have a more frank discussion about end of life issues in this country.

...I am daily astounded by what I see as the growing problem of our cultural ignorance of the inevitable circle of life.

We increasingly live in a world disconnected from the "natural" physicality of this planet where there are daily and seasonal rhythms and cycles of birth, growth, activity, rest, decline and inevitably death of all living things. Many people are mobile enough throughout their lifetimes that their contact and experience with the elderly is limited, and they therefore have limited or even no experience with watching others, and themselves, pass through the various stages of life and play different generational roles.

As a culture, we increasingly only define ourselves in terms of the ever-present NOW.

What a shock it is, to many, that we will not continue to exist in this "now" forever.

And that is what drives countless through futile, invasive and undignified interventions -- the lack of acceptance that the physical body is not perfect, certainly not forever, and that we are limited by our physical bodies.

It is psychologically unhealthy, IMO, to deny our own physicality.

I agree with both of you and have seen plenty of examples of people denying the inevitable throughout my career----although the attitude seems to be more prevalent in recent years than, say, twenty or thirty years ago. Most recently, I gave a talk at my church about end of life issues and several members had difficulty understanding that it might not be God's will to prolong the process of death through artificial means. I can't argue with people's spiritual beliefs, but it concerns me that so many folks are unrealistic in their expectations and exhort health professionals to "do everything" even if "everything" is costly, painful, and only prolongs the length rather than quality of life.

And then the politicians play into these cultural fears by telling the public that proponents of health care reform are going to "pull the plug on Grandma". No one wants that responsibility. No one wants to make that decision and second-guess themselves. I spoke with a gentleman who, after seven years, still struggled with his decision to make his mother's code status DNR. She had end stage Alzheimer's and, for the last years of her life, could not communicate, could not respond to others, could not participate in her own cares. Her joints were contractured and, although it was painful to move her (she could not talk but she could scream) the nursing staff had to turn and reposition her q 2 throughout the night to avoid bedsores. She was incontinent of both bladder and bowels. She couldn't eat---I don't think she had a g-tube or an NG but I think the nursing staff force-fed her pureed mush three times a day. She lingered in what must have been a living Hell for several years and remained a full code up until the last few months of her life. Still, her son wondered if there was anything he could have asked to have been done to continue her life. Why would anyone put someone they love through that kind of torture? I don't understand.

I'm sorry, but I think it is selfish of families to refuse to let their loved ones go. The scenario described by my.toys horrifies me. To think that a dying woman was denied pain medication because of the family's selfish need to be recognized by her is unfathomable.

[Butterfly0328]

Perhaps she was just really mad that this doctor could put an actual time frame on her expiration date. It really ****** me off when they say, "you have four month, six months" etc. They are not God!! I probably would have done the same thing.

[linearthinker, DNP, RN]

I'm sorry, bad news is no reason to behave like an *******. Decorum, people. Have some.

[diamondmeadows, BSN, RN]

I agree with those of you who have posted about quantity of live vs. quality of life and refusal to discuss end of life issues. It is so hard to see someone obviously suffering because their families won't let go. I think it's especially horrifying when adequate pain control is denied.

However, I think some of these patients and family members probably would have agreed with you too until it happened to them or their loved ones. I think it's a lot easier said than done on this issue when it actually comes down to you dying or your mom dying.

Also, most people are not nurses (not yet anyway, but give the nursing schools a few more years and we'll see!) and have not seen how this actually plays out, so I think they don't anticipate the road they are going down when they are accepting interventions offered. They don't expect their loved one to end up miserable and suffering. I think sometimes, like the PP whose church member had lingering feelings about his mom's DNR status, people just don't know where it's okay to draw the line, either. How much pain is too much? If someone doesn't have advance directives and is no longer able to make their own decisions, it can be so hard to try to decide when they would have chosen to stop.

We can wax philosophical all day, and honestly I think we should talk about these issues and clarify our values about them, but it's important to keep in mind that it's different when it's your own "MeeMaw" lying there needing you to make a decision, and it's definitely different when you're being told you're going to die.