Medical staff rude to my brother;complicated;advice please

TheCommuter, BSN, RN · Nov 29, 2009

I'm so very sorry that your brother was not treated with the utmost compassion during a very vulnerable time in his life. The healthcare providers with whom he dealt seemed to be brusque and cold, and really should have communicated in a more professional manner. I extend my condolences to your brother for the loss of his friend.

However, I can see the possible points of view of the staff members clearly. Your brother's friend had a terminal prognosis, yet she was subjected to futile treatments, extreme discomfort, and physically brutal rescuscitation efforts during her final days on earth when these measures would not have changed the course of her disease process. I suspect that the healthcare providers were becoming personally frustrated at being directed to do everything possible to save a person who could not realistically be saved due to the diagnosis of terminal CA.

I'm certainly not defending anyone's behavior. I am simply listing some possible reasons that underlie the callous behaviors of members of the healthcare team.

PostOpPrincess, BSN, RN · Nov 29, 2009

It is a very difficult thing when the healthcare providers are placed in this situation.

I do not envy them. Who wants to perform CPR on someone and hear their ribs crack? Not me. I have done it, but I often ask for "forgiveness" for having to do so. It's awful and can cause caregiver guilt. I've been there too. I don't like it when I am placed in that situation.

I "hear" the resentment via your statements about the HCP's side. I think your brother was not prepared to let his friend go yet and that being often the case (this happened so quickly) the HCPS could've been a little kinder. Sometimes, however, when they are already "compassion fatigued." --it's really, really difficult to do. Especially when they keep hitting a brick wall (i.e. they are wondering how someone can allow someone they love go through the "torture" of it all.) instead of allowing a peaceful death.

I honestly think that the HCPS were speeding up the process by pushing your brother to make a decision he wasn't ready to make. And they will need to be reminded of it--they should know when and how far someone can be "pushed" to make a decision. Were they wrong? Somewhat, but not completely.

Was your brother wrong? He was in denial and grieving and he wasn't ready. Is that wrong? No.

I think it was unfortunate for your brother to have to deal with this situation. I sincerely hope that he discovers the peace he needs, and that he tried to do everything he could for her, regardless of the outcome. I also hope he comes to the realization that there was nothing that could've changed his friend's outcome, so that he can have peace and not resent what might've have been.

WarmBlanket · Nov 29, 2009

This past week was a difficult one for my brother. After caring for a lady with cerebral palsy for 14 years(She lived in), she died. It started on the 21st when he brought her into the ER due to stomach pain. After doing a scan, it was determined that she had terminal cancer and had to have surgery to assess/remove the tumors.
Before the surgery, two surgeons sat down with my brother(who had POA). One doctor was fine, explained the procedure and was very compassionate. The conversation with the other doctor and my brother went like this:
Brother: I want everything to be done for her.
Doctor: You have to think about her quality of life (He was referring to the fact that she had CP and that if she survived the surgery, her life would not be that great anyway)
My brother took offense to this as he felt that her CP should not matter and that the best care should be offered.
The same doctor also raised his voice to my brother when my brother requested that CPR be done if needed, telling my brother that her ribs would most likely be broken and "did he really want that to be done to her?"
Anyway, she made it through the emergency surgery. The doctors and nurses began to pressure my brother, telling him to call hospice as she was terminal. This was on the 22nd, a Sunday, He said that he would call but that he wanted to see an oncologist about her prognosis first. He knew that she was terminal but just wanted these questions answered. He also wanted her to have pain relief but not so much that she could not communicate.
On Monday the 23rd, the breathing tube was removed( her liviing will stated that she did not want life support). By this time, one nurse in particular was acting in a very odd way. Two examples a) A doctor noticed that the lady's oxygen had been removed and the nurse told the doctor that my brother requested that it be removed. He did not. and b) When they transferred the lady to another room, the nurse grabbed the wheelchair away from my brother and said, "I will push the wheelchair and you can be the candleholder". Now, I am not a nurse yet and maybe that is nurse-ese for something, but that comment just sounds off.
By Wednesday the 25th, she was still hanging on. My brother had still not seen the oncologist. Doesn't this seem weird? She has all of these major tumors but an oncologist could not swing by? So my brother stays with her and comforts her. He has still not called hospice. At 4pm, the social worker from the ICU floor rudely hands my brother a piece of paper with the name and number of a local funeral home on it, shakes her head and says in a snotty tone,"I am leaving. Call this number if you have issues. It's too bad you could not have called hospice" . My brother's friend died about four hours later.
I feel that the the first doctor, the nurse and the social worker acted inappropriately. Can I please get some insight from all of you? Were these people acting normal in their world?

You have asked for insight . This was a very sad situation and in my opinion it was made worse by your brothers denial of the outcome. As you can see I have used bold and underlining to make my case : Who was the most vulnerable and important person ? You seem to think it was your brother. He was entrusted to care for someone who was debilitated and dying . Someone who had a living will that stated "no life support". She had terminal cancer and could have gone home with hospice to pass away with dignity . Instead she was put through surgery and had to spend her last four days "hanging on" in pain at a hospital . Maybe after 14 years he could not let go but this was not about your brother , it was about a sick and dying friend.

suanna · Nov 29, 2009

Your brothers friend had already expressed her wishes via her LPOW that she did not want heroic measures taken. Your brother had her prognosis discussed with him by an attending doc, who semed to be expressing the same thing that was in her living will- "she dosen't want to suffer if there is no hope of recovery..." The only activity of the oncologist may have been to look at her OR report and make a note on the chart that the patient is days from death and should be referred to hospice for comfort measures- from what you describe he wasn't involved in her care at all- there was no oncology intervention to be done. From all the staffs perspective your brother was forcing them to make a terminal patient suffer unnecessarily because he refused to believe the information given him by the attending physician. I'm sorry I'm not more on your brothers side, but honestly I have to feel for the poor woman who was put through a prolonged and painful dieing process that was not her wishes. When a family member won't listen to the primary doc and makes my patient go through more pain than they should I have a hard time not being a little "brisk" myself. We live in a country where people expect every specialist to be at thier beck and call to explain the same thing over and over. Sepecialty docs have gotten very busy and depend on the patients attending physician and the nursing staff to do the teaching and condition updates if they are going to see and treat enough patients to keep thier practice open. If a specialist has time to meet with not only his patients but every family that is related to every consult he gets wheather he treats the patient or not, it isn't a specialist you want on your teem- no one is referring to him for a reason, and he has lots of spare time.

shoegalRN, RN · Nov 29, 2009

I recently had to withdraw care on someone who walked into the hopsital complaining of a headache and turned out to have lung CA with mets to the brain. He had a poor prognosis, and yet, his family wanted "every measure taken" to ensure he survives. This poor man went through surgery, as well as multiple organ failure with his kidneys shutting down, to dialaysis, to being on 3 different pressors to keep his blood pressure up. He was also coded twice, which included broken ribs and all.

Hospice is there to provide comfort measures and make sure these pts die with dignity after a poor prognosis is given and there is a very poor outcome which will affect one's quality of life. If your brother's friend stated she didnt want any life support given, I feel your brother should have respected her wishes. It seems to me that your brother had a hard time letting go for his own reasons and wanted every measure taken to save this woman's life, even at the cost of her having a poor quality of life.

I'm sorry the docs and nurses were rude to him, but after having a pt who is 92 with CA being made a full code, I can certainly understand where they are coming from.

loriangel14, RN · Nov 29, 2009

I can see where they were coming from. She had terminal cancer and yet your brother chose to put her through the agony of surgery and intubation and also denied her adequate pain control because he wanted her to be able to communicate with him. That is a very selfish attitude and I have seen it many times where I work. Instead of allowing a patient to pass with peace and dignity they turn the last few days into a spectacle with no thought to the patient.

Tait, MSN, RN · Nov 29, 2009

Without being there myself I do not feel I can make any comment on the actions that could have been taken, however many of the comments the staff made to your brother were thoughtless, cold and immature.

We may have our opinions, concerns and grievances, but these should never be forced on family. If they request our advice it should be done with respect, compassion and empathy. If I don't feel I can provide that to a family I don't agree with I incorporate other members of my support team, aka the Chaplain, to help a family make these difficult decisions.

Tait

Nascar nurse, ASN, RN · Nov 29, 2009

From my experience (and this is only a possibility because I was obviously not there), I have found many times when telling a loved one something they don't want to hear, they tend to preceive the message as "rude", even if it wasn't. This seems to especially occur as multiple healthcare members become involved with the same message. Again, I don't KNOW that this is the case here, but would certainly consider it a possibility.

As a sideline note, I cringe when I read treat the pain, but only enough to allow them to communicate!?! Wow! Again, who is this about. The patient or the caregiver. (If it's me in the bed, please, just knock me out.. don't make me suffer just to talk to you).

burberrylover · Nov 29, 2009

Thank you for your replies. A few things:

1) The living will was not found until Sunday, after the emergency surgery took place. Apparently, the DRs were able to go through with the surgery before having that in hand. Once it was brought in and examined, the breathing tube went out.

2) My brother never requested that pain medication be withheld to the point that she would feel pain. He just did not want the staff overdoing it.

3) I think the fact that his friend had CP is important here. Sad to say but a lot of people do not believe that handicapped people should be allowed to live. My brother felt that they were pushing her to die because, in their eyes, her life was not as important as, say, a young teenager or a father of three....the language that was used "Her life was horrible before and it will be horrible now"direct quote from the DR.

4) While I agree that doctors are not miracle workers, I do feel that yes, they should be at the family's "beck and call". Doctors make an extremely good living and I feel that they have to earn that. I am not saying doctors should be abused but asking for an oncologist to step in for five minutes and say, "Here is what I, as a cancer specialist,think" is simply asking this person to do his job.

5) While I can appreciate all of the points made-and agree with most of them-nothing warranted the fact that a)the doctor raised his voice to my brother b) the rude comments made by the nurse and social workers. I understand that they might have been frustrated but they needed to remain professional. Their behavior was not professional; it was rude. And to that end, an apology from them will be made when everything is said and done.

burberrylover · Nov 29, 2009

From my experience (and this is only a possibility because I was obviously not there), I have found many times when telling a loved one something they don't want to hear, they tend to preceive the message as "rude", even if it wasn't.

If you read the OP, you don't find the nurse's words and social workers actions rude?

Nascar nurse, ASN, RN · Nov 29, 2009

From my experience (and this is only a possibility because I was obviously not there), I have found many times when telling a loved one something they don't want to hear, they tend to preceive the message as "rude", even if it wasn't.
If you read the OP, you don't find the nurse's words and social workers actions rude?

Yes, I find what was written to be very rude. My point is what actually gets said & what is the caregiver hears (both words and tone)is not always the same thing due to their stress with the situation.