Medical staff rude to my brother;complicated;advice please

[burberrylover]

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?

[burberrylover]

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.

I did remind my brother of that and he told me that it was said in the exact same way I wrote and in a nasty, sarcastic tone.

[MedSurgeMess]

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).

This is exactly what I was going to say....I have heard doctors tell families that the loved one is dying in nicest way possible, only to hear them on the phone later telling every person in their contact list that this doctor is the meanest uncaring SOB possible. When you get bad news, it's never easy to take, no matter how kindly it's given. But since we weren't there, we shouldn't just assume that the doctors were just rude and mean.

[loriangel14, RN]

I find it curious that the OP seems more concerned with what her brother went through rather than what the patient went through. Most of her post conveys her brothers "suffering" rather than any concern for the painful death he subjected the pt to by denying her adequate pain control.Why would he feel that she should endure a painful ending just so he could talk to her.

[MedSurgeMess]

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.

I don't think that this was the major issue, but may have played part in it....terminal cancer and her age, from my experience would have been the limiters.....

[burberrylover]

I find it curious that the OP seems more concerned with what her brother went through rather than what the patient went through. Most of her post conveys her brothers "suffering" rather than any concern for the painful death he subjected the pt to by denying her adequate pain control.Why would he feel that she should endure a painful ending just so he could talk to her.

I never said he wanted pain medication to be limited so that she would suffer. Must a person be unconscious on pain meds for them to work?

[loriangel14, RN]

Of course not. But the primary goal should be to make the patient as comfortable as possible. Whether or not they can still talk should not be a concern. I see it over and over.Families want loved ones to be pain free but when it makes them drowsy they complain that they aren't able to "chat" with the pt and want the pain meds decreased.

[proudnurseRN]

"I do feel that yes, they should be at the family's "beck and call". "

No, The doctor, and medical staff, are there for the patient, not the family. Yes, treating the family is part of the job, but first and foremost is the patient. It seems you are forgetting this.

You didn't come here for advice. Maybe you came here to vent, or seeking only opinions that agree with yours. Maybe you came here to argue. I'm not really sure what your intentions are, but if it obvious that when you realized the majority disagreed with you that you became hostile and argumentative.

I have nothing else to add, as I agree with most of the other posters, particularly the ones that say that you are more concerned with how you brother was treated, as opposed to how the patient was treated, particularly since her wishes were in writing. Biased a bit, me thinks.

[burberrylover]

I'm not really sure what your intentions are, but if it obvious that when you realized the majority disagreed with you that you became hostile and argumentative.

Who is being hostile? I did not say that I disagree or do not appreciate or insights. I have questions. My brother did, too. Having questions or concerns is not a sin.

[tencat]

I never said he wanted pain medication to be limited so that she would suffer. Must a person be unconscious on pain meds for them to work?

Sometimes, yes. Sorry, but that's the way it can be depending on the pain severity, a person's tolerance to medications, etc.

As to the staff being rude....totally understand that. It gets so dang frustrating to see people suffer needlessly because caregivers think health care workers can and should make people live forever, regardless of quality of life. If a person is full of cancer, it is certainly appropriate to refer to hospice, and an oncologist is not necessary for that process to happen. And it's really hard to be nice to someone who is demanding that we continue making the patient suffer because he/she can't let them have a peaceful death, in spite of the overwhelming evidence that the patient is NOT going to get better. I feel bad for your brother, but I think he was being pretty unreasonable as well....

[Batman24]

You want the staff to medicate for the patient's comfort not your own. Many families do this and it is wrong. It should have been explained to your brother that they were treating the patient's needs and not his own. It might sound harsh but it's true and often necessary for family to hear.

The staff was right in this situation. They knew she was terminal and knew the best thing for her was hospice care as this point. Your brother should have listened. Surgery, tubes, etc. isn't the way this woman wanted to go. Most staff feels the same way. They see the needless suffering the patient goes through all for the benefit of the family. The focus needs to be on the patient and you bring in a social worker to help the family deal with their grief.

Hearing someone you love is dying is so hard. In this case seeing as she went so quickly it is even worse as the family had no time to prepare. Help your brother to grieve his beloved friend. Assure him how much she loved him and how she is now at peace. Repeat that again and again to comfort him. I pray he feels better soon.

[CuriousMe]

It also seems that the HCP's involved could have done a better job in educating and speaking with this PT' caregiver. I don't disagree that this PT could have had a much more peaceful end, but that might have been a possibility if someone had sat down and really talked with this Pt's caregiver instead of just displaying frustration with his decisions.

[leslie :-D]

while i understand your brother wanting to consult with an oncologist and delay hospice while he seeks answers, sadly, pts filled with cancerous tumors, LACK the time necessary to appease the poa.

while being rude is unprofessional and maybe even uncalled for, it's understandable when they know how the pt is going to suffer needlessly AND is going to be robbed of the peaceful death that EVERY ONE OF US IS ENTITLED TO.

honestly, i think your brother needs to deal with it, knowing that the hcw's wanted his friend to receive hospice care so she wouldn't have to suffer.

i've been a hospice nurse for many yrs and let me tell you, compassion is overrated, when dealing w/families who deny the reality of terminal illness and the journey it ultimately takes.

'sometimes'- a gentle dopeslap to the upside, is much more effective in redirecting and orienting to the pt's reality, rather than the poa making requests that necessitate futile, invasive and timely interventions.

me thinks it's time to move on...

so this poor pt can rip.

take care.

leslie