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?

[leslie :-D]

you know burberry, your situation reminded me of when my son was born 11 wks early...

my water had broken when i was 25 wks pregnant but signed out ama after a couple of days.

this necessitated me going to the hospital on a daily basis until i delivered.

and even after delivery, it was sev'l wks that my son was in nicu, then special care, then transferred to a hospital closer to us...then finally home.

the whole experience was a nightmare for me.

i found everyone rude, snippy and even some were blatantly contemptuous...

specifically the nurses and the doctors on the mfm team (maternal fetal medicine).

i was incredulous that anyone could be so cold, callous and snarky...

nevermind several of them.

well, much later i ordered copies of all the medical records.

much to my surprise, it was ME (yes, ME) who was considered to be "anxious and demanding"...

that i was a highly difficult pt to manage, and the chief of the mfm even threatened to transfer me to another hospital.

(which is true, and i laugh whenever i remember the chief threatening me, and my snippy response.)

my point?

that perception is everything and all that time, i had truly believed THEY were the monsters...

and that my reactions were always in response to being treated so shabbily.

(i mean, REALLY...did they ALL have to clap as i was finally discharged from their care????)

so yeah, maybe they were rude, but maybe your brother was a bit stressed as well.

when you become a nurse, you will be reminded of this thread and experience that "AHA" moment...

and finally understand what most of us are trying to explain to you.

truly, wishing you and yours, the very best of everything.

it's all good, i promise.

leslie

[wooh, BSN, RN]

I don't think people are trying to say that your brother was lying about what the hospital staff said. I think most are suggesting that that due to his own personal distress, it's possible that he misinterpreted their meanings and tone. It's something that happens all the time in situations like he was in. It's easy to take offense to non-offensive things and only hear what you want to hear when you're given such devastating news.

We have a reports of a variety of people at the hospital being "rude" to your brother. The common denominator there is your brother. Not saying he caused it. Not saying he deserved it. Just saying, he was stressed, and in that stress, I could offer him all the compassion in the world and in his stress he'd think I'm the meanest thing to ever walk the earth. Nobody thinks he's "lying." I just think stress and grief colored his perceptions of all the interactions he had.

[Virgo_RN, BSN, RN]

However, I would like to add just one more thing about the pain management...Too many times I have seen family members demand pain medication be stopped because they want to talk to their loved ones, when in fact it isn't the pain medication making the person unresponsive.

Off topic, but I recently had a patient c hx of cancer, on treatment, present to the ED with right sided chest pain. Doc does the exam and eval, we order some labs and tests. While I'm giving the patient some morphine to make him more comfortable, the wife states "I stopped giving him his oxycodone because I don't like how confused it makes him." :angryfire

Now, of course I was not rude, but this person did need some frank discussion and education. I wonder if she thought I was being "rude"?

[Junebugfairy]

again, is yelling at a patient's family member appropriate? is thrusting a piece of paper with a funeral parlor's name on it ok?

if someone will not listen, sometimes a little yelling can get your words to enter the brain more easily...

in all seriousness.. final preparations must be made, so giving a funeral home number was a good thing, many people just do not know who to call.

[nursel56]

he is going to ask for the apology. i never said that i was.

"an apology will be made" sounds like something you are deciding, not your brother. most of your responses give the impression that you are protecting your brother from the sandlot bullies instead of giving him some feedback in the effort to assist him as he pursues this issue. i understand that he is very emotional right now, but many people have issues with how a sudden crisis is handled by hospital staff, including myself when my dad died in a ct scanner. believe me, we wanted to raise holy hell with the staff before we faced the fact that our dad was gone. the truth is, though- that isn't something that needs to be done immediately.

you've had response after response pointing out that a person in the middle of such a traumatic event misinterpets the tone and intent of other people. all i was trying to say is that if you take away the subjective part of your brother's experience- most of it can be viewed in a different way. yet you continue to insist that they were rude, snotty, sarcastic, grabby, odd, yelled and thrust paper in your brother's face.

i don't think anyone is going to turn anyone into the authorites....who said that? i did ask my brother to clarify and he did stress that the doctor was referring to her cp being a detriment. the doctor raised his voice as well. there is no place for yelling from either side.

again, referring to "an apology will be made". not maybe, not should be, but will. how do you suppose that would happen? not trying to be snide or sarcastic. that's shorthand-- if you know a way of compelling several people to apologize without involving a formal complaint to the hospital i'd be interested in hearing it.

so why didn't the nurse say, 'i will push the empty wheelchair. it is against policy for you to do that". she handed him nothing to carry.

i don't really know what she meant. point was it isn't necessarily a rude thing. what do you think "you be the candleholder" meant?

well she had insurance.....

insurance doesn't mean that someone can direct their own care and expect the insurance company or medicare/medicaid to pay for it.

4. rude social worker-- well, yeah- turn her in and demand an apology.

i don't quite get your snideness here...can you explain?

you interpreted that as snide? that's not how i meant it at all! that's why i put the smiley-face in there.

you've got some really great responses here from the nurses-- please don't assume that those who disagree are burned out and jaded- they are offering another point of view with the best interests of the patient in mind! you asked for feedback, you got feedback. if all you wanted was validation, i am sorry you are disappointed.

[AOx1]

In past careers, I have had to keep my mouth shut when I disagreed with a customer or a superior or whatever.

The difference here is that as nurses, we are primarily charged with being the advocate of the patient's best interests. We are to stand up and expect that the patient receives the best possible treatment, or in this case, that the patient is allowed to die according to their expressed wishes.

An expectation of consumerism as the driving force behind health care and its provision seems to be the dominant trend emerging in today's view of healthcare. I find it frightening. If this continues, will we be expected to provide the best care only to the highest bidder? Will physicians be pressured to provide care that goes against accepted medical standards and is futile simply because someone is willing to pay for it? This is what you can expect in a market driven health care economy. Press Gainey has opened a can of worms.

[kids]

Again, is yelling at a patient's family member appropriate? Is thrusting a piece of paper with a funeral parlor's name on it ok?

I don't base my opinions on heresay. When the person it actually happened to comes along to discuss it, I'll give my opinion.

I've been the family member receiving news I didn't want to hear and I've been the nurse standing with the exact same doctor hearing her say the exact same words to a different family. What I 'heard' each time was completely different.

This situation is exactly why I believe that if a person is deemed to be in the final stages of a terminal diagnosis that the wishes they expressed in a Living Will should over ride a PoA.

[TopazLover, BSN, RN]

I have been watching this thread for 2 days and keep reminding myself that nurses fight for what is best for the patient. In general doctors fight death. Families fight to keep their loved ones, and the patient is the one who is actually in the fight to live or die. There are cultures that believe that every effort must be made to maintain life as long as possible. We nurses tend to see this as prolonging the death.

Each one of these facets cannot be without stressful interaction with each other.

We, as nurses, know how hard we worked to get our education and acquire the knowledge that has been shared for many, many pages. The OP is acquiring this knowledge and my guess is that the brother had little of it. His knowledge base was most likely focused on CP. During these stressful times is not the best time to be getting medical education at the oncology level. In general what families know about disease and death is what they have picked up in bad TV shows, historical talks from the family historian about how Aunt Gertie died, and conversations with friends and neighbors.

I firmly believe each facet in the care of this poor woman was doing their best with the knowledge they had at the time. Much of what has been presented I can see clearly in my mind. The perceptions based on knowledge, attitudes, and skills from all sides were very different. How could they not be?

Can we use what we learned here and exchanged here to educate more people before they are faced with this kind of situation? Perhaps the brother should not have been given the responsibility for the HC POA. I know in my family I have been asked to do this job and take it as a heavy responsibility because I know what it means. Did he?

Educate, educate, educate before the crisis.

My prayers for all the family, the care givers, and all who are faced with these situations - ever.

[nursel56]

Can we use what we learned here and exchanged here to educate more people before they are faced with this kind of situation? Perhaps the brother should not have been given the responsibility for the HC POA. I know in my family I have been asked to do this job and take it as a heavy responsibility because I know what it means. Did he?

Educate, educate, educate before the crisis.

My prayers for all the family, the care givers, and all who are faced with these situations - ever.

Amen to that! Your repetition "educate, educate, educate" is so pertinent. Nothing is quite so awful, and really preventable as to have everyone in the family running around ransacking through files, drawers and old charts to find out if, where and when an Advance Directive might be when the final trip to the hospital is made for the chronically ill or disabled. I try to bring it up whenever I can with the families I work with, in a gentle way- but the OP did bring to fore the reality that families perceive that the healthcare monolith devalues the life of their disabled family member. I really don't believe that is true.

[PostOpPrincess, BSN, RN]

you know burberry, your situation reminded me of when my son was born 11 wks early...

my water had broken when i was 25 wks pregnant but signed out ama after a couple of days.

this necessitated me going to the hospital on a daily basis until i delivered.

and even after delivery, it was sev'l wks that my son was in nicu, then special care, then transferred to a hospital closer to us...then finally home.

the whole experience was a nightmare for me.

i found everyone rude, snippy and even some were blatantly contemptuous...

specifically the nurses and the doctors on the mfm team (maternal fetal medicine).

i was incredulous that anyone could be so cold, callous and snarky...

nevermind several of them.

well, much later i ordered copies of all the medical records.

much to my surprise, it was ME (yes, ME) who was considered to be "anxious and demanding"...

that i was a highly difficult pt to manage, and the chief of the mfm even threatened to transfer me to another hospital.

(which is true, and i laugh whenever i remember the chief threatening me, and my snippy response.)

my point?

that perception is everything and all that time, i had truly believed THEY were the monsters...

and that my reactions were always in response to being treated so shabbily.

(i mean, REALLY...did they ALL have to clap as i was finally discharged from their care????)

so yeah, maybe they were rude, but maybe your brother was a bit stressed as well.

when you become a nurse, you will be reminded of this thread and experience that "AHA" moment...

and finally understand what most of us are trying to explain to you.

truly, wishing you and yours, the very best of everything.

it's all good, i promise.

leslie

And Op, one more thing to add to Leslie's comment, give yourself and brother some breathing room and come back another time to reflect. Everything is so sore right now, an open wound.

It will be clear someday.

[PostOpPrincess, BSN, RN]

And Leslie,

I am a nightmare patient like you too.

A couple of hospitalizations for me and loved ones and I remember some of my own behavior.

I cringe now...but I remember being in survival mode then....

So...I feel for both sides...

[NRSKarenRN, BSN, RN]

Closing as thread has run its course... thank you to all who presented various reasons for staffs actions and brothers interpretation of events. May you both find peace in the days ahead and a lesson to take with you during your clinical experiences.