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Batman24 12,451 Views

Joined: Dec 2, '06; Posts: 2,135 (50% Liked) ; Likes: 3,206

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  • Nov 30 '09

    As for the "thrusting" of the name of a local funeral home ... I'll paint a picture for you.

    It's easy for a nonmedical person to misinterpret many of the more subtle communications that go on between nurses/other HCPs and patients/families/caregivers. When I walk into a patient's room and say hello, how are you, what brings you here today & shake hands ... the patient/family/caregiver are likely to think I'm simply being friendly. And I am - but in that moment I've also assessed mental status, affect, respirations, skin color & temperature, muscle tone, and the patient's understanding of their condition.

    In the same vein - I believe it is likely that your brother did not "hear", because of his stress level, repeated suggestions to begin to think about arrangements for the patient. No HCP or social worker would have denied his shock, anger, and grief over the situation - but is simply reality that some unpleasant details of death must be dealt with quickly. Sometimes, regrettably, as a HCP, the time to guide patients/families/caregivers gently through a situation simply runs out and direct action, now, is required.

  • Nov 30 '09

    As for the "raise Holy Hell" bit ...

    I'd come back from the other side and inflict Hell on someone who cared for me for over a decade, but neglected to come up with my expressed, written wishes regarding end of life treatment until after I'd been subjected to pointless, painful interventions that I was powerless to stop.

    As a nurse caring for that patient, whether in the ER, OR, PACU, or ICU, my response would have been the same: given the patient's condition & prognosis, why are we doing this? I would find it very regrettable and distasteful to participate in. And then, if the patient's long-time caregiver suddenly provided a document initiated by the patient that would have made it unlikely that those pointless, painful interventions would have been performed ... I would be cold too. Professional, but cold.

    Why? Because I'm a stone cold *****? No. Because I am compassionate. Because I do everything I can to alleviate suffering, or see that it is avoided.

    Everyone has to pick their battles in life. As I see it, your brother has to grieve and cope with the loss of someone about whom he cared deeply. If he sees the perceived rudeness as the most important thing for him to deal with right now, then ... I guess that's what he'll do.

  • Nov 30 '09

    I agree with pretty much everyone else that's posted here. I just wanted to add one thing in response to this statement:

    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 the fact that she had CP had anything to do with it. I think the bottom line was that they knew she had terminal cancer and they wanted to make her comfortable, not put her through a lot of pain and suffering in the end. It doesn't take an oncologist to know that some cancers are terminal. The fact that everyone was suggesting hospice indicates that they already knew the prognosis.

    I can understand your brother's feelings and wanting a second opinion from a specialist.. He's human. A friend dying is very hard to deal with. I'm sure he was just hanging on to hope that an oncologist would say that something else could be done. Deciding that all the doctors and nurses felt like she didn't deserve to live because she had CP is just an easy way to displace his anger on them for the situation. The truth is, they wanted to do all they could to make her comfortable because they knew she was dying. The fact that she had CP was completely unrelated and did not make her unimportant to them.

    So..the doctor raised his voice to your brother and even said her life would continue to be horrible. The situation was stressful for everyone, doctors and nurses included. Who knows how long this lady suffered with cancer before it was diagnosed? Your brother was extremely distraught and probably not thinking clearly when all this unfortunate information just came at him from left field. Neither you nor I know if the doctor's statement was taken out of context or not. I have a feeling that most of the statements that your brother felt to be inappropriate were, but I cannot say for sure.

    I'm guessing that since she passed away, your brother has realized he probably should have listened to what the staff had suggested regarding her treatment. On top of his grief, he's probably also dealing with a massive amount of guilt that she was put through everything unnecessarily. I think the best thing that he could do, rather than focus on trying to get an apology from the hospital staff, is make peace with knowing that he and the doctors and nurses only wanted what they felt was in her best interest. They might have disagreed and butted heads, but she was what mattered both sides.

  • Nov 30 '09

    Quote from burberrylover
    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.
    I will very respectfully opine that the deceased lady is the one who truly deserves a heartfelt apology because she was robbed of the chance to ever have her final wishes honored. She endured traumatic emergency surgery, unrealistically heroic measures, futile treatments, questionable pain management, barbaric rescuscitation efforts, and four days of needless suffering before death. Although your brother has perceived the words and actions of the hospital staff as rude, he is not necessarily entitled to a formal apology from these people who were entrusted to tell him the blunt truth about the situation.

  • Nov 29 '09

    Quote from burberrylover
    I do, however,take offense to your description of her as a person "trapped in a crippled bodyform". She was more than that....she was a person who loved children and animals, enjoyed trips to the beach, had a friendly smile.... she was truly more than just her CP.
    maybe you should chill a bit?
    no offense intended at all....
    nor will i explain myself.

    take care.


  • Nov 29 '09

    hopefully the OB's ARE telling the patients ahead of time, and they are not finding out as they walk in the hospital door.....AND hopefully there are other competing hospitals to take away the business....

  • Nov 29 '09

    originally posted by burberrylover

    "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"


    the patient has every right to have adequate pain relief, even if said pain relief causes sleep/unconsciousness.

    your brother's statement about wanting the ability to communicate with the patient shows a certain level of selfishness and denial, and this is very frustrating to doctors and nurses. is it really in the dying patients best interest to be awake if severe pain is suspected?

    terminal cancer is just that, terminal cancer. no cure, no chance of meaningful recovery. attempts at treatment would be painful, futile, and would only prolong the agony.

    death is natural, everyone is going to die at some point. the very best thing we can do is ensure that death is dignified and painless. multiple painful surgeries, cpr, etc, is not painless or dignified for a terminally ill patient.

  • Nov 29 '09

    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.


  • Nov 29 '09

    You would not find a nurse performing medical interventions. Nurses perform nursing interventions.

  • Nov 29 '09

    Quote from burberrylover
    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....

  • Nov 29 '09

    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.

  • Nov 29 '09

    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.

  • Nov 29 '09

    Quote from Nascar nurse
    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.

  • Nov 29 '09

    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.

  • Nov 29 '09

    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.