Patients who die right after the family leaves the room.

chopwood carrywater · Jul 25, 2013

Hi there.
I don't work in hospice, but a friend of mine does and she's seen this happen several times. A patient will be circling the drain, the family stays and stays and stays, and the minute they leave for two minutes, the patient dies. The family ends up distraught and feeling guilty. It's terrible and sad.
What do you think is behind this phenomenon?

I think that it is probably due to coincide and odds. It is just that an experience like that is more memorable in a bad way for these family members. Often it seems that someone who is dying tries to hang on until a particular person(s) comes. Perhaps after the final piece is in place the person feels that it is okay to let go and die.

I think that there is no one answer; just as each of us live our lives differently, we all die differently.

I often tell the families that while it is meaningful to be there for the person when they die, I think it is also good to be there at various times during a persons stay in hospice. And sometimes a person can't be there at all. But hopefully a phone call will be of help to both people on the line.

But many times people must grieve and get through it in their own way, and I try to be there with a hug and kind words, or often with silence, when the pain and grief overwhelm the friends and family.

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MrChicagoRN, RN · Jul 25, 2013

There is the thought that a person may not want to die with family there, and holds on till they step out

DedHedRN · Jul 25, 2013

I also think that they do not want to die with the family there. I have seen it so often, that its got to be more then coincidence.

IEDave, ASN, CNA, LVN · Jul 26, 2013

Heard this many times myself, usually after discussing my late mother's passing. My gerontology professor had this happen with her father; when I volunteered with a hospice organization pretty much everyone had their stories about it; and when my mom died there were no family members at the hospital when she expired - in fact, the RN reported to me that she(mom) passed on while she(the RN) was tending to another pt.

While I can't speak for everyone, and I don't know of any studies done about this, my opinion is that there is some "plasticity" in the dying process, and someone actively dying has at least some control over it. With my mom, the RN reported that she was "looking around" just before she left. I asked if she(mom) was agitated, and she(the RN) said "no, she was just looking back & forth". This puzzled me, and then it just hit me that she was waiting for the room to be vacant before "moving on". Quite consistent with my mother's personality, and it actually gave me some sense of closure.

----- Dave

DroogieRN · Jul 27, 2013

This happened to me yesterday. Still so fresh and troublesome and I'm so glad to have three days off now. Patient stable all night and threw a PE right as I came on shift. There were literally 25 family members at the bedside all a.m. In an ICU but I let them stay. Sent them out at 1400 to eat and get some rest and so I could do some basic cares. Patient crashed and died quickly afterward. I firmly believe she waited until they left.

Bubbles · Jul 28, 2013

No reason for family members to be upset or feel guillty if they are educated and supported by the hospice nurses who can explain even before the patient's passing that this is something that often happens. Those of us with years of hospice experience have seen this happen way too often for it to be mere coincidence. We of the living do not know what death is like, but we have heard so many stories of people talking to loved ones who have preceded them in death. How many times has a person died shortly after being told it is ok for them to go? We always warn family members that hearing is the last sense to go, but how do we know what the dying person is feeling?

amoLucia · Jul 28, 2013

I believe it was Dr. Kubler-Ross who wrote something in Death & Dying that a pt will finally "let go" when they feel their family has accepted/recognized the imminent death. Like the pt now feels it's OK to pass on; like loose ends are being caught up.

I've also seen this happen after the provision of last rites to Catholic pts. Again, like the time is now OK and the pt has made his/her peace with God.

Can't explain it further but have seen it also in LTC.

chopwood carrywater · Jul 28, 2013

I am not saying that it is always a coincidence but, I do believe that sometimes it is coincidence. I also agree that it js important to provide education and support to the family do they are aware of changes that the dying person may go through as we'll as the range of feelings of family and friends before and after a person dies.

I always let them know that whatever happens, I will help them with whatever they need.

We die as we live, differently and in our own way. And it is the same for all of us who are dealing with the death, we grieve and remember in our own way.

Peace

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CT Pixie, BSN, RN · Jul 28, 2013

Working LTC I've seen this often. One patient and her family stand out. The husband would not leave her side for a couple of days. His children, grandchildren and I all pleaded with him to go with them to their house (literally 2 minutes away) if to do nothing else but to shower, change and brush his teeth.

Thankfully, he agreed to do just that. He came back and she was still with us which made him realize that his leaving would not cause or stop her from going. The family all gathered around again and then later left. The husband stayed behind. He told me he was running down to the vending machine downstairs and that he'd be right back while the CNA's tended to the patient. It was no sooner than the elevator doors closed that the CNA came to me and said the patient had passed. I know she was waiting for him to leave.

And then there were those (my own grandmother included) who hung on until every one of their loved ones that they held close and dear were 'home' with them. My grandmother was 'waiting' for her son. Calling for him frequently. (her grandchildren had all come to the house, some of us flew into be there, her daughters and husband was there). My uncle was a long distance trucker and was on the road when my gram declined and was close to death. We did not want to call him and have him drive like a maniac trying to get home before she passed, knowing that could lead to more tragedy. Gram hung on....we all prayed she'd let go. Then it dawned on me, she was waiting for her son. I told my grampa, the next time she calls for him, you go in and just tell her 'you' are there (acting as the son). She was in and out of consciousness and when she finally called her her son my grandfather went in and said, its ok mom, i'm here. You could actually see a change in her, it was as if she relaxed and were at peace. Five minutes after my grandfather did that, she took her last breath. I don't care what anyone says, I 100% believe she was waiting to pass until her family was ALL there.

lpoore · Jul 29, 2013

I have had this happen also. I believe the pt does not want them dying to be the last sight the family remembers.

melsch · Jul 29, 2013

Often patients wait until they are alone to die. I have even encouraged family to leave for an hour or so if a patient seems to be hanging on for some reason to see if possibly it is just that they want to be alone, with the reassurance that I will call if there is a drastic change, or the patient passes. Families who are ready and wishing for peace for their loved ones are usually open to the suggestion. Families also know their loved one and if it is their personality that they might want to be alone they sometimes come up with the idea on their own.