So disgusted

Yes, for me those last few minutes can be crazy depending on the city fire and police dept personnel and policy. If the family calls 911, one city near me scrambles both the FD and police. Depending on the police officer there, sometimes there create a taped-off crime scene investigation. That never made sense to me. The city I work, sometimes we have medical examiner cases but even then it's never a crime scene investigation.

Here the responders must, under the law, do everything possible unless they actually see the special out of hospital DNR.

I'm sorry this happened to him.

Holy crap!!

Terrible! So not how hospice is to be! What ever happened to common sense and compassion and for the 'live in' how about ethics!

Indeed ... and whatever happened to the concept that the patient and family is the "unit of care" in hospice?

In these days of tight staffing, over-scheduling and strict oversight of OT - not to mention nurses needing a life of our own - it's getting harder and harder for us to provide the support and education that would prevent many of these scenarios. The OP is further hampered by being per diem, so, even though she knew the patient from previous visits, she probably had no way of knowing how much, if anything, the primary nurse was able to do by way of preparing the family for the moment of death.

Full disclosure: I was spoiled by working inpatient - families came to me and I was, by definition, able to be present for much more of the dying transition than a homecare nurse could be.

Speaking of compassion - the trauma of losing a spouse is second only that of losing a child. I think it's unrealistic to expect a spouse, by herself, to behave rationally at the moment of her husband's death, regardless of its predictability. In my 41-ish years of nursing, I have provided end of life comfort care for almost half that time, as a nurse on a dedicated AIDS unit in the 90's and as a hospice inpatient nurse. Yet, when my partner fell down dead in our bedroom, I was just as panicky and tremulous as if I'd never seen a corpse before - and my first call was 911.

We all have a vision of what constitutes "a good death". Hospice nurses strive to enable their patients and their families to have this experience. Yet, invariably, patients and their families turn out to be as human as we are - stubborn, angry, ignorant, inexperienced, in denial, demented - sometimes even venal. People tend to die as they have lived and family dynamics play out the way they always have. I think it's important to be realistic in our expectations as to what's possible in a given situation and avoid taking the difficult deaths as a personal affront.

The best we can do is all we can do.

So wrong on so many levels

yes it is - or it seems so to you - and me, and many others

a regard for people, alive or dead not every one has it

laws, regulations and the understanding of death do not make the scenario any easier

at least here the police and ambulance called out and then heard it is a hospice patient do minimal if the person has passed, no heroics until hospice staff arrives and then hand it over - then again there are a few wannabe heroes joining the EMT force who no matter what.... unless they have a DNR in hand (and then it is hard for them not to jump into action)

if the basic understanding is missing, be it in the patient, the family/caregiver or any other involved, your story will repeat! Sadly! keep teaching, do not be discouraged! the poor patient got his deserved rest after all - not the way we would like to see it happen, but he finally reached his destination.....

At least he was past the point of suffering.