unrealistic family of dying resident

[maah]

I don't mean to complain but I need to get this off my chest. There is a couple of families at my work that just can't let mom or dad just go, die. One in particular. He is a cardiologist, mom is dying, he never visits her really anyways. Now that mom is very close to death her wants everything done for her. Our unit MD even says that if we stop with the 2-3 antibiotics she would die. She moans everytime you touch her, but her son insists that we can put her on morphine. how do you deal with family members like this. I feel that our unit Dr. doesn't want to affend the cardiologist, so I don't think he is really advocating for the poor res. Any suggestions

[burn out]

Is the comcern about the antibiotics or the morphine. By all means give the morphine, to stop antibiotics ..isn't that withholding medical care?

[maah]

Thank you for your posts everyone. Unfortunately we can not give morphine, or as we , usually give is Roxanol Sl, without family consent. Her son doesn't think she needs pain meds. You all made me realize that yes her son is a Dr. but he is still her son and a human like the rest of us. I keep you all posted on what happens. thanks again.

[CapeCodMermaid, RN]

Unfortunately probably all of us have had a case like this or most surely will have some time in our careers. I am curious though-in what state do you need permission to give Morphine? I live in Massachusetts the most over-regulated state there is and we do NOT have to have permission for pain medication.

My other comment is about the antibiotics-of course it's withholding medical care if you don't give them, but not doing CPR or IV's or GTubes...these are all withholding medical care as well but patients and their families (with a proper and invoked health care proxy) can and do refuse these treatments all the time.

And,we always have to have family permission for a hospice eval. We, too, have to give the families a choice of hospices. If the person is on Medicaid, there is no financial burden on the family. If they are Medicare or Managed care, the family has to pay the room and board, unless the patient's condition is poor enough to qualify for 'inpatient' hospice in which case hospice pays for everything.

[roxyblueyes]

The key word in your statement is "won't let go". It's difficult to let go to the finality of death, also the unknown precession to the final days and the thereafter. There are a miraid of books on the birth experience and next to none on death - possibly because no one has came back to relate how to die???? Anyway Health Care workers have an insight the family doesn't as we walk that final road with some one frequently. If you become the families "guide " and educate them on what to expect, and show them you are there for them to they may mellow. As far as not letting them go - I remind the families that thier loved one is very tired and needs that final rest. I ask them to think of the worst work week they ever spent in thier life and try to remember the exhaustion they felt. Then I remind them that thier loved one has spent a life time of exhausting exerting experiences and need to be allowed to seek rest. With many families guilt and fear of the unknown keeps them on the defensive - stay calm and break through the barrier with education and support and the family should begin to become more receptive to the passing.

[roxyblueyes]

The key word in your statement is "won't let go". It's difficult to let go to the finality of death, also the unknown precession to the final days and the thereafter. There are a miraid of books on the birth experience and next to none on death - possibly because no one has came back to relate how to die???? Anyway Health Care workers have an insight the family doesn't as we walk that final road with some one frequently. If you become the families "guide " and educate them on what to expect, and show them you are there for them to they may mellow. As far as not letting them go - I remind the families that thier loved one is very tired and needs that final rest. I ask them to think of the worst work week they ever spent in thier life and try to remember the exhaustion they felt. Then I remind them that thier loved one has spent a life time of exhausting exerting experiences and need to be allowed to seek rest. With many families guilt and fear of the unknown keeps them on the defensive - stay calm and break through the barrier with education and support and the family should begin to become more receptive to the passing.

[marjoriemac, LPN]

I think a big issue is guilt. I have seen it so many times from families who do not visit, when the time comes, they realise that they have done little in life and feel they can make up for it in death. It is very sad, as they are really hurting themselves and their loved one. There is no easy answer though, emotions are powerful.

[azlisa]

What about clergy being notified? Sometimes spirtual guidence can be helpful. Sounds like pts son is going through some of the 5 steps of death/dying? I hope God is merciful in this case. Lisa W

[kidznurse]

Sadly death is seen as a failure of health care not a natural progression of life. Shame the death discourse is not more openly discussed amongst health professionals an the public. So many parents write birth plans very few write deah plans. I spent months discussing death with my grandmother after her cancer was diagnosed and how she would like to go , and guess what it was how she envisaged it. She had the strength to say no to treatment and to die with dignity peacefully surrounded by her families love and in her own home . Western Society puts pressure on for everyone to live at all costs . particularly in hospital. it's a terible place to die. Poor son in your story is a Doctor so feels even more pressure to perform " miracles" Irony is that death is also a miracle and a good death is as beautiful as a good birth or a life well lived. Grief counselling might help him but sadly doctors often are considered to be the last to need this.

Live and let die.

[Cherybaby]

I think a lot of the problem stems from the son being a cardiologist himself. They have this resolve that people cannot die. He is used to being in control of other lives, so he feels the need to take control of this one as well. It's the way he is grieving. By trying to jump in with a bunch of care is his way of dealing.

You also have to consider the family history that you do not know about. My grandmother is in an ALF. We all go to see her whenever we can. However, I have one uncle who refuses to. By my mothers own admission, her mother used to beat them both. However, my mother has chosen to forgive my grandmother as grandma gets closer to death. My uncle, however, refuses to hear about her at all. His opinion of her is quite different than my mothers...and they are both grieving in their own ways.

We, unfortunately, don't always have insight into our patients life history.

Cher.

[pumpkin92356]

Everyone deals with grief in their own way. Even a doctor whose mother is clearly diying and he wants everything done. Well, this could be because he needs to know that he done everything possible to prolong her life so that when the time does come the "If I had only tried this or that maybe...." I have seen this type of family involvment many many times over my nursing career and all you can do is listen and don't give your opinion be bias.