When a patient is dying, am I expecting too much?

[ShayRN]

I had a family the other day that I really just felt bad about. The patient was only 50 and had cancer of the lungs. Two dgters and a few young grandchildren. You can just tell these people really didn't have much. However, the patient was dying, soon. As I got on shift she was still alert and terrified so I asked her if she wanted me to call the Chaplin for her. She nodded her head, eyes as big as saucers. After he left I went to check on her and one of the dgters was in the room. I asked her, where is your sister? She said, she had to go home to get her husband and children. (I knew they lived well over 45 minutes away.) I said, does she want to be here when you mom dies? She looked shocked that I said that...Yes, she said. Should I call her back? Well, yes, right away. An hour later I went to check on the patient and her dgter was leaving, again. I calmly walked over, checked her pulse (none) she had that shallow, ineffective breathing and her heart was bounding. I looked at the dgter that remained and said, did your sister go out for a cigarette? No, she said, mom is sleeping so she went home. I looked her straight in the eye and said, go get her, now. She said, well, you don't understand, her husband got paid today and they need to get the check. Ok, I do understand, really I do. But your mom is dying as we speak. She looked shocked. Ran out of the room and got her sister in the parking lot. They said to me, now what? Umm, you say good-bye. I pulled up chairs to let them sit beside her and stayed in the room in case they needed support in the end. She died with her dgters holding her hands 5 minutes later.

So I guess, the problem I have is this...Both daughters were told by me that mom was dying soon. Both girls knew early in the day that death was soon. No plans were made by them to get the spouse to the bank by a friend or another family member. No arrangements were made for a sitter for the youngest child (a baby that is not yet 1) So, he was in the room when grandma died. No funeral arrangements were made. WTH! When you have a Hospice nurse telling you, your mom is going to die, soon. FREAKIN LISTEN! Am I asking too much?

(OH YEAH! As a side note, when your told you have Stage 4 lung cancer with extensive mets and a cancer center tells you nothing more can be done. HERE IS A THOUGHT! Make some arrangements. Tell your family what kind of service you want. How about put a downpayment on something. THAT way, when you die at 7:30 at night your kids aren't staring at the nurse saying "We don't know what to do. We don't have a funeral home picked out and Oh yeah, NO money to pay for it.) FYI, I found out you can be cremated for 850.00.

[Dottie, RN]

That is so horrible! IMO, I think you did everything right. It's not your job to go out and find the funeral home or make those arrangements. You told both daughters their mother was passing away soon in advance. I feel for this family too, and no one likes to admit that their loved one is passing away, but come on, it's their job to make the preparations and be ready. Sounds like they were totally unprepared. Maybe they were in denial? I'm sorry you had to witness this, but like I said, I think you did everything you could to inform this family of what was expected.

[ShayRN]

That is so horrible! Sounds like they were totally unprepared. Maybe they were in denial? quote]

Yes, deep, deep in denial. However, as a hospice nurse part of my job is preparing them. Also, since the social worker wasn't there (off-shift) another part of my job is helping them figure out what they are going to do.

[Jolie, BSN]

I don't mean to be harsh or unkind, Shay.

But, yes, I think you were expecting too much. These people were in denial that their too young loved one was dying. They were incapable of processing the very logical information that you were presenting.

I know you provided them with loving guidance, and some day, when their minds have cleared, they may recognize that.

Take care.

[LHH1996]

i am sorry you went though that and were frustrated. we all have been in that situation i am sure. the thing is ..not everyone is able to handle such things, don't have the mind set, or just don't understand what to do. not like us. you can only do so much to help and the rest isn't up to you.

[tencat]

I understand your frustration, Shay. They weren't listening well to you. You were right to get them to stay with their dying mother. But they were not listening because they were not able to listen. Grief and denial do funny things to otherwise rational people. You did what you could, and the end turned out well with daughters at the bedside. Getting there was rough, but you handled it well, I think.

I do have to ask, why was it a bad thing to have the baby there when his/her grandma died? And why didn't you have access to a social worker? If one is gone, another should be covering....and if not that is something you might want to bring up with the powers that be.

[Loralai]

Yes, you were expecting too much. Most people have never seen death before. They don't know what it looks like, what it sounds like. Their loved one looking tired with shallow breathing means to them that they just need a bit more rest, to a nurse it means they are dying. The shock of just accepting that a loved one is seriously ill is sometimes too much for a family to comprehend. Especially when such a short while ago you remember them as a vibrant, healthy, and active individual. You were also expecting this relatively young individual at 50 to fully accept their death, to plan for it, to know what to do.

There are many people in this world have never had to plan a funeral, who wouldn't have the first clue where to start, who to call, how to make arrangements. The death of their loved one could, quite possibly, have been the first experience this family had with making these plans. What you experience on a daily basis and makes perfect common sense to you, is something that many families honestly have never had to deal with.

[morte, LPN, LVN]

essentially a failure of socialization.....fragmentation of the extended family.....at one time, by simple exposure, they would have had a clue... ie.what did mom do when grandma died or even a generation further back...what happened went aunt/uncles died.....this doesnt happen so much any more.....we protect the kids well past the point that it is healthy, sometimes.....this is part of life that they need to deal with

[pennyaline]

You are angry. And you are being incredibly unfair to this woman's daughters. If they don't understand or react to terminal illness, death and dying the way we think they should, they're not doing anything wrong. They may have been in denial, or trying to juggle their own responsibilities and priorities, struggling unsuccessfully to grapple with the enormity of the impending loss, dealing with possible absence of emotional understanding from their own spouses, or experiencing any number of the aspects of a process of bereavement and grief that invariably turns us inside out. The process is never an easy one for families, no matter how much we think we've done to prepare them. To stand back later and criticize their responses from a clinical point of view and judge them negatively, as you have done in your post, is callous and utterly devoid of empathy.

You need to work out why you are so angry about this. Nurses are bereaved and grieve when their patients die, too. Have you allowed yourself to mourn this one? What her family did and didn't do correctly (in your opinion) is of no importance now. Let it go. Remain accepting and available for the patient's family so that you can support them in their grief, and allow your own grief and hard feelings to open up and resolve.

[mama_d, BSN, RN]

There are some times when I have to take a deep breath and put myself in their shoes. It's so easy to become somewhat jaded when you see the same thing all of the time.

I see denial up to the last breath fairly often. Yeah, it's easier on everyone when that's not the case, but sometimes cancer doesn't give enough time to get adjusted to the fact that death is coming soon. You said she was 50, that's younger than my mom is...I'd be having a very rough time with it, even with my background. As the oldest, I know a lot of it would fall on me, but honestly, I don't know how I'd cope. I don't even know for sure where the money for the next electric bill is going to come from, much less having to worry about a dying mother and everything that goes along with it.

You mention that the baby was in the room and the way I interpreted what you said indicated that you had issues with this...when my grandfather died, it was while he was holding my son, who was about six months old at the time. He doesn't remember it, obviously, but he's been told about it, and it's an important fact of his life. When his other great-grandfather passed, he commented that it was sad that they didn't get to while they were holding a baby, b/c that's something that makes everyone happy, and that everyone should get to die holding a baby. That's was his (immature) view of what a good death is, and I'm certain that it's based on what happened with my grandfather.

So, I totally understand where your frustrations with the situation come from, but also can see where they'd be coming from with their denial of the situation.

[sunray12]

This is a sad story. It sounds like the daughters were probably stunned and in denial. Without your guidance they wouldn't have known what to do, so it was very nice of you to direct this family through the process. It doesn't matter about the toddler in the imo. 1) He's too young to know what was going on and it's not like he was witnessing a death by violence. 2) Better for him to be with his mother and family at an important transitional moment than with a babysitter he doesn't know.

[hiddencatRN, BSN, RN]

I think it's good that you were able to get them to stay with their mother. But I'm with the others- they were not able to be rational at that point. When a crisis is effecting you personally, it's hard to know what you're supposed to do even if you'd be able to guide someone else through the experience.

My husband is a paramedic and I recently had a bike accident and wound up in the ER. He was totally freaked out and didn't really handle it well at all (in my shaken-up from the accident state I thought he was mad at me for some reason), but as a paramedic he is amazingly calm and collected with his patients. He told me later that it's very different to be a paramedic to your wife than to a stranger. And this was a very, very minor thing compared to seeing your mother die.

I'm sure the daughters are grateful to you for keeping them there, or at least will be once they can start to think about the experience rationally.