Tuesday, February 15, 2011

Difficult Family

A particularly difficult family member was my problem recently. a real pain in my ass. His mother, an 89 year old bed bound nursing home pt, was dying. Shitting blood and bleeding out through the gut. She looked like a picture of death when she rolled through the door, and my first move was to look for a code status, which I fully expected should have been "Do not Resuscitate." It was not. We all began to mutter under our breaths and slowly began to work on the unfortunate woman. Torture her, we said. We were just preparing to intubate when they brought her son back. He was in tears. Didn't he expect this? Despite pointed questions and multiple attempts, he was adamant that the woman should be full code. We intubated her, put in a central line, and began dumping in fluids and uncrossed blood. Her initial hemoglobin was 4.4. She coded multiple times, and we collapsed her chest wall with our compressions. I made repeated visits to the son in the family room; updating, and occasionally pleading the case to withdraw support. He had family members on the way, could we just keep her going until they arrived? He was crying constantly. We worked for three hours, diverting care from younger, healthier patients who just had to wait. Finally, the grandchildren arrived, and slowly, after much talk with the chaplain, the nurses, and myself, the man decided to withdraw support. The woman went quietly, in a darkened room, surrounded by family. When it was over the man hugged me, thanking me repeatedly. He cried some more, and this time I cried as well. I had bought him the time he needed to come to grips with his mother's death. Maybe I still resented him a little for what I felt was prolonging her misery, but at that moment I felt understanding for his point of view, and I realized that often we feel family members are "difficult" or hard to deal with, largely because they just dont agree with exactly what we think should happen, and the decision does not rest solely with us.

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