Late night emergency call

The call came late on a Sunday evening; I'm on call until Monday morning, so I assured the nurse I would indeed come in. A new patient was being admitted to the care facility where I work, as an emergency, impending death, and was accompanied by a family with high needs. I took report from the nurse who brought the patient in, who told me the patient had been in home hospice care and taken a terrible turn for the worse. The white middle-class family was completely undone, the nurse said, and it's not surprising given the suddenness of the change.

I found the family with the patient, all of them in hysterics (except the patient who was barely responsive and fighting for air). Listening for just a few minutes I realized that the death of this family member represented, for the family, a loss simply impossible to contemplate. YOU CAN'T DIE, they kept screaming at the patient. And I do mean screaming. The rooms are kind of soundproofed at the facility, but if the door was cracked you could hear them down the hall.

Four hours of struggle--the family fought every medical intervention on the part of nursing staff. At one point the patient's partner said to me, I knew you all would just drug her up so she can't even talk to us. And then, to the patient, WAKE UP, TALK TO ME!! In vain I tried to explain that the patient's disease was the reason for her inability to speak. We could have withdrawn all medication and with no oxygen getting to organs or brain, conversation was just not going to happen. There is, as a friend tells me often, a reason why they call it respiratory FAILURE.

The family did permit the nurses to give medicine for comfort, but every dose was a fight. The family believed the medicine was killing the patient, despite teaching from nursing staff and from me. And the family--partner and grown kids--remained resolutely hysterical, out of control, inconsolable. They could not leave the patient alone, but kept climbing on the bed, grabbing hands and arms, grabbing her head, her face, pulling at her, trying to get her to respond. The partner was the "gatekeeper" for the bunch but was so out of control that it was impossible to reason or even comfort. All interventions apparently felt like confrontations and escalated the wailing and screaming. In brief moments one or more of the adult children appeared to comprehend that the patient's death was inevitable, but they were not able to move out of hysteria and consider the patient's needs at all. Everytime I or the nurse entered the room we were met with openly hostile stares. We knew they were angry at the situation--the illness and death of their loved one--and we were easy to blame because we were there.

Who knows what earlier traumas had destroyed this family's coping skills. I don't know anything about them, though I wonder if the patient was perhaps the only grounded or pragmatic one, and without that voice, the family became like a solar system whose sun has mysteriously vanished, flung suddenly without gravity into the terror of deep space.

It was not a peaceful death. The patient's partner was lying atop the patient screaming, YOU PROMISED YOU'D GET WELL. The adult children surrounded the bed, sobbing, choking, wailing, DON'T DIE, YOU CAN'T LEAVE US!!! Not a comfortable way to leave this world.

The drama didn't stop with death; the family ripped all the medical devices off the patient before the coroner had released the body (luckily the coroner DID release, it would have been very messy indeed had the death been a coroner's case). After a couple of hours with their loved one, the family members were all cried out. Only then was I able to speak to the partner, to say how sorry I was for his loss, to say that I knew that all they wanted was for their loved one to get well, and how sorry I was that we could not offer them that solution.

I learned the next day that the patient had had cancer for three years and it had spread widely. But in that time there'd been no estate or funeral planning. The family just simply could not entertain this person's death as a possibility. It was not going to happen, not now, not ever. For whatever reason, the death seemed so horrible that it could not even be thought of. This was the unsurvivable loss, the event feared above anything. I have seen other families who have defined/experienced a particular loss as unsurvivable, and the consequences reach through generations. One family had experienced a divorce after a husband and father left. This impacted them so badly that fear of abandonment echoed on down, especially, among the women of the family, fears of abandonment by a man. It was almost encoded in the DNA: one does not survive abandonment. So I fear for the partner and children of our patient who died that Sunday evening. I hope somewhere they find a way to regroup and survive.

But what a failure I felt. There was simply nothing I could think of to bring peace or calm to that room. I wonder now what would have happened if I had simply been blunt, simply said, "Look, she is going to die, and she's going to die tonight. You have a decision to make: what do you want her last experience of you to be????" I don't know--that might have helped them focus. Or, it might have escalated them into physical confrontation with staff--they might have insisted on removing the patient to hospital for resuscitation, against the patient's wishes. I just don't know. Tomorrow I'll be visiting with my very-experienced chaplain boss, and I will ask him. At least, examining my feelings, I had a glimpse of what the family felt: helpless and angry. However, my one advantage was that if life has taught me anything it is that the unimaginable, the worst, can and does happen, so I was able to stay out of their panic and determination that their loved one not die. Staff said it helped THEM to have me on the floor throughout the struggle and willing to stay in the room with the screaming. So that's something, but wow.

What a night!!!