Friday, September 19, 2008

Shock and Shame

1300 hrs -- I've stopped by one of our inpatient units to see how our patients are doing. The charge nurse, Charlotte, stops me before I begin to make rounds:

"The family in 413 has gone nuts," she says. "We've all tried to calm them down, but nothing's workin'. At least now they're stayin' in the room instead of shriekin' up 'n down the halls and makin' all the other families upset."

"Great," I mutter. "When did Mrs. P. die?"

"Oh, she's not dead, yet... awful close, though," Charlotte replies.The charge nurse then informs me that the "noisy crew" consists of two, middle-aged daughters, one teen-aged girl and an infant.

It's become clear that Charlotte and her staff have "given up" on this group. The usual form of emotional support offered by hospice staff is lost on this family. As long as the family remains exiled in room 413, the nurses, patients and families can get through their day in peace.

I take a deep breath... it's time to introduce myself to Mrs P's family. I quietly open the door, enter the small vestibule and peer around the corner to get a view of the room and its inhabitants.

"Look at the baby, look at the baby, look at the baby..." , the women chant excitedly.

One of the daughters is in bed with the patient. She has straddled Mrs. P. between her legs and propped her up into a sitting position. She is also forcing the nearly dead woman's eyes open with her fingers. Daughter "number two" is dangling the infant directly in front of the unresponsive patient.

"Look at the baby, look at the baby, look at the baby...", the chant is rapid-fire and unending. A short gasp escapes from me and I immediately bolt from the room.

I have counseled many families on the importance of maintaining a calm energy around their dying loved ones. Scream and howl all you want out in the backyard... just don't bring it to the bedside. A "peaceful" death... right? Isn't that what we're shooting for?

Is the family dysfunctional? Are there cultural differences at play that I haven't been made aware of? I don't know, but the scene in room 413 has shocked me and I feel ashamed. Shame on me for being both shocked and incapable of going back into the room.

Humbled, I walk back to the nurse's station and sit silently next to Charge Nurse Charlotte. I don't even get a chance to warm up the chair's seat cushion and...

"SHE'S DEAD! SHE'S DEAD!", screams the teenager as she runs through the hallway. "SHE'S DEAD... SHE'S DEAD!"

"Hoo boy", I say. "I guess that means --"

"Yup...", interrupts Charlotte. "She's dead".

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