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Some people insist it’s superstitious to believe the old saying that trouble comes in threes. Others think it’s hocus pocus, non-scientific, absurd. But anecdotally, it seems to happen that way. Bad things come in three’s. Death comes in three’s. Complicated family or patient interactions come in three’s.
That’s exactly what happened recently. Three complicated patient/family situations played out in the days before each patient died. In all 3 situations, what seemed obvious to us caregivers was not obvious to the family. All 3 patients were dying and all three were surrounded by family who could not see what we did for them. And all three created stressful interactions between the nurses and the families.
CASE
Grief masquerading as anxiety The first situation was in some ways the most difficult because Brad, the patient’s husband of 30 years, was an earnest and sweet caregiver. His wife had had multiple readmissions; each time she was weaker, but his hope endured. She had stage IV cancer and had been through several lines of therapy and was so weakened she could not tolerate more. But her doctor mentioned that if she was able to get a little stronger there was another treatment option she could try.
Brad grabbed hold of that lifeline with everything he had. With the slightest change in her condition — confusion, dehydration, infections — he rushed her to the ER. During each admission, the option of hospice was offered, but each time they refused, convinced she would get strong enough for that last chemo. On her final admission her condition deteriorated rapidly, so fast that Brad could not seem to register how poorly she was doing. He was hypervigilant to the smallest details and repeatedly asked the same questions “She’s snoring, is that ok?” “She’s been moving her legs around, what do you think that means?” He’d stand at the nurse’s station, hanging over the counter and waiting for her nurse and sweetly say, “I don’t want to bother anyone, I just have one question.” Brad was endearing and annoying at the same time. He wanted her to live so desperately. But his constant need for reassurance was exhausting for the staff.
