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Grief masquerading as control The distraught family of the second patient responded to the situation with confrontation, which quickly led to frustration for the people caring for Susan. In spite of good clinical nursing, the family constantly questioned everything we did. This family was a few doors down from Brad and his dying wife, and the contrast was stark. Susan had been estranged from her family for many years, but when she was admitted to the hospital they rushed to her bedside. They had known she was ill but not how far her cancer had progressed. We knew they were in shock and worked to provide support for them while keeping our focus on Susan. She was obtunded when she came into the emergency room (ER) and was immediately placed on a ventilator. By the time the family arrived she was too fragile to consider transferring her home on hospice; she would never survive the journey. With no treatment options and in complete organ failure, she was terminally extubated per her Physicians Order for Life-Sustaining Treatment (POLST) instructions. Then she was transferred to the oncology unit to die.
Her family also held a bedside vigil and someone was there all the time, which presented its own challenges. When she survived for several days the family began to think she might rally enough to interact with them. Susan required a morphine drip, which the nurses titrated for comfort, and any change in the rate was contested by the family. The goal of keeping Susan comfortable was explained to the family, but each time the rate was adjusted upward they became more confrontational. They believed we were trying to speed up the dying process. They wanted to have more of a say in her care. They wanted to believe she could pull through even as she was actively dying.
Grief masquerading as anger The third family struggled with the rapid progression of their loved one’s disease. Elise was feeling poorly on the day of her wedding anniversary but was able to participate in a family celebration. Only 2 days later, she developed severe abdominal pain and was hospitalized. Almost as soon as her pancreatic cancer was diagnosed she progressed to respiratory failure. Extended family and friends came to visit but could not believe she was in the intensive care unit (ICU) when she had been celebrating only a week earlier. Surely, we were wrong when we said she was dying. They, too, questioned everything we did, but instead of being just verbally confrontational they were angry and physically threatening. At one point security had to intervene (code gray) when her son began shouting at the nurses. As the reality of what was happening with Elise settled over the family they calmed down. Yet barbed comments continued to be made about what had happened to Elise, blaming health care workers who delivered the bad news as if they had caused her condition.
