Family Matters

Today I was reminded how much of what we do in hospice revolves around the family instead of the patient. It is the family who are left to grieve, and they do so at different times and in different ways. They also come to grips with the impending death of their loved one on differing time lines. This makes for some interesting and challenging dynamics, not to mention conflicts, at end of life.

I worked with a son who thinks that if he makes sure that his mother gets all of her medications and food, she really won't have a terminal illness. Forget that she has progressive breast cancer and a growing tumor on her pancreas. Forget that her pain is only barely managed, and just when we think her nausea is controlled, something else tips that balance. From his point of view, she just needs to get up, move around, and be herself. His terror is barely concealed, but he thinks we don't know about it. When he is ready, we will speak of it, and try to help him deal with it.

Then there was the daughter who can't accept that her father is dying, even though he has been unresponsive with no intake in several days. After all, only a week ago, he was talking and eating. Some of the nursing staff say she's in denial, and I tell them I agree. Then I go on to explain what a wonderful coping mechanism denial is, how it helps us distance ourselves from a truth we can't accept until the time comes when we can. She will be OK, but in her own time. In the meantime, we have to give her our support too.

Finally there was a patient admitted to my inpatient unit this afternoon. The family has a history of conflict among themselves and with hospice staff. The sons who accompanied the patient were not happy about her admission, and directed their hostility to some staff members. It seemed to help to explain that hospice house admission represents loss of control to them, and we can't expect them to be happy about that. We should even expect that there would be some resistance. If we meet their hostility with friendliness and a polite attitude and don't get drawn in to their drama, we will be better able to meet the patient's needs. The sons left before I had a chance to speak with them. Hopefully tomorrow I'll be able to meet with them and address some of their issues.

Challenging, yes. Interesting, always.