I always find it quite sad when I get handoff on a patient and the off going says, “There’s been no family here.” It happened yesterday. On a patient who had been in the hospital for two months. She had four sons, one of whom had power of attorney and refused to give his contact information to our social worker who had tried for days to contact him and finally got through via her medicaid application. So here she sits, all tubes and drains and lines and artificial airway. Lonely. Probably scared. Totally disengaged and in no way willing or able to participate in her care.
Family. It can be my worst enemy or my best ally while I’m caring for one of its own. I place families in three rough categories. Up My Ass, Pleasantly Present and Nowhere To Be Found. On any given day I may have a smattering of all three, the worst being multiple UMAs or NTBFs at the same time. The woman above was a clear case of NTBF.
PPs are the best. They don’t need much explaining. They just need Nobel Peace Prizes. They’re present, helpful, observant, stand back when they need to and step in when its appropriate. I love PPs. I like to think that I’d be a PP if any family of mine was hospitalized. They get a disproportionately small paragraph in this post, but have disproportionately more respect from me.
NTBFs have a spectrum of their own. Sometimes Dad just needs a lap chole and nobody can get the time off work to come sit and chat while he sips his broth and munches jell-o. They show up on discharge day and Dad’s no worse for the wear. The other end of the spectrum is like the woman above. Often they’re incredibly complex cases with many co-morbidities and complications. I’ll never forget a patient who was on my unit dying. He’d been there for several days and had had no visitors or family at the bedside. He was obtunded and unresponsive and we were withdrawing life support based on a phone call from a son who had legal DPOA. The son lived a plane flight away and there were two local children who provided no contact. The patient indeed needed to be allowed to pass. As the time neared, I found myself sitting in his room while I did my charting, thinking about different family relationships and dynamics. I realize some families must just suck. Physical and emotional abuse, estrangement, fighting, substance abuse and mental illness would all be very difficult to deal with in a family. I get that. I have no idea what kind of father, brother, son, uncle or grandfather he was. Maybe he was one of those I just described. But as I sat watching this man take his last breaths I couldn’t help but be sad for him. I felt strongly that he shouldn’t have to die alone. So I held his hand and wished him peace wherever he went. Even more sad was the phone call I had to make to that son after he passed. We needed to know what he wanted to do with the body. “I don’t care what you do with it” was his reply. So the remains were sent to the county medical examiner’s office to be mass cremated with the other unclaimed, perhaps unloved bodies.
UMAs are, in my opinion, the worst. They think of themselves as PPs, but they most definitely are not. Quite often, the patient is very complex much like the NTBFs patients. A typical UMA has been in the hospital for some time, is very ill, may have had some unfortunate complications and if there is an error to be made (diagnosis, medication or otherwise) it inevitably will happen on these patients. Murphy’s Law. This leads to distrust of all staff (somewhat understandable) and further travel UMA. They do shifts, just like the nurses. They have their own shift handoff too. An update, a warning and a phone call 10 minutes after leaving the unit for an update. I take particular offense to UMAs. I know I shouldn’t; I’m learning not to. But I still do a little. It’s the trust thing. I take pride in my excellent care. I’m type A at work, I’m smart, I think critically, I’m personable, I’m organized, I’m observant and I get what I need from doctors and surgeons. And when someone doesn’t have the trust in me or my staff enough to leave their family member alone in the room under our care for one single minute, I take issue with that. And then I take that issue and I stuff it way down next to my ego. Because experience has taught me to just go with the flow with these folks. They micromanage, they perseverate on the things they think they understand, they control the things they can. Like refusing to use the call light and waiting until it is answered, instead opting to trawl up and down the halls until they spot me in another patient’s room and stand waiting outside the door until I have to come out like a trapped and cornered raccoon. UMAs usually have a rudimentary knowledge of basic medical sciences from their family member’s experience with illness. They always want to know lab results. “What was his blood sugar this morning? Oh, it was 205? Well you must not be giving him enough insulin because at home it’s always under 150. I’d like to talk to the doctor right now please” or “what was his white blood cell count? It was up? Well the doctors don’t have him on the right antibiotic then. Call the surgeon right now because there must be some infection inside.”
Gah! It’s making my blood pressure rise just typing this! I believe medicine and nursing are as much art as they are science. And UMAs take some artistry. I look at them as a challenge though, and this helps me stay neutral and calm. Because I love a challenge. And I think I’ll always be working to perfect my own art of nursing. I’m sure it will never be perfect, but that’s the challenge right?
So if you find a family member in the hospital, be a PP. It’s your duty as family to be present (author’s opinion). Bury the hatchet if you find yourself being a NTBF, find closure or resolution, forgiveness and grace. You’ll feel better. Bitterness rots the bones (its actually envy, but I like to insert any negative emotion into the quote). And don’t be an UMA. You’ll turn everyone off, create tension and counter-productivity, and make some nurse’s day more difficult than it already is. We want the best outcome for your loved one, and you won’t find that outcome up my ass, you’ll find it in being pleasantly present!
So here’s to family, good and bad (raising an imaginary champagne glass, beer stein, wine glass, ice water etc.) May you never be hospitalized, and pass peacefully in your sleep at 98 years of age.
And for your viewing pleasure, here’s the third member of my family. Don’t be jealous, but I trained him to poop and pee in the toilet. True story.